A recent documentary, narrated by Jane Goodall and created by the U.N. Foundation, has highlighted the success and power of the Global Fund to Fight Aids, Tuberculosis and Malaria. 

Watch the documentary below.

With a patchwork of indoor residual spraying (IRS) programs across a diverse landscape, Ghana is undertaking an ambitious scale-up of IRS for malaria control based on a four-way collaboration among Ghana’s government, the private mining company AngloGold Ashanti (AGA), and PMI, with significant financial support from the Global Fund.

AGA has conducted malaria control operations in the southern forest zone since 2005. AGA’s efforts have focused on IRS and targeted larviciding, as well as scaling up of ITN and ACT distribution. A 75% reduction in malaria was reported in AGA’s workforce between 2005 and 2008.

In the northern savannah zone, malaria control programs were PMI-supported and implemented in collaboration with the Ghana Health Service (GHS) to cover six continuous districts, representing more than 708,000 people in 2009. Two more districts were added over 2010. PMI’s approach is highly collaborative, relying upon existing GHS health volunteer networks and recruiting IRS spray operators from local communities. AGA has provided valuable assistance in community sensitization and training of spray operators.

Ghana’s national malaria control strategy calls for a scale-up of IRS to one-third of the country’s 138 districts. The close collaboration and information sharing among AGA, PMI, WHO and community partners will be invaluable in ensuring that this goal is met.

The third joint retreat for Civil Society delegations to the leading global health initiatives and networks, which took place this May, recently released a draft of its report. The retreat was attended by representatives from UNAIDS Program Coordinating Board, the Global Fund, UNITAID, GAVI Alliance, International Health Partnership, Roll Back Malaria, Stop TB Partnership, and the Partnership for Maternal, Newborn and Child Health, and focused specifically on developing a more strategic approach for working together as civil society to better influence and shape policies to ensure renewed commitment and action to achieving the Millennium Development Goal targets by 2015.

The report contains progress updates and background information on achieving the MDGs and improving access to health services, strengthening health systems, current gaps in international health financing, and an overview of Global Fund replenishment campaigning efforts, which it cites as the overarching priority for all participants, pointing out, “Most agree that it will be extremely difficult if not impossible to meet the health MDGs if donors are not willing to support the Global Fund adequately over the next three years.” The Global Fund and advocates agree that $20 billion, which would allow for the continuation of funding for existing programs and significant scaling up of well-performing programs, is the minimum amount that donors should pledge in order to be effective. Advocates are pessimistic because donors have signaled that they will provide far less, but many also believe that effective advocacy regarding the MDGs over the next few months could help increase the odds in their favor.

Roll Back Malaria in particular is focusing their efforts particularly on the 2010 Global Fund replenishment campaign, the success of which is considered especially crucial because the Global Fund provides about 57% of all international funding for malaria control and treatment. RBM is also stressing the importance of promoting an integrated approach among MDGs 4, 5, and 6 to ultimately strengthen health systems.

The overall goals of the Global Malaria Action plan are to achieve universal malaria control coverage by the end of 2010 and to eliminate malaria as a public health problem by 2015. The report claims that these goals will almost certainly not be met if the current funding and support climate persists. Although nearly 200 million insecticide-treated nets have been distributed, that represents less than two thirds of the estimated current need. In addition, access to effective treatment lags in many parts of the world because of difficulties with procuring ACTs, the proliferation of fake drugs, and the persistent use of less effective and resistance-enhancing monotherapies. Scale up of indoor residual spraying and access to diagnostics, the two other main pillars of malaria control, has also slowed in recent years.

The recommendations the report makes regarding malaria are:

1. Strengthen civil society participation and community-based action: more community systems strengthening is needed to complement government services
2. Sustainable, predictable funding and good governance: Political will is key
3. Holistic approach for the MDGs with disease-specific control programs
4. Partnership

Civil Society Participation: The history of malaria and other endemic diseases clearly shows that without community involvement in the provision of health services many people would not have access to basic health prevention and care. The contribution of community health workers is crucial to meeting the health MDGs, but the essential role that communities play in mobilizing people to access health services, providing care to complement government services, and in particular in reaching marginalized or hard-to-reach communities is not yet widely acknowledged.  Malaria can kill within 24 hours. Community participation is also key to ensuring good governance and country ownership.

