ACAMALARIA News and Editorial

ACAM introduces Sanofi-aventis to the realities of Malaria programming in the COMMUNITIES

May 23, 2010

After discussions between ACAM’s director and Sanofi-aventis staff, both in Washington DC and Nairobi Kenya, it was agreed that ACAM would undertake a field operation in Usalama, a village of over 6000 population with a history of remarkable success in spearheading a community-based effort to bring clean water to their dispersed households. The community accomplished this with technical support from the AMREF-Kenya country office and financial help from a small NGO located in New York City, known as Mwikali’s Gift. Now the community wanted to address their next major health priority: the eradication of malaria.

 

The objective for Sanofi-aventis was to assist their organization to better partner with communities to develop and sustain effective malaria prevention and control activities. Already Sanofi-aventis had undertaken the development of educational materials for this purpose; they understood that these materials alone could not be readily adapted by communities in order to create effective malaria activities in their local level. The opportunity to interact with several groups of residents from Usalama, provided by the NGO, Mwikali’s Gift, allowed for direct dialogue regarding the needs, current level of understanding of malaria program interventions, and their current access to these life-saving malaria program options in the context of the National Malaria Control Program (NMCP). 

 

From March 9-12, 2010, the team interacted in the field with local AMREF staff, together with the Usalama Project director, who facilitated organizing 186 enthusiastic community participants, who had had previous experience with their successful water and sanitation project. This greatly facilitated their ability to set forth a designated Task Force to move the malaria program forward and to create a shared vision for a MALARIA-FREE Usalama. It was soon learned that the current access to LLINs for malaria prevention and ACT for treatment, both interventions promoted by the NMCP policies, was non-existent.

In follow-up discussions at the Kibwezi Health Center (the closest govt. health facility to Usalama), it was confirmed that LLINs had been out of stock for several weeks, and that no pediatric ACT dosage was available due to unfilled orders from KEMSA, the Kenya Medical Services Agency. This effort did not attempt to investigate causality of these shortfalls, but rather defines the current situational dilemma and offered a plan for “strategic partnering” that was then discussed with the Usalama community leadership for incorporation by their Task Force.

Finally, the consultant’s team prepared a list of recommendations for consideration by Sanofi-aventis in their efforts to improve communications with communities, the “Last Mile Barrier”^], an analogy borrowed from telecommunications professionals, to effective malaria programming. The experience found in Usalama is unfortunately common in many African settings, but today’s innovative communication technologies can help to promote change.

ACAM’s Reflections on 2009: Learning All the Time

January 22, 2010

Once again, a new decade has dawned for ACAM’s involvement in Africa. But there is a gaping hole since the last details were posted on its website. In fact, an entire year has slipped by without an update being added. What can the matter be?

The fact is, 2009 has been a pivotal year for ACAM’s operations. Backtracking to mid-year, in order to pursue “an upfront and personal” perspective on the new Obama Administration’s changes regarding global health and malaria programming, ACAM’s Director returned to Washington, DC for an intensive round of meetings in pursuit of this information —- all within the Beltway.

A brief list of the sessions (a total of 26 attended) include: a “Call to Action” held with key members of the new White House team; several sessions at the Center for Strategic and International Studies (CSIS), a major think tank located on K St.NW, intent on providing guidance to the new Administration for their Global Health Initiative (GHI) programs; several meetings hosted by the Global Health Council, including one targeting faith-based organizations with the key question, ” What Does Faith have to do with it?”; and the Grand Finale closing out AED’s NetMark project, a major effort to inject social marketing and private sector involvement into national malaria control programs, especially in Africa. Finally, PAHO convened a remarkable session celebrating their Region’s malaria activities; for the first time the role of the community in planning, producing, and evaluating these efforts was truly celebrated!

The good news was that at most of these sessions, when the audience got an opportunity to ask questions, ACAM’s Director invariably was selected to ask repeatedly the following question, “In your work, how are you involving the Communities you are called to serve to produce sustainability, equity and community ownership?” This was usually followed by comments about “grassroots” engagement, but lacking any clear definition of what “grassroots” meant to them. The Director then questioned, namely, “What grows in your “grassroots”; are there any weeds or stones. Or was it really Astroturf, doomed to a landfill eventually?”

