Research Topic

Social Implications of Malaria and its Relationship with Poverty

Geneva Business School

MBA in International Relations

Submitted by:

Nitin VISRAM ALWAR

Geneva, Switzerland

Approved on the application of:

Dr. Keltoum IRBAH

Words: 17634

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Declaration of Authorship

“I hereby declare  That I have written this work on my own without other people’s help (copy- editing,translation, etc.) and without the use of any aid s other than those indicated.

 That I have mentioned all the sources used and quoted them correctly in accordance with academic quotation rules.

 That the topic or parts of it are not already the object of any work or examination of another course unless this has been explicitly agreed on with the faculty member in advance.  That my work may be scanned in and electronically checked for plagiarism.”

Nitin V Alwar

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Acknowledgment

This study was supported by the Geneva Business School. I would like to express first of all my gratitude to Prof. Damien Bezançon and Dr. Oliver Elliott from the Geneva Business School in approving the thesis topic. My sincere thanks to my Supervisor Dr. Keltoum Irbah for her guidance, support and knowledge throughout the research period. Thanks to the colleagues from Geneva Business School who provided the insights and technologies that greatly assisted the research.

3 TABLE OF CONTENTS

1. Title 01

2. Declaration of Authorship 02

3. Acknowledgment 03

4. Abstract 05-06

5. Introduction 06-08

6. Key Concepts 6.1 The approach of Malaria 08-09 6.2 Malaria and Poverty 09-10 6.3 Malaria and Sustainability Development 10-11 6.4 Socio Economic status and Malaria 11-13 6.5 Health Management and Malaria 13-14

7. Literature Review 7.1 Malaria and its risk factors 14-16 7.2 Malaria and children 16-18 7.3 Business and Malaria 18-20 7.4 Malaria and Poverty 20-22 7.5 Malaria Eradication 22-24 7.6 Malaria and Covid-19 24 -25 7.7 Malaria Control 25-26

8. Context of Tanzania 26-32

8. Methods 8.1 Limitations 33

9. Findings 9.1 Empirical Findings 33-39 9.2 Theoretical Findings 39-41

10. Conclusion 41-46

11. References 46-49

12. Appendices 49-56

4 Abstract:

Tanzania is facing a serious situation affected by malaria, which is one of the leading causes of illness and death in the country, accounting for more than 30% of the national disease burden. In order to directly address and develop prevention strategies it is important to obtain a detailed knowledge of the factors associated with the increased risk of malaria. Identifying specific risk factors in the country can provide support for existing safety measures or the introduction of new products and can indicate areas where security activities are currently underway. Malaria control began about 100 years ago during the German colony.1 Significant success has been achieved over the past decade with a national scale built on new safety and quality standards for access to testing and treatment. In this regard, several international programs have developed malaria control strategies over the years, including the Millennium Development Goals and the Roll Back Malaria Partnership. Key national policies the malaria planning guide includes the National Health Policy, the National Poverty Reduction Growth Strategy, the Third Health Strategic Plan, and the ongoing Local Government Program Programs. Tanzania, consisting of Tanzania Mainland and Zanzibar has eight geographical areas of Tanzania: Lake, West, North, East, Central, South, Southern Highlands and Southern West Highlands zone and Zanzibar. Current data highlights that Tanzania is currently infected with malaria, with 60% of the population now living in hypo endemic areas, a drop from 30% in the 2000 climate remains favorable for transmission nationwide, with almost 95% of Mainland Tanzania at risk.2

5 Executive Summary

Malaria, one of the oldest and most deadly diseases on earth, has a long history of checkered history. In India, the issue of malaria has been a major step forward when Roland Ross, a British military major under the Indian Medical Service, announced on August 27, 1897 that he had established that mosquitoes could transmit malaria by biting a patient first. The malaria parasite in the blood and bites an uninfected person. This introduced mosquitoes as an important link in the spread of malaria and raised public health scientists with a view to eradicating malaria.3

1 Malaria control in Tanzania. Current status and Future Prospects

2 Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis

3 https://www.who.int/news-room/fact-sheets/detail/malaria

6 Malaria represents serious disease that affects about 40 percent of the world's population in 107 of today's high-risk areas.4 It kills a child every 30 seconds, as well as three million people a year - most of them in the poorest countries in sub-Saharan Africa. Moreover, Malaria is often referred to as the epidemic of the poor. Although the disease is largely determined by climate and environmental factors, not poverty at the same time, the impact of malaria mainly affects the poor - those who are less able to afford prevention and treatment. The impact of malaria is felt not only in terms of human suffering and death, but also in significant costs and burden - to both families and the national economy. Malaria slows economic growth and development and perpetuates a vicious cycle of poverty. Therefore, it does not appear as a coincidence that the only parts of Africa that have significantly reduced malaria are the northern and southern hemisphere, home to some of the richest countries on the continent. In the Western Hemisphere, the worst-hit country of malaria, Haiti, is also one of the poorest countries in the region.5

The campaign to eliminate malaria started in the 1950s but failed globally due to problems including the resistivity of mosquitoes to the insecticides utilized, the resistance of malaria parasites to medication employed in the treatment, and administrative issues. In addition, the prototype eradication campaigns never involved most of Africa, where malaria is the most common. Even if the majority of forms of malaria are successfully treated with the existing antimalarial, morbidity and mortality caused by malaria are constantly exploding (Talapko, 2019).

Introduction:

The study outlines and discusses social implications of Malaria and its Relationship with Poverty. The World Health Organization (WHO) reports malaria is responsible for one in five deaths of African children under age 5 every year. Malaria takes its toll not only in lives lost, but also in medical costs, lost income, and reduced economic output.

Aims and Research Questions The issue of malaria represents a pivotal topic which involves several factors that affect this phenomenon. As an imperative topic, the approach constitutes of numerous actors that are included in this focus. This research aims to comprehensively assess how the disease of malaria impact social and economic levels on the global society. The subsequent research drives to address the following interrogations:

 Why malaria matters for businesses?

4The global battle against malaria started in 1955, and the program was based on the elimination of mosquitoes using DDT and included malarial areas of the United States, Southern Europe, the Caribbean, South Asia, but only three African countries (South Africa, Zimbabwe, and Swaziland). In1975, the WHO announced that malaria had been eradicated in Europe and all recorded cases wereintroduced through migration. 5 https://www.cdc.gov/parasites/malaria/index.html.

7  What are the greatest challenges facing the coalition of actors? What resources are needed to address those challenges

 What is the main impact in terms of development?

 How to shape an inclusive environment?

 How to face the challenges of economic impact? How does malaria affect a country's development?

 How does malaria impact society?

Hypothesis postulate: poverty promotes malaria transmission, and it causes poverty by blocking economic growth.

PROCESS OF THE RESEARCH

To begin with, I have searched online for all the relevant articles that relate to my specific topic. Then, I went to the United Nations Library at Geneva to use their electronic platform to search for additional articles. Following, I also visited the World Trade Organization library to search for applicable books, articles or papers. In addition, during the research I took contact with Experts, to this end I sent mails, I phoned different organizations as well as diplomatic Mission. Regarding this structure the study is organized into 5 chapters. Chapter one delves into both introduction and framework; it delivers the methodology utilized to gather and analyze the content of the subject. The second chapter provides an overview of the key concepts that are pertinent and postulate a deeper comprehension of the terms used in my research paper. The third chapter deals with the literature review. The latter examines the different views and opinions expressed by numerous authors who wrote critical articles that analyze some of the main reasons and factors that may contribute to the prevalence as well as the eradication of malaria. Chapter four presents the findings from empirical and theoretical standpoint. They provide an overview and a global reflection of the topic. Moreover the experts propose suggestions for improving the situation of malaria; further, they introduce recommendations that may contribute in combatting this phenomenon. The fourth and last chapter focuses on the main conclusion of my research. On the basis of my study, I will review the possible solutions for the indicated problematic and introduce my overall opinion on this research.

8 Disease Burden in African Region: Foremost Malaria affects the lives of almost all people living in sub-Saharan Africa. Most people who are infected live-in areas with persistent malaria infection - infections are common, and a certain level of immunity is sufficient. That is the reason why very few people live in areas where the risk of malaria is high and unpredictable due to high temperatures or rainfall. People living in northern or southern major areas or in highland border areas are at risk of spreading seasonal infections and malaria. In areas with persistent malaria outbreaks, very young children and pregnant women have a higher risk of malaria and death. Most children get their first cases of malaria in their first year or two when they do not have enough immunity in the clinic - these first years are the most dangerous. Indeed, 90 %of malaria deaths in Africa occur in young children. Elderly women in permanent transmission areas have high protection, but this is especially avoided in early pregnancy, which increases the risk of infection.

Malaria is highly prevalent in five North African countries: Algeria, Egypt, Libya, Morocco as well as Tunisia. In these countries Plasmodium vivax is transmitted by mosquitoes, which is much easier than in sub-Saharan Africa. Precautions are being taken to prevent the re- emergence of malaria parasites in the mosquito population, as well as to prevent the entry of other organisms that could effectively spread malaria (a threat in southern Egypt).

Key Concepts

Malaria:

Malaria is a life-threatening disease caused by parasites that are transmitted to humans through the bite of an infected female Anopheles mosquito. It is safe and treatable. The estimated number of deaths from malaria stood at 405,000 in 2018. Children under the age of five are the most at risk of contracting malaria; in 2018, approximately 67% (272 000) of all malaria deaths worldwide. Total funding for malaria control and eradication reached US $ 2.7 billion by 2018. Contributions from the governments of the former countries were US $ 900 million, representing 30% of the total amount.6

People with malaria often experience colds, colds and flu-like illnesses. Left untreated, they can develop serious problems and die. An estimated 228 million cases of malaria occurred worldwide and 405,000 people died most of them children in the African region in 2018. In addition, around 2,000 cases of malaria occur in the United States each year. Most cases in

6 WHO Final report of the Commission on Social Determinants of Health. WHO; 2008. Publications and documents: “Towards health-equitable globalization: rights, regulation and redistribution”. 9 the United States are for immigrants where malaria transmission occurred, most are from the sub-Saharan Africa7.

Economic Impact of Malaria: Malaria caused a negative impact for the business: the disease is responsible for the unemployment rate, the increase in health care costs, and the decline in productivity, all of which can affect a company's reputation. Poor children and women in rural areas are at greater risk of dying or having a significant reduction in malaria, which is destroying family resources, and overall, African households lose up to 25% of the disease. Leading economists estimate that malaria causes 1.3% annual “growth” in African countries with malaria. Malaria hampers investment and tourism affects, land use and crop selection leading to very low agricultural production, reduced labor productivity, and disrupts learning. Malaria can depress the country's economy, contributing 5-6% of the country's gross domestic product. In some places, malaria causes 15% of school-related absenteeism. It is estimated that in some parts of the world, malaria can affect up to 60 percent of school-age children. The suffering and loss of life caused by malaria is often accompanied by economic burden on families that bear direct costs in their pockets. Personal expenses include expenditure on pesticides, doctors' fees, anti-malarial drugs, transportation to health facilities, patient support, and funeral expenses. There are also indirect costs for families and families. Permanent neurological and physical damage caused by severe episodes of the disease disrupts children's learning and their overall well-being. This can directly affect their education and their ability to benefit in later life and Unemployment in the same vein also affects household income. 8 Malaria and Poverty The issue of Malaria on both society and the government carry a heavy burden, reducing the chances of economic growth and affecting household income. With malaria costing Africa about US $ 12 billion a year in lost GDP and spending 25 percent of household income and 40 percent of government spending on health, reducing and controlling malaria will directly help countries and communities lift themselves out of extreme poverty. Dealing with malaria will have a positive impact on achieving global primary education goals as the disease is a leading cause of illness and unemployment among children and teachers. For instance, Epidemics of malaria cause impairment in children's physical and mental development which

7 World malaria report 2018. Geneva: World Health Organization. 8World Economic Forum. Business and malaria: a neglected threat? Davos: Harvard School of Public Health; 2006.

