ACAM's Goal: Helping African Communities Access Quality
Goods & Services for Malaria Prevention & Control.

Larry Casazza, MD, MPH

Larry Casazza is a public health specialist working in malaria and childhood survival programs. He has dedicated his career, spanning twenty-five years, to implementing community-based activities aimed at improving the health and welfare of women and children.

Currently he is the Director of CAM, African Communities Against Malaria. He has also held senior positions at World Vision and the CORE Group in Roll Back Malaria/IMCI programming, and serves as a faculty member at Johns Hopkins University's Bloomberg School of Public Health. Dr. Casazza holds a Master's in Public Health from Johns Hopkins University and Medical Doctorate from University of the State of New York at Buffalo.

For the effective and scaled implementation of RBM programs, the existing malaria and child survival expertise of NGOs and other community-based resources must be coupled with improved management capability to ensure the coordination and effective use of existing resources. Only then can the Abuja targets for malaria prevention and control be reached by African nations. To date, four RBM NGO secretariats, with support from USAID's funding of the CORE Group, have formed for this purpose. More are needed, either newly established or alligned within existing organizational structures.

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Jill Irvin

Jill Irvin serves as the leader for Alder Associates strategy competency and specializes in business strategy and operating model development. Her skills include global growth strategy, operations and cost restructuring, governance design, and business reengineering.

With clients, Jill works closely with executive teams and business leaders to develop and articulate breakthrough business strategy and develop rigorous models for strategy implementation. Her unique approach to the development of strategic initiatives and executive-board program management provides key insights into cultural, political, and organization issues posing barriers to strategy realization.

Jill has led numerous strategy engagements across North America and Europe including work at DuPont, Budget Group, Salt River Project, Partner’s Healthcare, and Ingersoll-Rand. While her work primarily focuses on Fortune 500 clients, Jill’s capabilities have translated into entrepreneurial environments, designing and launching new business ventures across multiple industries.

Before joining Alder Associates, Jill was a principal in Computer Science Corporation’s (CSC) Strategic Services Practice where she managed client and practice development responsibilities.

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Jackie Eiting

Jackie Eiting creates breakthrough performance for large organizations by integrating senior executive development with business strategy implementation. Jackie has over 18 years experience in transformational coaching, large-scale change and executive development, and has worked with major corporations in the US and Europe.

Prior to co-founding Alder Associates, Jackie held partnerships in Computer Sciences Corporation (CSC) Transformation and Change Group and Charlie Smith & Associates, a leading transformational consulting firm. Jackie has also established her own consulting practice specializing in executive coaching, executive team development and leadership development.

Jackie has led engagements at Ingersoll-Rand, DuPont Legal, The Limited Corporation, General Growth Management Properties, The Rouse Company, EMCO Ltd. Canada, IBM Corporation, Cunnard-Ellerman Shipping, Marrion Merrill Dow, Inc., Campbell Soup Company Canada, Land Rover Corporation, US Air Force, Aeronautical Research, and Procter & Gamble.

Jackie earned a Bachelor of Arts in Political Science from Northwestern University and a Masters of Psychiatric Social Work from The University of Hawaii.

African Communities for Malaria Prevention & Control

Rolling Back Malaria One Village at a Time

Malaria is killing far too many African children, and blighting the lives of many millions more. Over a million people die of malaria each year and 90 percent of these tragic losses occur in Africa - most of them young children. A society cannot progress if it is losing its younger generation at such a rate.

Malaria not only attacks the poorest societies, it keeps them poor. Annual economic growth in countries with high malaria transmission has historically been lower than that in countries without malaria. Economists calculate this difference as a growth “penalty” from malaria of 1.3%. Over time this penalty has pushed the poorest countries 32% behind wealthier countries. In dollar terms that is a cost of more than US$12 billion annually in Africa alone. In human terms it means a desperate struggle for poor families who spend as much as a quarter of their income in battling malaria, who have to cope with lost hours as they deal with children whose learning is impaired by missing school, and whose development can be hampered by neurological or other damage from the disease; it means equally desperate efforts by health systems when their hospitals and clinics are overwhelmed by the annual malaria epidemic and they have no resources to mount sustainable control campaigns.

