This World Malaria Day, control programmes across the world are reflecting on how far they have come. Photograph: Joe Klamar/AFP/Getty Images
How one Ghanaian town sprayed away 74% of malaria cases in two years
The impact of malaria on productivity led one mining company to implement a comprehensive anti-malaria programme, now used in 22 districts. Sue George reports on the Obuasi model
Dated: Friday 25 April 2014
In the Obuasi area of Ghana, private sector investment in tackling malaria has led to substantial business and community benefits, with drastic reductions in malaria prevalence.
Obuasi is the site of a large gold mine owned by the company AngloGold Ashanti. In 2004, the company saw that its workforce were suffering high levels of malaria, meaning that many of them were off sick at any one time. This was clearly having an impact on its business.
AngloGold Ashanti set out to tackle this with a comprehensive programme that encompassed malaria prevention and treatment and featured indoor residual spraying as a major form of prevention. It is a comprehensive method of malaria control that the company now refers to as the Obuasi model.
"We had a goal of achieving a 50% reduction [in malaria prevalence] within two years," says Sylvester Segbaya, programme director for AngloGold Ashanti malaria control. "Within two years, we actually had a 74% reduction."
While the Edwin Cade hospital in Obuasi saw 6,711 cases of malaria in 2005, the figure was down to 973 by 2009. In late 2013, it was just 238.
The World Health Organisation recommends indoor spraying with residual insecticide (IRS) as a significant method of preventing malaria. It is "… a powerful way to rapidly reduce malaria transmission. Its full potential is realised when at least 80% of houses in targeted areas are sprayed," it says.
This was the case in Obuasi, where the spraying of mines, surrounding buildings, homes and then entire districts have meant that there are simply fewer mosquitoes that can spread malaria. This is benefiting all parts of the community, not just miners. People are spending less on malaria treatment, children are more likely to be healthy and attending school and under-5s are less likely to die of the disease.
Such a large programme could not be carried out by a private company alone. Partnerships with the public sector were key from the start. The programme was set up in collaboration with Ghana's ministry of health, which made regular reports to the National Malaria Control Programme.
This worked so well that in 2011 the Global Fund granted $130m (£77m) to the company to carry out this work in partnership with government and public sector bodies. The idea was to spread this work to other parts of Ghana. As of April 2014, 22 districts of Ghana have been treated. This will increase to 40 districts by the end of 2015 and will concentrate on the north of Ghana, where the malaria burden is greatest.
The work also involves training local people to carry out the residual spraying and to get involvement from all areas of the community. Though IRS has been criticised by some for exposing people to insecticide, Segbaya says that health issues are always taken into consideration. Rooms used by people with asthma or allergies are not sprayed and there is the added advantage that other pests, such as cockroaches and bed bugs, are destroyed.
So why despite this success has indoor residual spraying been so little used in comparison to the mass distribution of bed nets? Because it has to be carried out comprehensively in a particular area in order to be effective, and this can be both technically demanding and comparatively expensive.
"With bed nets, all you do is distribute them," says Segbaya. "With indoor residual spraying you have to hire people, train them in managing the pump, mixing insecticide, handling people's property, all of which require more skill."
Another factor is the cost – a net to protect one or two people costs £2-3. "Currently it costs around $400,000 (£238,000) to spray one district, which is maybe $10-15 (£6-9) per person. This is almost three times the cost of providing bed nets."
These figures may not be immediately attractive to donors, and cannot be borne by the public sector alone. However, the private sector may be better able to support these costs, especially when measuring them against increased productivity.
Trevor Keel is head of technology at the World Gold Council, the market development organisation for the gold mining industry. Many of its members – large gold mines – operate some kind of community health programme to support their workforce and the surrounding communities.
"Our interest initially stemmed from the fact that gold is used in the rapid diagnostic tests that are now the most common way of diagnosing malaria," says Keel. So protecting the miners and their communities from malaria seemed logical. "This is a great example of what the private sector should be doing," he adds.