1 0 also contributes to mental retardation, low graduation and low return to education. As malaria is the leading cause of child mortality in Africa, accounting for 20 percent of all child deaths (one in five), increasing malaria control programs will have significant benefits? Proper use of the $ 10 sleeping net has been shown to reduce deaths among people under five by as much as 25 percent.9 To illustrate with social fact, pregnant women (especially during the first and second pregnancies) and their unborn babies are at greater risk of contracting malaria; the disease is four times more likely to affect pregnant women than other adults and has life- threatening consequences for both mother and baby (Alonso, 2019). Consequently, prevalence of Malaria is directly related to poverty and economic inequality in less developed countries because of the significant costs these countries have to incur by the people and governments. Costs include the purchase of essential medicines, medical treatment, care, supply and employment of qualified health care workers, lost working days resulting in loss of income, funeral costs and total loss of economic opportunities through tourism during the outbreak. The direct costs of illness, treatment and premature death are estimated at least $ 12 billion a year. The total funding for malaria control and eradication was only $ 2.7 billion in 2016, but this amount is not enough to complete the program until it is completed. To achieve the 2030 targets from WHO, $ 6.5 billion a year will be invested by 2020. That could be a problem because, on average since 2014, investment in malaria treatment and control has actually declined significantly in the affected countries. Malaria is a serious disease that affects everyone but poses a serious risk to children under the age of five, especially in sub-Saharan Africa. There is a strong link between Malaria and poverty in developed countries. Efforts to eradicate the disease have been enormous, but the lack of funding, drug and pest control, social and economic instability in some countries, and the lack of training and knowledge on the disease present significant challenges in eradicating the disease.10

Malaria and Sustainability Development As whole Malaria continues to be a threat to the social and economic development of 91 countries around the world. Significant progress has been made in the fight against malaria over the past 15 years, with more than six million lives and a 45 percent reduction in the number of cases between 2000 and 2015. Efforts to combat malaria are on the decline. In 2016, 216 malaria cases were reported, an increase of 5 million cases from the previous year. Most of these (90%) occurred in the African region. That is the reason why there is an urgent needs to increase malaria efforts and not lose momentum. Three key steps were implemented in 2016 to accelerate progress towards the control and eradication of malaria through the

9 https://www.malariaconsortium.org/userfiles/file/Past%20events/factsheet2%20- %20malaria%20and%20poverty.pdf 10 https://borgenproject.org/malaria-and-poverty-in-underdeveloped-countries/ 10 global launch of the WHO Global Malaria Technology Strategy 2016 - 2030; Roll Back Malaria Promotion Program; Action and Investment to defeat Malaria 2016-2030 and the Sustainable Development Goals (SDGs) which focus on eradicating AIDS, tuberculosis, malaria and neglected tropical diseases. All of these categories share the same goal of malaria mortality and drop cases > 90% by 2030. 11 Increasing economic development, urbanization and deforestation are also expected to lead to changes in broadcast consciousness. Malaria is more prevalent in rural areas than in urban Africa and is closely related to malaria and agriculture, including intensive agriculture, terracing, irrigation and drainage. As a result, good farming practices reduce the presence of mosquitoes, while improved agricultural productivity indirectly leads to income, nutrition and social development and reduces the risk to people in rural areas. Urbanization with drastic changes in socioeconomic and physical landscapes has led to a decrease in the spread of malaria in many malaria-endemic countries, indicating that this trend may continue, especially with the support of direct malaria control. Movement between rural and urban areas greatly affects transmission. When people move to the city, parasites can be brought into their bloodstream and the presence of mosquitoes can spread the infection between employees and communities. There are multiple opportunities to accelerate progress towards global human development goals. In a sustainable and lasting way, identifying policies aim at reducing malaria cases and related deaths in all countries, increasing the number of malaria-free countries, regions and territories and reducing transmission are key factors in the permanent eradication of this global epidemic. At this crucial juncture in moving decisively towards a malaria-free world, the need is urgent and stressful.12 Socio Economic status and Malaria: Malaria is often referred to as the disease of the poor or the disease of poverty. Even a dreadful test of the global spread of malaria is enough to accept this claim on a large scale, given the incidence of malaria on the poorest continents and countries. Nevertheless, to a lesser degree the evidence is less consistent and more difficult to collect, analyze and understand. Malaria is also said to cause poverty and prevent or reduce people's ability to escape poverty; however, the evidence for the link between poverty and malaria, as well as the causal mechanisms between the two, is limited. In addition, the available evidence is often inconsistent and inconsistent or substandard, making it difficult to develop effective policies with sound evidence. A better understanding of the link between malaria and poverty is needed to guide the development of coherent and effective policies and tools for tackling

11 https://www.un.org/sustainabledevelopment/blog/tag/malaria/ 12 Learned From Two Decades Of Responding To Malaria Globally Swiss Malaria Group 11 malaria and poverty together.13 In recent years, there has been an increase in the number of community health workers, and others involved in disease control programs, that those social structures play a significant role in the distribution of health and disease, and that issues of power relations, inequality, exclusion and discrimination are made, distributed, and treated diseases. These substances will have a significant impact on the condition, the apparent size, and the distribution of the disease burden. However, in the context of malaria control, the term social responsibility remains absurd. To address the social burden of malaria we have therefore adopted an anthropological approach in which the aim is to better understand the process by which social and cultural factors affect the biomedical burden of malaria. In addition to the public and private health problems it causes, malaria is also an economic problem. In other words, the connection between illness and the business world is real and powerful. The clearest evidence is that in countries where it is well established, malaria is one of the leading causes of unemployment. As a result, anti-malarial measures and programs are part of the fight for corporate sustainability as the virus killed 627,000 people in 2012 and malaria is causing a $ 12 billion loss, according to the World Bank. A sick worker suffers from between two and three episodes of malaria each year, not to mention his family taking vacation time. Therefore, they are more affected; companies are also better equipped to fight the disease. In Africa, where the biggest challenge for the public sector is to reach remote villages, the authorities can rely on them. It is the companies that have the knowledge to manage the goods and the staff they need. The benefits of investing in the fight against malaria are not limited to finance. The struggle contributes significantly to agriculture, education, women's empowerment, poverty eradication and the achievement of other sustainable development goals. Countries continue to invest in a variety of new resources and the private sector and improve their public financial management systems that will be truly successful in attracting foreign and over- counter funding to fight malaria until it is eradicated.14 Regarding the situation of Refugees in Tanzania, the country has serious shortcomings in terms of water, sanitation, and shelter and refugee education. Refugees desperately need mass support, and 23,231 million are needed to meet some of their needs. Although most Tanzanians have returned or obtained citizenship, some of these people still live-in camps today.15 About two-thirds (63%)16 of the world's refugees, internally displaced persons,

13 Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis 2002

14 Socio-economic Impact of Malaria in Africa volume1 2018 15Traditionally Tanzania is very hospitable to refugees. Thirty years ago, the country was home to more than a million refugees. During the 1990's, hundreds of thousands of people fled Tanzania as a result of the Burundian civil war as a result of clashes between Hutu and Tutsi ethnic groups.

12 returnees and others affected by UN High Commissioner for Refugees Malaria Refugees living in remote areas, especially in sub-Saharan Africa, pose a serious health risk to the number of malaria refugees. Women and children of childbearing age make up the majority of the population, and pregnant women and children are at increased risk of developing malaria and death. The migration of local malaria-infected people from low-income areas to high-risk areas for vulnerable refugees. On the other hand, malaria transmission is possible in high-risk areas of the host country if the right vector is found in the migration of refugees from high and low indigenous areas.17 The highest rate of malaria was in refugee camps in Tanzania, with 399 annual cases of malaria confirming cases for all refugees. 1,000 and 728 confirmed cases against children of 1,000 refugees under the age of five. The UNHCR's malaria control strategy includes the support and promotion of malaria control policies and programs to reduce risk and mortality: they provide internationally recognized malaria control services and appropriate protection against malaria to vulnerable people.18

Health Management Health management is a complete management of a health care facility, such as a clinic or hospital. The health care manager will be responsible for ensuring that the operation of the health facility is in line with the objectives of the facility staff and the needs of the community, on a budget basis. The person in charge of health management oversees the day- to-day running of the facility. The terms health care and health care management are often used interchangeably, and many believe they are the same thing. Those are two different things. Worldwide, 300 to 500 million cases19 of malaria occur annually, resulting in the deaths of more than ten million people, most of them children under the age of five. The high burden of malaria and death falls on the poor, who also have very low incidence of malaria intervention. Malaria control requires an integrated approach, including prevention (including vector control) and treatment with active antimalarial agents. Lack of information, early education and early diagnosis and effective treatment for early detection hamper the success of the Global Malaria Program in reducing severe disability and mortality. Malaria case management strategies should be considered an integral part of malaria control programs. They should be based on sound epidemiology in the area in question, taking into account the number of people at risk, including young children, pregnant women, local residents and groups at work risk, and seasonal malaria. Knowledge of local antimicrobial resistance to

16 Burden of Malaria in Post emergency refugee 17There are an estimated 1.118 million refugees in 1.0 refugee camps in nine countries, with at least 50 cases of malaria per 1,000 refugees. 18These strategies are aimed at ensuring the delivery of long-lasting antimicrobial nets to pregnant women and children and the use of accurate diagnostic tests and effective treatment of people with malaria. 19 WHO Malaria Case Management 2009

13 anti-malarial drugs is also important in case management planning. This section of the guide includes practical ways to ensure that high-quality anti-malarial drugs are always available to users. By and large uninterrupted access to medicines in health facilities is the most important foundation of an effective case management system. It saves lives, improves health and improves trust and the use of health services. As drugs are specialized and expensive, efforts should be made to improve existing supply chain management systems. Misconceptions, improper maintenance and distribution leading to drug overdose significantly reduce patients' medical benefits.

