Fighting killer disease in Cameroon: Urgency for multisectoral framework implementation to combat malaria.

Community health worker sensitising population to sleep under mosquito bed net to prevent malaria

A few months ago, Cameroon adopted a national multi-sectoral framework for the fight against malaria, with the aim of reducing malaria-related morbidity and mortality by 80% by 2028. 



But to achieve this result, all hands must be put on deck and efforts by different stakeholders synergised for effective implementation of the various strategies. 

Malaria is amongst the number one killer diseases in Africa in general and Cameroon in particular. The disease, gotten through mosquito bites, has a high prevalence rate in the country with transmission rate highest between the period of July to October, according to the World Health Organisation, WHO.

 

High burden of malaria

WHO identifies Cameroon amongst the 11 High Burden High Impact countries in the world, bearing 70 percent of the global burden of malaria. This disease has a significant impact on the country’s human resources and economic potentials.

Most recent statistics from the Ministry of Public Health for 2023 show that the country records about six million cases and almost 4,000 deaths due to malaria every year. The data also revealed that the disease is responsible for roughly 50% of hospital admissions with children under the age of five accounting for 60% of deaths, and pregnant women amongst the most vulnerable groups. 

From an economic perspective, healthcare expenditure on infectious and parasitic diseases, including malaria, amounts to 424 billion FCFA or 50% of Total Health Expenditure, going by the latest National Health Accounts of 2019.

This expenditure is estimated at 105 billion FCFA for malaria, or one-eighth of the total expenditure. 

Studies have also shown that malaria reduces the country’s Gross Domestic Product, GDP, growth, as it is one of the main causes of absenteeism in the workplace. 

With an estimated working population of about 11,354,040 people in 2019, forecasts estimated that 50% of people carrying the parasite would fall ill on an average of five days a year. This gives an average of 28,385,100 days of work missed each year. 

According World Bank figures of 2022, malaria jeopardises economic and social development of Cameroon at an indirect cost of 120 billion FCFA for workers. This amount could go up to at least 250 billion FCFA lost per year if the direct cost is taken into account.

 

Insufficient resources

Despite the efforts made by the Cameroon government, in collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria, GFATM, and the US President's Malaria Initiative, PMI, only 47% of the required amount, estimated at over 336 billion 955 million FCFA, is available. 

This means that 55% of the resources needed to adequately implement the activities of the strategic plan have yet to be mobilised. That is a total of 186 billion 971 million FCFA to finance the priority activities of the National Malaria Control Programme, NMCP, from 2024 to 2028.

According to the NMCP Deputy Permanent Secretary, Dr Jean Fosso, government's response to tackle malaria is contained in the National Malaria Control Strategic Plan 2024-2028, which is structured around four pillars, amongst which are the political commitment at national and community level to mobilise funding and other necessary resources and the strategic use of information to make decisions and implement programmatic actions.

“So, to implement these four pillars, the Ministry of Public Health alone cannot ensure this mobilisation. We need everyone's participation,” Dr Fosso said. 

Dr Jean Fosso: National Malaria Control Programme, NMCP, Deputy Permanent Secretary

 

 

 

 

Multisectoral framework against malaria 

Cameroon recently became the first country in West and Central Africa to adopt a multisectoral plan to fight malaria. A national multi-sectoral framework for the fight against malaria has been drawn up, with the aim of reducing the number of cases and death rates linked to malaria, and providing the funding needed to effectively combat this silent killer. 

The fruit of frank collaboration between the various actors in Cameroon’s health system and partner administrations, the document calls for synergy and the involvement of all government ministries to combat the disease more effectively, as it has been established that the Ministry of Public Health cannot meet the challenge of malaria elimination alone. 

“We are counting heavily on this multi-sectoral framework to boost the fight against malaria in Cameroon and achieve our target of reducing mortality and morbidity by 75%, compared with the situation in 2015,” the NMCP Deputy Permanent Secretary told this reporter.

The said plan also requires each ministry to dedicate 1% of their annual budget to fight against the nebulous disease. This annual contribution is an important input to help bridge the financial gap in curbing this disease.

While highlighting the relevance of the multi-sectorial framework, the Minister of Public Health, Dr Manaouda Malachie, during a public outing, had described the framework as “a compass, a veritable guide to multisectoral actions and resource mobilization, drawn up and validated with the participation and consensus of all stakeholders”. 

 

Gov’t ministries to take ownership 

An official of the Cooperation division at the Ministry of Public Health, Dr Hamida Yacoubou, assured that the multisectoral framework for the fight against malaria is a strategic document that will enable government to fight malaria more effectively by building on the synergy of the various stakeholders involved. 

These stakeholders include parliamentarians, the Ministry of Public Health, sectoral ministries, financial and technical partners, decentralised local authorities, NGOs, community-based organisations and civil society. 