After attending multiple sessions, a pattern began to emerge. It was the young students, usually seated at the back of the room, but with a keen interest in Global Health, who grasped the significance of the community perspective missing in the presentations from the panelists. Also “missing” was a clear sharing of their project’s budget priorities and allocations. More specifically, what percent actually impacted at the community\beneficiary level? This hopeful note reflects the new involvement of members of the Association of American Colleges and Universities (37 of its 837 members, or 16%) now offering majors or minors in global public health and the number is growing exponentially. Nevertheless, their impact on policy, program design and priorities will be some time in coming, perhaps a generation away.

Meanwhile, the first six months of 2009 were preoccupied with ACAM’s efforts to galvanize the NGOs, CBOs and FBOs to participate in Kenya’s Round 9 Global Fund Malaria Proposal. ACAM’s main focus was assisting the leadership within KeNaaM’s (Kenyan NGOs against Malaria) partners to mount a Civil Society Organization (CSO) component for Kenya’s Proposal. Of course, all this must be conducted within the consolidated efforts of the Kenyan Country Coordinating Mechanism (CCM) as prescribed by the Global Fund. In addition to preparing a PowerPoint training presentation based on Aidspan’s reference materials, the Director drafted both the Summary Rationale and Terms of Reference for Technical Assistance to CSOs for preparation of their Round 9 inputs

Unfortunately, due to communication difficulties and conflicting agendas, the CSOs failed to mount a timely and quality response for input into the Global Fund (GF) Proposal. As diagnosed by one of the hard-working team members, the process was ‘hijacked’ by certain self-interested CBOs (most who have been on the HIV “gravy train”) who don’t really know how to meaningfully work within communities. A Lesson Learned would be to screen out those organisations in the future and to work only with those who directly engage with communities and engage Community Health Workers (CHWs) using the Kenyan Community Health Framework. Finally, Kenya’s Round 9 Malaria submission was soundly rejected by the Global Fund’s Geneva Review Panel.

Furthermore, although GF Country Coordinating Mechanism (CCM) guidelines clearly delineate the roles and responsibilities of all the participating members, the balance between government and non-government members as designed by the Geneva headquarters, was not fully understood by the CSO members. Follow-up analysis of Round 9’s preparation performance will be critical before scaling up for any future proposal submissions from CSOs.

On a more positive note, building on the euphoria over Obama’s Inauguration on January 20, 2009, staff from Vestergaard-Frandsen journeyed to Kakamega for an exuberant local celebration involving one of Kenya’s Favorite Sons and America’s First Black President. It truly was a media extravaganza with the inauguration of a local health post health constructed with Vestergaard input in order to provide a convenient follow-up point for the many HIV-positive cases detected during its earlier successful HIV Screening campaign that achieved 90% community compliance.

Lastly, prior to departing from Kenya, ACAM participated in intense discussions with Japanese members of the G-8 on a Follow-up session related to critical policies for G-8 health investments hosted by AMREF. Once again, they provided solid arguments for their investment in community-based approaches for sustainability and equity.

As a parting shot before leaving Kenya, ACAM’s director developed  training materials . In addition, an opportunity to apply for the Global Fund Board NGO position representing developed countries surfaced; this required concise, but exhaustive innovative responses to a long list of Board requirements. for use by KeNaaM, the collaborative group of over 70 NGOs in Kenya united together to create a Malaria Free Kenya.  KeNaaM’s management recognized the need for a revision of their strategy with renewed endorsement by all of the membership for future malaria program activities.

In summary, for ACAM, 2009 was a year filled with challenges and disappointments. The vision of KeNaaM’s partners coming together to take advantage of the new CSO pathway for Global Fund proposals proved to be naïve and weak. The strength of all its partners, large and small ones, was found to be unprepared to work together in a spirit of unity. Unfortunately, many lacked a working understanding of the constructive Global Fund CCM statutes. These standards, refined over time to respond to past Fund failures and weaknesses,  strongly favor engaging CSO input into Global Fund planning and implementation. Yet they are ineffective if all of the CCM members are not fully aware of their purposed significance or are unwilling to value the contributions and strengths of each member to produce truly sustainable and effective efforts. The CSOs have much to learn as well to function in this challenging new environment.

Truly, living is learning and we will go on.

ACAM is ALIVE and WELL in Africa

February 25, 2009

Chronology of ACAM activities since Moving to Africa

June 15, 2007

The following list highlights ACAM activities that have taken place since moving its operations to the field, namely, Nairobi , Kenya as the hub. Nairobi was chosen because of its strategic location in East Africa and its easy access to air transport throughout Africa. The list includes a mix of contracted activities and multiple professional consultations provided pro bono to organizations needing assistance on an ad hoc basis.

 

 

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