Literature review Previous researches have been concerned with this topic, and they have been carried out from various angles. They provide reflection, an overview of the cognitive content, objectives, and scientific ground for malaria control and elimination, as well as tools, methods, and scheme to that end. Moreover, the literature overview represents available theories and models that can be used to understand the relationship between Malaria and various other factors that are associated with Malaria. To this end, I have taken into consideration of several publications, articles and reports by various researchers and organizations. I have compared and analyzed these publications and built my own literature review in five parts. The overall purpose of the Literature Review is to shed some light on the relationship of the following points:

 Malaria and its risk factors

 Malaria and children

 Malaria and Business

 Malaria and Poverty

 Malaria Eradication

Malaria and its Risk Factors Essendi (2019) underlines some specific contexts and argues that in tropical countries, especially in sub-Saharan Africa, malaria is a major public health problem. Since the early 2000's, malaria control in sub-Saharan Africa has grown to control and eradicate the disease. These interventions include the use of artemisinin-based chemicals in treatment, as well as the distribution of long-term network nets and household residues. These interventions have been very successful, which has led to a reduction in the incidence and prevalence of malaria in many parts of sub-Saharan Africa. In the last few years, however, there has been a

14 resurgence of malaria in some areas, due to the complex number of risk factors that may contribute to an increase in the risk of malaria at the individual and domestic levels, allowing for effective use of control measures. We need to understand the individual and domestic factors that contribute to malaria infection in clinics for individuals. Identifying risk factors for malaria infection in clinics provides information about the local malaria epidemic and can lead to the effective and targeted use of malaria control measures. These risk factors can be used to assess why some people get clinical malaria and others know how to intervene in the area. In this regard Ariey (2019) raises consciousness of the form of method, work, and commercial enterprise that would be needed to bring down and at length eliminate malaria, the timelines over which such diminution are apt to be attained, and how they could be carried on. This cognition is indispensable so as to plan strategically for long-term occurrence. This document aims to assist malaria programs in evaluating whether elimination, or other reductions in malaria, represents a feasible and appropriate goal in a defined area, based on painstaking consideration of what reductions in transmission are likely to occur given the intrinsic malaria burden, the levels of program coverage that can be reached, and the financial investment available. The study underlines the fact that Tanzania is particularly vulnerable to malaria, which is one of the leading causes of disease and death in the country, accounting for more than 30% of the national burden. It is important to have a detailed understanding of the risk factors for malaria in order to directly address and develop preventive measures against this disease. Identifying specific risk factors in a particular area may support existing preventive measures or the introduction of new ones and identify areas where conservation activities are not currently in use. Identifying and measuring the extent of disease spread over a wide area provides a measure to identify preventive and therapeutic interventions in high-risk or high- risk areas. This increases equity, efficiency and intervention costs. Vector-borne diseases such as malaria are ideal for cluster studies, reducing the most common areas where most diseases are found. Specific methods and limited vector efforts to address local groups of malaria. Several studies have used cluster analysis to identify habitats and transient malaria transmission in other parts of Africa. The epidemic of this disease in East Africa seems to have changed in recent years, and such research is relevant and timely as there has been a significant reduction in malaria, morbidity and mortality. When malaria is reduced, the progress of preventive and control interventions and the delivery of treatment depend on accurate knowledge of the risks and the ability to identify high-risk areas. Biometric measurements were taken from each child. Axillary fever was taken using a digital thermometer and the parent / caregiver was asked about the latest history of their child's fever. If the axillary temperature was .537.5 ° C or a history of fever was reported then a

15 rapid test (RDT)20 was tested for Plasmodium-rich protein II. falciparum. Thick and thin blood films are made for all children. The slides are colored with Giemsa, and are read twice at Teule Hospital, Muheza. Asexual stage parasites numbered 200 white blood cells (WBC) and 500 WBC gametocytes. Anti-malaria (Coartem®, spreadable, artemether / lumefantrine 20 mg / 120 mg) is given if RDT is approved.

In my development study, I focus on Identifying high-risk areas and ways in which risks can arise can impact on a wide range of malaria-focused activities, from increased surveillance to targeted interventions and treatment. In the case of low income, such as in rural Tanzania, any improvement in cost effectiveness and equity in disease control is essential. Recent investigation have emphasized provides evidence that the decline in malaria transmission and expansion can transfer age groups at risk of malaria infection in older children. Risk analysis provides universal access support and guidance for long-term insecticide-treated nets (LLINs) for all ages. Combination of cases reflects the diversity of risks. Besides, better management of LLINs or additional risk management interventions may improve outcomes and efficiency as malaria transmission continues to fall to the ground.

Malaria and Children Kapologwe (2020) reviews the question of Infrastructure development and upgrading to support safe surgical services in primary health care facilities is an important step in the journey towards achieving Universal Health Coverage (UHC). The report aimed to comprehend the public sector’s endeavor to ameliorate the structure of primary wellbeing installation. To this end the author appraises the construction rates, geographic extent, and physical position of each artifact, surgical safety and services provided in public primary health facilities. According to Kakkilaya (2015)21 the death toll from malaria each year is 1-3 Millions of children, especially African children, are affected by malaria. Information set out in the document indicates that for older children, the lessons for malaria are similar to those for adults. However, in children under five years of age, especially infants, the disease is more serious and worse. In the first two months of life, babies are not infected with malaria or because of the ineffective protection provided by maternal antibodies; the symptoms may be mild with low- grade parasites. In permanent and stressful areas, the insect level increases from 0 to 10% in the first three months of life to 80 to 90% in one year and remains high in childhood. Death is very high during the first two years of life. During the school years, pre- school children would improve their immune system and asymptomatic parasites by about

20Paracheck® Pf device, Orchid Biomedical Systems, India.

21 Malaria in Children 2015: https://www.malariasite.com/malaria-children/

16 75%. In Africa, on average, 1 child in 20 dies from malaria, and in the worst-affected areas, 1 out of 5 or 6 people die from malaria and other related diseases. The highlight IS that in all cases the differences between the ownership and use of ITNs under the age of five were not significant. These findings are accompanied by a decrease in the number of children suspected of having malaria taking anti-malarial drugs. However, differences exist between the areas in terms of both ownership and use of ITNs. Regarding decisions to seek health care, the reviewed literature has shown that caregivers generally have a better understanding of food allergies in both diseases and symptoms. However, the common belief was that symptoms associated with seizures were not associated with malaria, which is why they were not curable in today's health care system. In addition, some caregivers treat themselves, prompting others to seek medical attention, thus ending their quest for health care. In addition, many of the revised studies are designed for the framework of health beliefs. There is a lack of evidence of adherence to prescribed medications.

Caretakers make a distinction between the 10% symptoms of mild malaria from those of severe malaria in that the former was characterized by a combination of common fever, chills, weakness, loss of appetite and vomiting while later manifested by a high fever, chills, loss of appetite, the child becomes very weak. A combination of high fever, loss of appetite, vomiting, stiff body, and irregular movements of the limbs were reported as symptoms of convulsions. In contrast, in some studies, convulsions, altered perception, and coma were identified as symptoms of severe malaria. In addition, caregivers associate vomiting and loss of appetite with malaria but see these symptoms as minor symptoms unless they appear to be associated with another more serious symptom.

The researcher draws attention to the fact that caretakers seek treatment for malaria from a variety of health care providers based on their views and beliefs regarding illness. For example, in a study conducted in Lilosa and Handeni, it was found that caretakers associated with malaria and evil spirits wanted to be treated outside of modern health care. In addition, some caregivers, upon seeing the symptoms, first respond to these infections through traditional home care. Report found that about three-quarters of caregivers reported treating their sick children at home before visiting community health facilities. Traditional home- based care practices employed by caregivers include placing a child under the bed, throwing or bathing in cold water, and urinating on a sick child are some of the practices. This traditional modus operandi is designed to lower the child's temperature. In some cases, paracetamol and aspirin were used for the same purpose as traditional home remedies. In cases of persistent symptoms, out-of- home treatment was considered and, where appropriate, preferred treatment options were by traditional healers or the nearest health facility. In southern Tanzania, biomedical care, mainly from shops or government and non-governmental

17 health facilities, has been reported as the most common treatment for suspected cases of malaria. Choosing which provider to take care of was not in line with socio-economic conditions at home or the presence or absence of convulsions.

The researcher is of the opinion that effective treatment of malaria in children less than five years of age requires early diagnosis and prompt action. The researcher echoes this view with the concept health theory model which states that a person’s willingness to take action to respond to health shocks depends on key factors:

 The level of threat posed by a health problem as determined by a person’s perception of the severity of the disease and its potential

 The view of a person of gain that may be obtained by engaging in a particular course of action commensurate with his or her view of the impediments to committing that particular act.

Business and Malaria According to the Foundation Malaria Bad for Business UK (2017)22 the World Economic Forum report is accurate. In sub-Saharan Africa, 72% of the companies surveyed reported the negative impact of malaria, while 39% felt that these effects were serious. The disease continues to affect the company's profits across the African continent and beyond - through unemployment, reduced productivity and rising cost of benefits. Malaria among the company's employees also increased transmission capacity in the wider local community, which in turn affected the local economy through declining incomes, loss of savings, and investment and tax revenue. Similarly, UK businesses working abroad are not immune to the effects of malaria. While London-based mining and metals company BHP Billiton built the Mozal aluminum smelter in Mozambique with a combined $ 1.4 billion investment, the company faced 7,000 cases of malaria in two years and the death of 13 foreign workers. The total cost to the company due to malaria-related illnesses, absenteeism and medical treatment was estimated at US $ 2.7 million. Alluding to the multiple factors Twenty-two percent of business leaders respond to a report by the World Economic Forum’s Executive Opinion Survey that malaria currently affects their business. 10 percent reported adverse effects. In Sub-Saharan Africa, 72 percent of response firms reported current impacts as 39 percent saw these impacts as negative. Respondents speculate that the upcoming incidence of the disease may be similar to its current outcome. Several large corporations have taken action against malaria and have

22 Malaria Bad for Business UK (2017)

18 benefited from the subsequent development of new business contacts, the promotion of employee and customer loyalty, and the protection of employees and certain markets. Even if malaria affects customers, however, some businesses may not be encouraged to take action against them. They can, apprehend for good reason, see malaria as a problem that affects all businesses, and that it would not be expensive to take costly measures that could result in a small profit directly from the business itself. 22% percent of respondents worldwide reported that the disease affected their business to some extent. In addition, 10 % reported side effects, and 76 percent had minor side effects. Malaria is not good for business. According to Bloom (2006)23 in some firms, getting involved in malaria control can be very beneficial. Poor health can affect businesses directly, with its impact on employees, customers and the reputation of the company. Although academic records are limited, there is some evidence that malaria has directly impeded business activities, and many large companies have taken part in controlling malaria to reduce their impact on it. Poor health can also affect businesses indirectly by holding back the country's economy; malaria has been shown to have significant indirect effects on the economy. In addition, although it is clear that workers with malaria are a problem in the business (due shortages and deaths). On the one hand, business action on Malaria many of the resources needed to control malaria basic business skills and abilities. Companies in a wide range of fields, including but not limited to health care, have the capacity to support prevention and treatment programs. Business organizations can assist firms by developing best practice guidelines. Several large businesses have taken action on malaria, with benefits that include developing new business contacts, promoting employee and customer loyalty and protecting employees and, to some extent, markets. Mouzin (2011)24 report suggests that with strong business practices and skills, critical and often broad-based infrastructure, the private sector has been put in place to help implement malaria prevention and control strategies. The companies featured in the report were initially involved in malaria prevention to protect workers and their operations. They soon realized that the benefits were far greater than expected. In hindsight, the relationship expanded to expand these defenses, sometimes to a national level. This can be summarized as Private companies can have a greater impact on the use of their power, using their power to secure funding from external donors and growth interventions that would not otherwise have happened. In Equatorial Guinea, Ghana and the Lubombo region of southern Africa, partnerships initiated by private companies play a key role in securing external funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria to promote malaria prevention.

23 World Economic Forum (2020) 24 Business Investing in Malaria control: Roll back Malaria 2011

19 This approach is most effective when national regulatory systems do not have the capacity to provide adequate operational infrastructure that will develop and expand additional human and financial resources. Alternatively, in areas with strong national plans, businesses can choose to increase efficiency by donating funds, human resources and technology, and by playing a promotional role. Preventing malaria remains very expensive. Consequently, with less relevance, the business can soon gain significant health and economic benefits, as well as higher returns on that investment.

The Effects of Malaria on Poverty Development and Human Rights Gonaléz (2014)25 considers that Malaria is not just a disease that affects more than 200 million patients and kills more than 600,000 people every year, mainly in Africa, where it is the major cause of illness and death among children under five years of age. In addition to its direct impact on human health, malaria is also responsible for the millions of lost workdays and absenteeism that have a devastating effect on children's academic performance. Countries affected by malaria often fail to bear the brunt of the burden we carry, and very poor families the cost of malaria to poor households can spend a third of their annual income to fight the disease, and mosquito-borne carriers. Other issues that need to be addressed include funding, management, and defining best practices from a strong technical point of view. It is impossible to imagine the progress of people who are constantly sick, and because malaria is one of the diseases of history that has played a major role in perpetuating poverty and inequality.

