A Cross-Sectoral Approach

A Cross-Sectoral Approach A . A£ O O e AvAg a* n e- e- o- Malaria and Development in Africa A Cross-Sectoral Approach American Association for the Advancement of Science Sub-Saharan Africa Program Under Cooperative Agreement with U.S. Agency for International Development Africa Bureau No. AFR-0481-A-00-0037-00 September 1991 Table of Contents Foreword ............................................................. v Executive Summary ....................................................ix Introduction MalariaandDevelopmentinAfrica:A Cross-SectoralApproach................ 1 Background Mala,'ia in Sub-Saharan Africa ........................................... 5 Report Recommendations ...................... ........................ 9 L Broaden Attack on Malaria by Strengthening Cross-Sectoral Cooperation for MalariaControl ..................... ...................... 11 Background ................................................ 11 Actions for National Governments .............................. 11 Actions for Donors .......................................... 13 Support Existing Cross-Sectowrl Cooperation in Sub-Saharan Africa ...13 I. Utilize Criss-SectoralApproahandResources to CombatMlaria Associated with Development Efforts .............................. 15 Potential Impact of Resource Development Projects on Malaria ............................................... 15 Example: Irrigation Development and Malaria Incidence in Zanzibar .. 15 Opportunities for Control of Malaria Associated with Development Efforts ...................................... 16 II. StrengthenLocalCapacity,IncludingDeveloping Cross-SectoraApproaches...................................... 20 Training ................................................... 20 Capacity Building ........................................... 22 Option 1: Regional Resource Centers ....................... 22 Option 2: Network of Specia ists .......................... 24 Option 3: Malaria Institute ............................... 25 IV.SustainableMalariaControlRequire;a Community-BasedApproach ...28 Recognizing the Social and Environmental Factors That Influence Behavior ........................................ 28 V. RaiseGlobalAwvareness of the Magnitude ofthe MalariaProblem in Sub-SaharanAfrica .......................................... 31 Increasing Attention to and Resources for Malaria ................. 31 Formulating :and Implementing a Market Strategy .................. 31 VI. EncourageInnovativeApproachesto MalariaPreventionandControl ... 33 Focus on Priority Populations in Addition to Pregnant Women and Children under Five Years of Age ............................ 33 Take Advantage of the Recent Movement toward Decentralization of Governments .......................................... 36 Establish Pilot Initiatives to Serve as Models for an Integrated, Cross-Sectoral Approach to Malaria Control ................... 37 Establish Incentives and Penalties for Individual Behaviors and Commercial Practices That Affect Malaria Transmission ......... 37 Promote Strategies to Prevent Human-Vector Contact .............. 37 Conclusion LessonsLearned ........................................... .......... 39 References ........................................................... 41 A ppendix ............................................................ 43 ListofBackgroundPapers ............................................ 45 BackgroundPapers .................................................. 47 PanelofExperts andOtherContributors................................ 223 iv Foreword The American Association for the Advancement of Science (AAAS) is the leading general scientific society in the US, with over 130,000 individual members. AAAS is also a federation of some 300 affiliated societies and academies, encompassing the physical, biomedical, and social sciences as well as engineering. For more than forty years a major goal of the AAAS has been "to improve the effectiveness of science in the promotion of human welfare." Programs have accordingly reflected this deep concern about the interac tions between science and society. In the international arena AAAS has capitalized on its relations with scientific and engineering institutions here and abroad to carry out collabora tive activities that address this goal. Since the early 1970s AAAS has devoted significant resources and attention to enhancing the contributions that science and technology can make to the economic growth of develop ing countries. Common to a broad array ofAAAS initiatives related to the developing world has been the forming of working partnerships involving foreign scientific groups, AAAS, its affiliated societies, and funding organizations. For nearly a decade now the AAAS Sub-Saharan Africa Program has addressed selected problems related to science, technology, and development in Africa, always in close collaboration with African scientific and academic organizations. The AAAS study of Malaria and Development in Sub-Saharan Africa conducted during 1990 and 1991, which is the subject of this report, has been among the most challenging of these endeavors. It has required our mobilizing and guiding a team of scientists and practitioners from Africa and abroad, with a broad range of specialized technical expertise and with solid on-the-ground experience, in order to attack a very serious, and extremely obstinate, health problem in the region. During 1990 AAAS and the Agency for Intenational Development (A.I.D) entered into a Cooperative Agreement under which AAAS would harness scientific and area-specific knowledge in order to examine the relationships between malaria and development in Africa and thereby develop innovative, practical strategies for preventing and controlling the disease. In particular, AAAS has been committed to taking a broad-gauged approach to malaria in Africa, one that gives serious weight to sociocultural, behavioral, and environ mental issues, especially their manifestation at the local level, as described below, in the introduction. The outcome of fifteen months o' concentrated study, and collective delibera tions, is crystallized in this report. It contains recommendations for action, and is intended to provide general policy guidance to A.I.D, imd to other organiz'ations explicitly concerned with malaria in Africa. AAAS adopted a several-stage workplan in carrying out this study of malaria and develop ment in Africa, relying on a sequential model that has proved effective in the past as well. Initially a small US steering group was selected, with its members drawn from key disciplines, including those in the natural end social sciences and engineering, all distin guished by having spent much of their professional lives working in Africa and other parts -4'/ of the developing world. The major task of this group was to conceptualize and map out the overall scope of work, thus establishing the basis for the next agenda-setting phase of the project, which included experts from sub-Saharan Africa. (A list of Steering Committee Members and of the other participants in this project is found in the Appendix.) Since Saptember 1990, when it first met as a working group, this larger Steering Committee has assisted staff in all aspects of the project. The comerstone of our multidisciplinary study was the intensive workshop held in Mombasa, Kenya, from May 27 through 30, 1991. Some two dozen participants set aside their customary responsibilities in order to prepare background papers for circulation, to travel to Mombasa, and then to engage in several days, and nights, of intensive discussion ofvital subject areas, during plenary sessions and especially within three informal working groups. Their involvement did not end when they left Mombasa, however, and participants were extremely helpful, and diligent, in reviewing and emending drafts of this report and of the appendix material. Indeed the report could not have been completed at this time, and in this form, without the contributions ofall the workshop participants, which are hereby acknow ledged, with gratitude. The report, to the extent possible, is a distillation of the collective wisdom of workshop participants. It has also benefitted from input provided by countless other specialists consulted over the past fifteen months. The interpretations and conclusions found in the report, however, are those of its contributors - members of the Steering Committee and other participants in the workshop - and ofstaff of the AAAS Sub-Saharan Africa Program. It is staff members who bear ultimate responsibility for their presentalion herc. The edited papers included in the Appendix are attributable solely to their authors. This report and background papers do not purport to represent the views of the American Associatiun for the Advancement of Science nor of the Agency for Intemafional Development, which undertook this work jointly, under a Cooperative Agreement. The overarching aim of this study, namely, the formulation of strategies for coping effec tively with malaria in the context of African development, does not end with the issuing of this report. AAAS intends to continue to work with African scientists and their institutions, and other organizations committed to combatting malaria in the region, disseminating the findings from this work, so as to ensure their reaching the attention of decisionmakers; encouraging the application of this approach, and its specific methods, to future malaria control endeavors in Africa; and continuing to foster capacity-building

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