Malaria is a major public health problem in Angola and is a principal cause of morbidity and mortality. Malaria accounts for 35% of the overall mortality in children, 25% of overall maternal mortality and is the cause of 60% of hospital admissions for children under five and 10% for pregnant women.
Currently only 3.6% of the national gross domestic product and 4.1% of the Government of Angola’s budget is spent on health, but with the end of war, government pledges of financial support for health are expected to increase.
Starting in 2006, the Government of Angola has made major strides in its efforts to provide quality services, effective preventive and control interventions, together with organizational support for sustainable national malaria programming. In all the baseline pulmonary planning for the national Measles-Malaria Initiative (Vida a Viva Campanha), they have displayed strong leadership commitment to its outcome, and have successfully engaged multinational donors, private corporate sector, NGOs and CBOs as partners in this effort.
Results from the Vida a Viva Campaign highlight the effectiveness of the collaboration across the various partners supporting the campaign. These include the delivery of: 2.9 million polio vaccinations; 2.2 million doses of Vitamin A; 2 million doses of Albendazol (de-worming medication); and 2.2 million doses of Measles vaccine. Specific to Malaria prevention, seven of the 18 provinces were identified as high-priority and included in the program for Insecticide-treated bednet (ITN) distribution. Approximately 600,000 bednets were distributed, reaching 93% of the targeted population for the seven provinces.
The challenge now is: "How to keep up the momentum and maintain the networking that "closed the gap" between the national planners and the households in the communities?" Truly, this is an amazing example of efficient, effective social mobilization that brought ownership of the efforts to those who need the services at the grassroots. But the campaign's success hopefully will be viewed as only the beginning, not the end of an effective, but somewhat separate health event.
ACAM presents three specific recommendations based on our conclusions for maintaining and nurturing this collaborative network and filling the gap for Malaria prevention and control.
First, the Ministry of Health should codify this network at all levels and establish regular, on-going venues for collaboration. This network can be leveraged for a variety of ongoing health issues from national to local levels, for example, use in the recent cholera outbreak. Over time, this network will become a natural infrastructure of resources that can easily be deployed and leveraged for a variety of health initiatives.
Second, engage in the development of leadership at all levels. Investing in the development of leadership at provincial and local levels will build a long-term capacity to empower communities to take ownership of their health. In ACAM’s experience, Peter Senge’s work in this area is a powerful and relevant tool. This type of leadership development will further result in a common language and set of practices that will mature over time, building a lasting excellence in public health, well beyond a single event or initiative.
Lastly, it is important that bednets are distributed to the remaining eleven provinces not reached in the campaign. This distribution effort can be a test of the ability of this new, fragile network to continue working together on a common set of goals. Building funding, delivery, and social mobilization plans and timeline are critical.
Building upon its recent successes, Angola is well poised to become a strong model for other African countries to dramatically reverse the burden of disease due to malaria in the near future.
The Zanzibar Anti-Malaria Network (ZAMANET) conducted its first Leadership training in a two-day Workshop for its members on November 25-26, 2006. This meeting followed the
Annual meeting of EARN, the East Africa Regional Network of national malaria programs in the Region, that brought together more than 20 NGOs from across Zanzibar island, including Pemba. The Workshop was conducted by Dr. Larry Casazza, director and founder of ACAM-African Communities Against Malaria with headquarters in Washington, DC, USA. This training was sponsored by the Zanzibar Malaria Control Program (ZMCP).
The training was based on principles drawn from an important resource used extensively by the private corporate sector, namely, Peter Senge’s “The Fifth Discipline”. It promotes the concept of creating a Learning Organization to bring about fundamental change toward achieving a Shared Vision. The foundation for change is a learning process approach where innovation is encouraged and results can be measured at the operational level. Information should be freely exchanged at every level and flexibility in the system allows for changes to be introduced as the program moves forward. In the initial session, the group came to the consensus that its Shared Vision is: A Malaria-Free Zanzibar. Next, after careful analysis of the health system, the group agreed that the principal producer of health is the households and communities themselves; they must be actively engaged in the program as an effective voice and participant in the national program if Zanzibar is to eliminate malaria and to sustain the results.
