April 24, 2012 11:43 pm

Ghana: Going beyond handouts to improve healthy outcomes

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Thomas Sandow, his wife Alice and children Henry and Irene demonstrate the benefits of fitting bed nets properly©Malaria No More UK

Thomas Sandow, his wife Alice and children Henry and Irene demonstrate the benefits of fitting bed nets properly

In a small hamlet up a rugged dirt road from Yawkwei in Ghana’s Ashanti region, Emmanuel Appiah pays a morning visit to Felicia Donkor, ducking swiftly from the makeshift shop on her porch into her tiny living quarters.

It is three days since he passed by to hand her a blue plastic mosquito net. Now he wants to check it has been installed correctly and is being used to protect her and her children from malaria as they sleep.

“I’m very happy with it,” she says, pointing to the net dangled over their single shared bed as she describes how her family has suffered from the disease in the past.

Mr Appiah, along with a dozen other volunteers recruited by a local pastor in recent weeks, had to get up before dawn for several days – arriving before sun-up, when the farmers leave for their fields – to distribute 700 bed nets paid for by international donors and the government’s own malaria programme. For most, they were the first received by the local community, which clubs together to offer small gifts or food to the distributors.

In many ways the work mirrors that being undertaken by others across Africa, as public health officials seek to implement pledges for universal coverage of bed nets, a practice that already appears to be having a significant affect in reducing cases of malaria.

However, there is one important difference in Ghana. In some countries, the emphasis has been primarily on distribution, ensuring that bed nets are delivered to the country, the village, or perhaps to individuals.

But in Ghana there has been greater focus in recent months on improved outcomes, for example, ensuring the nets are correctly installed and their users are educated through a “hang-up” campaign.

There are plenty of apo­cryphal stories about nets being misused for fishing, bridal veils or fences. There are sensitivities about the cultural associations of different coloured nets. And there are certainly frustrations about the hotter, stiffer material of some nets and the greater difficulties of hanging rectangular than conical ones.

But the very practical aspects of hanging up the nets, now being closely studied and replicated elsewhere in Africa, include removing the plastic outer wrapping, helping install them and educating recipients as to their use.

This reduces the temptation to resell them, tuck them away to use as a gift or store them for the future.

Foreign donations have supported Ghana’s strong local efforts, including assistance from the UK’s Department for International Development and the US President’s Malaria Initiative, as well as non-profit organisations such as Malaria No More.

The country’s relative economic prosperity, physical safety and political stability – compared with many of its west Africa neighbours – has helped to foster significant innovation, ranging from the introduction of a national health insurance scheme to the non-profit mPedigree system, which uses mobile phones to verify if medicines are counterfeit.

Accra, the capital, has gained a mosquito research centre funded by Vestergaard Frandsen, the bed net manufacturer, which it moved from neighbouring Ivory Coast after concerns about security.

The country hosts a pilot of the Affordable Medicines Facility – Malaria, which is subsidising artemisinin combination therapies to make them accessible to patients buying drugs in the private sector, although some local medicine manufacturers express frustration at being excluded pending international audits of their quality.

Paul Lartey, manager at US company LaGray Chemical’s Ghana office, says: “Our government should support people like us. Reliance on donors is unsustainable.”

Ghana also has two clinical research sites for GlaxoSmithKline’s experimental RTSS malaria vaccine, being tested across Africa.

Samuel Adjei, clinical co-ordinator for the vaccine site at the Presbyterian Hospital in Agogo, sees signs of improvement while stressing the need for fresh approaches.

“Artemisinin combination therapy has made a huge difference,” he says. “But we still rely on microscopy and don’t have rapid diagnostic tests. More than 30 per cent of paediatric out-patients have malaria.”

One concern is a fresh push for pesticides to kill mosquito larvae, pushed notably by Cuba in Ghana and much of Africa. While the approach has been successfully applied in limited areas in some countries, the latest advice from the World Health Organisation is that its current potential on the continent is modest.

Widespread use risks not only proving ineffective but is also wasteful of increasingly scarce resources.

The most significant threat noticed in Ghana is reduced donor funding, which could cause recent developments to falter and be lost.

Michael Steen Lunde, Vestergaard Frandsen’s regional manager, says: “We need to find fresh mechanisms for financing. Malaria may be becoming less sexy, but it carries on and will come back to bite with a vengeance.”

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