2nd Global Partners Meeting, Harare, Zimbabwe

WHO/CDS/RBM/99.09

RBM logo 2^ND MEETING OF THE RBM GLOBAL PARTNERSHIP
ROLLING BACK MALARIA IN AFRICA

Harare, Zimbabwe
30 June - 1 July 1999

Progress in Countries,
Consensus on Core Concepts,
Next Steps

Draft For Comment

Table of Contents

Executive Summary
Background
Meeting Methodology
Progress and Issues
Guidance on approaches to four core concepts at country level
Next

ANNEX I     Final Agenda
ANNEX II    Group Assignments and Results
ANNEX III   List of Participants
ANNEX IV   List of Documents

A. Executive Summary

This document reports on progress and outcomes from the 2^nd Meeting of the RBM Global Partnership that took place in Harare, Zimbabwe. The meeting was organised jointly by the WHO Roll Back Malaria Cabinet Project and the WHO Africa Regional Office, and hosted by the Africa Regional Office, and the Regional Director Dr. Ebrahim Samba.

The meeting was attended by over a hundred participants (annex 2). It purposefully included a dynamic group of representatives from development and research institutions, endemic country governments, NGOs and private sector companies. These individuals and institutions often have different perspectives and mandates but share a common commitment to work in partnership, and are unified by a common approach to roll back malaria.

It is strongly held that with existing tools we, as a global partnership, can succeed in significantly reducing - by at least half - the burden associated with malaria within the next ten years. New tools will speed progress, but even with these tools it is recognised that reducing the burden of malaria and ensuring that gains are maintained over the long term is extremely complex. It is because of this complexity that a global movement to Roll Back Malaria has been initiated. The movement is supported by a broad based partnership with governments of malaria affected countries, UN organisations, development Banks, bilateral aid agencies, NGOs, the private sector, and research and development groups and organisations actively supporting community action.

This Harare meeting reported on the progress of RBM Global Partnership action in countries – with a particular focus on Africa – during its first year. The meeting went further, and through well developed presentations and carefully facilitated groups, emerging issues were identified and explored. Strong recommendations were put forward to ensure effective country-level RBM action over the coming months. Approaches were developed and recommendations made in the following areas:

How malaria action could be better incorporated into health sector reform,
Ways in which the private sector and intersectoral action could be brought into country-level partnerships
Ways in which country partnerships could foster community-level action and catalyse a social movement to roll back malaria, and
Means through which roll back malaria effort could best be financed within the context of ongoing efforts by governments and donors to move (where possible) to supporting health sector budgets at central and district level.

In addition, in the areas of strategy and guidance, over the next 6 months the RBM Global Partnership is committed to:

Joint work undertaken by governments and supported by country partnerships to initiate national efforts for RBM action

Finalising the WHO-Wide Composite Strategy Workplan and Budget for Rolling Back Malaria

Taking forward work on roles, functions and organising arrangements for the RBM WHO Cabinet Project, RBM Global partnership

B. Background

In July 1998, The WHO Director General Gro Harlem Brundtland launched the Global Partnership to Roll Back Malaria (RBM). Roll Back Malaria builds on a strong foundation of support and efforts undertaken by the African Heads of States, WHO's Africa Regional Office, science and research communities and G8 Summit leaders. To optimise the effectiveness of WHO's contribution to rolling back malaria world-wide, the Director General placed RBM under the WHO Cabinet. The RBM Cabinet Project was developed so that it could function as secretariat for the Global Partnership -- providing strategic direction, ensuring consensus, and catalysing action. It will also enable WHO to be an effective actor in that partnership by uniting WHO departments and regional offices around core RBM strategies and principals.

July 1998 marked the beginning of an 18 month RBM preparatory period which would focus on the development of strategies, systems and partnership arrangements that could best support countries as they initiate action to roll back malaria. The formal UN basis for the Global Partnership was formally established between UNDP, UNICEF, WHO, and the World Bank in New York on October 31^st, 1998. The partnership already included representation of endemic countries and was quickly expanded to include bilateral government agencies, the private sector, and NGOs. The birth of this culminated in the 1^st Global Partnership Meeting to Roll Back Malaria, hosted by WHO Geneva on 8-9^th December 1998.