AngloGold Ashanti – which also operates in Mali, Tanzania and Guinea – is now starting similar programmes in its other mines.
Obuasi is the site of a large gold mine owned by the company AngloGold Ashanti. In 2004, the company saw that its workforce were suffering high levels of malaria, meaning that many of them were off sick at any one time. This was clearly having an impact on its business.
AngloGold Ashanti set out to tackle this with a comprehensive programme that encompassed malaria prevention and treatment and featured indoor residual spraying as a major form of prevention. It is a comprehensive method of malaria control that the company now refers to as the Obuasi model.
"We had a goal of achieving a 50% reduction [in malaria prevalence] within two years," says Sylvester Segbaya, programme director for AngloGold Ashanti malaria control. "Within two years, we actually had a 74% reduction."
While the Edwin Cade hospital in Obuasi saw 6,711 cases of malaria in 2005, the figure was down to 973 by 2009. In late 2013, it was just 238.
The World Health Organisation recommends indoor spraying with residual insecticide (IRS) as a significant method of preventing malaria. It is "… a powerful way to rapidly reduce malaria transmission. Its full potential is realised when at least 80% of houses in targeted areas are sprayed," it says.
This was the case in Obuasi, where the spraying of mines, surrounding buildings, homes and then entire districts have meant that there are simply fewer mosquitoes that can spread malaria. This is benefiting all parts of the community, not just miners. People are spending less on malaria treatment, children are more likely to be healthy and attending school and under-5s are less likely to die of the disease.
Such a large programme could not be carried out by a private company alone. Partnerships with the public sector were key from the start. The programme was set up in collaboration with Ghana's ministry of health, which made regular reports to the National Malaria Control Programme.
This worked so well that in 2011 the Global Fund granted $130m (£77m) to the company to carry out this work in partnership with government and public sector bodies. The idea was to spread this work to other parts of Ghana. As of April 2014, 22 districts of Ghana have been treated. This will increase to 40 districts by the end of 2015 and will concentrate on the north of Ghana, where the malaria burden is greatest.
The work also involves training local people to carry out the residual spraying and to get involvement from all areas of the community. Though IRS has been criticised by some for exposing people to insecticide, Segbaya says that health issues are always taken into consideration. Rooms used by people with asthma or allergies are not sprayed and there is the added advantage that other pests, such as cockroaches and bed bugs, are destroyed.
So why despite this success has indoor residual spraying been so little used in comparison to the mass distribution of bed nets? Because it has to be carried out comprehensively in a particular area in order to be effective, and this can be both technically demanding and comparatively expensive.
"With bed nets, all you do is distribute them," says Segbaya. "With indoor residual spraying you have to hire people, train them in managing the pump, mixing insecticide, handling people's property, all of which require more skill."
Another factor is the cost – a net to protect one or two people costs £2-3. "Currently it costs around $400,000 (£238,000) to spray one district, which is maybe $10-15 (£6-9) per person. This is almost three times the cost of providing bed nets."
These figures may not be immediately attractive to donors, and cannot be borne by the public sector alone. However, the private sector may be better able to support these costs, especially when measuring them against increased productivity.
Trevor Keel is head of technology at the World Gold Council, the market development organisation for the gold mining industry. Many of its members – large gold mines – operate some kind of community health programme to support their workforce and the surrounding communities.
"Our interest initially stemmed from the fact that gold is used in the rapid diagnostic tests that are now the most common way of diagnosing malaria," says Keel. So protecting the miners and their communities from malaria seemed logical. "This is a great example of what the private sector should be doing," he adds.
AngloGold Ashanti – which also operates in Mali, Tanzania and Guinea – is now starting similar programmes in its other mines.
Source: http://www.theguardian.com/global-development-professionals-network/2014/apr/25/ghana-anglogold-malaria-reduction?CMP=twt_gu
Paulina says: Some good news......
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