By Kemo Cham
In 2019 Sierra Leone joined the continental campaign - dubbed ‘Zero Malaria Starts With Me (ZMSWM)’ – to eliminate malaria, when the government signed the African Union (AU) pact earlier agreed by heads of state of member countries.
Malaria is the parasitic disease that is caused by a plasmodium and is transmitted by the mosquito. According to the World Health organization, the disease is one of the largest killers across the world, with the developing world, particularly Africa, accounting for the highest burden both in terms of mortality and fatality.
In order for Sierra Leone to fulfill its obligations as part of the ZMSWM campaign, the government forged ties with a Pan-African NGO with vast experience in public health advocacy, Speak Up Africa, which is based in the Senegalese capital, Dakar.
In this edition of The Interview, I talk to James Wallen, Malaria Programme Officer at Speak Up Africa, about how the organization has been going about its task.
Wallen, who shares his time between Dakar, where he is based, and Freetown, was in the country between late August and 15th September.
We spoke about the goal of the ZMSWM campaign, how Sierra Leone is faring and what lies ahead for the country and Africa as a whole in fulfilling the daunting task of malaria eradication in the next 10 years, as envisioned in the United Nations Sustainable Development Goals.
I started by asking James to explain in broad terms the work of Speak Up Africa.
James: We have four main areas of work within public health for the moment, although we always want to look to new opportunities. So our four current areas of work are malaria, vaccination and immunization, sanitation, and neglected tropical diseases.
We work in lots of different countries, mainly in Francophone African countries, although we have expanded into Anglophone countries as well in the last few years. [We are] not just in West Africa, we work across Africa on these four different areas and with lots of different regional and national partners.
Sierra Leone is one of the newest countries to join the Speak Up Africa family. Please explain how you got to work in the country.
In Sierra Leone we are working with the National Malaria Control Programme (NMCP) on this campaign called Zero Malaria Starts With Me. In 2018 this campaign went from being a Senegal specific campaign to being a Pan-African campaign. All 55 heads of State of the African Union formally endorsed this campaign in 2018. And subsequent to that, countries have been launching their own versions of the campaign nationally.
Sierra Leone launched their campaign in April 2019 on World Malaria Day, several months following the continental launch.
We were brought in to provide some technical assistance to the NMCP to help them on the implementation of this campaign. We received some funding from Comic Relief and GSK [GlaxoSmithKline], the pharmaceutical company, who are our funders for this particular piece of work. We are just kind of following the NMCP to some extent, because they set the priorities, they know the national situation very well in terms of malaria, in terms of what they need. We have just been brought in to kind of help them implement the communications and advocacy strategy.
You mentioned the ZMSWM campaign. I know you are working with an alliance to achieve its goal. Tell us about this alliance.
The ZMSWM has three main pillars of the campaign. The first is around political engagement. Building political will. So that typically involves engaging politicians at the national level, be that the president or parliamentarians, etc. And this is just to build the profile of the issue and make sure it’s prioritized effectively in terms of resource allocation and policy.
The second is private sector engagement. So a big part of this campaign as well is engaging particular companies, large companies in Sierra Leone, to create new partnerships and to invite them to participate in the campaign and to contribute to malaria control and prevention; because one thing we have noticed is that typically the private sector has not been very engaged in malaria control and prevention and there is a huge need for additional resources, whether that’s financial resources or material, technical, human resources, which large private sector companies have. So we have been engaging private sector companies; that’s large part of the campaign here as well.
The third part of the campaign is what we call community engagement. That’s engaging the population as a whole.
In Sierra Leone, what we have done is strategically identified three districts in the country, which are Kono, Kambia and Moyamba. These were identified by the NMCP. And this was mostly for practical reasons. We weren’t able to go to all districts immediately. We needed to trial this in a few districts. And we want to engage lots of different community stakeholder groups, so that the messages of the campaign get out to a very large number of people, to everyone, hopefully; that’s the idea, so that communities themselves really take ownership of the fight against malaria and they have all the information necessary to protect themselves and their families and their communities.
So that, broadly speaking, are the three parts of the campaign.
As part of this alliance there is the Malaria Media Coalition (MMC). What’s its role in all this?
The media is really an important partner for any communications and advocacy campaign, because the media has the capacity to reach a very large number of people, potentially the whole country, if you have enough journalists involved, through their different medium, through print, online media, radio and television, you can reach a very large number of people. And of course we want the entire country to know about malaria and to know about the campaign and to know how to protect themselves and their communities. Just for that basic reason, the media is essential.
The media is also really important because they can contribute to advocacy efforts. So when we are doing advocacy at the national level with parliamentarians, etc, it’s really great to have journalists kind of amplify that and we know that politicians will take an issue more seriously if the media are also discussing it, because it shows that it’s an important topic for the country as a whole.
The media can also report on particular governmental commitments, and make sure that everybody knows what the government has promised to achieve by a certain date, etc, and journalists can really hold the government to account in that way.
