African Medical and Research Foundation’s (AMREF’s) Support to RBM Efforts in Eastern and Southern Africa By Eliab Seroney Some, AMREF HQ Fourth Global Partnership Meeting to Roll Back Malaria The World Bank, Washington, DC April 2001

What Is AMREF?  International health NGO founded in 1957  Headquarters in Nairobi, Kenya  Operates in nine (9) countries in eastern and southern Africa: –Kenya, Uganda, Tanzania, south Africa –Mozambique, Rwanda, Somalia, Sudan, Ethiopia

Range of Support to RBM (1)  Preventive interventions –Testing models of delivering insecticide-treated mosquito nets (ITNs) (Kenya, Uganda, Mozambique) –Workplace health promotion (HIV/AIDS & Malaria) (Kenya, Tanzania, Republic of South Africa) –Health promotion and education (all countries) –Integrated management of childhood illness (Kenya, Uganda, Tanzania, consultancy to other African countries and agencies)

Range of Support to RBM (2)  Curative interventions –Surveillance anti-malarial drug sensitivity and treatment failures (Kenya, Tanzania, Uganda) –Quality control of laboratory tests and clinical practice at primary health care levels (K, Ug, Tz, Sudan, Somalia, Mozambique) –Emergency response to malaria epidemics (K, Ug, Mz, Tz)

Range of Support to RBM (3)  Support to health systems –Capacity building through  Face-to-face interactions (seminars, workshops),  Distance education/continuing education (over 2,000 students per year) (K, Ug, Tz, Sudan, Somalia and other countries)  One-year diploma in community health  Production of health promotion and learning materials through AMREF’s rural health series of books and manuals

Increasing Scale of Action: Case One: Community-based ITNs Promotion  Local stitching, promotion, sale and re- impregnation involving 75,000 people in four sites, : –Sagana (near rice scheme); Taveta (sisal estate); Migori (Around Lake Victoria); Turkana (Migratory community, arid area with seasonal malaria)

Case One: Community-based ITNs Promotion  Strategies –Organized community groups –ITNs as an income generating activity –Modes of payment adapted to local purchasing power –Community’s own people used for awareness and demand creation –Linkage to commercial sources of ITN goods

Case One: Findings SiteBaseline Coverage Nets made After 3 years Re- impregnatio n Status 2001 Sagana17% %25%Active Taveta0%45232%4%Active Migori9%43411%**Inactiv e Turkana0%652*****Active

Case One: Lessons  Organized community groups (OCGs) are present in most communities and the could be successfully introduced to ITNs for malaria control  Linkage to income generation is crucial for ITN sustainability at community level  OCGs create awareness and demand for eventual commercial sector up take of ITNs  OCGs facilitate targeted delivery of ITNs to specific areas and sub-population groups  NGOs in partnership with Governments most suited to empower OCGs and communities

Case Two: Integrating Malaria Into Other Health Programmes  Malaria integrated into a child survival programme in Luwero and Nakasongola districts in Uganda, 1992 –  Other elements: Immunization; Control of diarrhoeal diseases, Nutrition; Acute lower respiratory infections; Maternal care/Family planning; HIV/AIDS, orphans support.  Malaria: ITNs, Treatment, Information, education and communication.

Case Two: Strategies  Community-based health care system established  Capacity building of Village Health Committees, Community Health Workers; Youth peer Educators, Traditional Birth Attendants  Shared resources, with synergism with other interventions  First line drug (Chloroquine) availed to CHWs for malaria treatment  ITNs sold without subsidy

Case Two: Findings  Functional community based health care systems established in all four (4) sub-counties for health and other development initiatives.  Use of ITNs. –Mothers: %. –Children: 40 – 49%. –Father: 20 – 22%. –Others: 0 – 2%.  First line drugs available 100%.  Incidence of malaria in children below 2 years: –Baseline: 230 – 450 per –Post-intervention: 160 – 190 per 1000.

Case Three: Employer- based Malaria Control  Network of workplaces/employers –potential system for scaling up  Starting April 1998 to September 2000 and with funding from DFID, AMREF in partnership with MoH, Kenya, mobilized employers and Organized Community Groups to promote ITNs  Main strategies –Acquisition of ITN through salary deductions –OCGs in collaboration with medical department of the employers handled all aspects of ITNs –OCGs supplied ITNs to surrounding communities and other employers

Case Three: Findings  14 employers and 80 Organized Community Groups in coastal and western parts of Kenya, with 97,000 beneficiaries  26,000 ITNs sold to employers and surrounding communities, 11,400 direct to employees and their dependents  Net coverage: 8-100%; Re-impregnation 25-80%  Reduction in malaria illness: 25 – 87%  Reduction in expenditure on anti-malarial drugs 23 – 97%

Summary/Conclusions  Government-NGO partnerships most appropriate to explore introduction of malaria into and capacity building of communities and private sector  NGOs most suitable to facilitate targeted delivery of ITNs to difficult areas and not-easily- reached populations by capacity building local organized community groups  Enabling Mechanisms –Grants –Memorandum of understanding –Joint planning, monitoring and evaluation –Co-resourcing

Challenges  Limited access of NGOs to resources, e.g. those channeled through Governments, for testing of innovative approaches.  Empowerment of communities by Governments as the key development partner.  Limited resources to scale up innovative approaches.