It was agreed that during the RBM preparatory period there would be three meetings of the Roll Back Malaria Global Partnership, at six monthly intervals, and then a subsequent move to annual meetings, which would be hosted either by WHO or other partners. The broad aims of these first three meetings were set out as follows:

1^st meeting	Consolidating support for rolling back malaria (Geneva, 8 – 9 December 1998)
2^nd meeting	Consensus on key concepts, issues and solutions, strengthened by a review of progress to date in Africa (Harare, 30 June – 1 July 1999)
3^rd meeting	Partnership arrangements, organising principals and progress during the preparation phase (Geneva, 2 – 3 February 2000)

C. Meeting Methodology

Some of the meeting participants had extensive exposure to roll back malaria thinking and have been instrumental through its evolution. For others it was their organization, or their country's, first formal involvement with the Roll Back Malaria Global Partnership. Thus the meeting aimed to accomplish a range of critical tasks.

It needed to:

introduce key concepts and principals for discussion to those who were less familiar with roll back malaria,
report on progress and identify key issues and recommendations based on work to date in Africa over the last year, and fundamentally,
engage partner representatives around the table to help guide each other, and the RBM Cabinet Project, on the way forward at country level – particularly with some key issues.

Presentations were made by representatives of endemic countries, bilaterals, multilaterals, and private sector institution. To provide material for discussion, presenters were asked to both report on progress and critically examine key issues and challenges they saw emerging. Significant discussion time was preserved throughout. Through carefully facilitated groups, emerging issues were identified and explored and strong recommendations put forth to ensure effective country-level RBM action over the coming months.

Significant input in the planning and structure of the meeting was received from endemic country government representatives and other global partners.

D. Progress and Issues

Strategy, Principals, Guidelines and Partnership

During the first Partners meeting in December 1998, it was widely held that WHO leadership for strategy and partnership development, and the role as Secretariat for the Global Partnership, could not be assumed. WHO needed to "earn the right to lead". The focus of partnerships needed to be at the country level - with national governments in the lead - rather than on rigid partnership arrangements built at international level. The Global Partners steered away from developing blueprints for action in favour of guiding principals that would allow for flexibility of countries to draw on support from the Global Partnership in designing their responses. It was widely agreed that in the six months following the first Global Partnership meeting, significant progress had been made by the Cabinet Project, the WHO Regional office for Africa, and other partners in the articulation of strategies, principals, guidelines and partnerships arrangements. The following aspects of progress were highlighted:

Roll Back Malaria Strategy, WHO Composite Workplan and Budget
Guidance on inception process at country level
Development of Advocacy Materials
"Six elements" of the technical approach to Rolling Back Malaria
Draft framework for implementing the internet based information site
Strengthened Communication linkages between global and regional partners

Issues and challenges

Major issues addressed during discussion included:

The need for consensus and continued development of targets for Roll Back Malaria at global and regional level were emphasised. The stated goal of halving mortality and morbidity burden associated with malaria was seen as technically possible but will require significant resources and effort.
Resource mobilisation was discussed as a clear priority (particularly at country level) over the next 12 months.
The institutional implications for WHO of a transition from a program of 'Accelerated Implementation of Malaria Control' to a country partnership in support of rolling back malaria were discussed. The capacity requirements for regional and country offices in particular were highlighted especially given what is perceived as WHO's limited capacity at country level to support health sector development dialogue and efforts. Overall reform in WHO should lead to WHO pulling cohesively together around a WHO-wide approach to malaria. It will also address some of the problems with the flow of resources.
The first Global Partners meeting saw a commitment to explore establishing a small Director General's 'contact group' for the partnership. This is not yet in existence. It has been difficult to secure agreement as to who will be in this group given the sheer number of partners interested in involvement in this body. The idea has been put on hold for the time being so that the institutional implications can be thought more carefully through. One of the thrusts over the next eight months will be to focus strategically on an institutional frame for country partnerships
The need to develop a stronger institutional basis for the global partnership over the next year came out strongly. The partnership is clearly strong and functioning, but its sustainability and effectiveness over the coming years requires that interactions between partners involve institutions and not just personalities

Country Action to Roll Back Malaria

It was necessary to think through country experiences with Roll Back Malaria in a critical manner during this early stage. Some of these countries have, for some time, been thinking, initiating action and helping to jointly define an approach to RBM. Presentations by representatives from Tanzania and Mozambique highlighted how RBM principles and approaches are being adopted and adapted in countries based on political commitment, the nature of health sector reform activities and other factors. These presentations and subsequent interventions by other national representatives enabled participants to discuss emerging issues and strengths of the RBM partnerships at country level.