Predictable Funding: Current investments in malaria control have saved lives and provided far-reaching benefits for countries, but additional sustainable and predictable funding needs to be available to build on successes and strengthen community involvement. In some locations, due to extensive and successful malaria control efforts, the entire cohort of children lack immunity from malaria because they have been protected from exposure. These groups remain susceptible to more severe infections until malaria transmission is greatly reduced and eliminated. Support for new drugs and insecticides development is also essential to minimizing future risk and costs and to reverse resistance. Without sustained and predictable funding, the significant contribution of malaria control towards the achievement of the health MDGs could be reversed.

Holistic Approach: Each MDG is interrelated and interdependent, which requires a more integrated and holistic approach. For example, achieving maternal and child health goals would be impossible without targeted support for malaria, which disproportionately affects children and pregnant women. A holistic approach would help to break the cycles of in which each symptom further contributes to the rest, creating a trap.

Partnership: Finally, donor agencies, governments and development partners should also ensure strong inclusive, effective global and local partnerships to improve collective action. Getting rid of the burden of malaria is a huge task that requires effort and collective action from all sides. Reaching the MDG targets will only be possible through a significant scale-up in program implementation – effective prevention and treatment coverage – that no single agency or government can achieve on its own.

In more than a third of the 108 malaria-endemic countries, recorded cases and deaths due to malaria have fallen by 50% since 2000, which shows that MDG targets can be achieved with high coverage of populations with mosquito nets, improved access to effective diagnostics, and treatment. However, malaria still kills approximately 850,000 people a year, 85% of them children in Africa, and it is four times more likely to strike pregnant women than other adults. Increased participation by civil society and advocacy for these issues are crucial steps in helping to raise the additional funds necessary to sustain the momentum against malaria, continue to make gains and consolidate successes to guard against future risks.

Read the full report: 3rd CS Retreat Mtg Report Draft.

A new deal was signed in Kampala last week involving the Global Fund and six manufacturers of malaria drugs working in a public-private collaboration negotiated by the Clinton Health Access Initiative, which will likely cut prices of malaria drugs by more than half and help to ease the pressure on family medical costs. According to this deal, over the counter malaria drugs will cost the same as those provided in government hospitals, with the goal of strengthening Kenya’s anti-malaria campaign.

Artemisinin-based combination therapies, or ACTs, are about 10-40 times more expensive when sold over the counter than the older drugs which have lost their effectiveness because malaria parasites have developed resistance to them. Because of the high cost, many people still buy these cheaper but less effective drugs. Current statistics indicate that only one in every five patients treated for malaria has access to life-saving ACTs.

“These agreements bring us closer to the day when all who need malaria medicines will get them at affordable prices,” says Global Fund Executive Director Michel Kazatchkine. The six manufacturers that have signed Master Supply Agreements with the Global Fund are: Ajanta Pharma, Cipla, Guilin, Ipca, Novartis and Sanofi-aventis. All six pharmaceutical firms meet the Global Fund’s quality criteria for supplying ACTs to first-line buyers.

Under the agreements, private importers will now pay up to 80 per cent less than they did in 2008-2009 for ACTs, bringing the factory gate prices down to the same level as public sector buyers. Currently ACTs make up only 5 per cent of treatments provided through the private sector. Widening access to ACTs will help Kenya reduce morbidity and mortality from the disease, hopefully accelerating progress towards its eradication.

Last Friday, Health Minister Richard Kamwi officially opened a new ARV clinic at the Otijwarongo State Hospital in Namibia, which was built with financial assistance from the CDC Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The clinic has already managed to attract new patients, as it presents a clean, private, and secure image.

Kamwi said the clinic would provide this region of Namibia with “more accessible and readily available health services” and coincides with the country’s objective of bringing essential health services closer to communities. While the clinic mainly addresses the needs of HIV/AIDS care and prevention, it will also focus on improvement of maternal health, reduction of child mortality, and combatting malaria. Jeff Hansen, the country director of the CDC in the U.S., hopes that this new clinic can function as a focal point for uniting the community around improving these health issues.

In advance of the upcoming G8 Summit, Prime Minister of Canada Stephen Harper arranged a meeting with the head of the Global Fund to Fight AIDS, TB and Malaria on Friday afternoon. The Global Fund’s Executive Director Dr. Michel Kazatchkine commented, “The very fact he could arrange a meeting at this time, two weeks prior to the G8 is clearly a strong sign of support to the Global Fund and to global health.”

