Initiatives
Mosquito Net Utilization
Issue:Regular use of Long Lasting Insecticidal Nets (LLINs) has been shown to reduce all-cause child mortality by around 20%. The two variables with the greatest influence on net use are the number of nets in a household, and the size of a household. LLIN use increases with the number of nets in a household, but decreases as the size of the household increases. Achieving universal coverage with mosquito nets is therefore the key strategy towards achieving high utilization rates and ultimately impact in terms of child mortality. Once high household coverage has been achieved, other key determinants of net use include ambient temperature, presence of nuisance biting mosquitoes, knowledge of malaria risk and knowledge of how to hang a net. These factors can be effectively addressed through well-designed communication programmes and initiatives that are delivered at the same time as the nets are distributed to households.
ALMA action on net utilization: ALMA, working with UNICEF and other key partners, is prioritizing the collection and dissemination of best practices in improving net utilization. It is also encouraging Countries and funding partners to prioritise communication strategies to enhance net utilization in conjunction with national level campaigns. ALMA partners are also working to ensure strategies such as routine distributions, post-campaign “hang-up” visits and periodic wide-spread communication and messaging are established to ensure that nets are being used in the years after their distribution.
Incorporating Hang Up Campaigns, by Marcy Erskine (IFRC)
Quantification for universal coverage, by Marcy Erskine (IFRC) and Matt Lynch (JHU/CCP)
Overview of AMP activities and future plans enhancing net utilization, 14-15 February 2011
Behavior Change Communication Working Group, by Hannah Koenker (JHU/CCP)
Strategies to Increase the Use of Insecticidal Treated Bednets to Prevent malaria
Enhancing Net Utilization Wrap Up, 14-15 February 2011
World Malaria Report 2010: Global Malaria Program, by Richard Cibulskis (WHO)
Lessons from Zambia, by Paul Libiszowski (PATH)
LLIN Funding overview, Melanie Renshaw (ALMA)
Person to Net Ratio, Cambodia Slide
Using Evidence to Develop Communications for ITN Use, by Megan Littrell (PSI), 15 February 2011
A Business Perspective in Fighting Malaria
Factors Associated with Insecticide Treated Bed Net Use, by David Larsen (Tulane University)
UNICEF's Approach to Communication For Development (C4D), by Valentina Buj, 15 February 2011
VCWG: Continuous Distribution Workstream Update, 14-15 February 2011
Removal of Taxes and Tariffs
Issue: The existence of importation barriers, including both tariff and non-tariff barriers, can negatively affect the cost and timely delivery of essential anti-malarial commodities. This effect is widely recognised by African leaders and their international partners, as evidenced by the Abuja Declaration of 2000 that committed all signatories “to reduce or waive taxes and tariffs for mosquito nets and materials, insecticides, anti-malarial drugs and other recommended goods and services that are needed for malaria control strategies.” Recently, the 64th UN General Assembly of 2009 reaffirmed the importance of removing tariff and non-tariff barriers on anti-malarial commodities. Unfortunately, to date only four African nations have completely removed tariffs on all five essential anti-malarial commodities identified by the World Health Organization (Guinea, Kenya, Tanzania, and Uganda).
ALMA action on removal of taxes and tariffs: ALMA is working in partnership with the Malaria Taxes and Tariffs Advocacy Project (M-TAP) to help expand access to essential commodities used in the global fight against malaria by:
- Identifying importation processes that can delay access to essential anti-malarial commodities or increase their cost, and;
- Working in partnership with stakeholders in the global malaria community to provide national governments with data on the impact of importation barriers to aid the decision-making process to promote policy changes that remove importation barriers and increases the capacity of national governments to achieve their targets for malaria control.
