“My experience of the SDC is as a funder of key interventions”

Article, 25.04.2015

Since the year 2000, malaria mortality rates have fallen by an estimated 47% globally, and even by 54% in Africa, thus reaching the target set by the Millennium Development Goals. The same trend has been observed in Tanzania, an SDC priority country. Apart from strengthening the national health system, the SDC funds Tanzania’s research-oriented Ifakara Health Institute where Dr Prosper Chaki works as a senior researcher in malaria control strategies.

Photo of Dr Prosper Chaki.
A researcher at the SDC-sponsored Ifakara Health Institute in Tanzania, Dr Prosper Chaki works as a backstopping expert for the country’s National Malaria Control Programme. © SDC

The fight undertaken worldwide against malaria is undeniably proving successful. Although nearly 600,000 people are still said to die from the disease every year, malaria mortality rates among populations at risk are estimated to have been halved. Between 2000 and 2013, an estimated 4.3 million deaths were averted. These figures are encouraging in that they confirm that the target set in the 2000s by the Millennium Development Goals in reference to malaria (“halt and reverse the incidence of the disease”) has been reached. And this partly thanks to the SDC’s commitment.

A wide variety of factors have contributed to this positive development. Among them are significant improvements in prevention (such as use of insecticide-treated mosquito nets, indoor spraying of insecticides, raising awareness among communities) and a better access to diagnostic and treatment services.

Acknowledged dedication

The strength and the extent of Switzerland’s dedication in the field of malaria control are widely acknowledged. Switzerland is the host country for several global health institutions active in the control of malaria, and the SDC coordinates the “Swiss Malaria Group”, a coalition of a dozen entities based in Switzerland from academia, industry and NGOs. At local level, the SDC is building the capacities of national authorities and local health facilities in several partner countries, while supporting awareness campaigns among the population.

Tanzania is among the countries which have massively curbed the incidence of malaria. Among the various beneficiaries of the SDC’s support in the country is the Ifakara Health Institute (IHI), one of Africa's most eminent health research organisations. The IHI specialises in malaria transmission, tests new control methods as well as the effectiveness of drugs and diagnostics, and conducts vaccine trials.

Dr Prosper Chaki joined the IHI in 2006, where he works as a backstopping expert for Tanzania’s National Malaria Control Programme.

Dr Chaki, what is your assessment of malaria prevalence in Tanzania?

During my career I have seen the malaria burden decrease significantly and malaria transmission among the population fall across the country. The first household survey that we conducted, in 2005, under the Dar es Salaam City Urban Malaria Control Programme, showed that malaria prevalence in the city was 21% (which means that less than a quarter of the population tested positively for malaria parasites). By 2010 this percentage had fallen to 10% and by 2014 prevalence was estimated to be as low as 4%.

What contributed to this positive development?

The force of infection as a determinant of malaria transmission (measured by the number of infectious bites a person receives in one year) has been substantially reduced. It has fallen in Dar es Salaam as well as in most other parts of the country. When I was growing up in Ifakara, in the Kilombero valley, researchers estimated that each person was exposed to about 1,000 infectious bites per year. Now the number is less than 30 infectious bites per person per year.

Is it a direct consequence of the awareness raised among the population on how to protect oneself against the mosquitoes?

I would say that it is a combined consequence of effective delivery of products and good uptake by the population. Raising awareness is certainly very important. To this extent the support given by the SDC to our national health system and many awareness campaigns, as well as to the Global Fund to Fight AIDS, Tuberculosis and Malaria can be praised. Millions of insecticide-treated mosquito nets were distributed in Tanzania among other measures. As of today nearly 80% of our population has access to a net. Then, on the research side, developing new tools and investigating how best to implement them, combining technology and local knowledge, is essential.

In what way?

I’m thinking about the research on mosquito nets carried out in the Kilombero Valley, and the research on urban larval source management. My experience of the SDC is as a funder of key interventions carried out by the Swiss Tropical and Public Health Institute in collaboration with local partners like the IHI. Although the SDC is not a large funding agency compared to some of the others, it has supported strategic moves towards capacity-building among researchers and managers. This has to continue. In spite of the positive developments mentioned, there are still malaria ‘hot spots’ and populations with high prevalence. We need to continue producing evidence and think creatively about how to tackle the disease.

Testimonies from the field

It is a fact: malaria prevalence is declining all over Tanzania. Aeshi Kisandu, principal Assistant Nurse in the district hospital of Bagamoyo, remembers the situation when she first began working in the hospital in 1991: “At the time malaria used to be a killer disease. It stood among the top five of diseases in Bagamoyo, with high rates of admissions and deaths.” Since 2002, the hospital has benefited from a series of assistance programmes co-sponsored by the SDC. Aeshi Kisandu recalls that one of them allowed each clinic to allocate a long-lasting insecticide-treated mosquito net to all pregnant women during their first antenatal care visits, as well as to all newborn children. Then, in 2006, the Ifakara Health Institute started to support Bagamoyo Hospital with human resources, drugs and malaria diagnostics commodities. “I am convinced that all these efforts have contributed to the tremendous decrease in malaria cases and deaths recorded at our hospital”, Aeshi Kisandu states.

Mwanamosi Mohamed, a 37-year old street vendor and mother of four children, confirms that she received a mosquito net during each of her pregnancies. As she is now awaiting a fifth baby, she has come to be treated against a malaria infection. Mwanamosi Mohamed says though that this is something unusual for her and her family: “I make sure that my family sleeps under mosquito nets after I was made aware of the importance of using nets in order to protect against malaria.”

From her position as a district medical officer in Ilala Muncipality in the periphery of Dar es Salaam, Dr Mwanahamis Hassan can establish a direct link between behaviour changes and statistics. In her municipality, malaria has moved from 3rd to 8th place as a cause of death among adults. “Apart from the distribution of nets to the population, generalised use of malaria rapid diagnostic tests, and on the clinical side, of artemisinin-based combination therapy and injectable quinine and artesunate, have been successful”, she observes. The SDC has been helping Tanzania’s central and district health authorities to ensure universal coverage with malaria intervention for the last twenty years.