“Malaria elimination is feasible in Ghana.” Professor Fred Newton Binka, the celebrated Ghanaian Epidemiologist and former Vice-Chancellor of Ghana’s University of Health and Allied Sciences, who made this statement is convinced that Ghana and many other African nations have the technical knowledge and tools to eliminate malaria.
For him, what will now be needed to combine the technical knowledge and tools with to eliminate malaria is strong political commitment.
“The magic bullet to achieve malaria elimination or eradication is a strong political commitment to do so,” he defends his assertion on malaria elimination.
Each year, more than 200 million people get sick and over 400,000 die from malaria, most of them young children in sub-Saharan Africa.
The African Continent also accounts for over 90 per cent of global malaria deaths.
Sadly enough for the African Continent, in every two minutes, an African child dies from malaria. Malaria remains a major public health problem in Ghana and by extension, in many Sub-Saharan African countries.
The World Health Organisation (WHO) statistics in 2015 indicates that the Africa region served as a home to 90 per cent of malaria cases and 92 per cent of global malaria deaths recorded in that year.
In each year, many countries in Africa spend huge budgets on malaria related activities. For instance, according to WHO, in 2018, an estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally and that nearly three quarters of the investments in 2018 were spent in the WHO African Region.
The severity of the malaria disease explains why many African countries spend huge sums of money each year fighting it. This is because the disease has dire consequences on socio-economic activities of people who are affected by it, thus affecting the general economy of the country in which these sick people live.
In a study titled: "Estimating the risk of declining funding for malaria in Ghana: the case for continued investment in the malaria response" published on June 10, 2020, via www.malariajournal.biomedcentral.com, estimated that it will cost Ghana US$961 million between 2020 and 2029 to eliminate malaria.
It is important to mention that Ghana has for this year—2022, approved GH¢85 million for malaria prevention and control. Had it not been the existence of malaria, this money could have been used for other purposes, including the construction of roads, schools, or for the expansion of government’s factories.
However, all this money goes into malaria activities.
Even though a number of malaria prevention and control interventions have been rolled out in Ghana in recent years, the disease still remains one of Ghana’s major causes of mortality and morbidity.
Figures from the Ghana Health Service (GHS) indicate that in 2019, malaria accounted for 42.8 per cent of Outpatient Department (OPD) cases, 22.2 per cent of inpatients admissions and 1.1 per cent of inpatient deaths in Ghana.
Similarly, in 2020, malaria accounted for 41 per cent of OPD cases in Ghana and also 21 per cent of all admissions in Ghana is due to malaria.
In 2021, there were 12 million suspected malaria cases in Ghana out of which 5.7 million were confirmed. Ghana also recorded 275 deaths in the same year.
Similarly in 2016, a total of 590 under-five children died from malaria in Ghana. The figure, however, dropped to 327 in 2017— showing an improvement in the country’s effort in the fight against the disease.
Although malaria kills without recourse to one’s age and gender, the disease is quite fatal in children and pregnant women, particularly children under-five years.
Looking at the grave impact of malaria on Ghana’s and that of Africa’s economy, Prof. Binka wants African leaders to commit more resources to fighting the disease, stressing that Africa is the most affected region in terms of malaria infections in the world.
For him, since other continents are not badly affected by malaria like Africa, it is Africa that must take the lead in finding lasting solutions for malaria since the disease was having a dire consequences on the continent’s economy.
The former Vice-Chancellor of the University of Health and Allied Sciences, further stressed that in order to get things done to help eliminate malaria in Ghana, approaches to fighting malaria must be varied in regions and in seasons.
For him, one-side fits all approach which is being used currently will not help to eliminate malaria in the country.
Prof. Binka also called on the government to commit more resources to fight malaria in the country, saying “If resources are not given to the people at the local government area, we can’t do anything.”
He was of the view that “when money is given at the national level, they don’t distribute it to local government,” pointing out that the local government—the district assemblies, will need money to implement malaria elimination programmes.
He expressed the concern that investment in malaria elimination in Ghana had been very low, needing a bigger allocation of funds.
Touching on other efforts Ghana can adopt to better it chances of eliminating malaria, the learned Epidemiologist suggested that more Ghanaian citizens are trained in the testing and treatment of malaria.
Prof. Binka believes that if at least, two million Ghanaian citizens are trained to test and treat malaria, it would greatly enhance Ghana’s drive to eliminate malaria in the country.