The US National Library of Medicine (2016) obtained Socioeconomic data for 318 children aged six to 10 years living in 100 families, followed up for a period of 36 months. Most mosquitoes have been recorded using a collection of traps that light up each month. The spread of HIV was estimated every three months with malaria cases determined by detection. They tested the relationship between the agricultural success of emerging farmers (the main source of livelihood) and the socio-economic status. Thirdly, we have investigated the role of selected factors in mediating the relationship between Socio Economic Position and malaria. Housing development and agricultural development interventions to reduce poverty should be investigated further as a multi-sectoral intervention to fight malaria. Further research is needed to better understand the complex mechanisms between poverty and malaria and to develop sustainable malaria control strategies. In the case of malaria, some experts say that now that we have started on this road we cannot stop and that, with all that has been achieved, the only way forward is to follow the process to its logical end: eradicating malaria

25 IS Barcelona Institute of Global Health 2014

20 completely in some regions to eradicate malaria from the world, to achieve the success of smallpox.

Many studies have attempted to grasp the diverse characteristics that make malaria an illness closely related to poverty and the impacts of malaria on the aforesaid poverty of patients who are affected. Richi (2012) posits that our understanding of poverty has extended from a slender focal point on income and consumption to a multidimensional approach of instruction, health, social and policy-making involvement and rights, personal safety, and environmental quality. Thus he considers that poverty encompasses not just low income “but lack of access services, resources and skills, vulnerability, insecurity, voicelessness and powerlessness. Multidimensional poverty is a determinant of health risks, health-seeking behavior, and health care access and health outcomes.”

That is why additional reasons to conclude Hunt (2010) suggest that health workers and human rights workers must work together for a common purpose. They need to find a sensible, effective way to exercise human rights for malaria that strengthens prevention and treatment, including infants, pregnant women and the poor. All agencies working to fight the disease, including pharmaceutical companies and public-private partnerships, have human rights responsibilities. Thus, key objectives should be the strengthening of health systems and the introduction of effective, independent and accountable procedures for all malaria practitioners. Human rights do not provide magical solutions because there are no magical solutions. But human rights play a different, constructive role. In the fight against malaria, it is time to make a human right offering without exaggeration, but clearly and confidently. In order to make progress, we must get the message clearly and unambiguously, that human rights, including the right to health, are not shared with the assets of health workers that they can use: to develop better policies and programs; to collect additional funds from the Treasury. Together, human rights organizations and health workers can tackle the scourge of malaria and find out how the right to health can strengthen existing malaria control programs and help identify new policies, programs and projects. Malaria may affect and extend poverty at the household level in an amount of direct and indirect ways. As outlined above, the total costs of malaria include the direct, indirect and opportunity costs of falling ill and seeking treatment for malaria. Social unit endure important costs when a household member is afflicted with malaria. The direct and indirect costs of malaria might be significant, foster impoverishing misfortune families. The expenditure of malaria to poor households can be particularly austere when the sick individual is a productive member of the household, peculiarly the capital income-earner. Other household

21 labor might be diverted from income-generating activities to care for sick family members. Decreased productiveness and time away from work cut down household income. The cost of malaria to poor households can be especially severe when the sick individual is a productive member of the household, particularly the primary income-earner. Other household labor might be diverted from income-generating activities to care for sick family members. Reduced productivity and time away from work reduce household income. According to studies from Africa, the cost of lost labor from malaria illness might account for more than 75% of the total household cost of malaria.

Malaria Elimination

The World Health Organization (2020) put emphasize on the fact that Malaria rests one of the biggest threats to public health and economic development in Africa. More specifically, in Tanzania, Malaria is a leading cause of illness and death, particularly among children under five years of age and pregnant women. Malaria represents moreover a major cause of outpatient, sick patients, and admission of children under the age of five to health facilities. Malaria control spans decades in Tanzania. The greatest success has been achieved over the past decade at the national level with the development of new prevention strategies and improved quality and access to testing and treatment. Several global initiatives have developed malaria control strategies over the years, including the Millennium Development Goals and the Roll Back Malaria Partnership.

In the Publication by Wang and Chaki (2019) the researchers use a model developed by China. The latter has made significant progress in eradicating malaria, through sixty efforts including government leadership, policy formulation, environmental strategies, capacity building and the cooperation of sectors that have played a major role in the malaria control and eradication program. In particular, China's 1-3-7 model is one of the most important refined experiences from many years of operation and a key step in innovation that has contributed significantly to the success of the national malaria control program in China. From billions of cases in the 1950s, China recorded zero cases of infection found in the region in 2017. Meanwhile, insignificant progress has been made in many parts of sub- Saharan Africa where malaria remains a major health problem. According to the World Malaria Report (WMP) 2017, 216 million cases of malaria and 445,000 deaths were reported worldwide, 90% of which occurred in sub-Saharan Africa. To eradicate malaria in Africa, new efforts and approaches are needed. It is thought that the Chinese model and considered response systems strategies would be adopted to control malaria in epidemics in Africa. In Tanzania, as in other sub-Saharan African countries, malaria is a major cause of illness and death, especially among children under five and pregnant women. The incidence of malaria

22 varies greatly due to local variability in determining the transmission capacity of malaria and the wide variety of their local combinations. Both global and local reports have shown a 50% reduction in the spread of population infections in children aged 2 to 10 years (PAPfPR2-10) across Tanzania between 2000 and 2012. The proportion of Tanzanians living in high-risk areas decreased from 11.6% to 2.3% in 2012. However, the dramatic decline in the number of malaria transmission has never been equally demonstrated everywhere; there are areas that have been experiencing small changes in the prevalence of disease, mainly in southern and northwestern Tanzania.

Conversely, this is the first time that China has launched a co-operation project to control malaria in Africa, to explore the feasibility of using the Chinese experience there in the form of health cooperation in China and Africa. A major challenge for the project is to understand how control functions are performed in the local health system and to integrate this testing function with local resources. The experience and lessons learned from this pilot project will help to create a home-made model of Chinese aid, which could be extended to other regions of Tanzania or other African countries. Using the existing relationship between Tanzania and China, the project evaluated the effectiveness and efficiency of Chinese models and strategies, including local resources and the WHO Initiative as a community-based, collaboratively developed and implemented initiative in Tanzania.

In his study Talapko (2019) outlines Malaria Trends in the World. To begin with the author mentions that the WHO report on malaria in 2017 shows that it is hard to reach two decisive objectives of a Global Technical Strategy for Malaria. Indeed, these are a diminution in death rate and morbidness by at least 40% by 2020. Since 2010, there has been an important decrease in the worry of malaria, however investigation indicate a slowdown, and even an gain in the amount of cases between 2015 and 2017. Therefore, the figure of malaria cases in 2017 has risen to 219 million, in comparison to 214 million cases in 2015 and 239 million cases in 2010. The most critical step in the global eradication of malaria is to reduce the number of cases in countries with the highest burden (many in Africa). The number of deaths from disease is declining, thus, in 2017 there were 435,000 deaths from malaria globally, compared with 451,000 in2016, and 607,000 deaths in 2010. Despite the postponement in worldwide advancement, there are nations with diminishing malaria cases during 2017.Thus, India in 2017, compared with 2016, recorded a 24% decline of malaria cases.

The Global Fund provides 56% of all international financing for malaria programs. Since 2016, six countries have been certified by WHO as malaria-free and others are making progress to achieve this milestone. Malaria deaths have dropped by 46% since 2002. However, the decline in new malaria cases has stalled in recent years. Funding has plateaued

23 and insecticide and drug resistance are increasing, risking a resurgence of the disease and a loss of hard-won gains

Covid-19 and Malaria:

According to Sands (2020) the COVID-19 epidemic is on the rise, with rapid infection and 50,000 deaths a week. Although vaccines are urgently approved, they will not be available in large quantities in countries where the Global Fund has invested until the end of 2021. Current efforts to reduce its negative effects on global health and economic systems. On the contrary, we need to expand the global response. Now we see the light at the end of the tunnel; let’s get there as fast as we can and minimize the damage done along the way. World leaders are quick to say that we should not leave anyone behind in the fight against COVID- 19, only when everyone is safe. The availability of vaccines tests this commitment when it removes the sense of urgency and fear in rich countries.

At current levels, COVID-19, including HIV, tuberculosis, and malaria, kills the same number of people each month. However, as a result of the conflict-related effects of the COVID-19 epidemic, the death toll from these three diseases has increased due to closure, re- deployment of new virus, and disruption of life-saving services. In addition, some countries that have survived the COVID-19 scandal may be severely affected by their economic consequences. No country can be immune to the financial costs of an epidemic; chronic economic shocks leave deep scars that will have a profound impact on public health in the years to come. Unfortunately, the global track record is not encouraging. I do not want to diminish the commitment and commitment of many donors, the fact that the fight against a previous disease - HIV, TB and malaria - has left many people behind. When diseases no longer threaten those living in rich countries, they are reclassified as developmental or social problems without being considered a global health threat. That redesign means that they are attracting a certain number of resources.

Even if we set aside the inequality of our current global health care system, creating this false distinction between the diseases we care about and the diseases we do not know will not work in the past and will not work in the future (Thawer, 2020). Politicians in developing countries do not invest in the fight against the threat of infectious diseases when the first diseases are already killing their own people. We need to overcome the multi-skilled diseases and the infrastructure to prevent future threats. Many low- and middle-income countries support their COVID-19 solutions in the laboratory, disease surveillance, social networks, and supply chains designed to fight HIV, TB and malaria. As we move into the next phase of the fight against COVID-19, we must be careful not to announce the immediate victory and hold on to

24 our politicians with commitment without leaving anyone behind. To increase our ambition, we must not only seize this opportunity to fight the virus, but also to end the unresolved battle against HIV, TB and malaria and to strengthen our defenses against future infectious diseases.

Malaria Control:

The WHO Global Malaria Programme (GMP) is responsible for coordinating WHO's global efforts to control and eliminate malaria. Its work is guided by the "Global technical strategy for malaria 2016–2030" adopted by the World Health Assembly in May 2015.26

A comprehensive study from Glassman and Mcqueston (2014) reverse that the Global Fund has spent $ 8 billion to fight the disease since 2002, and the President's Malaria Initiative has disbursed more than $ 3 billion since 2005. On the other hand it has always been a challenge to find a case of malaria that meets the same criteria as seeking treatment for other diseases and health system problems. It demonstrates how to define "success" when choosing a conditional subject in a program, policy, intervention, technology: it's expensive and extremely durable, and widely used.

Demombynes' and Trommlerová's paper appear to be the best evidence of influence. Their work shows that the increase in ownership of insecticide-treated bed nets in areas with malaria in Kenya has seen a 58 % reduction in infant mortality and a 39% reduction in childbirth. Yet, even if this study uses Demographic and Health Survey data to measure impact at the national level, the method of distributing insect-infested nets and any other system components to promote their use is not well documented. Therefore, it appears to be quite difficult to understand and grasp what makes Kenya such a success story of malaria without this knowledge in the implementation of the program.

The progress in Swaziland, Senegal, Malawi, Madagascar, and elsewhere in the Roll Back Malaria Progress & Impact Series. These reports use daThawer, S. (2020).ta on the divisive trends as well as the limited impact of lives saved to prevent malaria, making it difficult to share what has been described. We have found some studies that do not comply with our terms in some way. For example, a study reviewing drug overdose in China could not separate the effects of interventions from other factors such as rainfall and GDP growth. Pre- and post-tests in Tanzania established organizations but were determined to determine the

26https://www.who.int/teams/global-malaria-programme

25 impact of malaria deaths. None of these studies measured costs at all. Finally, Mauritius' anti- retroviral treatment program is rare and has not found convincing contradictory facts.