During discussion periods, interventions from country representatives of Senegal, Nigeria and Sudan revealed that countries in the region are getting started with significant action. Senegal contributed examples of effective partnership development and innovation particularly in the area of sub-regional and intercountry co-operation. A presentation on Roll Back Malaria in Complex Emergencies together with subsequent interventions, revealed that there is strong potential for positive action emerging within these countries.

Discussion revolved around ways in which the Roll Back malaria concept will alter perceptions of malaria control since its acceleration from 1998 onwards. This transition will not be possible unless supported by countries. In order for RBM to succeed there has to be a change in the way people in responsibility work.

Issues and Challenges

Presently, even in countries that set their own priorities and pursue them through sector-wide approaches, malaria is often not high on the list of national priorities. It is often not reflected adequately in the allocation of resources. This maybe is because the contribution that malaria has to the burden of disease is not fully appreciated. Countries must be supported in being able to assess burden of disease and use this knowledge to set priorities.
There is a need to continue simplifying and clarifying the messages of roll back malaria, particularly at country and community levels
Trans-national approaches and programmes should be encouraged to strengthen individual country approaches
Political commitment to change policies and approaches to malaria control will be essential in most settings.
Joint planning and undertaking of country missions by partners must occur wherever possible. To facilitate this requires a stronger system of communication among agencies.

How the Partnership is working together in support of rolling back malaria in Africa

The partnership is coming together in strong and innovative ways. Presentations by the World Bank, UNICEF, USAID and DFID illustrated the ownership and responsibility for RBM which is held by a broad number of agencies, each integral to defining their comparative advantage and core inputs into the RBM strategy.

Some examples of how these roles are emerging were given by the World Bank and DFID as they highlighted their role in helping to define the strategy, bring partners together in the areas of health sector development, and examining the way in which malaria action within countries is financed. The Africa Development Bank and World Bank put forward ideas and approaches for better intersectoral collaboration within the context of roll back malaria. UNICEF emphasised how it can help partnerships to massively increase the numbers of people within communities who sleep under bed nets. UNICEF's integral role in helping the partnership to support community action was made clear. USAID articulated its approach around treatment policy, surveillance, norms and standards, support of improved case management through child survival programs, and strong links with research and development efforts for new tools.

In discussion, organisations such as the Red Cross highlighted how working with their vast network of volunteers at community level in Africa, they could support community action and movements to Roll Back Malaria. The French Government highlighted its commitment institutionally, technically and financially.

Presentations by private sector partners - such as the representative from the Italian Oil Company ENI - challenged us to think outside the norms at the potential of harnessing the private sector for RBM advocacy work, and to massively expand prevention and treatment coverage. Dr. Vincenzo Boffi began his presentation by discussing how ENI has contributed to Roll Back Malaria in Azerbaijan. He went on to stimulate discussion on how ENI, and by extension other private sector companies, would like to expand on this partnership through means other than financial contributions. This lead to other private sector entities making similar offers.

Issues and Challenges

Emphasis needs to be placed on changing the way 'we' [multilateral and bilateral agencies] work to support countries articulate, and deliver on, their strategic priorities.
Over the next year, there needs to be a focus on translating (i) the high level institutional support and (ii) the efforts of each agencies "projects" and "teams", to the mainstreaming of RBM thinking throughout multi-lateral and bilateral agencies.