Dr. Casazza expressed his optimism and satisfaction on the steps taken in Zanzibar to control malaria and urged participants to use the training as a tool to achieve the goal of the Shared Vision. He added that malaria can be conquered as long as there are concrete and unified steps taken across all the stakeholders, including government, NGOs, international institutions and donors, and the community at large - reaching down to the households themselves. All are key partners in the Learning Organization that can be a powerful tool to move from the current reality toward the desired future.
Finally, the training was also attended by Ms. Beatrice Minja, chairperson for TaNAAM, an NGO collaborative organization on the Mainland that has advised ZAMANET in its earliest organizational steps. She urged the participants to emulate TaNAAM’s success story and promised to remain close to ZAMANET as it grows and evolves.
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The editorial below is from ACAM's director, Dr. Larry Casazza. It was inspired from a January 1, 2006 editorial in the New York Times and acknowledges this resource for its message content . |
Let’s Make 2006 a Banner Year for Roll Back Malaria |
There is no question that 2005 was a banner year for speeches from key global leaders about fighting poverty in the Third World. But as we approach the first month of 2006, we are faced with the key question; “Will we see the action in 2006 that confirms commitment to the promises made in 2005?” For African countries moving toward enactment of the highly effective interventions that could dramatically reduce morbidity and mortality due to malaria, there is mounting optimism that 2006 could be the year in which major strides against malaria and poverty in general might be seen. But there have been promises in the past (for example, Abuja targets for 2005) that have come and gone, and missed the mark by a long shot in most African countries. And there has been talk of Millennium Development Goals since the turn-of-the-century, but with little real action seen at the ground-level. As we enter 2006, we must consciously ward off cynicism and defeat before we start in order to prove that change can definitely be made. There are valuable "lessons learned" from the past that can be scaled up now that more resources have become available and planners and national and regional levels are willing to consider new strategies. It's time to recognize that the old ways of undertaking increased coverage to poor populations, both urban and rural, must be revised. Namely, it's time to channel major resources into local level, village-based program that can actually deliver commodities and services to the communities who need them and who will eventually sustain the effort. And a strengthened civil society will institute ways to bypass corrupt local governments and to deliver the goods at the community level to those who need them. We have heard all the speeches in 2005. We know that six million children under five die each year from diseases that can be easily treated and prevented. The time for talking must come to an end and a resolved commitment to action take hold in 2006. We cannot wait any longer. How embarrassing it will be to present excuses for lack of major coverage improvements in 2006? |
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Relevant ACAM Activities in the Fight against Malaria |
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Presenter |
| Larry Casazza, MD MPH Director, ACAM –African Communities Against Malaria November 29, 2005 |
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| Larry Casazza, MD MPH Director, ACAM –African Communities Against Malaria September 30, 2005 |
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| Larry Casazza, MD MPH Director, ACAM –African Communities Against Malaria September 20, 2005 |
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W. Henry Mosley, |
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Larry Casazza, MD MPH March 2005 |
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Washington DC on February 4, 2006 |
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Malaria threatens almost half of humanity, annually infecting up to 500 million people and claiming an estimated 3 million lives. Sub-Saharan Africa is
hardest hit by the disease; here, malaria kills a child every 30 seconds. Mozambique is among the ten nations most affected by malaria. Stable
transmission rates make malaria Mozambique’s primary cause of morbidity and mortality, resulting in an estimated 44,000-67,000 malaria-specific deaths
per year across all age groups. It accounts for 40% of all outpatient consultations, 60% of pediatric in-patients and a third of all hospital deaths.
At the Kaya-Kwanga Hotel in Maputo, representatives from government, multilateral agencies, and the nongovernmental and private sectors met to
discuss recent developments in malarial prevention and treatment interventions and national policy, in addition to formulating “next steps” to defeat the
disease through improved collaboration. The meeting took place on Friday, April 15, 2005 with thirty-four participants from twenty-seven organizations
attending the all-day event.
The Workshop was sponsored by ACAM (African Communities Against Malaria) an NGO seeking to strengthen NGO collaboration for malaria at African
national levels in collaboration with NAIMA+, a collaborative group of international NGOs working primarily in HIV/AIDS. MISAU and international partners of NAIMA+ contributed to the agenda as did WHO, UNICEF, USAID, JICA and LDSI. GlaxoSmith Kline, Syngenta and Proserve provided logistical support
as well.