Possibly we need to look at a different standard for testing programs for the control and control of infectious diseases. Unlike other health issues, it is actually not possible to perform complex tests where the goal of the program is to eradicate the disease completely. In these cases, we rely on WHO decision-making. Still, many malaria controls programs currently do not intend to end, and while many inputs are considered effective for small studies, we still need to comprehend whether measured programs make a difference in malaria-related health outcomes, whether climate, housing development, or economic growth means these changes in level of people.

Context of United Republic of Tanzania:

Tanzania, is a country in East Africa within the African Great Lakes region. It crosses northern Uganda; Kenya Northeast; The Comoros Islands and the Eastern Indian Ocean; Mozambique, southern Malawi; Southwestern Zambia; Western Rwanda, Burundi and the Democratic Republic of Congo. Kilimanjaro, the highest mountain in Africa, is located in northeastern Tanzania.

Several important hominid fossils have been found in Tanzania, such as the six-year-old Pliocene hominid fossil. The genus Australopithecus became widespread in Africa 4 to 2 million years ago; Ancient Homo fossils are located near Oldway Lake. Since the advent of Homo erectus 1.8 million years ago, humanity has spread throughout the Old World, then to the New World and Australia under the Homo sapiens race. The Sepians migrated to Africa, realizing the ancient races and subspecies of the human race. The Hudsabs, one of the oldest surviving tribes, are thought to have originated in Tanzania, reminiscent of their ancient ancestors who used their oral history, fire, medicine and cave habitat, and lived in areas such as Homo erectus or Homo heidelbergens before them.

From the Stone and Bronze Age, migrations to Tanzania included southern Kushites, southern Ethiopians and southern Kushite people from the north of Lake Tarkana about 2,000 to 4,000 years ago, including modern Datog. Between 2,400. These organizations operate on Lake Victoria and Lake Tonganyika, similar to the East African population in West Africa. They migrated across Tanzania between 2,300 and 1,700 years ago.

26 German rule over the mainland of Tanzania began with the establishment of East Africa by Germany in the late nineteenth century. It was after the British rule after World War I. The Zanzibar Islands were ruled by Tonganyika, leaving a separate colonial empire. After independence in 1961 and 1963, the two companies merged to form the United Republic of Tanzania in 1964. These countries joined the British Commonwealth in 1961, and Tanzania is still a member of the Commonwealth as a republic.

The United Nations estimates that Tanzania will have a population of 56.31 million in 2018, much smaller than South Africa, the second most populous country south of the equator. The population is made up of 120 races and religions. Tanzania is an independent constitutional republic. Since 1996, its official capital is Dodoma, with the President, the National Assembly and other government departments. The former capital Dar es Salaam operates several government offices and is the largest city and a major commercial center in the country. Tanzania is the only party in the ruling Chama Cha revolution.

Tanzania is a northeastern mountain range and dense forest on Mount Kilimanjaro. The greatest lakes of Africa are partly inland Tanzania. Lake Victoria, the largest lake in North and West Africa, and Lake Tanganyika, the deepest lake on the continent, are famous for their fish diversity. Lake South Malawi. The east coast is hot and humid, with the Zanzibar Islands only on the coast. The Menoi Bay Conservation Area is a protected marine area in Zanzibar. Colombo Falls, located on the Colombo River on the Zambian border, is the second most damaged waterfall in Africa.

Healthcare System in Tanzania: Tanzania is one of the top ten countries with the highest rates of malaria and death: 3% of global cases, 13.4% of Eastern and South African cases and 5% of deaths worldwide. In the last few years, there has been an increase in crime and death. Between 2015 and 2018, the risk increased from 122 to 124 per 1000 people, while mortality decreased by about 4% (from 0.4 to 0.38 per 1000 vulnerable people).

Kapologwe (2020) notes that 93% of the population of the continent of Tanzania live in areas with malaria. There are three cases of malaria in the country. Sustainable transfers: 60% of the country falls into this category. 20% of the country is infected with persistent malaria (seasonally varied) Occasional malaria transmission: Occurs in about 20% of the country. In Tanzania 96% of malaria cases are caused by Plasmodium falciparum and the remaining 4% are caused by Plasmodium malaria and Plasmodium ovary. In 2017, the under-five mortality

27 rate was 5% and the infant mortality rate (at 12 months) was 9%. The proportion of those under 5 is 37%. There are 7,513 health facilities in Tanzania. 83% of these are public places or trusted institutions. Specialized hospitals under the Department of Health are state-of-the- art in health, and primary health care facilities are at a very low level. Eighty-five percent of people receive their health care from primary health care providers. The Global Fund and PMI provide 90% funding for malaria in key areas of Tanzania and excludes government-paid salaries. The African Development Bank, Danish International Development Agency (DANIDA), Japan International Cooperation Agency, UNICEF, United Kingdom International Development Division, World Health Organization and research organizations all contribute in the national health care system. The health system in Tanzania follows the model of government leadership structures in the form of government mandate. There are different levels of services. The system works on a pyramid system, with hospitals in it, which are very important worldwide. Their functioning as referral hospitals depends on the circumstances and complexity. They are failing to achieve this goal due to a lack of proper national infrastructure, lack of proper roads and connections to remote areas. There is a problem with the unequal distribution of funds. This explains many problems in the medical profession. This problem also applies to the general state of health services in developing countries: 85% of health care costs are borne by central and senior hospitals. However, only 10% of people are admitted to these hospitals. All other people, i.e., 15% of the economy, and 90% of the people assigned to health care.

Health care funding is an important part of a healthy health care system. There are three main types of fundraising: revenue collection, risk aggregation and purchasing. In recent years, demand for quality and affordable care has been growing, so the government is committed to responding to the process of developing a health financing strategy. Since the beginning of 2013, the Inter-Ministerial Committee jointly has made some changes in key departments and departments to meet the needs of the people. Improving prepaid plans is a key element of the strategic development agenda, which is seen as an opportunity (Kapologwe, 2020). Health insurance in Tanzania is still low. By 2019, 32% of Tanzanians will have health insurance, of which 8% are registered with the NHIF, 23% are members of the public health fund and 1% are private health insurance companies. Beneficiaries of NAAIF include members, partners and four dependents. Beneficiaries include a stay-at-home mom, partner and all children under 18 years of age. Some prepaid programs make up less than 1% of the population. Private health insurance schemes are aimed at urban dwellers. The availability of

28 low-cost insurance leads to greater reliability on direct payments during health care, which hinders universal health care in many developing countries. Direct payments lead to high levels of inequality and in many cases deny proper access to essential health care. The NHIF was established by Act 8 of Parliament in 1999 and came into effect in June 2001. The program was originally intended to include public servants, but more recently there have been laws that allow for independent membership. Employees of the legal profession are required to contribute 3% of their monthly salary depending on their employer. The program includes a key member, partner and four legal guardians under the age of 18. Availability has increased from 2% of the total population in 2001/2002 to 8% in 2019.27 Tanzania and Business Tanzania is the East African country between Kenya and Mozambique, the 13th largest country on the African continent and the 31st largest in the world. After gaining independence from Britain in 1964, the two provinces Tanganyika and Zanzibar were merged and renamed the United Republic of Tanzania in 1964. In terms of business strategies, Tanzanians value personal relationships because the culture of the country depends on relationships. Since the notion of friendship and trust are very important, they focus on getting to know their business partners. The approach of Business relies on two main components: traditional and sequential. With the government embarking on a strategy to advance the open and market-based economy to foster effective participation of the private sector, it is important for those who want to establish business relationships in the country to connect with other entrepreneurs. Various agencies such as the local Chamber of Commerce, the Rotary Club and other similar organizations.28 At the same time, Tanzania's economy is growing at a rate of 6-7% per year. The main business sectors in the country are agriculture and mineral production. The agricultural sector is considered a major economic activity as 80% of households depend on this sector and account for 27% of the country's GDP. On the other hand, mineral production is a source of great economic growth in Tanzania, as it accounts for up to half of total exports to the country. Other products contributing to Tanzania's economic growth are common consumer goods such as food, beverages, tobacco and textiles, which are considered the most reliable source of government revenue.29

International NGOs that are fighting Malaria: With the disease spreading rapidly in 91 countries around the world, half the world's population is at risk of contracting malaria at any time. Many situations occur in sub-Saharan

27 Healthcare in Tanzania wiki 2020 28 Doing Business in Tanzania 2016 29 Embassy of Netherlands Investments 29 Africa. However, many other areas are also affected by the disease. This includes the United States, Southeast Asia and the Eastern Mediterranean. In addition, malaria cases are frequently reported in North America and Europe. The disease is equally affected by accident in poor people and the lack of preventive measures. At the same time, children and pregnant women under the age of 5 are at greater risk (Ariey, 2019). Malaria is always a threat to the health of many. But it is also a great achievement of our time. The number of cases has dropped dramatically in recent decades and malaria-related deaths are being prevented today. There is much that can be done to reduce the spread of malaria and eventually to eradicate malaria. To begin with, it is very important to prevent malaria by preventing mosquito bites in infected areas. Tips include wearing mosquito nets, mosquito repellent, long-sleeved shirts and long pants. In addition, people can take malaria pills to prevent the growth of parasites in the environment. Finally, communities can prevent malaria by increasing mosquitoes and reducing their numbers. Most importantly malaria can be treated. Because of this, it is important that all malaria patients receive the treatment and medication needed to fight the disease. Many humanitarian organizations around the world are fighting malaria. Although this list is not limited to that, it gives you an overview of the programs that organizations use to protect global health.30

1. The African Leaders Malaria Alliance (ALMA) Alma comprises 49 heads of state from the African continent that are actively fighting malaria. The goal is to eradicate the disease by 2030. One of Alma's major projects is the Scorecard for Accountability and Action, in which countries are committed to taking real action against malaria.

2. Bill, Melinda Gates Foundation

The Bill & Melinda Gates Foundation, founded by Microsoft founder and CEO Bill Gates, operate on a number of issues around the world. Speeding up to Zero is one of their tasks.

30Raptim Humanitarian Travel

30 Therefore, the program focuses on creating new interventions to prevent malaria and to promote holistic support.

3. Comic Relief

At its headquarters in the UK, Comic Relief raises and distributes funds to charities around the world. One of their donations goes to the Malaria Consortium. The program aims to raise awareness of the disease in the community, train health workers and support vaccines and treatment. 4. Catholic Relief Services (CRS) CRS, which has operated worldwide for 75 years, has helped vulnerable people around the world. It currently operates in 18 malaria programs in 14 countries. One example is the distribution of the immune system needed by the community through their program to spread malaria chemotherapy. 5. GAVI GAVI, the World Vaccine Alliance, promotes equal access to vaccines around the world. Gavi supports the testing phase of new malaria vaccines in Ghana, Kenya and Malawi this year. This work is a milestone in the eradication of disease. 6. Goodbye Malaria As a business venture, Goodbye sponsors low-income projects to fight malaria in Mozambique. For example, a group of African founders have introduced this work and have focused on residual indoor spraying to reduce the spread of mosquitoes and parasites. 7. Lutheran World Relief (LWR) From the US, LWR operates worldwide with the motto "Help Your Neighbors". The organization helps the needy. LWR runs a number of malaria projects in Tanzania, including increasing public investment in malaria control. The project aims to increase public access to health services and treatment for malaria. 8. There is no malaria: As the name suggests, the absence of malaria is also effective in eradicating malaria. Their eradicating malaria. main focus is encouraging, which works hard to influence global agendas to do the work of As the name suggests, the absence of malaria is also effective in eradicating malaria. Their main focus is encouraging, which works hard to influence global agendas to do the work of eradicating malaria.