He is of the view that since many Ghanaians already have knowledge about malaria, training and certifying them to test and treat malaria would rather impact positively on Ghana’s malaria elimination process and also help to prevent abuse of malaria drugs or medications.
For him, training many Ghanaians in malaria treatment and also certifying them would help to have accurate data on the scale of malaria menace in the country.
Prof. Binka explained that people who self-treat malaria without going to any trained person to test and administer appropriate malaria medications were about 10 times higher than those who go to see professionals.
That, he argues, makes it difficult for the Ministry of Health and the Ghana Health Service, particularly the National Malaria Control Programme (NMCP), to have accurate data on the scale of the disease in the country.
“At the moment, the medical complexities of malaria are done with. We can now test for malaria very quickly and anybody can be taught how to test for malaria.
So what I’m saying is that we all know that if you catch malaria at the right time, in fact, the policy says that you must treat them within 24 hours, nobody will die from malaria and the drugs work,” Prof. Binka noted.
He explained that there are effective malaria drugs on the markets and when people are properly trained to test and administer the right medications at the right time, it will help the fight against malaria.
“Malaria drugs are working and there are tools to test for it and we can train people to test. When you test, this is what to give; so your licensing is telling you the dose and every year and you come for relicensing,” he explained.
Prof. Binka suggested that retired teachers and other civil servants staying in their villages could all be trained in malaria treatment.
“You are a retired teacher, civil servant, staying at your village and they say there is no hospital, but you are the hospital. We can train you and government can give you the drugs for the children and you can test them and you can treat them—you have given back to society,” he noted.
For him, information was critical in the fight against malaria and so when people are trained to test and treat malaria and are given tools to collect information and feed the NMCP, the NMCP would now use the available information to devise effective and efficient ways to eliminate the disease.
“The information is more important to the Ministry. You get the support to be able to test and treat, then you send the information to us by your smart phone. This is information age,” Prof. Binka observed.
Elimination on course
The Programme Manager of Ghana’s National Malaria Control Programme (NMCP), Dr Keziah Malm, also believes that the country can eliminate malaria.
Her conviction is based on the fact that a lot of activities and strategies are currently ongoing, all aimed at reducing malaria transmissions.
“We are really pushing for the eventual elimination of malaria in the country; if not in the whole country, part of the country,” she said.
Dr Malm, like Prof. Binka, also believes that it will take strong political commitment to weed out malaria entirely from the Ghanaian soil, saying “We need the full cooperation of everyone—we all have roles to play in that respect.”
According to her, “One of the key elements to help eliminate malaria in Ghana is to get the right political commitment. So, we realised the need to engage Parliament to push the agenda to eliminate malaria.”
“We want our political actors to make malaria very high on the political agenda,” the NMCP boss stated.
For Dr Malm, her outfit in collaboration with the Ministry of Health and the Ghana Health Service had organised a workshop for the Parliamentary Select Committee on Health to educate them on the need to put efforts together to eliminate malaria in Ghana.
“In order for them (legislators) to push the malaria agenda, we needed to give them the orientation, the technical background; so that they know which areas to they should help us with,” she explained the rationale behind engaging the Parliamentary Select Committee on Health in Accra recently.
Dr Malm also admitted that resource constraint remained a major barrier to Ghana’s efforts in eliminating malaria, saying “We need to put in resources at the right places to help us eliminate malaria; we have to do more.”
The Founder and Executive Director of Speak Up Africa, a not-for-profit advocacy and policy action think tank based in Dakar, Senegal, Yacine Djibo, also agrees that political commitment is key to eliminating malaria in Africa.
In a recent Twitter Chat on how to eliminate malaria and Neglected Tropical Diseases (NTDs) in Africa, the Speak Up Africa boss said “To live in a malaria and NTD-free world in our lifetime requires financial resources, political commitment, collaboration and finding efficiencies in controlling and eliminating both diseases.”
For her, malaria malaria and NTDs are entirely treatable and preventable but are still a major obstacle to economic and social development in Africa, affecting the most marginalised populations.
Ms Yacine Djibo has therefore, commended activism by civil society organisations in the African region for their roles in helping to eliminate malaria and NTDs.
“Civil society across Guinea, Ivory Coast, Senegal, Burkina Faso, Ghana, Benin, Niger, and Cameroon have made incredible strides in increasing public awareness and engagement on malaria and NTDs,” she Tweeted.
She added, “Civil society has been bringing communities together for collective action, mobilising society to articulate demands and voice concerns at local, national, regional and international levels.”