E. Guidance on Core Concepts

Many participants felt that it was time to firm up on critical actions to be undertaken by partners to Roll Back Malaria in Africa. In work done prior to the meeting, the following areas were identified as those that should be explicitly discussed and developed during the meeting:

How can partners contribute to a sustained capacity to roll back malaria within the context of health sector development efforts
Potential private sector and intersectoral collaboration at country level to roll back malaria
Function and challenges for country partnerships to support and catalyse community level action
Financing issues for rolling back malaria at country level and country resource mobilisation in different settings

Each of these topics was explored by two groups. The two groups then convened to consolidate their thinking and findings into a joint presentation in plenary. Through presentation and discussion, solid recommendations were provided to the RBM Cabinet Project on how the Global Partnership could support the Cabinet Project and countries in moving forward in these distinct areas (see Annex – for detail). Participants were encouraged to frame recommendations and next steps into time intervals of six months (to cover the end of the RBM Cabinet Project preparatory phase), and two years. They were encouraged to see these recommendations as those for the RBM Global Partnership as a whole, not just to the WHO Cabinet Project.

a) Sustained capacity to roll back malaria within the context of health sector development

There is widespread enthusiasm for the Roll Back Malaria approach to reducing the burden of malaria in countries by working within the context of health sector development efforts. In this way ownership and prioritisation can be assured by the countries concerned and efforts made sustainable over the long term. National governments, and partners that work with them, are now disentangling what this means in operational terms. In practice, this reflects both health sector development efforts and the malaria situation in specific countries. Many are finding it difficult to contemplate changes to the way in which malaria control is planned and financed given the low level of human and financial resources available. To respond to pressure for rapid results they see the first priority as getting more funds into malaria control action.

The presentation suggested that earmarked support for malaria control action, outside the context of other health actions, may not be essential unless specifically geared to malaria epidemics. Even then, action should be undertaken within the context of wider public health action. Several relevant examples were presented (e.g. Mozambique, Mali, Burkina Faso and Tanzania).

It was also recognised that, given the burden of disease attributed to malaria in most parts of Africa, Roll Back Malaria has the potential to initiate processes to roll back ill health. It can assist countries prioritise and plan, and mobilise political support for action to tackle high burden disease. It means that overall, roll back malaria efforts have the potential to serve as a lens to view and promote the progress of health sector development efforts.

The country context in roll back malaria becomes crucial. Examples of RBM action within the differing health systems of Zimbabwe (centralised) and Ethiopia (decentralised) were given. Health sector development efforts commenced in Ethiopia in 1997/98. RBM was launched at the same time and because the burden of malaria in Ethiopia there has been real and early success in uniting the two movements in a decentralised systems. Participants re-iterated the value of building on pre-existing public health action (e.g. IMCI) to get a more intense reduction of the malaria burden and to build on pre-existing partnerships where they are seen to be effective.

Recommendations

Effective communication within and between partners is essential. National authorities need to be in a position to lead country partnerships action to roll back malaria
Concerted country action that demonstrates the effectiveness of partnership work within the context of health sector development should take priority over the next six months
Human and financial resources need to be mobilised to support a transition from "isolated" malaria control to sector-wide efforts to roll back malaria - and to support these activities in the long term
Where necessary assessments (locally generated) must take place and access to technical support must be made available
Globally and regionally there is a need for wider understanding on the roles and responsibilities of different partners on ways in which partners action is co-ordinated, and means through which countries can access support
The development of blueprints for action must be avoided. Guiding principals must be developed but these must remain adaptive, incremental and country specific
Emphasis on roll back malaria in the context of health sector development should result in partners agreeing to work differently and more effectively: this may be best started in a few countries with an opportunity for learning and adaptation
There was a suggestion for a working group based at a country or multi-country level which dealt with issues on capacity development and retention.

b) Private sector and intersectoral collaboration at country level

Two groups met to discuss the challenge of stimulating, informing, and maintaining public private partnerships and intersectoral collaboration to Roll back Malaria. The groups convened to share their observations and make recommendations to the RBM partnership. The group presentation and plenary discussions where stimulating and provided:

Greater conceptual clarity and definitions of private sector which included both health sector and non-health sector actors, profit and not for profit actors in relation to malaria
A large set of previous and ongoing examples of partnerships
Insight into the range of incentives for the private sector to engage in roll back malaria which included profit, commitment to public well being, public and labour relations, supportive regulatory and legal frameworks.
The incentives for intersectoral action are somewhat different and requires a transition from vertical malaria programming and the engagement of other public sectors in the context of their development activities
Malaria operations tend to be 'operations' oriented. To achieve effective operation by other sectors, they must take on a regulatory role. In the health sector the environmental health services have traditionally played this regulatory role.