31

9. Médecins Sans Frontières (MSF)

At its headquarters in Geneva, MSF is committed to providing humanitarian assistance worldwide. Due to their strong focus on health services, malaria has become a major problem in many MSF campaigns in times of crisis. For example, in the DRC, MSF supports hospitals and counseling patients in the treatment of malaria cases.

10. Rotary International

Rotary International is a community organization with 1.2 million members working to address global issues. Raptim has become a favorite partner in the fight against malaria through many programs developed by Rotary International. For example, partners in Rotarian malaria are working to combat malaria outbreaks in Uganda, Zambia, Tanzania and Ethiopia.

11. United Against Malaria (UAM)

UAM, which has a network of more than 200 partners, is working together to eradicate malaria- related deaths. The organization operates on three key pillars: mobilization, commitment to political leadership and education on the use of malaria vaccines.

Methods:

To further enhance my research, I framed 5questions to ask to the experts in the related fields in and around Tanzania to get a clear qualitative analysis. The following questions are:

1. What do you think are the greatest challenges facing the coalition of actors who are trying to eradicate malaria?

2. What resources are needed to address those challenges?

3. Why malaria matters for businesses?

4. Does future concern vary in different industries or firms of different sizes?

5. What is the main impact in terms of development?

32 Limitation: Some limitations need to be highlighted in terms of research activity to add. The result is more value. It is almost impossible for anyone to do stupid resistance research. The result also depends on many external and uncontrollable factors. The researcher has encountered various problems while conducting related collection and analysis Information. The time limit is the most important factor in the argument tthe overall probability of error. Lack of time also prevents the researcher from creating more descriptive Questionnaire for data collection in respect of project requirement. There are budget limits another major factor that has had the opposite effect on overall research activities. Lack The use of various paid databases and journals for storage has prohibited the study in the budget. And of course, Covid-19 has made things slow in terms of communicating and meeting people. Minimum use of libraries and the researcher was not able to meet and interact with the experts.

As I mentioned in my limitation, due to covid19 I was not able to meet the experts in person. So, I contacted them via phone and email. They decided to answer the questions through phone because they felt it is easier to explain. The experts include 2 Health Doctors, 2 Business holders from Tanzania, 1 is setting up her own NGO in Nigeria and 2 students.

Findings: Empirical findings:

The first point was to apprehend how the expert appraisethe greatest challenges facing the coalition of actors who are trying to eradicate malaria. According to the World Health Organization, the United Republic of Tanzania is one of 11 countries in the world that account for 55 percent of all cases of malaria said one of the health expert. Different definitions of cultural differences and personal preferences; those who have money are not the organizers of this category. Various local challenges for those trying to implement a universal system with different treatment options and different local opinions about the disease. Many of the equipment used to fight malaria today was developed during the last century: mosquito nets treated with insecticides, residual house spray, rapid diagnostic tests, and artemisinin drugs. Rapid research and development (R&D) of new malaria prevention and treatment tools is essential to eradicate malaria in the future. In addition, the integration of SMC with other medical services such as malnutrition testing,

33 treatment and vaccination allows these interactions with multiple children simultaneously to address the many causes of infant mortality - said a field medical officer. However, this strategy is not intended to be a permanent tool in the fight against disease. The effect of this distribution is limited, lasting for weeks. Less than 1% of today's healthcare funding goes to building anti- malarial tools. Diagnosis, drugs, pesticides and vector control methods are performed, as well as immunotherapy treatments such as monoclonal antibodies. The list of challenges seems endless and can only be solved by developing world power. Lack of capacity undermines countries' ability to set their own agendas to reduce disease burden. In addition, critical data gaps can lead to performance and loss of opportunity. Investment by companies and individuals in malaria-affected countries should be a top priority for national governments and providers- said a business owner in Tanzania.

What is the Resource to address the challenge?

The NGO Chairman argued the cost of providing long-term pesticide nets to all people living in local areas will be reimbursed at the rate of one net for two people after three years. Other vector control methods, especially indoor spraying, can be an alternative and the cost per person protected cost estimates is almost the same. The Health expert put in that Many interventions refer to new approaches and that require medical training, diagnosis, distribution of preventive interventions, monitoring, management, and operational research. The cost of the training of epidemiologists, entomologists, health workers and community health workers is estimated. Private sector intervention to control malaria is important to prevent and ultimately eradicate the disease. In fact, African against Corporate Partners of the United against Malaria Campaign alone has saved 10 million workers through “safe” malaria programs such as malaria awareness programs and net distribution said one of the business owner. The current Global Malaria Eradication Campaign seeks a policy that strengthens the health system to provide a legitimate place for events to take place in developing countries. To understand the benefits of this approach, it is important that you invest enough in the ‘human’ segment of health systems and understand the multifaceted factors that affect their participation. The challenges of strengthening this part of the health system are clear, as well as ensuring those current efforts to eradicate malaria do not undermine the renewed momentum of the health care system.

Measure to strengthen the effectiveness of prevention and treatment services. Limited information on how to improve the performance of private providers has been gradually acquired, but more action is needed in this area; In addition, much attention should be paid to the important issue of improving the performance of the public sector, especially the performance of employees. It systematically looks at how to reach poor groups using

34 prevention and treatment strategies. Lack of economic availability to significantly increase the value of malaria economic analysis is a major obstacle. One of the students from Tanzania argued that Economists supply almost everything needed for advanced research on malaria. In addition, economists who care about health may be more concerned with broader health care issues than with certain diseases such as malaria; Malaria research groups often have difficulty hiring economists. An evaluation of measures to improve access to and prevention of malaria. In general, we know what problems and what solutions are possible; we do not know how the various policies apply to specific country settings.

Why malaria matters for businesses?

The Business owners posited that Malaria-related illnesses greatly affect the shortage of staff and productivity. Unemployment increases when workers affected by malaria lose their jobs for one or five days. Workers are more likely to lose the same jobs when children and family members suffer from malaria. In addition, health care costs can cause significant losses in household income and increase stress for employees who eat at home. Involvement in malaria control interventions outweighs the costs associated with illness and death of the employer and work related to productivity, employer replacement and health care. Business plays a major role in supporting the fight against malaria by promoting, educating the public and building workplaces and community programs. In addition, the relationship between the private sector and government promotes the sharing of information and resources essential to economic and social development. Ensure that all health professionals who provide maternity services in the workplace and community programs are trained in national malaria prevention guidelines, including pregnancy. Make sure all women are aware of the dangers of malaria during pregnancy and their prevention and treatment options. The health expert gave this useful information “The World Health Organization (WHO) estimates that climate change will cause 60,000 deaths between malaria between 2030 and 2050. Climate change is expected to create 5% or 21 million malaria cases worldwide by 2030. This puts a lot of pressure on our health care systems”. This prevents malaria-carrying mosquitoes from benefiting the country. This will prevent foreign investment and tourism from entering the country, which will hamper business development. It promotes inequality, hinders sustainable economic growth and is a leading cause of death in Africa, preventing thousands of people from achieving their skills each year.

One participant strongly believes that Business leaders have a responsibility to support the fight against malaria. Without funding for the protection and treatment of local workers or in partnership with private public companies for new solutions. It is important to note that malaria is a challenge from national leaders to every citizen, and the private sector is no

35 exception. The private sector has ambitions in the health sector, improving the conditions of employees, consumers and national infrastructure. It plays a role in advancing national goals by bringing more resources to the list and participating in local and national programs to take advantage of the opportunities created to eradicate malaria. By eradicating malaria, “we will not only save countless lives, but ultimately save our precious resources, unlock billions of dollars in economic power and let the world know that Tanzania is open for trade”(chairman of an NGO).

The Chairman of the NGO also considers that Current needs provide immediate opportunities for new malaria-related opportunities, including diagnosis, treatment, drug development, vector control and monitoring. The health impact on a company’s reputation is another consideration for other organizations. Social commitment has become the password to today’s economy. Because activists, governments, consumers, and sometimes shareholders force companies to act responsibly, many businesses have invested in cleaning up their operations (e.g., not polluting the environment or employing children) or doing socially responsible activities. Development (e.g., NGO funding or health programs) in the health sector, pharmaceutical companies are already under pressure to lower drug prices in developing countries for diseases such as HIV / AIDS, and many companies have entered into public-private partnerships. Such activities strengthen brands and boost the confidence of employees and consumers.

Different Industries Tackling Malaria

Malaria business is deteriorating due to declining productivity, unemployment, rising health care costs and a disease that negatively affects the organization’s reputation in Tanzania. The spread of malaria among the company's employees affects the local economy as the number of workers is declining due to illness and unemployment, loss of savings, declining sales, declining income and tax revenue and declining public health budgets said one of the Business Owner. On the other hand, the other business owner says the companies have been able to quickly increase malaria control and have gained instant profits from investments. There are strong business models that play a key role in controlling malaria, protecting workers and their families, strengthening businesses and expanding community programs.

The private sector represents as a key partner and can work together to complete national programs to implement malaria control resources. Private sector activities such as manufacturing, agriculture and construction bring more people to new settlements and environmental changes, which promote the spread of infectious diseases say one of the participants. In carrying out regulatory functions, private sector partners play a key role in

36 monitoring vector and other epidemics by collecting and sending data over a single network to inform local and international authorities about disease status. In addition, the private sector has more intangible assets for vector control systems such as project management skills, financial and transparency training, leadership and management skills, distribution and planning and long- term planning skills. Control efforts in the context of a business are weak and can only be temporary if there is no consistent investment to ensure continued success.

The health expert opines that Many international organizations sponsor responses that focus on the epidemic. In addition, the Global Fund is in a precarious position this year as it conducts an interim review of their Global Fund Strategy to assess the impact and impact of investments on HIV, TB and Malaria. Malaria can be eradicated in decades. However, by the end of this year it will depend on whether it affects the radar or contradicts our progress. Governments, civil society organizations and international partners must all work together to combat the weak balance between COVID-19 and malaria. If standards were broken, millions of lives would be in danger. The disease has led to delays in malaria control programs and fatal delays in treatment. History has proved to be a force for good in human affairs. Significant gains can be eliminated in one broadcast season and failure to maintain active control can lead to renewal. Going back makes the situation worse than during control efforts, because repeated exposure to malaria can cause partial paralysis.

The chairman of the NGO argues strongly that the private sector remains an obscure and under-utilized resource in the planning and implementation of control systems or to improve existing public health services to improve efficiency. While opportunities are important, involving private companies in malaria control is not without its challenges. Another challenge for the industry is to ensure that malaria is controlled after the end of industrial activities. At some point, all resource development projects will stop, but they often do not have the long-term planning required to establish a strong partnership. The Sustainability Planning Project should start at an early age and should be carefully considered to improve capacity / efficiency and objectives in real time. The benefits provided by the private sector in health care should be used to better expand resources for resource development. The method has been found to be more effective in disaster risk management, apart from the activities of the organization.

What are the Main Impacts of Development?