Now a new threat is making itself felt: drug resistance. Resistance to chloroquine, the cheapest and most widely used antimalarial, is common throughout Africa; and resistance to sulfadoxine-pyrimethamine (SP), the least expensive alternative, is also increasing.

We need to move fast before this dreadful holocaust of Africa’s young grows worse. There are evidence-based, cost-effective interventions. The challenge is to deliver them where they are needed.

The Need

Why have Africans not availed themselves of solutions readily to hand, such as insecticide treated nets (ITNs) which are a proven protection for children from the bites of infectious insects? As Bill Gates has observed: “Bed nets cost just a few dollars each, but only a small fraction of African children sleep under one.”

One explanation for this apparent indifference of parents is poverty. Bed nets may cost “just a few dollars” but for many parents that is more than a week’s pay. When families must feed and clothe their children, provide drugs to treat their malaria, absorb the cost of days missed as they try to get them to the doctor for treatment - the cost of a bed net can be out of reach.

One story from UNICEF shows how such a hurdle can be overcome:
MWANZA, Malawi, 16 August 2005 - Magreta Makwemba sleeps soundly at night, knowing her family is safe - thanks to the use of insecticide-treated nets (ITNs).
“Before we had bed nets, we used to have a lot of problems with malaria in the family,” she says. “But since we got the nets, we are comfortable. Nobody is getting malaria now.” Magreta has bitter memories of malaria: her sister and one of her children died of the disease.
Magreta has now been using ITNs for three years. During that time none of her five children has contracted malaria. The market price for the nets is about $5 each - too expensive for most people here. But a UNICEF price subsidy reduces the cost of ITNs for mothers in Malawi to 50 cents each.
Magreta lives on less than one dollar a day, money she makes doing odd jobs, like gardening or cleaning. The truth is that, without the help of UNICEF and its partners, her children would not have the protection provided by ITNs.
It takes a helping hand but rolling back malaria is not an impossible dream.

First Steps

A critical first step was achieved in 2000 when the Abuja Declaration made the assault on malaria Africa-wide and top-down. In the six years since then a great deal has been done. The key tools in the battle have been identified-

Insecticide treated nets. ITNs have been shown to reduce mortality among children under 5 by 20 percent. This means the prevention of half a million deaths every year in sub-Saharan Africa. ITNs also protect pregnant women and young children from malarial anemia, which in the very young can lead to brain damage and death.

A recent development of long-lasting, wash-resistant ITNs which will remain effective for up to four years, avoids the need to re-treat the nets, something which has proved difficult to sustain, and even further enhances the value of this brilliantly simple intervention.

The Abuja Declaration set a goal of 60 percent of pregnant women and young children sleeping under a bed net by 2005. Kenya has so far achieved 46% of children under five and 50% of pregnant women; Mozambique has, with help from the Canadian Red Cross, just reached its 60 percent goal in key provinces; Malawi is moving steadily towards that goal with the distribution of one million nets per year; and the village of Jambiani, Zanzibar (pop 5,000), has achieved 100 percent. Jambiani also provides a tiny microcosm of the wonderful difference ITNs can make. Nets were first distributed in Jambiani in 2002 and this is the record:

Since October, 2005, no cases of malaria have been reported.

Intermittent preventive treatment. Intermittent treatment of pregnant women with sulfadoxine-pyrimethamine (SP) has been shown to reduce the risk of maternal anemia, placental parasitemia, and low birth weight and is now being integrated into the malaria control programs of a number of African countries. While further research is needed, there are promising signs that treatment of infants too can reduce episodes of malaria.

