Africa Health News March-april 2009 Final

A WHITAKER GROUP PUBLICATION

MARCH-APRIL 2009

AFRICA HEALTH NEWS PREVENTION

AFRICA ON TRACK TO MALARIA MILESTONE A new United Nations report estimates that more than 40% of people living in malaria-endemic countries in Africa now have access to long-lasting insecticide-treated mosquito nets (LLINs), putting the continent almost halfway to the UN goal of providing 100% of those in endemic countries with malaria control interventions by 2010. Over 140 million LLINs have been distributed over the past three years, the report stated, providing protection for nearly 300 million people. Preparations are underway to distribute over 240 million additional nets by December 2010. The results of the massive distribution effort are already apparent. Last September the World Health Organization (WHO) announced that at least seven African countries or regions have cut the number of malaria deaths by half since the global effort was stepped up in 2005. The WHO estimated that in 2006, 247 million people worldwide were infected with malaria, of which 881,000 died. Ninety-one percent of those who died were in Africa, and of that number 85% were children under five. The success of the distribution effort, stated the UN Special Envoy for Malaria, Mr. Ray Chambers in the report, “signifies perhaps the most encouraging development in a year that featured many noteworthy accomplishments.” Epidemiologists attribute these accomplishments to an extraordinary array of public-private partnerships between governments in malariaendemic countries, the US President’s Malaria Initiative (PMI), the Global Fund to Fight AIDS, Tuberculosis and Malaria, UN agencies, the World Bank, non-governmental and community-based organizations, global foundations, the private sector and academic and research institutions. The WHO predicts that the world can reach near-zero deaths from malaria by 2015 by using a combination of interventions including the use of bed nets, treatment of those who become infected and the elimination of malaria-carrying mosquitoes by spraying. Mr. Chambers cautioned, however, that momentum must not be lost. “At this unique moment in history, when dedicated leadership, proven interventions, available resources and collective will have converged to turn the tide against this scourge, we cannot permit complacency to dull our resolve,” he said. He added that the “same thought and energy that guided LLINs in 2008” will govern efforts pertaining to other essential interventions, such as treatment in public health facilities, the provision of rapid diagnostic tests and the production of an adequate quantity of antimalarial

medicines such as artemisinin-based combination therapies (ACTs). Funding for malaria is estimated to have increased threefold between 2004 and 2008, with about $1.5 billion going for treatment and prevention in 2007. This trend is expected to continue, supported largely by increased funding from the United States, which has pledged to contribute $5 billion over the next five years to the effort.

NOVARTIS RELEASES CHILDFRIENDLY ANTIMALARIAL Swiss pharmaceutical manufacturer Novartis, in partnership with Medicines for Malaria Venture, has developed a sweet-tasting child-friendly liquid version of its artemesinin-based antimalarial Coartem®, and is making it available at cost to 17 African countries where it has been approved by regulatory agencies. Until now, healthcare workers and parents have had to crush bitter-tasting tablets for children to swallow often resulting in incomplete doses being taken by the reluctant patients. The new Coartem Dispersible is expected to overcome this difficulty, resulting in better treatment for those most likely to die from malaria - children under the age of five. “This represents a major advance towards our target of achieving universal coverage with treatment by 2010,” said Professor Awa Marie Coll-Seck, Executive Director of Roll Back Malaria (RBM) Partnership, a coalition of African governments, United Nations agencies, donor governments, the World Bank and the private sector. A clinical study reported in The Lancet medical journal by Dr. Salim Abdulla of the Ifakara Health Initiative in Tanzania showed that the new drug provides a cure rate of 97.8%, which is comparable to the 98.5% cure rate of regular Coartem, the leading artemesinin-based combination therapy (ACT) in Africa. Since 2001, Novartis has provided more than 215 million Coartem treatment courses at cost for public sector use in malaria-endemic countries. A full treatment course for an adult costs just 80 cents and for a child 37 cents. To date, Coartem Dispersible has been approved by regulatory agencies in Benin, Burkina Faso, Côte d’Ivoire, Democratic Republic of Congo (DRC), Gabon, Ghana, Guinea, Kenya, Madagascar, Mali, Mauritania, Niger, Nigeria, Senegal, Tanzania, Togo and Zambia. Medicines for Malaria Venture is a public-private partnership that is currently managing the largest-ever portfolio of antimalarial projects in collaboration with over 100 pharmaceutical, academic, and endemic-country partners in 38 countries.

