Kenya will need about Sh42.8 billion between 2018 and 2020 to fight the disease yet the resources are not readily available.
At Pamela Atieno’s house in Siaya County, two boys aged five and three were running around the compound playing a game of hide-and-seek when we visited the home.
Ms Atieno waved and observed them briefly before leading us to a nearby tree shade.
“You know these children are my everything. They bring me so much happiness and make life worth living,” she said with a beaming smile.
“I love them so much, in a very special way, because they brought back joy and life in this house after my first born daughter went to heaven.”
Ms Atieno informed us that the deceased child, who was a year old, succumbed to malaria due to lack of proper treatment.
“I didn’t know much about the disease then. So when I realised that the baby had a fever, I just assumed it was nothing major and chose to go to a traditional healer instead of the hospital. And that’s how she died.”
Careful not to repeat the same mistake with subsequent children, Ms Atieno inquired and learned about prevention strategies for malaria and other childhood illnesses at antenatal care (ANC) clinics when she was expecting her two children.
“That’s where I got to learn about bed nets, malaria treatment and symptoms of the disease such as high fever.”
Ms Atieno is among the many Kenyans who have benefited from increased efforts by the government and other health stakeholders to enhance coverage and uptake of malaria prevention and control interventions across the country.
These initiatives have borne fruit. Indeed, statistics from the 2015 Kenya Malaria Indicator Survey show that the prevalence of the disease in the country is now eight per cent, down from 11 per cent in 2010.
In Western Kenya the prevalence of the disease is 27 per cent, down from 38 per cent in 2010.
“As a country, we’ve made strides in the fight against the disease. But we’re not yet where we want to be since coverage of malaria interventions is still not uniform in all areas,” said Njagi Kiambo, senior officer at the Ministry of Health (MoH) Division of Malaria Control.
“Some areas are doing well while others aren’t. Yet, we all need to move together because if one region lags behind, then we all suffer,” said Dr Kiambo.
In the Coast region, for instance, malaria prevalence rose from four per cent in 2010 to eight per cent in 2015, thus increasing the vulnerability of residents to the adverse effects of the disease.
War on the disease
To avert such drawbacks in the continent, the African Leaders Malaria Alliance (ALMA) — which tracks the progress of the war on the disease in the continent — has urged countries to be diligent and avoid taking their eyes off the disease lest they reverse gains already made.
“Even with the challenges, we need to keep working towards eliminating the disease as its impact on the society is huge,” noted Dr Kiambo.
A past malaria study found that the disease costs Kenya about $109 million (Sh10.9 billion) annually.
This amount shoots to $250.7 million (Sh25 billion) when costs associated with productivity losses due to malaria deaths are captured.
Moreover, the disease is the second leading cause of deaths in Kenya. According to the Economic Survey 2018, deaths from malaria rose 9.7 per cent to 17,553 in 2017. The most affected were pregnant women and children below the age of five.
To sustain progress made in the malaria fight, health experts note that it is imperative to establish sustainable financing sources both at the national and county levels. As has been the case for many years, all malaria interventions rely heavily on donor funding for effective rollout.
There are thus fears that gains made could easily go down the drain should the external funding subside.
“And even with the donor funding, we still don’t have sufficient resources to meet the needs for malaria control and prevention in this country.
So we need to look for additional sources of income locally,” said Zeba Siaanoi, advocacy specialist at Malaria No More which has been working with the MoH, county governments, philanthropists and the business community to help mobilise resources locally for the war on malaria.
Research conducted by Roll Back Malaria (RBM) on funding requirements for malaria control in Africa revealed that Kenya will need about $427,860,536 (Sh42.8 billion) between 2018 and 2020 to fight the disease yet these resources are not readily available.
The estimated funding gap that needs to be filled within the two years is about $267,550,156 (Sh26.7 billion).
“That’s why we need to mobilise resources locally in all counties, especially those at high risk of malaria transmission, so as to sustain and boost malaria control and prevention interventions there.”
Currently, only Busia and Kwale have established budget lines for malaria control in their jurisdictions. The money allocated for the disease fight in the two counties is Sh10 million and Sh5 million respectively.
At the recently concluded malaria summit in London, global leaders from the public, private and non-profit organisations called for such innovative funding approaches even as they raised over $3.8 billion (Sh380 billion) to help halve malaria cases in Commonwealth countries in the next five years.
This collaborative commitment is expected to prevent 350 million people from malaria and save 650,000 lives that would have otherwise been claimed by the disease in the region.
To utilise the existing scarce resources optimally, health experts note that malaria control interventions need to be targeted and sustained in areas where they are needed the most.
Christopher Odero, malaria expert at PATH Kenya, noted that since malaria transmission in Kenya is not uniform, resource allocation should be proportionate to the disease burden in an area.
“For instance, high risk areas like Western Kenya and parts of the coastal region need more attention as opposed to Nairobi or Central Kenya where there is very little or no malaria at all,” said Dr Odero.
He said that there is no magic bullet solution for malaria control and elimination; all existing interventions need to be fully exploited.
For malaria prevention, the Word Health Organisation recommends the use of insecticide treated bed nets that have been proven to cut transmission by 50 per cent.
It also advocates for indoor residual spraying which kills mosquitoes on walls of houses or other surfaces before they can bite people and transmit diseases.
Identification and destruction of mosquito breeding sites with chemicals and environmental management practises (like draining stagnant water and filling depressions that collect water) are also recommended.
To further avert infection, doctors prescribe monthly doses of malaria prevention drugs to expectant mothers so as to avert the detrimental effects of the disease.
But for people already infected, prompt diagnosis and treatment with recommended antimalarial drugs such as ACTs is paramount for speedy recovery.
Dr Odero said that complimentary interventions such as the new malaria vaccine, Mosquirix, are also expected to boost the war on the disease in high risk areas.
The Health ministry plans to provide the vaccine to over 100,000 children later this year in a pilot roll-out that will assess the feasibility of delivering four doses of the vaccine in real life settings while gauging its potential to reduce child deaths.
To enhance the vaccine’s uptake and support, Dr Njagi said continuous public education on malaria interventions is equally important.
“Take bed nets for instance, we’ve been successful in increasing their coverage but usage is still not satisfactory in high risk areas.
“We need to continue sensitising communities on their significance so they can embrace the nets.”
He noted that increased public awareness on malaria control will also help to counter cultural and religious beliefs that are detrimental to the fight against the disease; such as those linking the malady to witchcraft hence shunning medical solutions.
Dr Odero said that counties should also invest in enhanced surveillance practises and epidemic response programmes to rapidly contain any malaria outbreaks.
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