“A lack of political will” is often cited as an impediment to the delivery of health care in the developing world and a factor that stymies the fight against many of the preventable diseases the world is grappling with, including malaria. It is commonly perceived that countries fail to prioritize health care delivery, depend totally on donor aid and generally do not own the fight.
My experience working with African leaders proved the opposite. I recently completed a two-year detail with the African Leaders Malaria Alliance (ALMA) Secretariat, an organization that has successfully generated political will to control malaria on the continent. I assisted in establishing the ALMA office in Africa, a job that also involved liaising with member-country ministries of health and representing ALMA’s voice.
ALMA came to life in 2009 when forward-looking heads of states, led by His Excellency President Jakaya Mrisho Kikwete of Tanzania, demonstrated ground-breaking leadership and political will by taking ownership of the malaria problem. They made a commitment to holding themselves accountable to their citizens and the global community on this important issue.
The 49 members of ALMA now meet twice a year to discuss the progress, challenges and opportunities in fighting malaria in their countries. It is remarkable that, on average, about 75 percent of the members — heads of states and governments — are present.
It is even more remarkable to see them using an innovative tool, the ALMA Scorecard for Accountability and Action, which tracks member-country progress on malaria policy, financing, implementation and impact. The tool also tracks progress on reproductive, maternal, newborn and child health (RMNCH) indicators, including the prevention of mother-to-child transmission, deliveries by skilled birth attendants, exclusive breastfeeding, and diphtheria, pertussis and tetanus (DPT3) vaccinations.
This tool has been so successful in motivating action that countries have asked ALMA to help them develop country scorecards focused just on RMNCH. A new Elimination Scorecard has also been developed for countries in southern Africa that are marching toward the next level of the malaria fight — elimination.
In the five short years that ALMA has been working with partners and, especially, the office of the United Nations Secretary General’s Special Envoy for Financing the Health Millennium Development Goals and for Malaria, ALMA has made significant progress in the fight against malaria. ALMA’s strong leaders inspire accountability and action not just among themselves but within their ministries of health and the global community.
One indicator of progress is the World Malaria Report 2013, published by the World Health Organization, which estimates that deaths from malaria decreased by 49 percent overall in the African region and by 54 percent among children under 5 years of age from 2001 to 2012.
FHI 360 has contributed to malaria control efforts through work funded by the U.S. Agency for International Development, GlaxoSmithKline, the Bill & Melinda Gates Foundation and other funders. Our work to remove taxes, tariffs and nontariff barriers on antimalarial commodities directly supported ALMA efforts. Over a five-year period, FHI provided the evidence on the taxes and tariffs indicator for the ALMA Scorecard for Accountability and Action. While I was working with ALMA, the indicator on commodities went from red (no action) to yellow (partial action) and green (complete change of policy in almost all the member states).
Beyond our work with ALMA, FHI 360 partners with the global malaria community, such as the Roll Back Malaria partnership, and malaria-control funders, which include bilateral and multilateral organizations, foundations and the private sector. We also participate in efforts to advance global thinking on malaria efforts. FHI 360 is now co-chair with PATH of a high-level task force aimed at restructuring the architecture and governance of Roll Back Malaria.
It is clear that the political will to control malaria is present in Africa. What we need now is to work collectively to sustain — and increase— that will in order to ensure that we continue to make progress toward eliminating malaria altogether. My experience with ALMA shows that this goal is within reach.