Within this framework, it is planned that each of the stakeholders will be able to intervene to put an end to malaria within a few years.

According to the senior public health officer, malaria is a disease caused by several factors including environmental and lifestyle factors. As such, the Ministry of Public Health cannot effectively fight malaria alone. 

While laying emphasis on the need for government ministries to take ownership of the multisectoral framework, he indicated that malaria remains the number one public health concern in the country, due to its high morbidity and mortality. He said another indicator is the fact that malaria is not only neglected by people, but often consume enormous financial resources for treatment, thereby making the population poorer. 

“In Cameroon, we have 37.5% of the population living in poverty- that is people who live on less than 18,000 FCFA a month. In this population bracket, if you have someone who falls ill with perhaps two bouts of malaria a month and whose treatment for the two bouts cost an average of 35,000FCFA, I don't think the poverty gap will be closed,” Dr Hamida elucidated. 

Given the high burden malaria brings, he called on the population to use treated mosquito nets and make an effort to clean up their surroundings to destroy mosquito habitats.

“It's in the government's interest not just to disseminate it, but to commit to applying it, so that we can reduce the catastrophic health costs associated with malaria treatment, and reduce absenteeism in schools and the workplace,” he told The Guardian Post.

He equally affirmed that since the Roll Back Malaria structure was set up, the Ministry of Public Health has always involved other ministries, but this involvement was not entirely effective as the other government ministries did not have a clear idea of their role in the fight against malaria. 

“With the introduction of a multisectoral document, each partner now knows what its area of intervention is in the fight against malaria,” he disclosed. 

Hamida Yacoubou - Health economist - Independent | LinkedInDr Hamida Yacoubou: Official of Cooperation division at the Ministry of Public Health

 

 

MINPROFF at the battle front of Malaria

In a bid to understand the contribution of the Ministry of Women’s Empowerment and the Family, MINPROFF, this reporter met with MINPROFF’s Head of the Family Promotion Department, Placide Ntiga, who doubles as focal point for the national multi-sectorial framework to combat malaria. 

He acknowledged that by virtue of its responsibility in implementing government policy on promotion of women and the family, MINPROFF has, to date, focused on health promotion, particularly in the family environment. 

He affirmed that MINPROFF has been working to combat preventable diseases such as fistulas, malaria and cholera as part of its strategy to promote the health, nutrition and development of women and their children.

Quizzed on MINPROFF’s contribution to the noble cause of curbing malaria, the focal point said MINPROFF is resolutely committed to supporting the health ministry in the fight against the disease. This, he said, is through social and community mobilisation aimed at reaching the maximum number of people, families or communities to adopt attitudes needed to avoid or keep the disease at bay. 

“Malaria is transmitted by a mosquito. So for us, it's to work with families and communities to keep these insects away from their habitat as much as possible, by promoting healthy and clean environments, and by giving them advice on how to maintain the impregnated mosquito nets they are given,” he assured. 

He continued that: “We mobilise the community through advocacy, awareness-raising, the development of communication materials and mass awareness campaigns. We also do counselling, which means listening to patients who need support, who need to be helped to manage their illnesses. When an illness like malaria affects a family severely, they sometimes lose their bearings and become desperate. They need support from MINPROFF to ensure that the disease does not divide them, but rather that the family stands by the patient to help regain health”. 

 

Civil society making significant efforts 

With the disease ravaging the Cameroonian society, some civil society organisations and local non-governmental organisations committed to the course, are playing integral part and making key contributions in reinforcing strategies to combat malaria. They are also building advocacy towards mobilisation of resources, both at the domestic and international level. 

Impact Santé Afrique, ISA, a pan-African non-governmental organisation specialised in advocacy and strategic communication, has been a shining example in the campaign against malaria in Cameroon and across Africa. 

Founded by a public health specialist, Olivia Ngou, ISA has since creation contributed immensely to the improvement of the health of populations.

Speaking about their involvement in the malaria course, ISA founder and Executive Director, Olivia Ngou, said they are committed in making sure that government ministries are aware of the importance of their role in the fight against malaria.

“This means taking the document that has just been validated in Cameroon, disseminating it, popularising it and making sure that the ministries are aware of and immersed in this document, which describes very well the role that each ministry must play in the fight against malaria, and really getting the message across that the Ministry of Public Health alone will not be able to achieve the elimination of malaria if the other ministries don't get involved,” she told The Guardian Post. 

The public health specialist views malaria as having varied implications such as the environmental, social, economic and behavioural issue. 

“So, it concerns certain key ministries, and it would be important for these ministries to be involved and play their part in helping Cameroon achieve its vision of moving towards elimination of this disease,” he reiterated.

Highlighting efforts made, she mentioned that her organisation has been in close collaboration with the Ministry of Public Health’s NMCP to develop the multi-sectoral framework, and to organise a validation session with the Secretaries General of ministries. 

