We marked World Malaria Day on 25 April, but efforts to prevent and treat malaria continue all year round.
Lowering Costs, to Save Lives
Sabine Brou and her husband Augustin know the fear that malaria brings, and also the financial strain. Farmers in a rural village in the Yamoussoukro District of Côte d’Ivoire, both Sabine and their son Israel survived severe malaria in recent years. She remembers thinking that her life shouldn’t end so soon. But the mosquito net that would have spared them the risk of the potentially fatal disease was too expensive. “Before, we didn’t sleep under a mosquito net,” she said. “When you don’t have money, you just sleep like that, with the mosquitos and all.”
Raymonde Goudou Coffie, Minister of Health, said the situation of people like Sabine and Augustin is the heart of the problem in Côte d’Ivoire, where until recently only one in three children slept under a mosquito net. “It hurts to see a child who is barely two or even one year old with malaria,” Dr. Goudou Coffie said. “They have such a low chance of survival, because their body can’t fight it.”
Essentially, the Brou family and government faced the same problem: How to make a stretched budget go further in order to protect their family-- or millions of families-- from malaria. In 2014, Côte d’Ivoire joined a group of countries carrying out nationwide mass distribution campaigns of mosquito nets to protect their populations from malaria: 5.2 million mosquito nets were purchased by Mozambique, 7.3 million nets by Chad, 21 million nets by Uganda, in each case with the goal of reaching universal coverage of nets for all families at risk. A total of more than 200 million nets-- the largest volume of mosquito nets ever given out in a single year—were slated for distribution around the world in 2014, organized and funded by many partners. Nearly half, or about 100 million of these protective nets, were purchased using Global Fund grant funding. With this in mind, an effort to optimize net procurement was pivotal, to make sure that more people could be reached using available resources.
Simply put, this effort involved pulling on every available lever to improve a range of procurement factors: lower purchasing costs for the mosquito nets, quadrupling the number of producers supplying quality-assured nets and interacting with net producers to understand their processes and constraints was an important step. Reducing fees charged by middlemen, factoring in fluctuations in raw material costs and limiting variation in nets — extra tall? different color? – which allowed producers to charge a premium for non-standard mosquito nets, helped to streamline production and pricing. In Tanzania, for example, simply opting for a shorter net, at 180 cm instead of 210 cm, reduced the cost by $1 per net. Result: Tanzania could afford 6 million more nets.
Creating greater all-around predictability has been a plus for both countries procuring nets and producers. The Global Fund’s commitment to guarantee purchasing a large number of nets made it possible to expand production, make advanced orders, and get delivery with fewer delays. It also lowered prices. As a result, committing US$250 million to purchase 80 million nets in 2014 has meant the Global Fund partnership could ensure a lowered yet fair cost per net, down to less than US$3, compared with US$5 in 2010.
Côte d’Ivoire’s campaign to distribute 13 million nets is nearly finished. The nets distributed should remain effective to kill mosquitos for the next three years. Like millions of other Ivoirians, Sabine and Augustin were given two mosquito nets for free. Côte d’Ivoire has achieved universal coverage of nets for all families at risk of malaria. “Before, when we earned a little money we used to spend it in the hospital because of the mosquitos and malaria,” recalled Sabine. But since having nets to sleep under, there’s been no illness in their household. “The money we used to spend, we now keep to ourselves, to buy food, to better our lives and those of our children.”
‘You Are All the Global Fund’
“Vous êtes tous le Fonds mondial, en commençant par le gouvernement et les populations ivoiriennes,” said Mark Dybul, Executive Director of the Global Fund, during an event to mark World Malaria Day in Port Bouet, a district of Abidjan, Côte d’Ivoire. As a partnership organization, the Global Fund encompasses everyone involved in efforts to respond to HIV, TB and malaria. Working through partnership is the most effective way to fight these infectious diseases in countries and communities that are most affected.
The event, to mark completion of a mass net distribution campaign, was attended by Raymonde Goudou Coffie, Côte d’Ivoire’s Minister of Health, and Annick Girardin, France’s Secretary of State for Development and Francophonie. Malaria is still endemic in Côte d’Ivoire, and kills hundreds of children under 5. “Thanks to the generosity of external donors such as France, the Global Fund has invested over €200 million in malaria control in Côte d’Ivoire. And I would like to thank the Ivorian government, which this year has pledged to increase national funding for health,” Dr. Dybul added.
Mme. Girardin echoed his words by reaffirming France's commitment to the Global Fund. “The Fund is the pride of France and our presence here also demonstrates this commitment to Côte d’Ivoire,” she said. “Ebola is killing people in the spotlight, while malaria is killing people silently and en masse.” She added: “France is a major actor in malaria control. Alongside the Global Fund, it is involved in prevention, treatment and health systems strengthening.”