Removal of oral artemisin monotherapies
Issue The parasite that causes the most dangerous form of malaria - Plasmodium falciparum has developed resistance to all previous first-line treatment therapies, but new combination medicines containing artemisinin derivatives show an over 95% cure rate. Artemisinin derivatives need to be used in combination with other effective antimalarial medicines for the treatment of uncomplicated falciparum malaria. However, the widespread practice of using oral artemisinin-based monotherapies, which are easier and cheaper to produce and buy, poses an enormous risk and could result in the loss of artemisinins to parasite resistance. Removal of artemisinin-based monotherapy depends on effective drug regulation at country level. Only the removal of marketing authorizations for oral artemisinin-based monotherapies will make them unavailable in the public and formal private sectors. Persistence of artemisinin monotherapy in the informal private sector, which is common in many malaria-endemic countries, can be overcome by the provision of good access to quality medicines through a national drug supply management system.
In 2007, the World Health Assembly adopted a resolution to progressively remove oral artemisinin-based monotherapy from the market and replace it with artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated falciparum malaria. Globally, 34 countries have withdrawn marketing authorization for oral artemisinin-based monotherapy, but 28 countries have not yet taken regulatory action, including 18 in Africa. Out of 76 companies involved in the production and marketing of these medicines, a total of 36 companies have de-listed oral artemisinin-based monotherapy from their product catalogues but 40 companies, mainly those targeting the private sector markets of malaria-endemic countries, are still actively providing monotherapy.
ALMA action on removal of oral artemisinin monotherapies: In partnership with WHO, and RBM, ALMA is urging all ALMA countries to ensure that regulatory measures to stop marketing of oral artemisinin-based monotherapies and to promote access to artemisinin-based combination therapies (ACTs) are in place by end 2010.
ALMA tender
Issue: On February 1, 2010, African Leader’s Malaria Alliance (ALMA) members called on the ALMA Secretariat to investigate alternative mechanisms to ensure that every malaria-endemic country in Africa meet the goal for universal coverage of effective malaria interventions by December 31, 2010. The African Heads of State and Government called for the immediate acceleration of the procurement, shipment and distribution of long-lasting insecticide treated nets (LLINs) and requested that donors ensure the timely fulfilment of financing commitments.
Action on the ALMA tender: The ALMA Secretariat has placed a bulk order to procure and purchase nets for those malaria-endemic countries that have an unfunded LLIN gap and/or have not been able to begin the procurement process for LLINs. The ALMA Bulk Order is a tool for countries and partners to fast track universal access and resolve common challenges. The ALMA Secretariat is working with Ministers of Health and Finance to represent countries throughout the ALMA Bulk Order process and is partnering with UNICEF to manage the operational details of the ALMA Order. UNICEF utilises a system of Long Term Agreements with suppliers of LLIN products with full and interim WHOPES recommendation, based on a global level tender which pools procurements from all countries, leading to economies of scale and reduced net prices. The ALMA requirement will be included into UNICEF’s forecast and provide necessary information to the industry to pre-book capacity immediately. In response to the forecasted and confirmed ALMA requirements, manufacturers utilize their available production capacities to meet these requirements, significantly reducing delivery times. The map summarises the countries participating in the tender.
Local Manufacture of Malaria Commodities
Issue. Currently, the majority of malaria commodities used in the prevention and treatment of malaria in African countries are imported. Local production of malaria commodities in Africa is most highly developed in relation to mosquito nets. Nigeria and Tanzania currently undertake full production of long-lasting mosquito nets in affiliation with western companies. In addition, Ethiopia, Kenya and Malawi all have industries that cut and sew mosquito nets, using precursors supplied from external partners. In relation to malaria treatment, three formulations of amodiaquine+artesunate are manufactured in laboratories in Morocco. South Africa is a regional centre for the manufacture of insecticides used in controlling malaria-transmitting mosquitoes.
ALMA action on local manufacture of malaria commodities: ALMA is working with key partners including the GFATM to study opportunities and carry out a cost benefit analysis of local manufacture of essential malaria commodities in Africa. ALMA working with key partners will engage manufacturers to collaborate and to develop and action plan to increase the local manufacture of essential malaria commodities in Africa.
64th UN General Assembly, Agenda Item 47, 2001-2010: Decade to Roll Back Malaria in Developing Countries, Particularly in Africa