So specifically in Sierra Leone the MMC is a group of 60 journalists from across the country. It was launched back in February [2020]. And really the most basic objective of the coalition is to increase the quality and the quantity of malaria coverage in the news.
The MMC was launched about six months ago and shortly after that we got into Covid-19. But we continued working and we saw, just at the beginning of this month, there was the conference, which I think is the second after the launch.
What was that conference about?
This conference, which was on the 1st of September, there was a few reasons why we did that. The first is that we wanted to check in with how things are going. After we launched the coalition we didn’t want that to be the end of the engagement. We wanted to check whether journalists have been reporting on malaria and what challenges they have had, what successes they have had, what kind of initiatives they have been following.
So it was really great to kind of catch up with everyone and hear how the last six months have been, especially because Covid-19 has been so dominant in terms of health coverage in the last six months.
We also wanted to kind of increase the sustainability and the efficiency of the coalition. So one of the things we did at the conference was to elect two co-chairs for the malaria media coalition, as well as regional representatives from all of the five regions. The idea for having this is to kind of increase the sense of ownership for the coalition and to drive the efficiency for the way that it works, particularly set roles and responsibilities that are filled by different coalition members. And we really hope that that coalition, under the umbrella secretariat of the Health Reporters Network Sierra Leone (HRN-SL) will be able to take the coverage to the next level.
From what you just said the conference was more like stocktaking event. What’s your assessment of the media’s performance then in the last six months?
We saw a lot of examples of the articles that had been written about malaria by coalition members, lots of radio shows, like health themed radio shows, and this kind of things from coalition members.
I think the coalition has been doing a really great job. Again I put it to the context that Covid-19 has been such a dominant topic for the last six months, from the moment that we launched the coalition, that it’s really incredible to see that despite that fact, the coalition members have been doing such great work.
One interesting statistic, if I can just add in here, because I think it just kind of shows on a macro level what impact the coalition has had; if you compared the amount of media coverage about malaria in the first half of 2019 to the first half of 2020, it’s like seven times more media coverage on malaria in 2020, which is interesting. Of course the coalition can’t take credit for that entirely, because there are lots of other journalists who aren’t part of the coalition, there are lots of other organizations doing their different work, but I think it’s a strong indication that something is working, something is changing and people are taking the issue of malaria more seriously in the media.
Certainly there maybe one or two other areas you expect the network to improve on. What are these?
I would say improving the monitoring would be one main thing. One of the reasons, as I said before, is having this new administrative structure for the coalition – having co-chairs and regional representatives. The goal here is that the regional representatives can help to monitor the media output of that region and then feed that data to the co-chairs and to the Health Reporters Network Secretariat, which will allow us to have much more visibility on what’s going on, exactly what’s being produced, and therefore we would be able to show the impact of this happening in a more concrete way. That would be one thing.
I think another would just be really committing to and holding each other accountable to a minimum amount of media output. If that’s kind of one article or broadcast per month and everybody is committed to that and if you hold each other accountable to that, that’s a huge amount of media output. So I think that’s kind of basic way in terms of the commitment to actually doing the work and holding each other accountable to that commitment, I think is something that we can improve on as well.
You just concluded a tour in the provinces as part of your engagement in the ZMSWM campaign in Sierra Leone. What was that tour about?
We did a 10-day trip to Kono, Kambia and Moyamba, our three pilot districts. The main reason was to implement a series of activities that we called the district leadership forum. So in each of the districts we invited around 45 to 50 key stakeholder representatives. So this was community level representatives, religious leaders, paramount chiefs, unions, youth groups, women’s groups, local council, media, private sector, etc.
So we really had a fantastic cross section of stakeholder representation at these district leadership forums.
The main objective of these meetings was to identify challenges and solutions at the community level to malaria control and prevention, because we know that people who live in a district understand that district the best. So it doesn’t make sense for people to come from Freetown and go to district level to impose a particular solution.
What we wanted to do was to facilitate a dialogue for and to encourage people to think critically about the challenges they face at district level, to identify potential solutions and then to create an action plan for the next few months about what specific actions and activities each stakeholder group could implement to realize those solutions.
The secondary objective of this tour to these three districts was private sector engagement; how we wanted to engage companies that are based at district level.
For example, in Kono, we had engagement meetings with three diamond mining companies, which was really fantastic, to hear both about what they were already doing in terms of contributing to malaria control and prevention in their companies and then to also encourage them to think about other ways that they might be able to contribute using the resources of their companies at the district level and potentially also at the national level.
These were just initial engagement meetings and the plan now is for the District Health Management Teams (DHMT) to have follow up discussions with those companies and create specific action plans and to support them as needed to implement them.
You have been working in other countries on malaria before Sierra Leone. Can you compare what the private sector has done there and what Sierra Leone can learn from that?
As I said, private sector engagement is a really key part of the ZMSWM campaign internationally.