PAGE TWO IMMUNIZATION

GLOBAL HEALTH PROGRESS

GLOBAL COMMUNITY REDOUBLES EFFORTS TO ERADICATE POLIO

DELEGATION VISITS EAST AFRICA TO EXPLORE PARTNERSHIPS

Spurred by recent setbacks to the global campaign to eradicate polio, the Bill and Melinda Gates Foundation and Rotary International are partnering with the Governments of Germany and Great Britain to inject $635 million into redoubling the effort. The funds will be used to intensify vaccination campaigns in northern Nigeria and northern India, which account for more than 80% of the remaining cases. The virus is also active in Afghanistan and Pakistan. In 1988, 166 national governments joined forces with the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF to launch the global polio eradication initiative. Since then, about $6.17 billion has been spent on the effort. While occurrence of the disease has since been cut by 99% to about 1,625 cases a year worldwide, in recent years numbers have been rising again in parts of Nigeria and India where vaccination campaigns have not been effective.

A child receives the oral polio vaccine The Gates Foundation will provide $255 million over the next five years and Rotary will add $100 million. Britain has pledged $150 million and Germany will give $130 million. The funding will support the Global Polio Eradication Initiative through the purchase of oral vaccine, the development of new vaccines and enhanced monitoring of and rapid response to new outbreaks. In February, the Gates Foundation announced it had bought more than 100 million doses of oral vaccine in Nigeria.

BUILDING LOCAL CAPACITY

AFRICAN INITIATIVE LAUNCHED TO FUND LOCAL HEALTH RESEARCH IN KENYA & MALAWI Two new grant-giving bodies have been launched in Kenya and Malawi to give local stakeholders greater control over funding for locally-developed strategies for health research. In Kenya, a new NGO, the Consortium for National Health Research, will administer the funds, and in Malawi activities will be undertaken by the existing National Research Council of Malawi. The two new funding bodies were established in collaboration with the Wellcome Trust and the Department for International Development (DFID) in the United Kingdom, and with the International Development Research Center in Canada. The Wellcome Trust and DFID have agreed to commit ₤10 million (approximately $14 million) over the next five years to each country. “Countries need to be able to develop and implement their own research strategies to meet their own priorities,” said Dr. Jimmy Whitworth, Head of International Activities

at the Wellcome Trust. “Through the Health Research Capacity Strengthening Initiative we aim to build the capacity of these African countries to make their own grants according to their own needs.” “DFID’s focus is to ensure that research makes a much greater impact on policy and practice in our partner countries,” said Mr. Graham Teskey, Head of Governance and Social Development at DFID. “It is our hope that the training fellowships, research grants, institutional grants and other forms of support, which will be provided by this initiative, will help counter the brain drain and attract young bright African scientists and researchers back to Africa to undertake high quality research.” The initiative is the first time that international donors have worked together to establish funding schemes planned and developed locally. Other African countries such as Zambia have expressed interest in developing similar schemes in their own countries.

A delegation from Global Health Progress (GHP), an initiative of the global researchbased bio-pharmaceutical industry, visited Rwanda and Kenya in March to explore strengthening public-private partnerships with governments and NGOs in the region. The group, led by Mr. Chris Singer, President, International Section of PhRMA (Pharmaceutical Research and Manufacturers of America), and Ms. Alicia Greenidge, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), met with a host of health ministry officials and other health stakeholders to learn about existing public-private partnerships with pharmaceutical companies and challenges on the ground in Rwanda and Kenya, and to examine how GHP can enhance and expand partnerships in the region. While in Rwanda, GHP held a reception honoring Her Excellency Mrs. Jeannette Kagame, Rwanda’s First Lady, and presented her with a leadership award for her dedication to improving access to HIV/AIDS care and treatment for Rwandans. The award was accepted on her behalf by Minister of Health Dr. Richard Sezibera. To better learn about healthcare challenges and to celebrate Mother and Child Health Week in Rwanda, GHP hosted a roundtable discussion on the successes and challenges of maternal and child health in the country. The delegation observed the ACCESS Project, a US-based NGO dedicated to improving the public health system in Rwanda, during its second countrywide mass drug administration campaign. Over four million Rwandan children between the ages of five and 16 received Mebendazol to combat intestinal worms and over 100,000 received Praziquantel for the parasitic disease schistosomiasis. In Kenya, the delegation visited the African Medical and Research Foundation (AMREF) and the Johnson & Johnson Management Development Institute (MDI). MDI partners with AMREF, the University of California at Los Angeles and the Global Business Schools Network to hold intensive management seminars for leaders of AIDS service organizations. GHP also held meetings with officials from the Academic Model Providing Access to Healthcare (AMPATH), a working model of HIV preventive and treatment services in Kenya.

