Malaria NightWatch

Malaria Response: Timely Public Health Intelligence... Today, malaria requires innovative approaches, comprehensive policies, evidence-based strategies, coordinated efforts and, not least, accountability for tracking progress (7) on key fronts - e.g. hygiene, sanitation, prevention, care and research. However, that does not mean that things can change overnight. Reorienting the response to malaria in high-burden countries is a long-time process (9), if only because of the time lag to restructure the workforce and because of the enormous inertia stemming from inadequate institutional landscapes.
At the same time, there are promising perspectives for transforming the workforce that context-sensitive policies and effective strategies require. For example, Malaria Observatories, once fully established, could, and should, become institutional reservoirs for generating that precious workforce. The challenge is, therefore, to ensure that emerging partnerships and networks of governance are:
I) Adequately inclusive of all actors and sectors (see below);
II) Responsive to local needs and demands (1,4,10);
III) Accountable, flexible and coherent;
IV) Focused on sustainable and equitable development - see Malaria Observatories: Opportunity for Development (Michel ODIKA, World Bank, Washington, 2010). 

Getting started: historical and political opportunity for effective action… The project to establish a Malaria Observatory in Congo-Brazzaville (Central Africa) must be regarded as a wide-ranging opportunity in terms of sustainable and equitable development. Why? Possibly because opportunities are often the starting-point of long-lasting enterprises and, therefore, constitute a substantial part of our time on the solution...

As things now stand, Congo-Brazzaville is likely to become the world's first country to establish a Malaria Observatory (1,2,3). Thus, today the foundations exist for high-burden countries, most of them in sub-Saharan Africa, to formulate responses commensurate with the challenges of:

I) Stopping and reversing malaria (4,5);

II) Reaching and achieving most of the Millenium Development Goals (MDGs) (3,5);

III) Reducing health care costs (efficiency savings) by improving governance and leadership (6);

IV) Institutionalizing and optimizing multi-stakeholder partnerships and networks (2) operating under the supervision of a Malaria Coordinating Authority.

For the first time ever in the world, complementary partners - e.g. health professionals, environmentalists, NGOs, etc. - will be called on to work together on preparing, budgeting and implementing a country-specific Malaria Action Plan (MAP). However...

Building a critical mass of capacity for positive change (9). However, Congo-Brazzaville will initially face such challenges as:

I) Involving key stakeholders;

II) Providing basic data and strategic information (7);

III) Translating "Action Frameworks" into "Action Plans" with supporting budgets, assigning responsibilities and tasks, and, not least, allocating resources to all partners that are called on to act (4,10);

IV) Mainstreaming "Malaria Action Plans" into "National Development Plans" and "Expenditure Frameworks".

What else? In order for all those concerned to work towards common objectives according to common priorities, Congo-Brazzaville is likely to experience additional challenges, such as:

I) Strengthening governance (Capacity building) and leadership (Building capacity);

II) Establishing the legal and policy framework;

III) Creating space for multi-stakeholder collaboration and participation;

IV) Developing pertinent and relevant partnerships, notably with research centres, NGOs and multilateral institutions (2).

Spurred by the growing awareness of global threats and of the stratification of health outcomes along environmental and social fault lines (6), the Congolese highly strategic decision to establish a Malaria Observatory constitutes, not only a "credible alternative to development assistance" (4,10), but equally a "major shift in scope" (3,5). But...

From advocacy to action... But that is just the beginning. Because malaria and its toll cannot be reversed in the short-term, there is crucial need for sustaining full-scale responses for the next years. Consequently, each plan or programme established today must become the building blocks for longer-term and sustainable strategies to free Congo-Brazzaville of malaria. So to speak, African governments will have to make this conceptual leap in their planning and actions. In other words, they have no choice but to move from the reactive to the active and strategic (8).

Ultimately... The time has come for common ground on addressing malaria. Today, there is robust political commitment. Otherwise said, success in terms of real progress on key fronts is in sight. However, securing this success will demand unprecedented resources beyond... Congo-Brazzaville. It is my highest hope, therefore, that other African governments make clear their political will and historical commitment to establish... Malaria Observatories (3). Why?

EXPERIENCE-BASED ANSWER: It bears reminding, in the final analysis, that fighting malaria is, and must remain, a... "global agenda for action" (9,10). Otherwise...

Doctor Michel ODIKA (Project coordinator, Congo-Brazzaville)

1. Paludisme: enjeu géopolitique et géostratégique (Michel ODIKA, Tribune de Genève, 2011).

2. Observatoire du Paludisme: projet de souveraineté sanitaire (Michel ODIKA, Projet de société, République du Congo, 2011).

3. Malaria Observatories: MDGs-based Perspectives for Africa (Michel ODIKA, World Bank, Washington, 2011). Unlike strategies previously implemented in Congo-Brazzaville, the project to establish a Malaria Observatory can be viewed as an innovative bridge to most of the Millenium Development Goals (MDGs), especially those related to:

- Mitigating the damaging impact of poverty on individuals, societies and economies (MDG I);

- Reducing child mortality (MDG IV);

- Improving mother and child health (MDG V);

- Fighting... malaria (MDG VI);

- Promoting environmental safety and sustainability (MDG VII);

- Fostering partnerships for development on a global scale (MDG VIII).

4. Paludisme: forteresse de l'aide au sous-développement (Michel ODIKA, Tribune de Genève, 2011).

5. Malaria Observatories: Focus on the Millenium Development Goals (Michel ODIKA, World Bank, Washington, 2011).

6. Reducing health care costs by reducing the need and demand for medical services (James FRIES, New England Journal of Medicine, 1993).

7. Estimating trends in the burden of malaria (Richard CIBULSKIS, American Journal of Tropical Medicine and Hygiene, 2007).

8. WHO/World Malaria Report 2010.

9. From malaria control to eradication (Kamini MENDIS, Tropical Medicine and International Health, 2009).

10. Malaria Funding Requirements (Michel ODIKA, World Bank, Washington, 2010). To get high-burden countries to the crucial point where future generations are free from malaria will require that every aspect of the response be scaled up and sustained over the longer-term - i.e. environmental safety, high-quality care, effective governance, innovative leadership...