In Senegal, one example I can give is that there is a company called WARI, a mobile money transfer company. We created a partnership with them for them to fund a particular programme, which is called the Community Champions programme. So basically they provided the funding to train a certain number of community champions on malaria sensitization. These community champions would go from house to house in the pilot districts to check that, for example, if all the families have their mosquito nets hung up, or if they knew about the signs and symptoms of malaria, if they knew where the local health center was, etc, and all of the different prevention and treatment information necessary.
Once a family had received that sensitization and they have put up their mosquito nets, then they can receive some kind of a certification from the community champion, like a sticker, to be a Zero Malaria Household.
So this was something that was completely funded and facilitated by WARI, obviously with support from the National Malaria Control Programme and Speak Up Africa; because the company itself doesn’t necessarily have the knowledge and the technical capacity about malaria to do the trainings themselves, so we were able to facilitate that for them.
That’s a really kind of concrete and great example of what a private sector company can do, specifically in Senegal.
I will also like to just mention that in different countries now, like in Ghana, there is what’s called the Ghana Malaria Foundation. It was initially created a couple of years ago and it’s now in the process of being reconstituted. And this is a structure that can be found in a few different countries now. A really great example of this is in Zambia. They call it there End Malaria Council, which is basically a public private partnership structure, so it includes representatives from government as well as from private sector, and their goal is basically domestic resource mobilization. As a fund they have the ability to receive money directly from private sector companies.
One of the challenges if you don’t have that kind of structure, a fund or a foundation, private sector companies might not be willing to give money directly to the government, for example. They already paid their taxes, they might have some issues with transferring money directly to the Ministry of Health.
So it is really good to have a separate, independent body, that could be a foundation or a fund and that body can both think strategically about how to generate more resources, which companies to engage and how, what to propose to those companies, etc, so it kind of operate at strategic level as well as having the financial infrastructure to receive money and then to disburse it again.
So that’s something that I will be really interested in seeing in Sierra Leone and creating at some point, maybe this year or next year, maybe something that’s driven by the national malaria control programme in the ministry of health. We have already had some discussion on the potential of doing that in Sierra Leone. But if I could choose one thing, I think that I would recommend that Sierra Leone does and other countries have tried, it would be that.
The goal is to end malaria. When you come from a country like Sierra Leone you don’t tend to see how that is possible, because Malaria goes beyond seeking treatment. It has to do with the environment, which I think is the greatest factor here. So, is it possible to end malaria and what would it take?
I will tell you a couple of things. One is that one reason to be hopeful is that last year, I think it was in November, an article was published, co-written by 26 leading malaria experts, and they were all attesting to the possibility of malaria eradication within a generation.
It’s kind of an incredible claim to make. And of course, nobody really knows. They are saying that theoretically it’s possible, but that there are so many factors. As you said, it’s a huge question. They are saying it’s theoretically possible to do, but there is no guaranty of that happening. As you have alluded to, so many things would have to happen for that to be the case.
So it’s possible, but it’s still very ambitious. Incredibly ambitious goal. We talk about malaria elimination by 2030, malaria eradication within a generation by 2050, resources will have to be greatly increased; again one of the reasons why private sector involvement is so important is because we can’t just rely on funding from USAID and Global Fund, who give the majority of money to malaria control programmes.
Even with the huge amount of funding they provide there is still a US$2billion annual shortfall in order for the global technical strategy to eliminate malaria to be successfully eliminated.
The WHO’s formal, official technical strategy to eliminate malaria, they have calculated how much money that would cost, and currently there is about US$2billion annual shortfall in other to make that happen. So just on that basic front, resources need to be increased, either from national governments increasing their funding, from private sector, from bilateral donors, from wherever; that needs to happen.
But it is also not just that. We need everybody to actually follow the advice that they are given. There is still a problem in many countries where people do not go to the hospital or take their kids to the hospital. If they have fever, they wait too long. You know, most of the deaths of malaria – 70% - are children under five. And so parents of those children are responsible for taking them to the clinic and they need to receive that information but they also need to be responsible for following that advice.
There are lots of other preventive treatments for malaria. It’s not just bed nets. There is intermittent preventive treatment for infants. There is intermittent preventive treatment for pregnant women. There is seasonal chemo prevention.
So there is lots of ways that the malaria burden can be reduced and of course the government primarily is responsible for making those services available and making them free, which they are supposed to be in Sierra Leone. But people also need to actually go and use them. And that still is a big challenge, which is why our sensitization is absolutely crucial, but it’s not the end of the story.
I could go on and on, but yea, there are lots and lots of things that would need to happen in order for malaria elimination and eventually for malaria eradication to happen. But I am hopeful and we should all be hopeful and that’s what the ZMSWM campaign is trying to drive towards. It’s a message of hope and of optimism, that it’s possible, but it requires this mass mobilization of every member of the society embracing the message, embracing the campaign, that I have a role, I have a responsibility, whether I am the present, whether I am the head of a private sector company, whether I am the mother of the household trying to look after her kids, everybody has a responsibility. And there is no way that malaria elimination or eradication will be possible if all of the responsibilities just lies on the government or all of the responsibilities just lies on international donors, etc. It really has to be a nationwide holistic effort.
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