PAGE THREE REPLENISH AFRICA INITIATIVE

HIV PREVENTION

COCA-COLA COMMITS $30 MILLION FOR CLEAN WATER IN AFRICA

PROMISING RESULTS FOR WOMEN’S MICROBICIDE GEL

The Coca-Cola Company announced on March 16 that it would commit $30 million between now and 2015 to providing access to safe drinking water and sanitation to at least two million people throughout Africa. The initiative will not only benefit the communities in which the soft drink company operates but will also ensure a sustainable water supply for both local business and Coca-Cola. The funding will be administered through The Coca-Cola Foundation’s Replenish Africa Initiative (RAIN) and implemented in partnership with local communities in each host country. “No single organization can resolve Africa’s development challenges, but together with civic society, nongovernmental organizations and government we can make a positive difference in the lives of people who make up our communities,” said Mr. William Asiko, President of The Coca-Cola Foundation. “Having access to clean water still remains a luxury, not a given, in large parts of the continent. RAIN helps us both fulfill our environmental goals while also providing health benefits that will allow our communities and our business to grow and prosper.” The strategy for achieving the goal includes three components: ■ Improving water efficiency by 20% by 2012; ■ Returning all water the company uses for manufacturing processes to the environment at a level that supports aquatic life and agriculture by the end of 2010; and ■ Expanding the company’s support of healthy watersheds and sustainable community water programs to balance the water used in its finished beverages. The World Health Organization (WHO) reports that more than 300 million Africans lack access to safe drinking water, and millions die each year from preventable waterborne illnesses. “Africa’s water crisis threatens the health of its population and, therefore, its prospects for economic growth,” said Mr. Muhtar Kent, President and CEO of the Coca-Cola Company, which is the largest private sector employer in Africa. “Helping African communities tackle

PHOTO: OBI-AKPERI

their water challenges is an important priority for our company and our bottling partners, and is an area where we can make a positive and lasting impact,” he added. The Coca-Cola Foundation currently has water projects reaching about 300,000 people in 19 African countries. They include Angola, Côte d’Ivoire, Egypt, Ethiopia, Ghana, Kenya, Mali, Malawi, Morocco, Mozambique, Niger, Nigeria, Rwanda, Senegal, South Africa, Tanzania, Tunisia, Uganda and Zambia. The Foundation has implemented over 130 programs in total in 32 countries across Africa. Critical areas of focus have been water, entrepreneurship, education and health. In January, The Coca-Cola Company was named the winner of the World Environment Center’s (WEC) Twenty-fifth Annual Gold Medal for International Corporate Achievement in Sustainable Development for implementing strategic business initiatives in the high impact areas of water stewardship, sustainable packaging, energy management and climate protection. Coca-Cola’s Signature Contribution, “returning to nature and communities an amount of water equal to what it uses in all of its beverages and their production,” was cited by the independent international Gold Medal jury as an exceptional demonstration of leadership in sustainability. The WEC Gold Medal Award will be presented to The Coca-Cola Company at the 25th Gold Medal Presentation Gala on May 8, 2009, at the National Building Museum in Washington, DC. WEC is an independent non-profit whose mission is to advance sustainable development through the business practices of its member companies in partnership with government and other stakeholders.

A clinical trial involving more than 3,000 women in the US and southern Africa has demonstrated the potential of a vaginal microbicide gel in helping women to protect themselves against HIV infection. Results from the trial, conducted between February 2005 and September 2008, showed that one 0.5% dose of the HPTN 035 microbicide was 30% effective in preventing HIV from attaching to cells in the genital tract. “These findings provide the first signal that a microbicide gel may be able to prevent women from HIV infection,” said Dr. Salim Abdool Karim, Professor of Epidemiology at Columbia University Mailman School of Public Health, Deputy Vice Chancellor at the University of KwaZulu-Natal and Director of the Center for the AIDS Program of Research in South Africa. “Indeed, for the millions of women at risk for HIV, especially young women in Africa, there is now a glimmer of hope,” he said while presenting the trial’s results in February at the Conference on Retroviruses and Opportunistic Infections (CROI) in Montreal, Canada. The breakthrough could eventually enable women to more effectively take control of their health in an epidemic that in Africa disproportionately affects them. While consistent and correct use of male condoms is most effective in the prevention of HIV transmission, their use remains beyond the control of most African women. Dr. Karim cautioned, however, that more research was needed before the microbicide was ready for widespread use. In sub-Saharan Africa, the World Health Organization (WHO) estimates that women represent nearly 60% of adults living with HIV, and in several southern African countries young women are at least three times more likely to be HIV-positive than young men. Most women are infected with HIV through sexual intercourse with an infected male partner. The six sites in Africa where the trial was conducted were Durban and Hlabisa in South Africa; Harare, Zimbabwe; Lusaka, Zambia; and Blantyre and Lilongwe in Malawi. The HPTN 035 trial is considered the first successful clinical screening of a vaginal microbicide.

