Question: You have been on the campaign against malaria for over the past 20 years. What has it been like to fight a disease that's still rife even today?
Answer: In the year 2002, malaria was a serious problem but its profile was low. By then, there was very little investment in ending it. But after years of advocacy and convincing the government as well as other actors, today we are seeing more investment pouring in to support malaria interventions. This is actually how the plans for malaria elimination process started. So, the situation in terms of efforts being invested to tackle the disease has been improving over the years. The fight must continue if we really want to eliminate the disease. I think it's now important that we start engaging communities in scaling up the fight.
Have the communities not been fully engaged in the fight against malaria in Tanzania?
I won't say the community is not wholly engaged. It's partial. There has been some engagement. Most of the malaria interventions in place are not community-based. They have in some sort been imposed on people. Such malaria programs don't originate from the people themselves. If communities don't own the anti-malaria programs that means their commitment to fight the disease is very low.
So, what involving the communities will mean in eliminating malaria?
If you engage the communities, they will develop their innovations of eliminating malaria and they will start understanding the new knowledge on malaria interventions and utilize it. If it's not community-owned, it's like someone bringing something new to them. The seriousness about taking the best practices on malaria treatment and prevention is lacking. This is also manifested in vector control, whereby people tend to wait for the government to go and carry out interventions in their localities. The community must be the first actors as much of the success of programs depends on the willingness of the households to take up the responsibility.
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So, what needs to change if Tanzania has to place communities at the centre of these malaria interventions?
The communities must be made to understand that they have a crucial role to play in combating malaria. They need to understand that it's their responsibility to tackle their health problems and not to wait for someone else. So, we need to improve community systems.
You have been involved in malaria control programs through Tanam. What have you done to reduce the malaria prevalence in the country?
Our focus, right from the beginning, has been on eliminating malaria. We understood that as a single organization, we couldn't do it. So, we mobilised NGOs, community-based organisations (CBOs), faith-based organizations and other groups to get one voice that we need to push the malaria agenda. Through that voice, we have managed to advise the government on which way to take in the malaria fight. For instance, we understood that by relying on CBOs, we could reach out to households and this could reduce the government's burden. That way, it was possible to mobilise resources through CBOs to reach the people affected by malaria at community level. We owe the biggest part of our successes in empowering communities. Our advocacy wasn't only about mobilising resources through CBOs, but also it was about advising the government to make use of local products to build sustainability. For example, we advocated for the A to Z factory. You see, we as a country used not to have permanent substances to treat bed nets. We used not to have nets that were not rerated in the factory. That was tedious business. So, we advocated for transfer of technology that gave rise to the A to Z factory. We went ahead to advocate the use of larvicides.
What is it that Tanam hasn't yet done that you still need to do in malaria fight?
The next thing that we want to do is to advocate the first line treatment for malaria to be manufactured right here in Tanzania. We haven't had this chance and I do believe, as a country, we can do it. By having our own products, we create employment for our people, we make use of our own natural resources. For stance, Arthermther, which is one of the components used in making the malaria combination therapy is grown in Iringa Region. It's time to use our own chemical products to make malaria drugs.
What do you think is impeding the efforts to use our own resources to make anti-malaria drugs?
The challenge here is lack of investment into it. If the government will seriously look into it, perhaps seek partners to make it possible that can be much better. There is huge competition in that area, I know, but all can be done. The investors can be called in to do it in our own country. That is, the private sector. All this will depend on whether the government will make it a priority.
Taking an example of the Kibaha Biolarvicide plant which was launched about 3 years ago here in Tanzania, do you think we, as a country, have utilized it fully?
