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Let's build on gains made in malaria war

COMMENTARY
By Dr Githinji Gitah | April 25th 2016

As Kenya joins the rest of the world in marking the World Malaria Day, the country has a lot to be proud of in its war against the disease.

The prevalence of malaria in the country has dropped from 11 per cent in 2010 to 8 per cent in 2015, according to the latest Kenya Malaria Indicator Survey.

Prevention has been the key winning strategy in malaria control, with adoption of the use of mosquito nets growing steadily across the country.

Long-lasting insecticidal nets are today the preferred form of coverage for all people at risk of malaria in public health programmes.

The most cost-effective way of achieving greater use of insecticide-treated nets has been by providing them free of charge, to ensure equal access for all.

Effective behaviour change communication strategies have also ensured people at risk of malaria sleep under treated nets every night, and that the nets are properly maintained.

Amref Health Africa on its part has ensured that people at the household level in areas affected by malaria are informed on how to protect themselves and the need to seek treatment early.

This is through training and equipping community health workers to provide treatment at the household level and make referrals to hospitals. This year’s theme for World Malaria Day is End Malaria for Good.

Following the great progress made under the Millennium Development Goals, it is important to build on this success and ‘end malaria for good’ under the Sustainable Development Goals.

The reality today is that malaria remains the leading cause of morbidity and mortality in Kenya, where at least 25 million Kenyans are at risk. The disease still accounts for 30-50 per cent of all outpatient attendance and 20 per cent of all admissions to health facilities.

Pregnant women and children under the age of five years remain the most vulnerable groups that require special attention. Children under five are particularly susceptible to infection, illness and death and more than two-thirds of all malaria deaths occur in this age group. In fact one out of five deaths of children under five in Africa are due to malaria.

In addition, malaria during pregnancy often contributes to maternal anaemia, premature delivery and low birth weight, thereby leading to increased child mortality.

Besides young children and pregnant women, non-immune travellers from malaria-free areas are particularly vulnerable when they become infected.

Eradication of malaria could enable Kenya to save at least Sh1 billion annually, excluding costs associated with productivity loss in the event of death.

The most direct economic benefit accruing from reduced malaria prevalence is the associated reduction in household health expenditure.

Malaria is not only deadly; it’s also very expensive. Studies indicate that household expenditure on malaria treatment ranges from about 7 per cent of household income for the average household to 32 per cent of household income for the poorest groups.

In Kenya, where out-of-pocket health expenditure is still common, malaria can lead to financial impoverishment, even when it is effectively treated.

To effectively win the battle against malaria, we must begin to attack the disease from different dimensions.

Within the context of a devolved government structure, it is paramount to ensure that county governments prioritise and finance malaria prevention and control interventions as a primary challenge.

The National Community Health Strategy was devolved to the counties and currently salaries for healthcare workers comprise over 70 per cent of the health budget for most counties.

Many counties are relying on partners to fund the community health strategy, and as a result, they have only partially addressed the disease.

About 90 per cent of financial resources used to roll out malaria interventions and improve the country’s health still come from external sources, with only 10 per cent originating from the Treasury.

The overall malaria prevention and control programme in Kenya could potentially benefit from devolution. Counties could mobilise additional resources outside of the health system to deliver commodities or engage the private-sector to invest in malaria prevention and control strategies that impact the work force and community.

As county governments initiate planning and budgeting for health service delivery, advocacy and support for malaria prevention and control activities by partners and donors will be critical.

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