PAGE FOUR BUSINESS OF HEALTH

LEADERS IN HEALTH

AFRICAN ENTREPRENEURS PROMOTE SUSTAINABLE SANITATION SOLUTIONS

DR RICHARD SEZIBERA MINISTER OF HEALTH, RWANDA

Three social entrepreneurs from Africa were in Washington, DC, in February to promote their creative - and lucrative - solutions to some of Africa’s most intractable sanitation problems. The three - Kenyan David Kuria, Nigerian Joseph Adelegan and South African Trevor Mulaudzi - have each identified a problem in their communities and set about finding a solution based on a business model rather than turning to aid or public funding. Their innovations are successfully changing social behavior and improving public health, the environment and the economy. Toilet Malls Mr. David Muria, an expert on environmental sanitation, is making the toilet a hot commodity in Kibera, one of Kenya’s largest slums. “Why just do two quick things in the toilet?” Mr. Muria wondered. His solution was to found Eco-Tact, a company that builds toilet malls that provide shoe shines, food, phone booths and other commercial services as well as the usual facilities. Founded in 2007, Eco-Tact toilet malls now serve about 30,000 customers a day. Each complex, owned locally as a franchise, is equipped with eight toilets, a A toilet mall in Nairobi water kiosk, a baby changing station and gender separate showers. By employing a franchise model, Eco-Tact has ensured local involvement and sustainability. Franchise owners can also increase income by harvesting biogas from digesters of human waste, urea from urine and compost from sludge. Mr. Kuria is collaborating with several NGOs - Ashoka, Rotary International, the Global Water Challenge and the Acumen Fund - to extend the model to other African countries. Cows to Kilowatts When Dr. Joseph Adelegan, a civil engineer, observed a slaughterhouse in his native Nigeria disposing daily of the manure of 1,000 slaughtered cows directly into a local river, he

saw energy going to waste. In response, he designed a bioreactor that digests the waste into biogas to generate electricity and produce cooking fuel. Local women’s organizations sell the fuel at affordable prices to the urban poor. The solid waste that is left over makes cheap and effective fertilizer. Dubbed “Cows to Kilowatts” and “Power to the Poor,” the initiative also reduces the emisA Cows to Kilowatts sion of methane, a generator potent greenhouse gas, and has improved the water quality of the communities that live downstream from the slaughterhouse. In 2008, the Government of Nigeria began to replicate Dr. Adelegan’s model at other slaughterhouses in the country. He is now working with other social entrepreneurs to take the approach elsewhere in Africa. The Clean Shop Mr. Trevor Mulaudzi, a South African businessman and mining geologist, was shocked to see children skipping class to avoid using the school’s dirty and malfunctioning bathroom facilities. He founded The Clean Shop, which offers schools and large organizations sanitation services such as cleaning toilets and repairing plumbing as well as teaching students about good hygiene. Mr. Mulaudzi approaches the sanitation problem as an educator rather than a cleaning contractor and uses motivational techniques such as requiring students to bring his or her own roll of toilet paper as the “admission ticket” to the shiny new restroom. The technique builds a sense of pride and ownership by the users of the facilities. Mr. Malaudzi in a “clean shop” PREPARED AND DISTRIBUTED BY THE WHITAKER GROUP

Dr. Richard Sezibera, who became Rwanda’s Minister of Health last October, is a man committed to a prosperous, peaceful and healthy future for all Rwandans. As a Senior Adviser to President Paul Kagame and Presidential Special Envoy to the Great Lakes Region from 2003 to 2008, he has been a leading figure in Rwanda’s remarkable renaissance following the genocide of the 1990s. Now, he is bringing the same commitment to consolidating Rwanda’s position as a leader in healthcare in Africa. Rwanda has been lauded internationally as one of the first African countries to meet the United Nations Millennium Development Goal of halting and beginning the reversal of the spread of HIV/AIDS and malaria. In his first months in office, Dr. Sezibera has promoted one of Africa’s first patients’ bills of rights that lays out the rights of all Rwandans, Dr. Richard Sezibera regardless of with Mr. Aurelian gender, sexual Agbenonothe, UN orientation, age, Resident Coordinator, religion, cultural after the arrival in belief or disabilMarch of the Prevnar ity, to access to vaccine healthcare and choices regarding that care. He has also been in the forefront of ensuring that Rwanda be the first African country to procure the Prevnar pneumococcal vaccine, which prevents meningitis and other diseases among infants, donated by Wyeth Pharmaceuticals. Rwanda is the first African country eligible under the Global Alliance for Vaccines and Immunization (GAVI) to receive the drugs in 2009, based on its national immunization programs. Dr. Sezibera holds a medical degree and a Masters in International Relations from Georgetown University in Washington, DC. He was Rwanda’s Ambassador to Washington from 1999 to 2003.