Various modalities for private sector involvement were discussed. The example of 'corporate models for efficient distribution' was used during plenary as an example of intersection points for collaboration that would enable use of existing private sector infrastructure for distribution of health products. The preconditions (i.e. excess capacity), and incentives, and issues and constraints were examined. Other models were also examined.

Recommendations

A set of priority actions for the RBM partnership was given to inform and catalyse public private partnerships and intersectoral collaboration. Both groups suggested a strong corporate image and recognisable logo were essential if private groups, and other sectors of government, could easily collaborate. It is essential for RBM to develop a recognisable partnership wide image not just at the level of the RBM Cabinet Project. In the plenary session, recommendations, to enhance private sector involvement were synthesised: These included:

Globally - Establish an informal network to continue dialogue on the issues
Document exemplary case studies
Identify major global consumer product distributors and develop outreach strategies
Work with private sector to develop incentives for improved skills and quality of services
Promote adjustments in legal regulatory frameworks that create opportunities for more investment by private manufacturers
Country action – Develop national strategies for advocacy and an enabling environment
Develop national regulatory framework for public private partnerships

For intersectoral action at country level these recommendation included:

Build national capacities (policy framework, procedures and skills in intersectoral planning) in health impact assessment and health risk management
Strengthening environmental health services in light of new approaches to health and environment against the backdrop of health sector reform (decentralisation),
Realise new essential regulatory functions (e.g. health impact assessments), and strategic alliance between health and environment sectors, both which are dealing with cross-cutting issues.
In the context of health sector wide approaches, a strengthened environmental health services can play a regulatory role in intersectoral malaria transmission risk reduction

Significant exploratory work in this area has been undertaken by the World Bank particularly in the area of intersectoral collaboration. The World Bank convened a meeting of partners on 'Addressing malaria through infrastructure projects' in early June and continue to lead inform this area.

c) Functions and challenges for country partnerships to support and catalyse community action

Groups recognised that hitherto efforts to address malaria in Africa were fragmented. Uncoordinated efforts and initiatives, despite their number and scope, could not meet the challenges for effective action against malaria in Africa. As a result, potential partners especially at country and community levels, were inadequately engaged in the process. This lead to sub optimal use of available resources.

Groups identified and made as inventory of potential partners, establishing broad categories and the levels they work at. These categories included government, other national country partners, international organisations, national organisations (i.e. research institutes), NGOs, civil society and community level partners including CBOs, focused groups, traditional and private practitioners, local health systems, local industries, and community based distribution systems (i.e. drug vendors). The media and military were noted as omissions for consideration.

The groups first identified desired outcomes for roll back malaria partnership and community action broadly as:

Positive individual and community behaviour change that improves the health of the community
Improved knowledge of the community about malaria
Motivation for action to do something about their malaria situation and knowing that there is a supportive environment by which to engage in this
Programs at the community owned by the community

The group recommended that a framework for co-ordination of partners be developed by the government at national, district and community levels in a way that enables top down and bottom up communications. The structures for co-ordination, potential mechanisms, the synergistic linkages between different actors and identification of structure that reach the community need to be mapped out.

The roles of the different partners where discussed (details Annex 2) as were sustainability issues surrounding community action. Some of these included: continuous human capacity building, adequate budget, strengthened integration of activities. Real benefits to malaria-affected communities and households will be assured by:

Building on the capacity of the primary health worker to work with communities
Developing options for effective funding mechanism of community activities
Developing precise process indicators to measure whether community work is indeed functioning and seeing targets so we know if we are getting there
Community participation in planning, implementation and evaluation of programs
Identification and sharing of lessons learned
Understanding and building upon the critical role of women
Building on experiences from different communities, sectors and countries
Reinforcing the supervision and monitoring of health services with the community
Regular negotiation and consultation with communities

Concerns and challenges revolved around limitations of community participation and demands placed on communities from other sectors (i.e. education) and programs (i.e. credit schemes, rice banks). The potential, demand and load on communities needs to be examined carefully in different contexts and considerations for multi-skilled people taken into account-

Recommendations

Ensure adequate assessments of resource needs at community level, both human and financial
Hold first national co-ordinating meeting for RBM
Make account of potential partners and identify their possible roles.

d) Financing issues for rolling back malaria at country level and country resource mobilisation in different settings

The groups examined resource identification and opportunities, the management of resources and constraints and challenges and action. A variety of resources were noted as being available at country-level that could be mobilised. National budgets for health and non health sectors, additional funding from development agencies, non-governmental organisations and the private sector were seen as essential to advancing overall objectives.