“At this stage, there's a plan for developing operational actions, because we're in the strategic framework that gives direction on what needs to be done by each ministry…,” she said. 

She added that the ministries will be meeting in a later date to elaborate an operational plan of malaria control activities to be carried in 2025. 

“After that, we really hope to have a whole new dynamic where there would be a multi-sectoral committee… where these ministries could meet at least twice a year to take stock and report on where they stand on the implementation of these actions” she added. 

About Us – Impact Santé AfriqueOlivia Ngou: Founder and Executive Director of Impact Santé Afrique

 

 

 

Key ministries concerned

According to the public health specialist with over 10 years of working experience in the fight against malaria in Africa, besides the obvious role played by the health ministry, the ministries in charge of education, need to make sure that pupils and students are educated and trained on the fight against malaria and the prevention of the disease.

“If we start early with education in nursery, primary and secondary schools, we'll have a generation that will grow up with healthy behaviours that will considerably reduce the disease. Education is very important,” she averred, before divulging their wish work with the education ministries so as to establish a malaria curriculum in schools.

With the advent of climate change, coupled with the multiplication of host sites for female anopheles mosquitoes, the malaria advocate argued that it is important to work with the Ministries of Environment and of Housing in order to put in place strong actions to reduce the spread of these mosquitoes.

“The Ministry of the Environment and the Ministry of Housing are essential in preventing this disease and moving towards its elimination,” she stated. 

Explaining that the Ministry of Agriculture could work on the negative impact certain insecticides have on the disease, she maintained that it would also be in the interest of the tourism ministry to take the multi-sectorial plan seriously as places of high-risk contamination like Douala, Kribi, and the North regions could jeopardise the tourist activities. 

“Make sure there's information at airports and visa sites on malaria prevention, encourage them to sleep under mosquito nets and take their preventive medication during their stay, because they're at high risk of catching malaria and dying from it,” she advised. 

“The Ministry of Social Affairs, with whom we work, has a big role to play in identifying the most vulnerable populations, making sure there's space in the programme for us to communicate with people living with disabilities, making sure they're aware of the campaigns to distribute mosquito nets, the actions that are in society. This is to ensure that we don't leave anyone behind, even the street children and other populations at high risk of catching malaria if not protected,” Ngou noted

 

 

Lawmakers want sincere commitment of stakeholders 

Meanwhile, the President of the Parliamentary Caucus for the Amelioration of Health in Cameroon, Hon Njume Peter Ambang, has praised the initiation and adoption of the multi-sectorial framework to combat malaria.

While he sees it as being timely, he emphasised on the need for the different government ministries and stakeholders to match political will with actions so as to advance the malaria control agenda. 

“The multi-sectorial plan for malaria control is quite laudable. I appreciate it because anyone exposed can get malaria. If you can afford to get mosquito nets, repellants, mind you that there are relatives or friends who can’t afford. So, it affects everybody,” he saluted.

“It is important for each government ministry to think of taking 1% of their annual budget for the fight against malaria. This 1% can be in the form of seminars, sensitisation campaign, through the purchase of something related to the fight against malaria or in whichever form,” Hon Njume explained.

As parliamentarians, he mentioned that they have on several occasions during the oral question and answer phase of the National Assembly, interrogated the Head of Government and his ministers on malaria and other health issues 

“We pose questions during the oral question and answer phase to government ministers like the Prime Minister, Minister of Public Health and others,” he declared, while stressing that their parliamentary caucus also performs advocacy meetings for the anti-malaria cause. 

“I like concrete things and that is why our caucus is working with government through the Prime Minister to make concrete proposals on what we can do. If we don’t see the result or things changed, that’s when I will question the PM during his passage at the National Assembly,” he added. 

Hon Njume then explained that amongst other things, he had proposed to the Prime Minister to take dispositions in the 2025 budget of the state, up to 17 billion FCFA could be allocated to the Counter Fund in order for the country to in turn be award the sum of 110 billion FCFA. 

Achieving equity in the fight against malaria requires greater domestic  resource mobilization: Let's act now and save lives! | The Guardian PostHon Njume Peter: Engaged Member of Parliament in the fight against malaria

 

   

Multisectoral framework not exclusive to Cameroon

It is worth nothing that the multisectoral framework to combat malaria is not exclusive to Cameroon. Countries like Tanzania and Rwanda have already put in place a multisectoral framework to combat malaria with some remarkable improvement recorded. 

Studies show that in these countries, each government ministry tries to fulfil its responsibilities in the fight against malaria as they drift towards elimination.

There are countries like China and most recently Cape Verde, which have eliminated malaria by putting in place a multisectoral framework.  

 

*The report was produced with the support of Impact Santé Afrique and its partners

 

This article was first published in The Guardian Post Edition No:3298 of Friday November 22, 2024

 

about author About author : Macwalter Njapteh Refor

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