No. The country hasn't utilized it fully because we are not seeing the products in the market. We, as Tanam, went to the factory when it was launched and we wanted to establish how its marketing strategy would be and also know its market share that can be available for Tanzania. But, since that time, we haven't seen the product on the market even as we have our market share in it. Why aren't we utilizing the products? Well, we learned that there was no marketing strategy and when you don't have this, it means the distributor is not known, it means that there are logistical challenges. We also went ahead to test if the communities had the ability to make use of it, and assume the responsibility of controlling malaria vectors by using the bio-larvicides, we realized that the community was ready. The community is ready and can indeed make use of it. It's only that the authorities in the country have to create a good marketing strategy for it and find how best they can put the product in the market.
As a civil society, you advise the government and complement its efforts in such programs as malaria control. Do you think the government is currently employing the right approach in dealing with malaria?
Theoretically, the government has a good malaria strategy that is guiding the programmes. But within the strategy, there are few malaria innervations that are currently running. There are those which are not. For example, currently there is more push for the use of Insecticide Treated Nets (ITNs). It has helped, but ITNs cannot eliminate malaria. There has been the use of ACT that's combination therapy-we are seeing achievements in this. But we need a combination of strategies now. There is still a gap and some other strategies are yet to be implemented. As we look forward to eliminate malaria by 2030, the government needs to review the model of how we engage people, partners, and other sectors. We need to use a multi-sectoral approach in dealing with malaria so that we can tap into every opportunity and all interventions can be rolled out.
You have worked on malaria in Zanzibar. What do you think puts the Isles ahead of the Mainland in malaria control?
Zanzibar is an Island. It's a small area compared to the mainland where the malaria issue can be very complex. The mainland has also done quite a lot. A larger part of the country has reduced malaria but there are areas that need intensive work, such as the Coastal Belt. We seriously see that the coastal belt is very vulnerable. Why don't we put more intensive work there? There is the Lake Zone. Why are we not putting more resources there? It appears to me that the transmission actually comes from these coastal areas and the lakes because of people's movements.
There are campaigns going on in those areas on ITNs and other interventions such as Indoor Residual Spray. These are helping. We hope much more will be done. In Lindi, Ruvuma, Mtwara and Pwani; in the Coastal belt generally much effort is highly needed. But again, I would say it's not only about investing in malaria tools. There is a question of behavioral change and an issue of gender and human rights barriers.
My experience in our assessment as Tanam shows that where there are gender and human rights issues, malaria is also high. Where there are many community barriers, there is high malaria prevalence. If there is child abuse or domestic violence, you will not see the use of bed nets-people sleep outside! If we don't address community gaps, it will be difficult to make it.
If a policymaker approached you and asked you to propose one best way to tackle the malaria situation in the country today, what would you advise?
I would tell him/her to consider seriously the vector control strategies--that is dealing with the mosquitoes. I would indeed ask them to take it even more seriously.
What if the policymaker tells you the government has started doing that already? In fact, it has been reported that such strategies are being implemented in Dar es Salaam.
Those are just pieces. Doing it in one area and that's it is not enough. We need to comprehensively look at it as a countrywide issue. What can best be done is to set up a policy that will guide how this can be done in urban settlements and where there is a high concentration of the vectors. Vector control initiatives should be taken seriously and use all the by-laws and the community is addressing the issues. If community behaviors and barriers are not put in line with this strategy, we won't make headway. This is where the community must actually be engaged more strongly.
What if the authorities say it's very expensive to roll out such a program countrywide? That the government has many competing priorities?
I don't think the problem is the cost. The issue here is priority. If the intervention is made a priority, it will sail through. But remember, the government is not alone. Communities can do a lot. If they are mobilised and made to understand what it means, they will do it. The local leaders can then push the agenda forward through the communities.
And, how best can the government deal with vectors?
That's why I have always been an advocate of the fact that the government should set up a department at the health ministry which will deal with human vectors.
That will help us save resources. Because if there is a department, it means that there will be a group of experts who are committed and assigned to carry out interventions that will help get rid of the vectors instead of having a small vector control desk. This desk can't work it out well because it cannot coordinate other stakeholders in other ministries for example agriculture, industry and the rest. We need a department that is capable of mobilising everyone to carry out interventions against vectors.