In this Zunia interview, Col(Dr) Kaka Stanley Mudambo, who is Roll Back Malaria Focal Point for Southern-African Regional Network talks about the status of malaria in southern African countries.
Zunia: This year’s theme for the World Malaria Day was–“Sustain gains, save lives: Invest in Malaria”. Notably, last year donor countries like Germany, Ireland and Sweden suspended funding to the Global Fund to fight Aids, TB and Malaria (GFATM) program over the corrupt use of grants.. Given this scenario, to what extend can this new motto boost the donor communities’ confidence to actually ‘invest in malaria’ in Africa?
Kaka Stanley Mudambo: The 2012 theme which embodies "Sustaining gains" can only be realized if funds are available - without funds it will not be achieved. For example: funds for the Lubombo Spartial Development Initiative (LSDI) (a cross-border initiative between Mozambique, South Africa and Swaziland) dried out in 2010 and the significant gains in the reduction of malaria deaths and cases observed over 5 years, were lost between 2010 and 2011 - by end of 2011, a notable increase in cases and deaths in southern Mozambique was observed. Thus the gains were lost and this can happen anywhere, malaria resurgence is always around the corner. Lives cannot be saved in scenarios where implementation of critical malaria interventions is hampered by lack of operational funding. "Invest in malaria": I therefore believe that emphasis should be on Governments to increase Domestic Funding for malaria and mobilization of in-country partners, private sector and corporates for parallel funding - this is a more sustainable way of malaria funding. Government have responsibilities to save the lives of their people and should invest in malaria - it is their responsibility. It is easier to mobilize funds from donors if governments have taken the lead and not go empty handed. However, this should be supported by transferring ownership of malaria programs to the district and community levels which allows communities to own the processes, determine and design activities that meet their needs. Donor funds come with a package of strings and conditions and this robs the National Malaria control Programs (NMCPs) of ownership. Issues revolving around accountability, transparency and good governance should be upheld by all countries so that donor communities are assured that their funds will be utilized by the targeted communities. We have seen serious problems of miss-use of Global Fund and other Grants and poor delivery and performance in some countries and this has severely dented donor confidence. As the endemic countries, we can only retain confidence in donor funding if we start to show tangible results that can prove and justify how the resources delivered have contributed towards reduction of the disease burden and uplifting the quality of life of those affected by malaria. We also need to ensure that we build on to the current successes in the reduction of the burden of malaria and prevent resurgence of malaria. In Southern Africa, the current drive towards pre-elimination requires sustained efforts, a paradigm shift and program re-orientation including use of new and appropriate tools that will ensure progress from pre-elimination to elimination while moving the remaining countries from control to pre-elimination.
Zunia: The World Malaria report 2011 states that Botswana, Namibia, and Zimbabwe are still in high risk of malaria. What put these countries at a higher risk compared to other African countries of the same region?
Kaka Stanley Mudambo: I do not agree that Botswana, Namibia and Zimbabwe are still in high risk because other countries such as South Africa and Swaziland are also at risk of resurgence because of cross-border import and export of malaria - this remains a huge threat to all countries.There remains a threat of people moving with parasites across the Southern African frontiers and this is the reason why the Southern African Regional Network (SARN) - Roll Back Malaria (RBM) partnership in Southern Africa is spearheading the establishment of cross-border initiatives. Under question 1. above, I gave an example of the LSDI - failure to achieve high coverage rates in Indoor Residual Spraying in Southern Mozambique due to lack of funding has led to notable increase in imported malaria in the cross-border districts of South Africa and Swaziland and so, all countries are at risk. What puts countries at risk is the mosquitoes do not need passports and have a flying range between 3 - 5 km and hence they can cross any border. Southern African borders are porous, people cross legally and illegally in all directions and some of them carry parasites. Malaria Elimination Eight (E8) countries (Angola, Botswana, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe) are strengthening cross-border initiatives which will ensure harmonization and synchronization of operations such as IRS, Monitoring and evaluation (M/E) and other interventions. This way, cross-border malaria can be minimized leading to malaria elimination in the E8 region. The other reason why there is increased threat is that the E8 countries are not at the same level of malaria control i.e. some are still in control while others are preparing for malaria elimination because of low malaria transmission. It is also important to understand that even in the same country, some districts may be more advanced than others and this again increases the risk/threat of malaria.