Antimalarial drug combination therapy (ACT). SP is a drug to which resistance is developing, but combined with artesunate, a derivative of the Chinese plant, Artemisia annua, it can markedly improve cure rates for malaria. Furthermore, ACTs will reduce the reservoir of humans positive with the parasite, thus breaking the malaria cycle. Other anti-malarial combinations are now more commonly available, such as Coartem©, a combination of artemether and Lumefantrine. The challenge is financing these promising drug combinations depending on the country-specific policies. Fortunately today in many countries now recipients of Global Funds awards, ACTs are being made available on a wider scale and the transition to this preferred case management policy is supported with staff training and logistics of supplies.

Improving access to effective antimalarial treatment. The majority of deaths from severe malaria in children are caused by delays in getting effective treatment. Death can occur in a matter of hours - so novel ways of minimizing delays are needed, including, for instance, training local shopkeepers in administering the right drugs in the right doses to a child immediately for whom the trip to a clinic would be fatally long.

Strengthening the health infrastructure. For parents to undertake the difficult and costly journey to a health facility, they have to be confident the treatment there will be worth it. Presently, health facilities are under-stocked and staff inadequately trained in dealing with severe malaria.

Even as we identify the tools, we can see the challenges inherent in them: Artemisia is a powerful drug - and presents the challenge of funding. Improving access for rural children is critical - and presents the challenge of devising ways to bring child and treatment together in time. Ensuring health clinics can meet the needs of families is clearly a great need - and one of the greatest challenges. Making bed nets available in rural areas is a brilliantly simple and cost effective solution - but supplying bed nets and training in their use still present major logistical and behavior change challenges.

Knowing the key tools is not enough - delivering these tools as workable solutions means tackling Africa’s daunting limitations in resources, capacity, and infrastructure.

The Continuing Challenge-

It is hard for those in the West to grasp that what we take for granted cannot be taken for granted in Africa. Consider the frustration of this scientist speaking to an American newspaper:
Imagine trying to monitor the effects of a new drug or vaccine over a year or more of study among thousands of people who have no home addresses, social security numbers or other means of documentation. “These are the kinds of problems that many donors and Western agencies just don’t understand.”
Dr. Regina Rabinovich, head of the infectious disease program at the Gates Foundation, commenting on this, noted that drug companies or others doing clinical research in Africa typically impose their own monitoring system tailored to fit the needs of a particular study, which they dismantle upon completion. What’s needed in her view is an African-run system of clinical research that is permanent and self-sustaining.

The same is true for our response to Africa’s malaria burden - it too must be African-run, permanent, and self-sustaining.

The Promise of ACAM-

How do you create something African-run, permanent, and self-sustaining in a country with virtually nothing?

First, there is never “nothing.” There are people, in African communities, who are providing services to their families every day, however fragmented they may be. Their wisdom is invaluable since it is the wisdom of how to improvise in local conditions - they have been doing this for years, and that know-how is essential to the appropriate adaptation and local ownership of these new malaria interventions available today.

When national programs are being planned, these community voices need to be represented by persons who know them well and can ensure that their needs are considered with appropriate flexibility and sensitivity. These trusted representatives of the communities are the NGOs (Non-government organizations) and CBOs (Community-based organizations) who have been working in these settings sometimes for over fifty years. Like the communities themselves, these NGO/CBO groups are fragmented and have become needlessly competitive among themselves. Rather, they should be consolidated into a coordinated team at the African national level with recognized shared goals. Only then can they apply that knowledge and experience gained from years of partnering directly with the communities themselves. And they need training and advice on how to combine their voices using communication and marketing skills developed by the private corporate sector world for sustainable engagement with multiple audiences at different levels in various regions.

They need an organized and well-managed body that notifies its members of funding opportunities and facilitates them to pursue resource opportunities at the national and international level - there are many groups out there now (the agencies of the RBM initiative, the Global Fund, major international foundations and international NGOs, for example) who are prepared to support proposals. Today the funding is not the issue as much as how to target it and capture the synergy possible among partnership collaboration that will get the maximum impact for the communities in need.

