15 April 2008

Africa: Making Partnerships Work Against Malaria


Kent Campbell is program director for Malaria Control and Evaluation Partnership in Africa (MACEPA). The organization was launched in 2005 to partner with the government of Zambia and its Roll Back Malaria (RBM) partners to accelerate national malaria prevention and control efforts. MACEPA also works to strengthen global malaria advocacy. MACEPA is a program of the Program for Appropriate Technology in Health (PATH), an international non-governmental organization that works to find innovative solutions to improve global health.

Campbell worked for the Centers for Disease Control for 21 years and headed its malaria program. He also worked with the United Nations Children's Agency (UNICEF) as their malaria advisor and with the Bill and Melinda Gates Foundation. He recently spoke with AllAfrica about MACEPA's work.

You have been working against malaria for most of your professional career – what inspired you to get involved in this effort?

It was really in many respects serendipitous. I entered [the malaria field] at an interesting time because it was at [the] lowest point imaginable in terms of international interest and commitment to malaria because it was when the eradication efforts of the 50s and 60s were grinding to a halt. There were lots of recriminations and disillusionment about what seemed to be a promise to eradicate malaria, which seemingly failed, and there was very little enthusiasm about malaria at that point.

But over a 21-year career at the CDC, where I headed the malaria program, we were able… to be involved in a great deal of the work that established the credibility of insecticide-treated bed nets, that helped set the framework for more effective drug use policy, the whole set of issues of how to prevent the effects of malaria on pregnant women and their fetuses. It was really a very exciting time in which some of the building blocks, which now form some of the intervention structure for malaria control, were developed and put into place.

The challenge had been for over a decade that the global financing … still had just not jelled. The second thing was that national governments didn't have the confidence that it was a good investment. They knew it was a huge problem, but was it a good investment in the sense of: were global partners going to get on board, would it pay health and political benefits in the short term?

And so a group of us working with the World Bank and Global Fund [to Fight AIDS, Tuberculosis and Malaria] said one of the things that would potentially act as a catalyst... would be one or two countries going full steam comprehensively on malaria control, and... document[ing] the process as well as the health benefits of that process as a way to give confidence from an Africa-based example as opposed to a northern-based example. It was that national African voice that was missing from the global stage to demonstrate commitment and to demonstrate the assurance that this was a good investment.

Your initial partnership has been with Zambia – how has that progressed?

An emerging group of partners saw Zambia's commitment [to malaria control] and wanted to invest in it. Our job then became as the government's key partner in terms of strategy development, program design and evaluation, to support the government. That started in late 2004-2005. Zambia has really moved so much faster and with so much more result than I ever could have imagined. They're really teaching us how to move forward.

What occurred then is the expansion of this effort – we're now working with Ethiopia and are beginning to work with Zimbabwe and Tanzania in a broader community of programs. There are several other countries that are moving forward very aggressively - Rwanda, Kenya, Eritrea, Zanzibar - and they really have sprung forward using a common set of methodologies.

It is a multi-country effort that is demonstrating very clearly that malaria can be controlled, controlled with current interventions that we have available. And while there isn't enough funding to do the effort thoroughly at this point, the global partners are stepping forward with additional funding because it is the best investment in health in Africa right now.

It's a quick, very impressive win that an African nation can have over a problem. It's in the range of four to five dollars per capita per year and can drop childhood death rates by 20 percent in three years and that's just exactly what Zambia is demonstrating.

Zambia says it is committed to protecting 80 percent of its people from malaria by the end of this year. Where does it stand in terms of reaching this goal?

Zambia started in 2004 with population coverage with bed nets of no more than 10 percent. Last year they were on average across the country at about 40 to 45 percent. It would appear that by the time the annual survey is done in June this year Zambia will be at about 60 to 70 percent on average across the country.

Could you address the topic of malaria eradication? (Bill and Melinda Gates called for the eradication of malaria in October 2007.)

The call for eradication was really to set a vision. It wasn't to say this should be the program objective for malaria control this year. This was building on the fact that we know that malaria can be controlled. We know that the current set of interventions – drugs, bed nets, insecticide spraying – can be enormously powerful to bring down malaria transmission, maybe even in some places stop malaria transmission. Probably not in Central Africa, but maybe in some places where there's a lower level of malarial transmission - some places in the Americas, some places in Asia.

The call for eradication was not to set a new strategy; it was really actually to set a vision for the global community and to say that we need to take a multi-decade view and make a multi-decade commitment to malaria because it is the most controllable threat to the health and well-being of the world's population.

One of the things that has happened, however, is some people have taken a position that this is actually distracting from the immediate challenge of getting on with the job of malaria control. For example … [they perceive that] looking way out in the future and talking about the research and vaccine development and drug development agenda that's needed over the next two to three decades is potentially distracting attention as well as potential resources for the near-term agenda. That may happen but I personally don't see it happening yet. It will only happen if the global community allows it to happen.

Is the call for eradication a distraction? No, I don't think so. I know it is occupying a lot of people's time as they're trying to convince themselves and other people that it's not a good idea. My major statement to those people is why don't they put their attention to more aggressive efforts toward controlling malaria because that's the pathway to eradication if we ever get there and the fact of the matter is that is the trajectory at this point. So identifying that as a long-term goal should sustain, if not increase, the amount of resources and commitment.

Is there anything else that you would like to add?

The early successes that we're seeing in a few countries – Ethiopia, Zambia, Rwanda – are extremely encouraging but the next two to three years will be the acid test of whether the global commitment and the contract that the global community is making with African ministries of health and governments is going to be honored.

We have strong evidence to suggest that [malaria control] will be a key propellant to rural development. So we have to have more successes, we must have a five- to 10-year commitment at a minimum in Africa to gain the solid credibility … that malaria control must continue. We're not at that point yet and my great concern is that these early successes are going to, in fact, work against this effort, that it will seem so easy that somebody else should just get on with it rather than the people who have been funding it to this point.

We're facing in the next three years the make or break point for malaria. We have to have more country successes and we have to sustain funding. The one thing I do know is that African ministers of health are very encouraged. They're getting on board with this because malaria control is a good investment – they know this. They're going to have to have the global community there with them and not be fearful that the global community is going to turn to some other fashionable thing next year.


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