Malaria, both an ancient and modern scourge, claims a life every two minutes. It also knows no borders, which is a particular challenge in the highly affected countries of southern Africa. To realize the ambition of eliminating malaria, an innovative "no border" approach by committed faith leaders is producing results.
"It's not about the pulpit, it's about education, it's about healing a disease suffered by people in the church community," explains Bishop Cleophas Lunga, who is working in partnership with the Isdell:Flowers Cross Border Malaria Initiative. Bishop Lunga is the Anglican Bishop of Matabeleland, Zimbabwe and recently traveled with a southern African Anglican delegation to the US and the UK to make the case for continued funding and support.
Bishop Lunga contracted malaria twice as a child and is no stranger to the tragic impact and economic burden of the disease. Globally, malaria claims 445,000 people a year, 91 percent of whom live on the African continent
Nonetheless, the Bishop is an optimist. The victory to eliminate the disease is within reach. We have the tools and knowledge to reach "the very last mile," in rural and remote communities; the most difficult and important mile of them all.
Unusual players, unexpected success stories
"The role of the faith leaders in combatting malaria is being increasingly recognized, and it's a role that we're enthusiastic about," notes Lunga, noting his neighboring Anglican Bishops in Namibia, Angola, Zambia and Zimbabwe. It is within the highly mobile populations along porous borders that are hard to reach, and often where malaria transmission escalates.
Over a decade of collective global effort and resources have ushered in unprecedented successes. In 2016 there were 21 million fewer malaria cases than in 2010. From 2007 to 2017, malaria deaths were cut by more than half. Isdell:Flowers, working with community religious leaders such as Lunga, has put an emphasis on strengthening surveillance, community education, diagnosis and treatment.
"It is essential that we build on the long-established relationships that faith leaders have in rural and remote communities, we are the readily accepted messengers, and in this role, we can not only help save lives, but advance a shared global goal to eliminate this disease from our region," says Archbishop Albert Chama, Anglican Church of the Province of Central Africa, who lead the delegation to the USA and UK.
Bishop David Njovu, Diocese of Lusaka, Zambia, illustrated recent gains in his country and pointed to Kasangulu, a border town on the north bank of the Zambezi river with a historically high prevalence rate. Surprisingly, in August this year district health officials declared that the malaria prevalence rate had dropped to 1 percent. The success in Kasangulu reflects a broader one across Zambia. Among countries in southern Africa, Zambia is an example of commitment of government in tandem with several partners as well as increased domestic financing.
"The 3 Ts" for Cross-Border Elimination: Test, Treat and Track
What is at the heart of Zambia's success? Njovu cited a focused awareness-raising campaign coupled with the expansion of community health workers.
"They provide on-the-spot treatment for those with positive results," Njovu explains, but just as important, "they also track where people who have tested positive live and immediately travel to those areas to do more testing and treating."
As a community liaison and advocate for the initiative, Njovu has found a significant personal connection: "I have buried so many people who have died of malaria. And most of the people who died of AIDS-related illnesses, actually died of malaria."
Beyond the 3-Ts, there are five critical factors needed to succeed to reach elimination, states Dr. David Heymann, Head and Senior Fellow of the Centre on Global Health Security at Chatham House. He cites access to health at the community level; trust in the health workers who are offering the treatment; a functional health system; cross-border collaboration, a regional approach; and the engagement of community-based organizations including faith-based groups.
"It is community-based groups that have an integral role within all five key components to a successful strategy at the community level," Heymann says, "they are the truly critical link." He adds that both Christian and Islamic faith-based groups are especially important in gaining community trust.
Fostering an enabling environment
An evidence-based elimination strategy in the border areas of southern Africa won't succeed without an enabling environment: strong political will and financial support.
"It's not only a smart investment, it propels us toward the last mile and toward our collective aim of global malaria elimination" says Christopher Flowers, CEO of J.C. Flowers & Co and founder of the Flowers Foundation. He, with Neville Isdell, former CEO of The Coca Cola Company, co-founded the Isdell:Flowers Initiative and sponsored the southern African delegation.
The delegation included Bishop Luke Pato, Anglican Diocese of Namibia and Bishop André Soares, Anglican Diocese of Angola.
At Lambeth Palace in London, a round table on malaria drew malaria scientists, researchers, NGOs and faith leaders and the delegation also met with Alistair Burt, Minister of State at the Foreign and Commonwealth Office and Department for International Development (DFID), Catherine West, MP and Vice Chair of the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases, Rt Hon Baroness Northover and Lord David Alton.
Starting in the United States, the delegation shared their insights and perspectives with representatives at the United Nations and members of Council on Foreign Relations before traveling onward to Washington, DC to meet with members of Congress and students and faculty at Harvard University, in Cambridge, MA.
"Winning the battle against malaria is not a sprint, it's a long, grueling marathon, and we must reach the last mile," said Neville Isdell. "It's clear that if we are able to get a Coke to the most distant villages in the world, we can also get the essentials to eliminate malaria." He added: "But proven tools to eliminate malaria will not work if people don't use them. The Church's active work in communities to change people's behavior is a game changer in the fight against the disease."