Recognising that RBM is not a prescription for vertical programming, there was consensus on the need for efficient use of existing resources. Within the health sector, other programmes such as IMCI and maternal/reproductive health programmes were noted as having potential resource for malaria control as were community level initiatives and insurance schemes.

There was general acceptance that an absolute shortage of resources for health action at country level. However the resources that do exist, both government and those from donor agencies, are often under-utilised or not utilised as efficiently as they could be. There was significant debate over the very real challenge of resource mobilisation for health and action to roll back malaria at country level. It was largely accepted that specific funds for roll back malaria should not be mobilised at country level, rather that additional resources should be mobilised for health sector development efforts and action to reduce malaria morbidity and mortality prioritised by government, with the help of other partners, should be planned and budgeted within those overall efforts.

The challenge is that planning and budgeting change takes time. In many countries there are very limited attempts to reform the health system along the lines of sector wide approaches, or the countries themselves is in an emergency situation. In these cases Roll Back Malaria should still endeavour to finance and support activities with health sector development objectives at the forefront, although the reality of this and the steps may need to be mapped out differently in these contexts.

The challenge within this challenge is that there is insufficient knowledge to know whether in certain situations whether, separate funding and reporting arrangements, earmarking and seed-corn funds for inception and catalytic activities would in themselves undermine efforts to move to broader health sector development.

The Roll Back Malaria Cabinet Project was noted as having the responsibility to assist countries to:

Prioritise malaria control objectives
Use available technical interventions
Define resource requirements
And monitor the integrated implementation of the RBM agenda

It was noted that the capacity of governments to manage financial resources varied by type of resource and this was cited as having direct implications on the accessibility of funds necessary to advance rolling back malaria. The working groups felt that Roll Back Malaria should emphasis sector development and reform (including decentralisation) through the establishment of basic integrated packages, and that using existing mechanisms (i.e. planning, budgeting, co-ordination) was highlighted as important means through which RBM could reinforce and strengthen ongoing health sector development efforts.

While it is widely recognised that there are more funds available to be accessed at country level, more clarification and guidance is needed on how to access funds. The prioritisation of community action within roll back malaria could almost be seen as being offset by health sector reform efforts. These often start and continue to focus on systems issues nationally -- and take a long time to be adequately planned and implemented at district level. The cost of many community initiatives such as the community component of IMCI,, monitoring etc. mean that the budget is often not available at community level for action.

RBM was accepted as a process that could strengthen institutional structure to mobilise and manage resources for health sector development. The main challenges are the same as for other health sector activities. Among those are administration, resource mobilisation, and absorptive capacity.

Recommendations

At country level:

Consolidation of resources, advocacy, integration of strategies to roll back malaria, organisation of inception meetings and launch of RBM concepts at national and district level
The medium terms should see the development of national intersectoral collaboration, enhancement of national capacity to manage resource, empowerment of community structures

Globally and regionally:

Clarification of Strategy that includes guidance on incorporation of malaria control intervention into sector development plans and strategies

F. Next Steps

The final session yielded the following recommendations for action by the WHO and by other partners over the next six months:

Framework for implementation of RBM at country level to be developed including

emphasis on multi-sectoral team, roles of different groups, advocacy, organisation of the process and concrete steps of implementation within the health sector development process and ongoing programmes

Action: WHO.

Joint work to be undertaken by governments and development partners to initiate national efforts for RBM actions: clarify what this means in practice, complete situation analyses (may involve reviews of existing data) - including the availability and accessibility of affordable effective medications, mosquito nets, insecticides etc, establish national goals, objectives, strategies and indicators for monitoring: work out the resource requirements, sources of funds, immediate resource needs to initiate the process establish strong partnerships involving in-country groups as well as donors.

