Carlos Odora
12 November 2008
opinion
Kampala — While much of the world managed to eradicate malaria in the mid-20th century, Sub-Saharan Africa did not. Africa bears the greatest burden of malaria both in human and economic costs.
The World Health Organisation (WHO) estimates that a child dies every 30 seconds from malaria and the disease imposes costs of $12b (about sh2 trillion) annually.
In Uganda, malaria is estimated to kill up to 320 people every day. Yet these deaths are preventable. Why does malaria continue to present a huge burden to Sub-Saharan Africa?
In 1950s, the WHO rolled out a campaign to eradicate malaria using the method of indoor residual spraying and treating the presenting cases using the most effective medicine, then Chloroquine.
The indoor spraying method targets adult mosquitoes intent on feeding on people inside their houses. The insecticides sprayed on the walls repel, irritate or kill the mosquitoes and in so doing break the transmission of the plasmodium parasite from mosquito to human.
Although the malaria eradication campaign failed to eradicate the disease, it was in fact remarkably successful in reducing the burden of disease and in saving millions of lives.
It also proved that the technique worked. However, because most countries in Africa lacked the necessary infrastructure on the ground, coupled with the necessary skills and resources, the campaign was not brought to scale on the continent.
Current efforts to re- introduce the method are facing stark uphill task in some countries especially in East Africa as the concept is viewed as a new technology. This has caused some constituencies to challenge its viability by misrepresenting its benefits as negative and demonising the insecticides as environmental hazards.
There is a need to engage these constituencies continually through constructive advocacy and debates in the print media and other outlets in a sustained manner if any reduction in malaria cases and deaths is to be realised.
Since the WHO campaign failed due to the lack of adequate skills and infrastructure, one would expect that the countries have had the benefit of time to build their infrastructure. On the contrary, we see its deterioration after the colonial era as well as the human development indexes. This pities most of the African people from being able to take matters into their own hands and overturn these debilitating trends.
To exacerbate the burden on the poor, some opposition party politicians who are misinformed, in an attempt to score points over their rivals, frequently frustrate development programmes by encouraging their boycotts. In Uganda, there has been an ardent opposition towards the use of insecticides for malaria control to the extent of having the judiciary involved in imposing a court injunction on life saving initiatives.
The above examples demonstrate how fluid and volatile conditions can be, presenting stark un chartered courses for implementing public programmes not only in Uganda but Sub-Saharan Africa.
There is a compelling case for one not to be presumptive and hope that, public programmes meant to serve the poor can just be delivered with ease. The examples call for new approaches if diseases and the causes of poverty are to be addressed.
Novel ideas that are inclusive and draw on the broader perspective of divergent constituencies might need to be sought while reinforcing them with evidence based facts generated through tested experimentation. Such an approach would limit the opportunities for people to pursue their own agendas by spreading propaganda that could potentially harm a good programme by distorting information.
Recent resurge in malaria elimination and eradication campaign have emerged as world leaders and donors weigh in on the challenges of ending poverty, where most of the malaria countries are also the poor ones and heavily indebted. Thanks to the donor communities who have availed funds to help support the efforts to stem the malaria burden.
In order to tap into the existing goodwill, sustained advocacy that is capable of comprehending issues and working to generate non-partisan approaches that serve the poor who take the brunt of under development is very vital.
The writer is a fellow with Africa Fighting Malaria
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