Efforts to eradicate malaria involve many industries; although effective drug interventions can be effective, they can rejuvenate if public mosquitoes are not controlled. It offers challenges and opportunities for vector research, pesticide research and development. A

37 strong focus on the dissemination of information and the acquisition of technology to communication professionals. In addition, mental and personal behaviors play a key role in learning how to produce and disseminate better information. The subjects use statistical / data analysis, testing tools and therefore technology. There are many opportunities in the technology industry at all levels to deal with malaria, for example issues related to biotechnology, information dissemination and climate change in the development and management of development drugs. There are many opportunities for companies of different sizes and backgrounds says a participant from Tanzania. In the past, the biggest opportunities for malaria control were large pharmaceutical companies and research institutes. As technology continues to emerge in the early stages of the Fourth Industrial Revolution, small beginnings now have more opportunities to implement skills. Technical solutions in key areas of malaria control, i.e., in various areas. The relationship between agriculture and malaria has a history of almost 2,000 years. It is not uncommon for many malaria cases to occur in rural agricultural communities. Farm habitats often lead to changes in water use, reverse livestock and wildlife degradation, and lead to deforestation, all of which increase the number of larval development sites and increase contact with mosquitoes argues the Chairman of the NGO. The use of certain chemicals to induce plant production indirectly affects the spread of malaria. Highly productive plants require a large number of pesticides and fertilizers. Numerous studies have identified the use of pesticides in agriculture as an important contribution to mosquito control. Human movement increases the spread of malaria in four main ways. The purchase of anti-malarial drugs at home has harmed individuals and their families; Travel and medical expenses for clinics and clinics; Missing days; Absence from school; the cost of preventive measures; Cost of cremation in the event of death. Financial, distribution and healthcare government officials; Buy medicines and goods; Public health interventions to combat malaria, such as spraying of pesticides or the distribution of bed nets infested with insects; Job lost due to loss of income; Collaborative business and tourism opportunities no longer exist. The direct costs (e.g., illness, treatment, premature death) are estimated at least US $ 12 billion per year. The cost of lost economic growth has doubled. Infants and children bear the brunt of malaria and death. Survivors can have lasting effects on their physical and mental capacity - and as a result financially Physical and mental consequences are considered negative but accepted says the business owners. One of the Health expert says Studies on the cost of malaria prevention and treatment especially for staff and health services are being continued in various regions including Tanzania. Households buy mosquito coils, sprayers, mosquito nets and sleeping nets, but these are not only needed to prevent malaria but also to control pests. When people are unable to work or their workload is reduced due to illness, there are economic consequences: lower wages paid to those earning; if the disease affects the crop, farmers may be less

38 productive, sick children may not be able to work for themselves, and even very young children may work, and parents may lose working hours. Finally according to the NGO chairman the death toll from malaria also has a significant economic impact.

Theoretical findings: Experts have published articles on the issue of Malaria in the Harvard Business Review. In partnership with the global health community, Harvard University is committed to helping achieve the vision of a world free of malaria. Harvard-conquered Malaria from Genesis to Globe Initiative to Basic Biomedical Research recognizes that through integration and communication across all sectors and environments, integrated multidisciplinary approaches, multiple control areas and long- term success are possible. Elimination and its broader social consequences. Despite the shocking burden, researchers and public health organizations are calling for an end to malaria by 2050. Professor of Statistics and Chairman of the Department of Health and Human Resources noted that great strides have been made in the fight against malaria worldwide. Between 2000 and 2015, Castro noted a 22 percent reduction in malaria cases and a 50 percent drop in mortality. But what we have seen since 2015 is that success in reducing mortality has been steady. In fact, between 2015 and 2017 we have an increase in malaria cases in 55 countries and an increase in malaria deaths in 38 countries." Nicholas Erisco, who holds a PhD in human health sciences, argued that the world could eradicate malaria by 2050. Erisco unveiled the only "just and moral" way to end it by 2050. In making his case, Erisco pointed to new emerging technologies to help fight malaria, increase government investment in malaria control programs, and ensure that 20 countries eradicate malaria between 2000 and 2015. Presenting the other side of the controversy was the global health crisis and the population of SM Sias Beddinger. He noted that the eradication of malaria was a major priority for some of the world's most vulnerable people, but the target date for 2050 was not. In an effort to stem the tide of malaria, Beddinger focused on building infrastructure, such as building roads and water supply systems in low-lying countries, which helped reduce mosquitoes and, in turn, reduced the spread of malaria parasites. The importance of a data-driven approach was a major issue when it came to decision- making and implementation. Eradicating malaria can be achieved, but more strategic planning needs to be done. Some African countries are already doing better than others, so this war must be a national one and most importantly, it must be more. Leaders need to understand what is needed, from malaria control to high-risk areas, to eradicate malaria and, in the long run, to eradicate it. A multidisciplinary approach is needed. It will be the work of a single program or researcher, but will be integrated with all other sectors.

39 Stakeholder’s opinions regarding the anticipated Vaccines in Tanzania: Tanzania is one of the countries where malaria is a major cause of instability, mortality and is considered a barrier to economic and social development. According to the National Malaria Control Program, 90% of Tanzanians are at risk of contracting malaria, resulting in 11 million clinics annually. Pregnant children and mothers are more likely to get malaria. In mainland Tanzania, the number of microscopic, confirmed malaria cases is 1,550,250 and the number of deaths is 8,525. Although the number of admissions and deaths has decreased over the past few years, some high-profile areas of malaria in the country are experiencing significant variability. It spread to others in small numbers. For example, there are regions with one percent or less and more regions with more than 300%. Existing malaria interventions in Tanzania include malaria testing through microscopy and / or rapid diagnostic tests, an inexpensive and effective treatment for malaria, such as artemisinin-based compound therapy. Vaccines are considered to be an excellent tool for effective interventions and eradication of various diseases in order to protect people from infectious diseases. Participants had high acceptance and good ideas on the combined use of malaria vaccines and ITN and their acceptance remained high even if the vaccine did not provide full protection, this is an important achievement of malaria vaccination policy decisions in Tanzania. Inclusive communication strategies should be designed to address stakeholder issues through a process that involves communities and health workers and should be implemented. Social factors associated with the adoption of a vaccine should be integrated into the communication strategy. In this regard, social actors such as front-line health care worker may play a key role and levitate appropriate actions.

From the Findings Experts underline the prevalence of Malaria as an hinderance to different parts of the society including the basic livelihoods and businesses. They opine that They conclude with explaining the failed policy for countries has made it clear that their intentions were to propose a new approach that beholds policies concerning the eradication of Malaria. Optimism should be encouraged, but also it should enhance the results. optimism sparked a campaign that eventually eradicated malaria from dozens of countries, but it also saw African delusions and donor fatigue as vague problems. Efforts to maintain the effectiveness of these tools and to develop new ones are urgent. Achieving maximum effectiveness requires integration into national healthcare systems: from the outset, the WHO expert committee developed a comprehensive and centralized plan for malaria eradication. In doing so, he built huge machinery that often-surpassed national governments and health ministries. Such systems have become isolated from national health systems and have failed to adapt to changing conditions, different levels of transmission, or problems with infrastructure. Control programs should be adaptable and responsive to local conditions. Health system capacity,

40 infrastructure, politics, demographics, socio-economic development and level of transmission and many other important factors that affect the delivery of services. Communities must be engaged: Without the cooperation of local people, malaria control efforts will be flattened. Projects and initiatives must be at the local level and communities must be very involved in this process. Communities can not only help deliver services for the treatment of malaria, but also monitor cases. New control options and technologies should be researched in conjunction with the implementation of existing tools. Malaria is an important target in this HIV Aims to prevent and counteract the spread of malaria with AIDS and other diseases. Coping with malaria will not only reduce morbidity and mortality from the disease, but it will also affect HIV / AIDS. This the link between the two diseases has been documented - HIV can increase the risk of malaria and death due to malaria, while malaria contributes to an increase in viral load in HIV- positive adults who are infected with HIV. For any kind of progress to take place it needs strong leadership and a clear signal from all around that malaria is a priority. Without this commitment, the disease will become a grim tale of lost opportunities, tangled funds and wasted political will. Pharmaceutical Research attempt to exacerbate this problem, there is no currently licensed vaccine to provide less expensive protection against infection, and many of the available drugs to treat the disease have become obsolete and ineffective due to the emergence of parasite- resistant germs. In addition, Anopheles mosquitoes, which carry germs to humans, are increasingly resistant to pesticides used to clean them from local areas. However, one of the most important barriers to the treatment and prevention of malaria is the reluctance of the pharmaceutical industry to enter the market. In sub-Saharan Africa, deaths occur in 0% and 80% of all clinical cases each year, respectively, with some mainly coming from India, Brazil, Afghanistan, Sri Lanka, Thailand, Indonesia, Vietnam, Cambodia and China. In the main cases there is a type of mosquito that is resistant to pesticides - and the mosquitoes that spread it also become resistant to the drug a large number of pharma companies have left the infectious diseases sector. That represent a huge challenge because we do not think this is the end of an infectious disease. As a result of integration into the vaccine business, the four major players control about 80% of the market for about $ 45 billion (CHF 43 billion). On the other hand, the development of an inexpensive, safe and effective malaria vaccine as part of a malaria control program is a priority for researchers in many countries, especially where malaria causes health problems. Most importantly, the malaria vaccine will supplement existing malaria control tools such as vector control and anti-malarial drugs, which control malaria poorly, and the mortality rate was one of the first outside Colombia when the SPF 66 clinical trials were conducted. Such a remarkable history raises the country's economic benefits, disease, and epidemic in Tanzania. Researchers have an important record of considering Tanzania when developing malaria vaccines because before an effective malaria vaccine is developed, a series of experiments and large investments are needed and should 41 include testing for various epidemics, including the severity of various infections and acceptance. Resistance to combined antimalarial therapies (ACTs) such as malaria control and reducing the new risks of malaria means a comprehensive and global response to ensuring that eradication of anti-malaria resistance is possible, with constant vigilance. Programs to develop programs such as the Roll Back Malaria (RBM) Partnership help ensure international support ahead of medical products. UHC The biopharmaceutical industry is helping to strengthen malaria prevention programs as part of our broader approach. Our support includes ensuring the availability of anti-malarial drugs and well-intentioned waste disposal equipment, improving hygiene and improving the skills of malaria health workers. Invest in R&D to create new solutions to malaria challenges. For example, our PDP helps develop new preventive and diagnostic interventions and our health program helps prevent drug retention and improve treatment. We currently have malaria products in more than 50 R&D development pipelines, including a Phase III product, and recently approved a new pediatric treatment. Focusing on those most at risk, it is time to work together to accelerate the care and treatment of malaria for people around the world. Companies should learn from each other and share skills with different partners. In doing so, we will explore new frontiers in the R&D of life-saving treatments and vaccines and establish beneficial relationships with resources to ensure that no time is wasted. Together we can change the way we deal with important global challenges, ensure that patients receive the care and treatment they need, and that no one is left behind.

Regarding the sector of tourism Health and macroeconomics go hand in hand, as good health for people enhances the country's economic outcomes, as it accelerates economic prosperity through higher levels of labor productivity, education and investment, and population change. However, all of these problems are often seen over time, combined with improved health statistics, and in many cases, it is difficult to establish a true causal relationship. International resources are limited, and decisions need to be made soon that investing in a termination program is more important than their use in non-health care-related projects or other health intervention programs. Affected countries could be linked to malaria eradication with an increase of .2.5 million visitors per year and US 32.2 million, which represents an average growth rate of 19.8% for all visitors to the affected economy. Mosquito-borne diseases place a heavy burden on infected people: they may suffer financially, including loss of health or poor health, as well as lost income and medical bills. While all communities are affected, there may be losses in productivity, pressure on health care services and potential costs in major disease control measures, but the local economy also suffers from financial losses, despite the worst spread of disease. This effect can be particularly acute on small islands, which use tourism as a platform for growth and sustainable economic development. Concerns have been expressed by staff that American and European tourists are

42 always watching the African continent as one country and do not know the great distances between regions. Sometimes, the biggest impact of a health epidemic comes from a completely inappropriate change of status. The lack of tourist attractions affects the entire tourism industry system. There are no visitors to the hotel revenue, restaurants, restaurants, shops and everyone you own. And since epidemics often strike very quickly and unexpectedly, the tourism industry has little opportunity to adjust to the changing number of visitors. As a result, airports may have to fly almost empty planes, hotel personnel have no guests to assist, and all passenger time may be immediately disrupted.