The goal was to mobilize NGO participation and contributions to confront malaria in Mozambique in collaboration with other public and private actors
committed to reducing the incidence and impact of malaria. The workshop emphasized the role non-governmental organizations can play in assisting
the Ministry of Health to implement Mozambique’s National Malaria Strategy. Participants also had an opportunity to meet with representatives of private
sector companies who make or market anti-malarial products, in addition to MISAU representatives of the National Malaria Control Program and major
technical assistance organizations working for malaria control in Mozambique.
The session was opened by Bishop Sengulane of the Anglican Church
who challenged the participants to move toward elimination of malaria as a major killer of children and adults in this country. The key learning objectives
were set forth as:
Dr. Francisco Saute, MISAU NMCP director, provided an in-depth summary of the national malaria program and policies and engaged in a lively question
and answer session with the participants. This was followed by presentations from representatives of WHO, UNICEF, USAID, JICA, and LDSI who
outlined their respective support to the national efforts with emphasis on the role of NGOs. This was followed by several NGOs, namely, World Vision,
World Relief, CUAMM, HAI, and PSI who presented summaries of their field programs with lessons learned from their years of experience. Finally,
Dr. Larry Casazza, ACAM director, summarized the state of the art information regarding the clinical interaction between malaria and HIV/AIDS.
This information concluded with the need to strive to integrate programming for these two diseases because of their strong clinical inter-relatedness.
Finally, the participants from MISAU, the NGOs, and technical and financial donors finished the day in a small group exercise identifying specific next
steps to be taken to strengthen the collaboration with MISAU in Roll Back Malaria efforts in Mozambique.
The meeting was closed by Dr.Saute, MISAU NMCP director, who expressed his appreciation for the open sharing and obvious willingness on the part
on NGOs to scale up Malaria programs in the country.
For more details and a copy of a CD-ROM containing all the presentations together with other important RBM technical references, please contact
Chiara Panaroni at naima@tvcabo,co.mz
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"ACAM contributes community/household perspective to Presidential Initiative Against Malaria"
July 25, 2005
Most recently, ACAM has been working closer to "home" , namely, with the House and Senate staff teams working on the language for the new legislation of the Presidential Initiative against Malaria. Ironically, the experience we have seen in our national efforts to respond to the Hurricanes hitting the Gulf coast has opened the discussion to considerations of the value of local resources to be fully engaged in any major national agenda.
Senator Brownback has lead the efforts in the Senate for the US$1.2 billion Presidential Initiative against Malaria. And the legislative language for the implementation of these funds needs to specifically recognize the involvement of NGOs already working at the community level. This will call for new coordination among global, Regional and national players to be certain that the results envisioned in the measurable objectives are valid, informative and lead to improved management practices starting at the community level.
I share with you a PowerPoint presentation I have discussed both with the Senator's staff together with National Security Council (NSC) staff and the House side who are involved in the efforts. The Dead Horse analogy comes from a course I recently took with Henry Mosley and Ben Lozare at Johns Hopkins sponsored by the Bill and Melinda Gates Institute for Population and Reproductive Health. The course material, taken from Peter Senge's, "The Fifth Discipline",(a methodology used by Fortune 500 companies for over the past decade) talks about the many faulty attempts to redress a problem that is not responding to our best efforts. Some of them are:
- buy a stronger whip
- change performance criteria for the horse
- increase funding
- site visits to see how others ride a dead horse
- change riders.
- hire a consultant to show you how to ride a dead horse.
While this may be humorous, it does carry a truth as well. I know we can do better for those whose silent voices we seek to bring to the ears of those who can make difference in our work.
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The Impact of Malaria on Health in Africa and its Interaction with HIV/AIDS: The Potential for NGOs to strengthen Civil Society for Sustainable Results
September 20, 2005
This presentation is a compilation of information that acknowledges the contribution of CDC, USAID, the CORE Group and the Advisory Board of ACAM. I thank you.
© 2006 ACAM. All Rights Reserved.