Leadership Interview: Success on malaria requires strong political commitment and a partnership approach
Interview with Dr Tedros Adhanom Ghebreyesus, Minister of Health of the Federal Democratic Republic of Ethiopia and Chairman of the RBM Partnership Board (2007-2009)
Q: In recent years, Ethiopia has made great strides towards combating malaria and other diseases. What were the factors for Ethiopia's success?
Dr Tedros Adhanom Ghebreyesus: Something that is very important and that we are enjoying in Ethiopia is government commitment. Very strong political commitment.
Malaria is one of Ethiopia’s top health priorities. The others include HIV/AIDS, tuberculosis, maternal health, and child health. The government has been implementing an ambitious plan to address the malaria problem. Our target was to distribute 20 million nets by 2008 in only three years. They were delivered right on target because of the government's commitment. Because of that we are making good progress on malaria.
In addition to that, Ethiopia is addressing malaria through social mobilization. We now have more than 30,000 health extension workers delivering services at the community level. We managed to deploy 2 health extension workers per village. These are salaried, full-time civil service staff working with communities to prevent malaria and other communicable diseases. We have moved away from the volunteerism by institutionalizing this health extension program the aim of which is to provide universal access to primary health care. Indeed, we believe that vast potential of our health extension program remains largely untapped. With stronger support and the right tools at their disposal, the prospects of what these ‘agents of change’ can achieve along with their communities has greatly motivated our malaria response community and all in our public health sector.
Another important thing is partnership. Local partnerships in Ethiopia have been very successful and we're also really benefitting from the efforts of the global RBM partnership, which is mobilizing funds, helping countries develop high quality proposals, and providing technical support to solve other major problems.
The good results are due also to the flexibility of Global Fund financing. The Global Fund was willing to frontload the funding, and we were able to get 2007 and 2008 funding in 2005 and 2006. This enabled us to scale up and procure 20 million nets, 60% of which came from the Global Fund. The World Bank did exactly the same thing when we faced some shortages. That kind of flexibility enables a more effective use of resources and to achieve targets on time. One of my recommendations to countries is to take advantage of the flexibilities of the Global Fund in order to accelerate progress towards our 2010 targets.
These are some of the factors that led to the success of the malaria control programme in Ethiopia.
Q: What challenges do you face today as Minister of Health in continuing to reduce Ethiopia's burden of malaria?
Dr Tedros Adhanom Ghebreyesus: There are a number of challenges but we are stepping up our efforts to meet them. As mentioned earlier, we have trained and deployed, right on schedule, a massive corps of more than 30,000 health workers. We have seen very encouraging results already. These health extension workers are having a significant impact on the provision of services directly to families and the development of an effective referral system. The challenge now is to maximize the use of this primary health care army in stepping up our efforts on malaria and other diseases.
Then, there is the challenge of implementing our newly designed public health emergency management system. We have designed a new early warning and surveillance system to detect and track epidemics as early as possible. Our new model addresses all the major steps of an health emergency management system: early preparedness; response and recovery. Clearly implementation will be a challenge, because this is a new system, a big design. It will surely take time, but we have begun work in earnest and are confident that it can be done and made to function well.
We also have put in place a Master's programme to train staff for public health emergency management.
We have already installed a new system for monitoring and evaluation. We're training our staff for this. This will help us understand challenges ahead and address any problem that we see that may limit our progress in malaria control.
A feasibility study for malaria elimination is now under way now in Ethiopia. My government's understanding is that elimination in Ethiopia could be feasible through social mobilization, which can help us not only combat but also eliminate malaria.
Our government decided that we need a high speed scale-up of all interventions--nets, IRS and ACTs-- which will require the mobilization of significant financial resources and will also require community mobilization. If you go the grassroots, you can mobilize the entire community and have a large scale intervention. With community mobilization, source reduction of mosquito breeding sites, and a combination of integrated interventions, we can eliminate malaria from Ethiopia.
Q: What must happen now, globally and in country, so that Ethiopia's malaria targets can be reached by 2010 and 2015?
Dr Tedros Adhanom Ghebreyesus: We need to have very ambitious targets, and in order to have that we have to maintain the heightened political will at country and global level. It's happening now. International and national partnerships are addressing financial gaps and strengthening systems.
The already existing funding must be made as effective as possible. We're working on that. We're making good progress on two objectives-- not only are we getting more funds, we're also increasing aid effectiveness. If that can be done globally and in country, then we can reach the 2010 targets.
All of this has to be done in line with our scale-up objectives. It is through scale up that we can make a difference-- the impact cannot come without it. When I say scale-up we should increase the speed also. That's why we have the 2010 targets in our RBM Partnership. We have to keep that target to scale up as much and as quickly as possible to have impact in Ethiopia and globally.
Q: How have the efforts of Roll Back Malaria Partners and the Partnership at the global and sub-regional levels contributed towards results at the country level?
Dr Tedros Adhanom Ghebreyesus: Global level advocacy has been very important. The Partnership has also been really important in placing malaria as an item on the global development agenda.
Efforts of the RBM and other partnerships are paying dividends now.
The RBM Partnership is stronger. We're all speaking one language now. We're helping countries to achieve results. For example, the RBM Partnership is supporting countries to develop successful proposals to the Global Fund. In Round 8, more money was allocated for malaria compared to HIV and that was really an achievement It is in large part, because of the RBM Partnership’s efforts that a significant portion of funds were raised at the New York meeting in 2008--more than US$ 3 billion.
The global partnership has been instrumental in helping countries achieve results, some of which I have already outlined. Partners assist countries in developing a successful plan, to secure resources, and to work together in identifying challenges, attracting technical assistance, and designing better ways of addressing problems for attacking malaria.
It is important that we acknowledge the strong support provided by the international malaria partnership especially in the last years. On behalf of the Government and people of Ethiopia, and all Roll Back Partnership Board members, I want to take this opportunity to thank all who those across the globe who have contributed to this unprecedented global momentum on malaria and to the results being achieved by individual countries . We now can expect to raise the resources we need to achieve the goal of elimination and ultimately towards total eradication of this disease that has caused far too much suffering for far too long. I believe an Ethiopia -- and indeed, a world free of malaria, is finally within our reach. And so, we must do all we can to sustain and deliver on this current global commitment to end the terrible toll of this scourge once and for all.