Dr. Goudou Coffie said that protection for mothers and children, strengthening health systems and boosting partnership were most important. “Nothing can be done if we do not pool our efforts to achieve maximum impact. The challenges that we face are huge, and I still believe that it is possible to eradicate malaria in Côte d’Ivoire by engaging communities with steadfast support from all of our partners. We will get there all together.”
An Asia-Pacific Free of Malaria by 2030
Partners from the Asia-Pacific region and the global health community have reaffirmed their commitment to tackle the emergence of malaria parasite resistance to artemisinin in the Greater Mekong Region and pledged to join forces to achieve the goal of an Asia-Pacific free of malaria by 2030. The Asia-Pacific Leaders’ Malaria Alliance is developing a roadmap to provide strategic guidance on how to achieve the goal of an Asia-Pacific free of malaria by 2030. The roadmap will be considered for endorsement at an East Asia summit in Malaysia in November.
Regional action, and leveraging domestic resources is key to success. Mark Edington, Head of Grant Management at the Global Fund, highlighted a regional initiative to fight resistance to artemisinin as an example of a partnership between multilateral agencies, technical partners and the Ministries of Health of the five countries. Under the three-year initiative known as the Regional Artemisinin Resistance Initiative, or RAI, the Global Fund partnership will invest US$ 100 million in activities to tackle artemisinin-resistance in Myanmar, Thailand, Viet Nam, Laos and Cambodia. By investing in a regional initiative, the Global Fund hopes to become a catalyst for other potential funders and to galvanize political commitment. “The RAI could turn out to be the best US$ 100 million the Global Fund ever spent,” Edington said.
UNOPS, the regional Principal Recipient for the RAI initiative, has launched a new website on the RAI with a grant map, summary of projects and activities on country and township level, as well as results for the main indicators. http://www.raifund.org/en
The Functional Monkeys Raise Money for African Malaria
Jeff Lowery and his nine-year old daughter Paige were in the midst of an impromptu jam session when they decided to name their band the Functional Monkeys. “I’d play music and she would sing and make up lyrics, and one of them was that monkeys are functional,” Jeff explained.
A little later, Paige decided the Functional Monkeys should devote their music to raising money for malaria control, after hearing of a boy at her local church who was making similar efforts. Jeff and Paige sell CDs and donate the proceeds to the United Methodist Church’s Imagine No Malaria campaign. Jeff and Paige, who live in Portland, Oregon, were among more than twelve and a half million United Methodist Church parishioners who were recognised this week at a function on Capitol Hill, in Washington D.C. Bishop Thomas Bickerton, who heads the church’s campaign, presented a cheque for US$9.6 million to the Global Fund, the largest single contribution from a faith-based organisation. All the more impressive is that the money comes from grassroots efforts. The United Methodist Church has pledged US$28 million to malaria control, and has raised US$18.1 million for the Global Fund to date.
Bringing the Net Effect to Liberia
The Ebola outbreak in West Africa exposed shortcomings of health systems in Liberia, Guinea and Sierra Leone, the three countries most affected by the crisis. But the outbreak has also underscored the power of partnerships in responding to global health challenges. Striving to achieve universal coverage of mosquito nets, Liberia’s National Malaria Control Program under the Ministry of Health, Plan Liberia, the Global Fund, U.S. President Malaria Initiative, Alliance for Malaria Prevention, UNICEF, WHO, the World Food Program and the Liberia Coordinating Mechanism – has its eyes set on a solid malaria prevention strategy, which can also allow public health workers to work on eliminating Ebola in Liberia. Patients with Ebola and malaria display common symptoms such as fever, headache and aching joints.
The partnership is supporting distribution of 2.8 million mosquito nets in Liberia. Given the current Ebola crisis, normal distribution efforts risked infection through public contact, and could put health workers and volunteers at risk. In response, WHO established “no-touch” guidance, where door-to-door deliveries reduced physical contacts between campaign workers and ordinary people, and did away with mass gatherings at distribution points.
To support the need for more than 400,000 additional nets, the partnership accessed US$1.6 million from the Global Fund’s Emergency Fund, launched last year to provide quick access to funds to fight AIDS, TB and malaria in emergency situations.
By decreasing incidence of malaria, with national coverage of nets, the chance of misdiagnosis of Ebola can also be reduced, as can the burden of malaria on the health system.
By the Numbers
Namibia is edging closer to elimination of malaria. The country has reduced confirmed cases of malaria from more than 20,000 in 2003 to less than 5,000 cases in 2013. The number of deaths associated with the disease over the same period was reduced from 1,106 to less than 10.
Swaziland offers a cautionary tale: The country almost eliminated malaria in the 1960s, but then reduced its focus on malaria control, and saw the disease resurge. Renewed efforts, however, have again reduced the number of cases down to only four deaths from malaria in 2013.