To sum up it is widely known that understanding a person's response to malaria and making plans is essential to the success of all malaria control strategies. As people better understand how to understand malaria, many of the social and moral barriers to the adoption and use of prevention strategies can be addressed in the development of malaria control programs. Similarly, a better understanding of health-seeking and behavioral treatment can lead to more effective communication strategies for malaria and encourage early treatment of clinical cases, especially in young children.

Conclusion: The incidence of malaria has dropped significantly in a number of countries in Africa, however this Malaria remains one of the dominant ill health of Africa and one of the average accounts for patient frequency in almost hospitals. Most of the countries the majority of children with malaria are not getting to public sector health care. In addition Malaria is a major inception of wicked incidence and mortality in children and pregnant women throughout Africa, more specifically between the Sahara and South Africa. The World Health Organization carries out a malaria control program on a global scale, focusing on local strengthening of primary health care, early diagnosis of the disease, timely treatment, and disease prevention. Though, according to the World Economic Forum-2020 Malaria could make a comeback due to the prevalence of the COVID-19. Interfering with COVID-19 in anti-malarial programs could lead to double-digital deaths in sub-Saharan Africa, the WHO have warned. Impact of

43 Covid 19 in the progress of eradication of Malaria Progress in the fight against malaria has stalled as mosquitoes and parasites have become resistant to treatment. Some predominant health officials argue that there is a chance to avoid death if regional leaders continue to take preventive measures. While the world is focused on tackling coronavirus, warnings about not losing other health risks are on the rise. The WHO argues the number of malaria deaths in sub-Saharan Africa could double this year Just as measles and polio vaccination programs are postponed for fear of spreading any coronavirus in contact with them, malaria can be another fatal consequence of the problem. In the worst-case scenario where all antiretroviral campaigns have been suspended and drastic of anti-malarial drugs drastically reduced - the number of malaria deaths in sub-Saharan Africa could reach 769,000. That is double the number of deaths in the region in 2018. These are not bad programs, emphasizing the WHO, indefinitely. There is a window of opportunity to reduce the possibility of high mortality. Although increasing every week, the number of reported cases of COVID-19 in sub-Saharan Africa is still lower than in other regions. COVID-19 is epidemic the fight against HIV, TB and malaria has a negative impact and threatens to delay progress for decades. Close to 75% of HIV, TB and malaria programs are distracted due to shutdowns, transport cancellation and transferring resources to COVID- 19. Recent research shows that COVID-19 could double the number of deaths from HIV, TB and malaria next year. By 2020 we may lose everything we have gained in the last ten years. We will not let that happen. We must unite to fight. Considering Economic Impacts: Malaria is the leading cause of death and disruption in Tanzania more than any other disease because of its prevalence in anti-malarial drugs. The study estimates that more than 1% of GDP is dedicated to disease, representing US 2. 2.2 Per person, and 39% of total national health spending. Their relationship between poverty and malaria has long been known but their methods are many and complex. Working in both ways, by holding communities to strengthen the cycles of poverty and disease. If malaria is to be controlled or eventually eradicated, the socio-economic conditions that fuel malaria transmission need to be considered. At the same time, malaria control should be seen as a strategy to reduce poverty. Government agencies provide about a third of their resources for disease. Independent costs, especially for drugs, coils, sprays and sleeping nets, represent 71% of the total cost. The link between poverty and malaria has long been well-known, but their methods are many and complex. Malaria is referred to as the epidemic of the poor. Although the disease is largely determined by climate and environmental factors, not by poverty, malaria affects the poor, at least those who know how to prevent and treat it. Given the treatment of malaria outside government institutions, performance management strategies in the private sector are essential. Along with private supplier regulations and other interventions such as promoting the use of sleeping nets in rural areas, further research and

44 application of information strategies are required. Community policies should be designed to influence behavior, encourage households to get an adequate flu diagnosis and complete appropriate treatment with appropriate medications.

Although many malaria control programs are currently not aimed at eradicating, and while many programs are considered successful based on early childhood education, we still need to understand whether measured programs make a difference in the health outcomes associated with malaria outside of climate change. Housing renovation or economic development which explains these changes at the human level. And of course, there is still much to learn about delivery strategies. Globally, COVID-19 has the potential to overestimate health systems. Interventions to stop the transmission of SARS-Cavi-2, such as traffic restrictions, absences, behavioral changes, closure of facilities and disruption of supply chains, may also delay malaria prevention activities. The effect of malaria is not only felt in the cost of the human suffering and death it causes, but also by the important economic expenditure and burden – to families/ households and national economies. Malaria slows economic growth and improvement and carries on the cycle of poverty. Research says that malaria will strain national economies, having a worst impact on few nation's GDP by an estimated 5 – 6%.

That induces the question: how businesses should deal with Malaria and other epidemics in near future? Business continuity plan may remain the appropriate solution to deal with the risk of infection. Such programs help companies stay in business and prepare for the worst or future epidemics or crises. Nevertheless, to move into the future, companies need to reflect their commitment. Businesses can play a key role in coordinating local response to an epidemic by planning a joint response to international and local stakeholders, supporting local communities and ensuring business continuity. Planning and management skills play an important role in responding to epidemics in countries with poor health systems and lack of management skills. In this regards, local health initiatives such as a development fund and community education to support staff and Prevention campaign. Collect money from offices in affected countries to buy protective clothing for local health workers. Contact local health facilities to identify immediate needs and the type of support that can be provided. In the end, global businesses need to reassure countries, whether they are sick or healthy. It appears fundamental to take into account the inherent risks and utter indifference and poor condition of health systems in Africa while doing business on the continent. Cooperation and current investment in Africa will be one of the only positive effects of this growing human health crisis - a new system for Africa designed to utilize locally defined and modern health systems, but acceptable, relevant, promoting societal integration and inclusive social Leading medicine.

45

REFERENCES: Articles Alonso, S. (2019). The economic burden of malaria on households and the health system in a high transmission district of Mozambique. Malaria Journal vol 18, number: 360. Briët, O. (2021). Priority Setting in HIV, Tuberculosis, and Malaria – New Cost- Effectiveness Results From WHO-CHOICE. Journal of Health Policy Management, Issue10. Chaki, P. (2018). Epidemiological characterization of malaria in rural southern Tanzania following China-Tanzania pilot joint malaria control baseline survey. Malaria Journal volume 17, vol 292. Finda, M. (2018). Relationships between house characteristics, malaria vector biting risk and community perspectives in rural Tanzania. Malaria Journal, vol 17, Issue 327. George, B. (2019). Malaria control in Tanzania: Current status and future prospects. International Journal of Immunology Sciences. Vol 1; Issue 1. Kapologwe, N. (2020). Development and upgrading of public primary healthcare facilities in Tanzania. BMC Health Services Research, vol 20, number: 218. Mosha, J. (2014). The independent effect of living in malaria hotspots on future malaria infection: an observational study from Misungwi, Tanzania. Malaria Journal, vol 13, Issue 445. Punnath, K. (2017). Malaria prevalence in Mangaluru city area in the southwestern coastal region of India. Malaria Journal, Vol 16, issue 1. Regina, N., Gonzaez, M. (2014). IS Barcelona Institute of Global Health. Sturrock, H. (2014). The independent effect of living in malaria hotspots on future malaria infection: an observational study from Misungwi, Tanzania. Malaria Journal volume 13, number: 445. Talapko, J. (2019). Malaria: The Past and the Present. Microorganisms. Vol 7(6): 179. Telemu, K. (2012). Prevention and management of malaria in under-five children in Tanzania: a review-Tanzania Journal of Health Research, vol 14, Number 3. Thawer, S. (2020). Sub-national stratifcation of malaria risk in mainland Tanzania. Malaria Journal, vol 19: Issue 177.

Book Ariey, F. (2019). Malaria Control and Elimination. Editions Ménard.

46 Journal  Harvard Business Review

 International Journal of Health Policy and Management (IJHPM)

 Journal of Health Management

 Journal of Health Organization and Management

 Journal International Journal of Healthcare Management

 Journal Policy development and advocacy

 Malaria Journal

 Business and Society Review

DICTIONARY/ENCYCLOPEDIA

 Cambridge Dictionary. Retrieved from https://dictionary.cambridge.org/

 Encyclopedia Britannica. Retrieved from https://www.britannica.com

 Dictionary of Business and Management, Oxford University Press

REPORTS:  WHO Malaria 2020. Retrieved from https://www.who.int/news-room/fact-sheets/detail/malaria Health care in Tanzania 2020  The WHO Global Malaria Programme. Retrieved from https://www.who.int/teams/global-malaria-programme  Severe Malaria Observatory 2019. Retrieved from https://www.severemalaria.org/countries/tanzania

47  Improving Socio Economic status may reduce the burden of malaria in Sub Saharan Africa 2019. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211205

 Covid 19 must transform the Definition of Global Health Security 2020. Retrieved from https://www.theglobalfund.org/en/blog/2020-11-19-covid-19-must-transform-the- definition-of-global-health-security/

 Malaria and Poverty in Underdeveloped countries2019. Retrieved from https://borgenproject.org/malaria-and-poverty-in-underdeveloped-countries/  Why is Malaria associated with poverty? Findings from a cohort study in rural Uganda 2016. Retrieved from https://idpjournal.biomedcentral.com/articles/10.1186/s40249-016-0164-3  UN Sustainability Goals 2021. Retrieved from https://www.un.org/sustainabledevelopment/

 Health System in Tanzania 2018. Retrieved from http://www.mmh-mms.org.mmh- mms.com/gesundheitsversorgung/gesundheitssystem-in-tanzania/index.php

 World Health Organization- United Republic of Tanzania 2018

 Socio-economic Impact of Malaria in Africa volume1 2018  US Commercial service. Doing Business in Tanzania 2016. Retrieved from https://tz.usembassy.gov/wp- content/uploads/sites/258/2017/02/Tanzania_CCG_2016.pdf

 Centers for Disease Control and Prevention 2018 https://www.cdc.gov/parasites/malaria/index.html  Raptim Humanitarian Travel. Retrieved from https://www.raptim.org/11-international-ngos-fighting-malaria/  What works in Malaria Control 2014. Retrieved from https://www.cgdev.org/blog/what-works-malaria-control  Malaria in children 2015.Retrieved from https://www.malariasite.com/malaria-children/

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Appendices:

Fig 1: Malaria Deaths

Fig 2: Global distribution of poverty tells us that malaria is strongly correlated with poverty.

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Fig 3 : Malaria Distribution in Tanzania.

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Fig 4: Tanzania GDP Composition.

Fig 5: World Health Organization reported this statement on the World Malaria Day 25th April.

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Fig 6: Efforts to prevent, control and eliminate Malaria contribute to sustainable development

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Theory of Change for infrastructure development of public primary health facilities in Tanzania From: Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving universal health coverage in Tanzania (2020).

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Health center and dispensary construction trends from 2005 to 2019 BMC Health Services Research volume 20, Article number: 218 (2020)

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PRISMA flow diagram showing the number of articles retrieved, screened, excluded, and included at each stage of the search of published articles examining the relationship of socioeconomic status with the epidemiology of malaria in sub-Saharan Africa. https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0211205.g001

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Reported malaria cases per WHO region from 1990– 2017.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617065/

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Fig 7: Malaria Prevalence among young children by household wealth level

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Fig 8: Malaria cases increase in Africa due to drug resistance

Fig 9: Diseases causing most deaths in Africa source WHO

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