Malaria Atlas Project (MAP)

MALARIA OBSERVATORY: MOVING FROM THE REACTIVE TO THE ACTIVE AND STRATEGIC (1,2,3)
Responding to malaria is one of the core priorities in Congo-Brazzaville (my native country, Central Africa ). To date, the Ministry of Health remains the most important source of information and analysis. Otherwise said, this official institution also serves as policy and advocacy tools for developing strategies…
Societies function more effectively when the State and its citizens engage openly on how policies are formulated and implemented. In the specific context of malaria, many methods and indicators exist for measuring the impact of the disease. However, most sub-Saharan African countries increasingly need innovative and effective approaches that focus, not only on medical and epidemiological indicators, but equally on environmental and socio-economic indicators...
MALARIA OBSERVATORY: STRONG FOUNDATION ON WHICH TO BUILD AN EFFECTIVE RESPONSE
Now more than ever, the point is to promote a better understanding of malaria's impact at household, community and national levels and propose actions tailored to specific conditions. In other words, African countries need a united action on a global scale. Only then can success be in sight. That, in the final analysis, is the chief reason why I spend time providing my native country with a Malaria Observatory. To me, as distinguished from conventional approaches, a Malaria Observatory enables to take full advantage of the resources (with special emphasis on resource-constrained settings) required to make significant progress on key fronts - e.g. environmental safety and sustainability...
Doctor Michel ODIKA (Congo-Brazzaville)

Malaria Observatory (http://www.slideboom.com/presentations/183737/Malaria-Observatory)
Observatoire du Paludisme: enjeu de sécurité nationale et de cohésion sociale (http://www.slideboom.com/presentations/169289/Observatoire-du-Paludisme…)
Regards croisés sur le paludisme (http://bloc-notes.blogs.lalibre.be/archive/2010/04/27/regards-croises-s…)

CAUSE FOR CAUTIOUS OPTIMISM...

This is the sort of news we all need. In concrete terms, Congo-Brazzaville, malaria-endemic country (Central Africa), is on track to establish the world’s first Malaria Observatory (1).

BACKGROUND AND CONTEXT…

With the Millenium Development Goals (MDGs, New York, September 2000) in sight, Congo-Brazzaville is attempting to ensure the highest possible coverage with malaria prevention and treatment programmes by the end of 2015. This will require not only adequate resources, be they human or financial, but also the strengthening of the Congolese health system, with special emphasis on governance requirements…

What else? We know that malaria is still a formidable opponent, and that if we are to ultimately eradicate this disease, we need new tools, such as “open and collaborative models” (2,3)…

MALARIA OBSERVATORY: MILLENIUM DEVELOPMENT GOALS WITHIN REACH…

Now more than ever, the response to malaria demands innovative approaches. In other words, only multisectoral responses – i.e. multi-stakeholder partnerships and networks – can be helpful in reaching and achieving most of the Millenium Development Goals (MDGs), notably those related to:

- mitigating the damaging impact of poverty (MDG I);

- rolling back 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).

MALARIA OBSERVATORY: PATH TO OPTIMAL COVERAGE…

While much remains to be done, high-burden countries, most of them in sub-Saharan Africa, can save millions of lives (4) and billions of dollars over the coming years by scaling up evidence-based, effective and cost-efficient policies (5). At the same time, however, the worst-affected countries will need to support operational research as an integral part of malaria programming, so that they can learn as they implement and continuously refine their delivery strategies…

MALARIA OBSERVATORY: IDEA WHOSE TIME HAS COME…

Malaria Observatories constitute a critical component of the long-term strategy against a public-health issue of the highest priority. Otherwise said, these platforms for better governance can be regarded as “Timely Public health Intelligence”. Why?

Plausible answer: There is no method but to be intelligent (Thomas ELIOT, poet and dramatist). So it is with the global response to malaria…

Credible answer: Health is the state about which medicine has nothing to say (W.H. AUDEN, poet). So it is with the multisectoral response to malaria…

ULTIMATELY…

The power of a Malaria Observatory must be matched by the capacity to deliver adequate interventions to all who need them. If malaria-affected countries fail to meet this crucial requirement, then they will have squandered a tremendous… opportunity (6,7).

Doctor Michel ODIKA (Project coordinator, Congo-Brazzaville)

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

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

3. Observatoires du Paludisme: carte à jouer (Michel ODIKA, Tribune de Genève, 2011).

4. Ending Malaria Deaths in Africa (Jeffrey SACHS, Scientific American, 2007).

5. Observatoire du Paludisme: genèse et exégèse d’un projet (Michel ODIKA, Tribune de Genève, 2011).

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

7. WHO/ World Malaria Report 2010.

The institutional capacities to reform the malaria response are not a given (1,2). They are typically weak in many, if not most, malaria-endemic countries. In these countries, there is scope, and need, for more coordinated and institutionalized approaches. For example, collaboration between health authorities and health professionals is often well-established, but is much less so with other key stakeholders – e.g. environmentalists, NGOs, research centers, technical partners, etc. – and usually limited to discussions on resource allocations for medical service delivery.

Today, an effective policy dialogue must be built. How to do that critically depends on background and context. However, experience from countries that have been able to accelerate governance reforms strongly suggests common elements. Indeed, those countries that succeed in advancing governance reforms (3) are also those countries that succeed in institutionalizing the direct participation of complementary stakeholders in intersectoral collaboration around a shared agenda.