He also asserts that it is time for the G8 nations to “take ownership” and live up to commitments with a vision of achieving real goals, in terms of lives saved, by 2015. Dr. Kazatchkine said, “If the effort could be sustained and expanded, that could lead to a world without malaria deaths by 2015 and to a huge impact on maternal and child health like virtual elimination of mother to child transmission of HIV… That is the kind of goal that a few years ago would appear as ideal or utopia but we know could be achieved now if the resources could be sustained or expanded.”

I’ve been working for Malaria No More for just over a year and a half and have loved the cause every step of the way.  For me, investing in the fight against malaria just makes sense.  Theres been demonstrated return on investment, economic benefits and lives saved.  Quite simply, the statistics made a powerful case to me.  Perhaps most compelling, we can end malaria deaths by 2015, there is a light at the end of the tunnel.

There is, however, a difference between knowing and seeing.

I have been blessed with the opportunity to travel to Dakar, Senegal and I’ve just been amazed by everything I see.  The people are extraordinarily friendly (especially to someone who doesn’t speak any French or Wolof) and Dakar is a gorgeous city, situated right on the water.  Dakar is also one of the most fitness oriented cities I have ever seen, every day hundreds and perhaps thousands of people gather on the beach to run, workout and stay in shape.

Beyond my wonder at this new, incredible place, is the shadow of malaria.

During my time in Senegal, I saw two women being treated intravenously to defeat their malaria infection.  Both women were adults and should survive with their treatment, but the energy had just been sucked right out of them before my eyes.

Despite being familiar with malaria issues, when I stepped off of the plane, I didnt feel any more vulnerable to a crippling disease, nor did any sort of warning constantly come to my mind.  But the evidence was there for me to see.

But despite the tenacious nature of malaria, success in Senegal has been wide spread.  Last year the government began a distribution of 2 million bednets for children under 5.  Youssou N’Dour launched his Xeex Sibbiru Song Contest campaign in order to raise awareness about malaria and the results are amazing to behold.

I saw health huts, rapid diagnostic tests, bednets and drug treatments that becoming more and more widely available.  All of these treatments and the support of organizations like USAID, The President’s Malaria Initiative and the Global Fund are rolling that shadow back.  Morning is coming in Senegal, as long as we keep up our support.

William Brieger of End the Neglect: The Blog for the Global Network for Neglected Tropical Diseases, explains astutely that tropical communicable diseases such as malaria are integrated into the environment and human activities, and thus require a holistic and integrated approach as opposed to relying any one intervention. Excerpt below:

“A common critique of the Global Fund to Fight AIDS, TB and Malaria is that there are other major contributors to the burden of disease in tropical countries… From the standpoint of malaria integration makes sense.  From the start, the Roll Back Malaria Partnership made it clear that malaria control (and eventual elimination) could not succeed unless health systems were strengthened. These are the same systems that are supposed to control filariasis, helminthic diseases, diarrheal diseases, and pneumonia as well as promote maternal health, child growth and development as well as immunization programs. It was a weak health system that contributed to the failure of the first effort to eradicate malaria fifty years ago.”

Brieger examines two recent articles that highlight this need for integrated prevention and control services: significant overlapping and negative synergies between malaria and helminth co-infections in outpatients in southern Ethiopia, and similar convergences between lymphatic filariasis and malaria vectors in Tanzania.

Brieger argues: “If basic health services are well funded, staffed, and supplied, no tropical disease needs to be neglected.”

Economist Jeffrey Sachs, author of The End of Poverty: Economic Possibilities for Our Time (2005), recently explained that development aid to ensure that the poorest countries can ensure universal primary health care can be scaled up significantly in just five steps. The cost per person of achieving universal primary healthcare is very low – just $54 per person per year in the poorest countries. The annual financing gap needed to achieve this is about $26 billion per year from the rich countries. The most obvious gap is in the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a global initiative that is desperately short of funding from the Obama administration and other governments. Jeffrey Sachs’ five recommended steps to respond to this gap can be read here:

There are a number of ways in which these funds can be mobilized at marginal or low costs. Jeffrey Sachs presents some of many opinions. The main point is that: “The money is there. The needs are urgent. The challenge is one of vision and morality.”

Listen to this article

Andrew Jack, of the Financial Times, recently spoke to Michel Kazatchkine, executive director of the Global Fund to fight Aids, TB and Malaria about the impact the recession is having and will have, on funding for drug stocks and whether they are still on target to achieve their goals with respect to eliminating malaria, mother to child transmissions, AIDS and TB.

To hear the interview please click here.