28 Sep Three Questions with Balla Kandeh: On the Road to Eliminating Malaria in The Gambia
Balla Kandeh is the program manager for the National Malaria Control Program (NMCP) in The Gambia. As a public health specialist and entomologist, he has more than 25 years of experience with the Ministry of Health and Social Welfare across various regions and districts in the country, including supporting the malaria program for the past 15 years. HRH2030’s Capacity Building for Malaria activity supports countries such as The Gambia to achieve their malaria control and elimination goals.
1.Tell us about the malaria situation in the Gambia and the success your program has achieved over the past few years?
A lot of progress has been made over the past 10 years. Malaria prevalence has been reduced from four percent in 2010 to 0.2 percent in 2014 and most recently, it was 0.1 percent in 2017.
So how did we do this? There are three main points: First, we developed two key strategic documents to guide our interventions – the Malaria Strategic Plan and the Malaria Policy – both cover the period of 2014 to 2020. Second, in these two documents, we outlined seven core intervention areas, these are: malaria case management; vector control; malaria in pregnancy; partnership and coordination; monitoring and evaluation; behavior change communication, previously known as information-education-communication; and seasonal malaria chemoprevention. We have had contributions from different interventions, so we cannot single out one specific intervention and say that this is the most important – it’s about the full package. However, research shows that the most cost-effective intervention is under the vector program, bed net distribution. It has been recognized worldwide that the use of bed nets can reduce morbidity by 50 percent. That is huge. Also important is indoor residual spraying. These two interventions are the key drivers toward the prevention and control of malaria. Third, I will say, partnerships, partnerships, partnerships. Partnerships are key to whatever we are doing. We cannot just blow our own trumpets and feel like it is our own making, because we have had a lot of contributing organizations. Among them are Catholic Relief Services and its partners Health Promotion and Development Organization, Agency for the Development of Women and Children, and Catholic Development Office; MRC which is the Medical Research Council at London School of Hygiene and Tropical Medicine, as well as The West African Health Organization, WHO, UNICEF, and of course Roll Back Malaria just to name a few.
So, it is through these three pillars that we have seen success. And when we conducted a malaria indicator survey in 2017, with over 20,000 blood samples, the prevalence had dropped to 0.1 percent, which means we are on the road to eliminating malaria in The Gambia, and that is very exciting.
2. Congratulations on your achievements! What do you see as the country’s next challenge, or what is left to achieve?
I think the key challenge is ensuring adequate resources to eliminate the disease. We have come this far, and we are proud of our accomplishments, but the further down you go, the more difficult it is to reach elimination. Malaria control takes less effort and is cheaper than reaching elimination, which involves consolidating achievements and performing surveillance to make further progress. It is costlier as you approach elimination because we are looking at and following one case at a time very closely. Tracing one case at a time to its source is more expensive than managing thousands of cases through general malaria control mechanisms. Meaning, if you perform contact tracing of a particular case in a community, you have to backtrack the individual’s movements for two weeks prior to the diagnosis to locate the source of the infection and then test and treat potential contacts. In addition, you have to follow the individual moving forward to ensure clearance of the malaria parasite from his/her blood. Getting to that level requires a lot of energy, manpower, and technical support.
Unfortunately, we are a victim of our own success. Because of our achievement in reducing malaria prevalence, donor support is decreasing. Our main challenge now is the need for increased resources. In addition to identifying alternate donor funds, we need to think creatively about new and innovative approaches such as alternative financing schemes, domestic resource mobilization, and leveraging the private sector, so we can provide the surveillance required to reach elimination.
3. HRH2030 is relatively new to partner with the NMCP in The Gambia. How can we best contribute to supporting your program’s goals?
Providing a long-term technical advisor to support the program, Dr. Dorothy Onyango, is a very key starting point. In addition to the technical support you are currently providing, our team needs HRH2030 -supported capacity building to sell our program to new and local partners and thus mobilize and secure additional resources. We are a small country – the smiling coast of Africa – and we yearn to support our own advocacy and resource mobilization efforts to give us the little push we need to cross the finish line and end malaria
Photo: In The Gambia, a health worker with Riders for Health demonstrates proper bed net usage to a village woman. © 2009 Riders for Health/Tom Oldham, Courtesy of Photoshare