Especially noteworthy is the fact that structural changes are not sufficient. Therefore, it is important to stress that structural changes need to be instigated in conjunction with changes in the organizational culture, from one of issuing decrees for change to a more inclusive collaboration with a variety of stakeholders across the levels of the malaria response. That in turn requires the institutionalization of collaborative mechanisms drawing practice-based knowledge up from the ground level to inform malaria-related policies and strategies. This management capacity should not be assumed: so to speak, it simply requires active investment in capacity building (governance) and building capacity (leadership).

What else? Creating the political alignment and commitment to governance, or leadership, reforms, however, is only a first step. Of particular importance is an in-depth understanding of unexpected forces or circumstances. Worldwide, for example, many reform processes do not have their intended impact, even with effective policy dialogue to consensus on specific issues and the requisite management for implementation across levels of a given system. Thus, the best-planned and executed policy reforms can unexpectedly run into unanticipated challenges or rapidly changing contexts.

Today, broad experience in dealing with complex systems behavior suggests that significant shortfalls or shifts away from articulated goals are to be expected. An important component to build into the reform processes is mechanisms that can pick up significant unintended consequences or deviations from expected performance benchmarks, which allow for course corrections during implementation.

Increasingly, leadership for more effective responses to malaria must be a sustained effort undertaken by the whole of society and engage all relevant stakeholders. Mediating multi-stakeholder dialogues around ambitious reforms always places a high premium on better governance. This requires re-orienting information systems (4) the better to inform and evaluate reforms, building field-based innovations in the design and redesign of reforms, and drawing on experienced and committed professionals and institutions to manage the direction and implementation of reforms.

While not a recipe, the above-mentioned elements of governance and leadership constitute in and of themselves an opportunity for advancing necessary reforms in malaria-endemic countries. Without reforms in governance and leadership, ultimately, other key reforms are very unlikely to succeed.

Malaria Observatory Project (Congo-Brazzaville)

1. Malaria Response: Call for New Institutional Landscapes (Michel ODIKA, Soul Beat Africa, 2011).

2. Observatoire du Paludisme: capital au service d'un idéal (Michel ODIKA, Projet de société, République du Congo, 2010).

3. Governance Reforms: Balanced Approaches to Be Found (Michel ODIKA, World Bank, Washington, 2011).

4. Information Systems: Network of Complex Relationships (Michel ODIKA, World Bank, Washington, 2011).

First of all, Malaria Observatories (1,2) can be best defined as innovative platforms for better governance. Their primary purpose is to help malaria-endemic countries attain and sustain the highest possible levels of equitable development, social cohesion, environmental safety and public health.

MALARIA OBSERVATORIES: FIVE KEY MESSAGES...

I. Facing the facts.

II. Identifying structural and operational constraints.

III. Producing strategic intelligence for promoting innovations, understanding current challenges and giving early warning of likely future challenges.

IV. Building a critical mass of capacity for positive change.

V. Capitalizing on experience- and field-based lessons.

Getting started: historical and political process focused on social progress. Today, the malaria response increasingly requires « old partners » actively involved in « new partnerships », not only within countries – e.g. health professionals, environmentalists, NGOs, research centres, etc. -, but equally on a global scale – i.e. multilateral institutions, bilateral cooperations, international NGOs, donor and recipient countries, etc. In this regard, international cooperation on national action against malaria could, and should, be consistent, not only with policies and strategies designed by Malaria Observatories, but equally with the promise to malaria-afflicted countries that donors will work with THEIR national plans, under THEIR coordinating authorities, using THEIR monitoring and evaluation systems (3,4,5). Donors certainly want to help malaria-endemic countries develop these things where technical assistance is needed – e.g. information and communication technologies (6,7) -, but they must own them.

From advocacy to action. By capitalizing on a set of key requirements, Malaria Observatories, once fully established in high-burden countries, could, and should, become credible alternatives to development aid (3,4,5). Why?

Malaria and Development Assistance: cause for increasing concerns. Today, for example, we can identify at least ten major problems malaria-affected countries often experience in their relations with donors (3,4,5). These include:

I. Donor preference for supporting short-term projects, rather than long-term or continuing programmes;

II. Donor preference for promoting medical approaches, rather than environmental safety and sustainability (hygiene and sanitation);

III. Donor preference for using their own financial mechanisms, rather than country-led processes;

IV. High transaction costs resulting from donors’ policies and procedures;

V. Donors’ tendency to follow their own agendas, rather than those set by recipient countries;

VI. Donors’ tendency to induce, rather than to… reduce, inequalities and disparities between recipient countries;

VII. Donors’ tendency to report on commitments, rather than on disbursements in real time;

VIII. Lack of transparency, with the result that donors’ policies, procedures and decisions are not always apparent;

IX. Limited harmonization of policies and procedures among donors;

X. Limited coordination between donors and national authorities.

Malaria Observatory Project (Congo-Brazzaville)

1. Advocacy for a Malaria Observatory in Congo-Brazzaville (Michel ODIKA, Human Development Project, Republic of Congo, 2010).

2. Observatoire du Paludisme: plate-forme de réflexion et d’action (Michel ODIKA, La Libre Belgique, Bruxelles, 2010).

3. Malaria Funding Requirements (Michel ODIKA, World Bank, Washington, 2010).

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

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

6. Socio-économétrie du paludisme (Michel ODIKA, La Libre Belgique, Bruxelles, 2010).

7. Health Information Systems: Facilitators of Policymaking (Michel ODIKA, World Bank, Washington, 2011).