Zunia: According to recent reports, Africa is threatened by the distribution of fake and poor quality anti-malaria drugs made illicitly in China. WHO estimates 30% of drug regulatory authorities in Africa don't function. So, even if we can convince people to ‘invest in malaria’, how effectively can we utilize this ‘investment’ within this seemingly broken health system?
Kaka Stanley Mudambo: At this stage, I do not want to be drawn into pin-pointing China as the source of poor quality anti-malaria commodities especially medicines because there are several countries which have been mentioned and it is the role of WHO and RBM Secretariat to deal with this issue. It is my belief based on current practice that Southern Africa through the SADC Secretariat is putting in place mechanisms to safeguard both entry and use of poor quality anti-malaria medicines in the region. Most of the countries in the SADC region have well developed systems for ensuring poor quality anti-malaria medicines are detected at different levels of the Procurement, Supply Chain Management (PSM) system. First: all countries are carrying out periodic – on-going monitoring of medicines as a result of the Pharmacovigilence mechanisms and structures that exist in all the countries: Second: in all Southern Africa countries, there exists a Medicines Control Authority that carries out Quality Analysis (QA) and Quality Control (QC) of medicines. Thus medicines can only be used once they have been tested and registered. At the SADC Secretariat the Pharmaceutical Business Plan is working towards Pooled procurement, local production of Medicines and other commodities and establishment of regional centres of excellency for laboratory testing and training. Once fully operational, this should further strengthen mechanisms for surveillance and monitoring. The SADC countries on regular basis also share the information on medicines during the malaria program managers, the Elimination Eight (E8), SARN Constituencies meetings and also during the SADC health ministers meetings. It is therefore important to emphasize that there are no broken systems, there are functional systems that require strengthening in terms of surveillance, Monitoring and Evaluation, QA and QC. It is however important to emphasize that, in some of the countries in Southern Africa, surveillance/monitoring/QA/QC systems are weak leading to entry of poor quality medicines.
This remains a threat to the region. I therefore believe that the SADC region is taking the right steps that will ensure joint efforts for the control of entry of poor medicines in the region.
Zunia: Again, the World Malaria report 2011 highlights an estimated 655 000 (537 000 – 907 000) malaria deaths in 2010, of which 91% (596 000, range 468 000 – 837 000) were in the African Region. Under this condition, is it possible for Africa to achieve the Millennium Development Goal 6 (combating HIV/AIDS, malaria, and other diseases) by 2015? And why?
Kaka Stanley Mudambo: Let me start with countries in the SARN region: by 2015, all countries in the region will have achieved the MDG Goal 6 by 2015 and our efforts are directed towards ensuring that most countries have achieved the goal by end of 2013. - several countries in the region have long achieved this goal. The drive towards harmonization and standardization spearheaded by the SADC Secretariat, facilitated by the Southern African Regional Network (SARN), supported by a host of partners and using guidelines from WHO has ensured harmonized development among the SADC countries. Because some countries in Southern Africa are moving towards malaria elimination and the existence of the E8 will ensure the goal is achieved. There are districts with zero deaths and cases in the E8 countries as shown by the recently completeed Malaria Program Reviews (MPRS). SARN is also supporting countries to ensure monthly reporting of the Roadmaps which provides continuous evaluation and monitorng and evaluation of progress made. I believe all endemic countries in Africa are providing monthly roadmap reports and that the existence of SRNs (RBM regional networks) will ensure success. We however, have to acknowledge that some countries in Africa will struggle due to on-going political and economic problems. Thus, the statistics given in the World Malaria report 2011 appear as though nothing much has been achieved because they are all lumped together. If you take them region by region, they show a different picture. I also believe that even for those countries which are struggling, there is some time to 2015 during which strengthened efforts can increase the number of countries that will cross the bridge. The main reason why most countries will achieve the goal is the availability of ACTs, RDTs, IPTp and that more countries are now utilizing IRS, Larviciding and LLINs. Effective utilization of these interventions combined with better program management by the BNCPs, M/E, BCC/IEC and support from the RBM and all malaria partners 2015 will have a good story to tell.
Zunia: The Southern African Roll Back Malaria Network (SARN) was launched at the Southern African Development Community (SADC) meeting of Health Ministers in November 2007.From your working experience, could you please share some of the lessons you have learned that other countries can benefit from?
Kaka Stanley Mudambo:
Col(Dr) Kaka Tendai Stanley Mathias Mudambo.
Roll Back Malaria Focal Point for Southern-African Regional Network
Hosted by Southern Africa Roll Back Malaria Network (SARN) Secretariat.