Action: countries with help from development partners

Joint work at country level to establish high level political support for the RBM effort Launch through high level political involvement with a dynamic political process. Present RBM to next African Health Ministers' meeting

Partners to work together to identify capacity needs within countries, put steps in place to ensure that the capacity is available, to enable regions and districts to intensify priority health actions and Roll Back Malaria

Agencies to be clear on the operational research agenda and key policy and technical issues, to minimise confusion, and maximise the efficiency of efforts to build national capacity: establish operational research agenda strong and well articulated technical guidance, effective technical support networks - including south-south dialogue thorough assessments of what is needed in 3 to 4 countries

Collective work to be made more efficient by sharing information on country realities and intentions; how partnerships are going

Public-private working group to be established to look at many issues including tariffs, regulations, access; also expansion of employer-based programmes

Development agencies to ensure that their regional and country offices and those of WHO are well equipped to help countries intensify their roll back malaria efforts: to share experiences about and discuss different concepts and approaches

Partners to establish concrete examples of how existing public health modalities - such as IMCI, RBM and integrated disease surveillance - can contribute to RBM (and how the RBM project will do it)

WHO and partners to ensure greater clarity on Roll Back Malaria principles and philosophy: make the strategy and work plan more specific.

During the next two years partners expect to see:

A strong movement to roll back malaria in place at all levels of society and working effectively

Demonstrable action within communities, and widespread understanding about, and action in relation to, malaria. Increased use of insecticide-treated materials. Better access to effective treatment

Functioning partnerships (at national and local levels) in malaria-affected countries, with catalysis of increased community-level action

A powerful global partnership, very clear purpose, high quality advocacy, and effective monitoring and evaluation.

Incorporation of committed private sector entities, professional associations, non-governmental organisations, civil society, service clubs, media and research groups, as well as different sectors, into global and national partnerships;

Effective mechanisms to involve community-level organisations into the RBM movement (including the small business sector)

The following principles of partnership need to be developed:

Partnerships need to be institutionalised at global level with a Memorandum of Understanding: clarification of roles and responsibilities. Need scope for regional partnerships

Action to interface with private entities to be developed

Country partnerships:

a partnership team to be responsible for Rolling Back Malaria: assessments and plans mobilising resources, ensuring that things are moving forward, monitoring and evaluation, and informing public and professionals.

Country RBM work requires people with catalytic skills, who help focus in-country energies to ensure that outcomes are achieved, and who work through existing structures where possible.

If partners are to succeed in sponsoring a movement, they need to learn from their experiences in supporting roll back malaria efforts, and modify their ways of working in the light of experiences.

Comments to:
Malayah Harper, Team Leader Global Partnership Development, Roll Back Malaria Harperm@who.int
David Nabarro, Project Manager, Roll Back Malaria, nabarrod@who.int

2^ND MEETING OF THE RBM GLOBAL PARTNESHIP
ROLLING BACK MALARIA IN AFRICA

Harare, Zimbabwe
30 June - 1 July 1999

Objectives

To jointly review action to Roll Back Malaria since the last partners meeting in December 1998.
To jointly review implementation of Roll Back Malaria in Africa and how the partnership is working together to support rolling back malaria in Africa.
To agree ways through which national authorities can effectively co-ordinate action - and partners - at country level, to roll back malaria
To identify next steps and organising principles

Expected Outcomes

Roll Back Malaria opportunities and challenges in Africa identified and addressed.

Future approach to Rolling Back Malaria in Africa identified and discussed

Partners' potential contributions to RBM globally, regionally in Africa and at country level defined and examined.

Definition and agreement of means to improve co-ordination among national authorities and partners, including the handling of resources for country RBM action.