The name we have for such a coordinating, knowledge-enhancing, savvy body is the NGO/CBO Secretariat who function at a Africa national level and now are creating strong ties for interaction among themselves as well..

And that is where ACAM comes in. Through these Secretariats, we take the grass-roots wisdom of African Communities and deploy it Against Malaria. ACAM (African Communities Against Malaria) is dedicated to the establishment, nurturing, and strengthening of these collaborative groups, and to ensure the sustainability of these partnerships who can bring about genuine ”community ownership” of the new malaria interventions and practices.

To date, four RBM NGO/CBO secretariats, with support from USAID’s funding of the CORE (the Child Survival Collaborations and Resources Group), have been formed in Kenya, Zambia, Uganda and Tanzania. ACAM is working to create more. Replicating this model over and over, we can change local expertise from an isolated and limited force - into a larger, powerful network that can deliver ITNs to attain the Abuja targets; ensure pregnant women receive intermittent preventive treatments; help finance delivery and research on antimalarial drug combination therapies; come up with creative (local) ideas to ensure prompt access to effective antimalarial treatment; and strengthen the health infrastructure. In short it can use African communities to deliver on the key strategies and roll back malaria.

The Secretariats use an ACAM-created basic toolbox to build and sustain the critical infrastructure that will ensure the coordination and effective use of existing NGO\CBO resources. These tools include:
a series of training workshops that both work to update the NGO/CBO partners on the latest technical interventions and motivate them to discuss how they might create synergy among themselves for scaling up application to their community clients
project management tools - sophisticated skills to make a project succeed and measure its results
marketing and communication tools - to help get those crucial messages out and internally communicate with one another
relationship and governance tools - for good governance of the organization itself, coordinated advocacy for critical needs, and outreach to Government, NGOs and international partners.

A Catalyst for Change

ACAM began because scaling-up progress against malaria is only occurring in isolated places and many of the countries worst affected by malaria still cannot see the way. Problems compound on all sides - the scale of the problem, the disjointedness of existing responses, mistrust among entities that needed to be partners, and always the shortage of funds.

ACAM Secretariats find ways past these problems - it takes steady patient work to build connections, infrastructure, and expertise, but once they are built, they can endure. The Secretariat in Tanzania will take the core skills from the ACA toolbox and adapt these to conditions and needs in Tanzania. These will not be the same answers that may be reached in Uganda - conditions there are different. But the Secretariat there can analyze the need, and working with local agencies and leaders, adapt to those conditions - and deliver.

WHO economist, Jacques van der Gaag has said that every dollar invested in children returns three dollars in future health savings. It goes without saying that that dollar must be intelligently invested - and with ACAM’s proven model for turning small efforts into powerful national networks each and every dollar you give will work to the utmost to save the lives of Africa’s children.

How You Can Help-

ACAM is an international non-profit organization dedicated to rolling back malaria in the most cost-effective and enduring way possible. We are very grateful for your willingness to join the fight to defeat malaria that your dollars will work to save the lives of African children and their communities.

To make a contribution by mail please complete the form inserted within and mail it with your gift to:

ACAM-African Communities Against Malaria Foundation
c/o Larry Casazza, MD MPH
526 8th St. NE
Washington, DC 20002

The Future Lies in the Children

A journalist visiting the village of Jambiani commented:
“For the last seven months Jambiani has been malaria free, providing hope for those who envision of a world where no more of Africa’s young dreamers have to die.”

Africa needs its young dreamers: they are the builders, the hopers, the core of our societies, the future. Make the scourge of malaria a thing of the past and you give families back their children. Make families strong and their communities will thrive. From these grass roots their dream, our dream, becomes an attainable reality.

Let’s not let another day go by.

© 2006 ACAM. All Rights Reserved.