To end malaria, Africa must commit more resources

— Joy Phumpahi, Executive Secretary, African Leaders Malaria Alliance (ALMA)

Joy Phumpahi is the Executive Secretary of the African Leaders Malaria Alliance (ALMA), an alliance of 49 African Heads of State and Government working to eliminate malaria by 2030. She was formerly Health Minister of Botswana, which has achieved a huge reduction in malaria transmission and deaths in recent years. 
During a recent teleconference Phumpahi talks about  the new road map to eliminate malaria known as the Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa By 2030 and its implications. She also highlights specific issues of malaria eradication in Nigeria and other African countries. Excerpts:

Role of ALMA
We’re at a pivotal moment in the fight against malaria. For the first time in the history of this fight against malaria, a malaria free Africa is actually in sight.
ALMA has played a critical role, not only in bringing African leaders together, and getting them to support efforts in their own countries… it has also developed an accountability and action tracking mechanism. This enables Heads of State to monitor performance of their own countries and the neighbours”.
 Despite the progress in the fight against malaria, 395,000 Africans were killed by malaria last year – most of them were children under the age of 5. “It is a real attack, not just of the livelihoods, but also the economies of our countries”.

 Catalytic Framework
 The Catalytic Framework builds upon the progress made during the MDG period. It clearly delineates the roles and responsibilities of every stakeholders, the key areas of focus, the targets and outcomes.
 It clearly also stipulates the role of research and new technologies, and how we can make them available. It also outlines for us the role of all of us in financing the Catalytic Framework.
While resources have been invested in the fight against malaria in the MDG era, we will have to more than double the resources as we work towards elimination. We are expecting a lot of resources to come out of the domestic arena – from the public sector and the private sector. There will be need for a new focus on those mobilizations.

Issues surrounding malaria vaccine
 We could definitely move faster – that goes without saying. But we must appreciate that we’ve moved extremely fast. We achieved considerable progress in the last 10 years of the MDGs – especially in the final 5 years.
 Now we are putting all of the interventions into play, and scaling-up. The real challenge is sustaining universal coverage - “If you’re spraying, you have to spray every year”.
 “What slows us down is when we’re not able to sustain the gains we’ve made”.
In a lot of cases, it’s not just about funding – it’s about the efficiency of our health systems. How fast we are able to procure, diagnose etc.
How much is needed? There are many different estimates. At least twice what was invested in the MDGs – we have to double our investment.

Impact of  Framework on malaria eradication efforts in Nigeria 
We have 15 countries that carry the bulk of the infections, and Nigeria is among the top three. The biggest challenge in Nigeria is achieving universal coverage and sustaining it. Nigeria is in dire need of additional resources for next year – 2017 – in order to fund the replacement of medicines, and sustain treatment.
The previous government explored the possibility of setting up a malaria bond – this is one thing the current government is looking at as an option to meet the funding gap they will have next year.
Nigeria also faces the challenge of weak systems – logistics and procurement. Nets manufactured do not meet WHO standards – companies need help to meet the WHO’s pre-qualification standards.

Accountability of governments
We have developed a tool at the national level – the ALMA scorecards. They contain smart actionable indicators, which help people identify where the key bottlenecks are. We do this on a monthly and quarterly basis.
This has been extremely helpful, and many African leaders have asked this to be done for maternal and child health.
We have also adapted this tool for use with malaria at a sub-national level.

Malaria and funding under SDGs
“We have to focus on efficiency gains. Efficiency gains in health can enhance outcomes by as much of 40 percent” This is the result of a study undertaken by the World Bank and DFID.
Funding is also a huge challenge. With over 160 targets in the SDGs, maintaining malaria as a priority is a challenge.
A study has been done by a group of 100 economists and about 17 Nobel Laureates, brought together by the Copenhagen Consensus, and they have taken all of the SDG targets, and rated them on a scorecard according to which one gives you the best return on investment. The malaria target has one of the highest returns on investment – especially investment on prevention and treatment of malaria. For every $1 you invest, you get $34 in return.
We are not saying that the fight against malaria is more important than the other targets. But, given the rate of return, if you are able to control malaria as quickly as possible, you will actually free up resources to effectively target the other SDGs. That is the strongest argument.

Investments in health in line with Abuja Declaration  
One of the tools that the Africa Union has decided to introduce into the Catalytic Framework is a scorecard on domestic financing. It shows, not only the amount of public expenditure allocation, but as a percentage and per capita spending on health in the country. All three of these recommended indicators are necessary.
 Very few countries already met the criteria of the Abuja Declaration. One of the countries that stands out is Swaziland, which has met all the three criteria. Using multiple measures to assess performance is going to be important.

ALMA’s expectations
At ALMA, we are going to embrace this AU tool, and report on what each countries is actually doing on a quarterly basis. In the end, this is an African challenge. Africa itself has to be the key funder and the key partner in resolving this challenge.

ALMA would like to partner more actively with the media going forward, now we’re in the SDG era. It is good to have the conversation with members of the media on how we can more actively engage with you, country-by-country, to make you active participants in this war. The elimination of the disease requires total engagement by all stakeholders.