ALMA SUMMARY REPORT – 4th QUARTER 2014
Introduction
The African continent has fought a long and hard war against malaria, person by person,
village by village, city by city, and country by country. In this millennium, every weapon
in the political, economic, social, and environmental arena has been honed, modified, and
deployed with both skill and persistence. The fight has been one of collective engagement
across a broad array of partners and tools; such that the current commitment is
unprecedented in our history.
For the past 5 years, a massive political charge has been led by Africa’s political leaders.
Through ALMA, Africa’s heads of state and government have transformed the
commitment that they have made at the African Union into a structured alliance with a
scorecard accountability and action mechanism that effectively monitors all member
countries, working with the countries and the rest of the malaria community to report
back, make recommendations, and take remedial action.
Progress
The 2014 World Malaria report applauds Africa’s 54% reduction in malaria mortality by
the end of 2013. This laudable impact on mortality and morbidity is accompanied by a
marked reduction in parasite prevalence. Even as our continent bemoans the loss of
430,000 children in 2013, countries are working hard to ensure that mortality will have
dropped by 67% at the end of 2015. We have averted 3.9 million children’s deaths with
our actions. This accounts for 20% of the 20 million child deaths that are estimated to
have been averted in sub-Saharan Africa since 2000. Thus, decreases in malaria deaths
have contributed substantially to progress towards achieving the target for MDG4 of
reducing, by two-thirds, the under-five mortality rate between 1990 and 2015.
This remarkable progress is the result of consistent implementation of vector control,
rapid diagnosis, early treatment, and surveillance interventions, by countries and partners.
In 2014, we saw more LLINs distributed than ever before with an amazing 190 million
LLINs estimated to be delivered to Africa, approximately 44 million more than ever
before. This also reflects the efficiency of the global forecast and bulk tendering process
launched in 2013. Additionally last month saw the delivery of the one billionth mosquito
net! As a result of this, the majority of countries achieved the required level of operational
coverage for vector control (see Figure 1).
1
MEMBERS
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Chad
Comoros
Republic of Congo
Democratic Republic
of Congo
Côte d'Ivoire
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Ghana
Guinea
Kenya
Lesotho
Liberia
Madagascar
Malawi
Mali
Mauritania
Mauritius
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sahrawi Arab
Democratic Republic
São Tomé and
Príncipe Senegal
Seychelles
Sierra Leone
Somalia
South Africa
South Sudan
Sudan
Swaziland
The Gambia
Togo
Uganda
United Republic of
Tanzania
Zambia
Zimbabwe
Figure 1:
Operational LLIN /IRS Coverage (% of at risk Population)
During 2014, most ALMA countries, working with partners such as the Global Fund, PMI,
DFID, UNTAID, the World Bank, the Bill & Melinda Gates Foundation and others, secured
resources for these essential interventions as demonstrated above, whilst others have secured the
resources needed to achieve universal coverage of at risk populations by the end of the first half
of 2015 (see Figure). The ALMA Awards for Excellence recognize such hard won country
milestones, in part achieved with the support of domestic and international partners.
2
Figure 2:
LLIN/IRS Financing 2014 Projection (% of need)
A Success Story
At the end of 2014, forty-one Global Fund New Funding Model malaria concept notes have been
submitted to the Global Fund, including twenty-five from Africa. Another nine countries in
Africa are working on their concept notes for submission in early 2015. By the end of 2014,
malaria concept notes worth US $2.9 billion were submitted to the Global Fund and this has been
estimated to increase to US $3.5 billion by the end of January 2015. All but two of the concept
notes from countries in Africa have moved into the grant–making stage, a success rate of 92%.
Countries, the Global Fund, and supporting partners are commended for this effective use of
donor funds. Controlling malaria where it is infecting and killing people most, is effectively
restoring sustainable development to African communities.
3
Challenges
Domestic financing of malaria control efforts continue to grow at a small pace. An ALMA
country demonstrated the potential for domestic funding growth when Global Fund resources
targeted for malaria were used to sustain essential HIV/AIDS programming and the government
stepped in with domestic resources to fill the outstanding malaria gap.
Sustaining coverage with essential malaria control interventions in the face of Ebola has proven
difficult. The three countries most affected by the Ebola crises experienced around 5 million
malaria cases in 2013. Access to malaria treatment in the three countries has fallen during the
outbreak:
•
•
•
In Sierra Leone, the number of children under five years of age treated for malaria at
public health facilities in July and August 2014 was 34% lower than the number
treated in the same period in 2013;
In Guinea, there were 37% fewer malaria cases reported from facilities in Ebolaaffected areas from August to October 2014 compared to the same months in 2013;
In Liberia only 56% of public health facilities submitted monthly surveillance reports
between July and September 2014.
Though rapid diagnosis and treatment have suffered, the countries have worked with willing
partners to sustain vector control. The Global Fund has released emergency funds to Liberia and
Sierra Leone to support the LLIN distribution in Liberia, and Mass Drug Administration in
Sierra Leone, whilst partners including MSF, WHO, and UNICEF have provided technical,
financial, and implementation support.
Resistance to Insecticides
A critical number of ALMA countries are facing serious problems of insecticide resistance. The
Global Plan for insecticide resistance recommends that countries develop long term plans for
monitoring and management, including the introduction of non-pyrethroids for Indoor Residual
Spraying, where pyrethroid resistance is detected (see Figure 3). This plan development is
complicated by the high cost of non-pyrethroids since most countries cannot afford them. We
must work together to stimulate the market to ensure stable high demand, guarantee production,
expand the number of manufacturers and to secure price reductions.
4
Figure 3:
Insecticide resistance status
From Control to Elimination
The next phase of the war against malaria entails advancing from malaria control to malaria
elimination. For the first time in our struggle against malaria disease and death, we are in a
position to put in place a framework for the elimination of malaria from the African continent. A
critical number of ALMA countries are on track to reduce malaria incidence by over 75% by the
end of 2015.
ALMA countries have demonstrated that working with malaria partners they can sustain high
coverage of essential malaria control interventions. This level of commitment has enabled the
continent to radically transform the policy environment within a short space of 5 years (see
Figure 4).
5
Figure 4:
CCM Policy Status
Monotherapy Ban Status
The Malaria Elimination Framework that ALMA has adopted includes an Elimination Scorecard
mechanism, which will support, monitor, and catalyze the appropriate policy environment,
management structures, programs, and processes; track the introduction and maintenance of
appropriate surveillance, treatment, and diagnosis data as well as epidemiological interventions
and data. The framework will encourage the development and graduation of countries from
moderate–high transmission; to low transmission; to pre-elimination; to elimination.
Conclusion
Malaria is a ruthless enemy that has robbed the African continent of productivity, human capital,
and sustainable development. It has made the attainment of current growth and development
extremely difficult and more resource intensive than investments in the growth and development
of other developing countries in the Americas, Europe, and Asia. Its removal from the continent
is crucial for a critical mass of Africa’s countries to attain middle and upper middle income
status by the end of 2030.
Like the African Union’s “The Africa We Want” for the United Nation’s 2030 Sustainable
Development Goals, Africa’s “Agenda 2063” commits to an Africa free of malaria. This is
ALMA’s goal, and we invite all our partners to join our member countries in committing
together to this essential development imperative -- making a Malaria Free Africa a reality.
6