ANNEX I

2^ND MEETING OF THE RBM GLOBAL PARTNESHIP
ROLLING BACK MALARIA IN AFRICA

Harare, Zimbabwe
30 June - 1 July 1999

FINAL AGENDA

*30 JUNE 1999*
08.30 – 09.00	Opening Ceremony Master of ceremonies: Dr A. Kabore, DDC, WHO/AFRO Welcome and opening – Dr E. Samba, Regional Director, AFRO
09.00 – 09.15	Nomination of Rapporteurs, Chair and Co-Chair, Dr. A. Kabore Rapporteurs Dr Rick Peeperkorn (Netherlands) Dr Patience Kuruneri (Africa Development Bank) Professor Takeshi Kasei (Japan) Chair: Dr Ok Pannenborg (World Bank) Co-Chair: Dr Sylvia Barrow (Canada)
09:15 – 09:30	Presentation of Objectives and Outcomes, Dr. A. Kabore
09.30 – 09.50	*Coffee Break*
Objectives 1:	To Jointly Review Action To Roll Back Malaria Since The Last Partners' Meeting In December 1998
09.50 – 10.10	RBM progress to date and key issues – WHO, Dr James Banda
Objectives 2:	To Jointly Review Implementation of Roll Back Malaria in Africa and How the Partnership is Working Together to Support Roll Back Malaria in Africa.
10.10 – 10.30	RBM Progress in Africa and key issues – supporting the country process, WHO/AFRO, Dr Kassankogno
10.30 – 11.00	Discussion
11.00 – 11.20	RBM Country progress and key issues – Mozambique Dr Abdul Razak Noormahomed
11.20 – 11.40	RBM Country progress and key issues – Tanzania, Dr Alex Mwita
11.40 – 12.00	RBM Progress to date and key issues – Addressing the Situation of Complex Emergencies: Dr Maire Connolly
12.00 – 12.30	Discussion
12.30 – 14.00	*Lunch*
14.00 – 14.15	RBM Progress to date in Africa and key issues – UNICEF, Dr Kopano Mukelabai
14.15 – 14.30	RBM Progress to date in Africa and key issues – World Bank, Dr Ok Pannenborg
14.30 – 14.45	RBM Progress to date in Africa and key issues – USAID – Dr. Hope Sukin
14.45 – 15.00	RBM Progress to date in Africa and key issues – DFID, Dr Caroline Sergeant
15.00 – 15.30	Discussion
15.30 – 15.50	*Coffee Break*
15:50 – 16:10	Discussion
Objective 3	To Agree Ways through which National Authorities can Effectively Co-ordinate Action – and Partners – at Country Level, to Roll Back Malaria
16.10 – 17.00	Synthesis of issues and challenges and application to four themes at country level. Drs Antoine Kabore and David Nabarro Introduction to group-work and process, Synthesis of issues and challenges Four themes How Roll Back Malaria can contribute to and function within the context of Health Sector Development Efforts Potential of private sector and intersectoral action at country level to roll back malaria Functions and challenges for country partnerships to support and catalyse community action to roll back malaria Financing issues for rolling back malaria at country level and supporting Country resource mobilisation in different settings.
17.00 – 17.15	Discussion
17.15 – 17.30	Closure of Day one, Chair
18.30 – 20.00	*Welcoming Cocktail and Light Buffet, WHO Cafeteria*
*1^ST JULY 1999*
09.00 – 09.15	Administration and clarification, Chair
09.15 – 09.30	Developing a Public/Private Partnership: ENI's potential Dr Vincenzo Boffi
09.30 – 16:00	Group work on key issues (presentation and discussion) : How roll back malaria can contribute and function within the context of health sector development efforts. Facilitators: Caroline Sergeant and Jorn Heldrup Potential of Public private partnerships and intersectoral collaboration at country level. Facilitators: Lucian Manga and Dennis Carroll Functioning and challenges for country partnerships to support and catalyse community action. Facilitators: Eliab Somé and Kopano Mukelabai Financing issues for rolling back malaria at country level and country resource mobilisation in different settings. Facilitators: Julie McLaughlin and P. Kuruneri
13.00 – 14.00	*Lunch (Buffet)*
Objective 4:	Identify Next Steps And Organising Principles
16.00 – 16.30	Facilitated Discussion, Dr Kabore What should we achieve as a Partnership and in support of country action over the next 6months and the next 2 years.
16.30 – 17.00	Facilitated discussion, Dr Nabarro Organising principles
17.00 – 17.15	Statement of Support from Dr T.J. Stamps, Honourable Minister of Health, Zimbabwe
17.15 – 17.30	Closing

ANNEX II

Summary of Group Findings

GROUP 1

How can partners contribute to a sustained capacity to Roll Back Malaria – within the context of Health Sector development

Terms of Reference

1. General Objective

Discuss briefly to potential that this "topic" offers to roll back malaria in countries and in which specific areas. Focus on how this potential could be harnessed and taken forward at country level.

1.1 Specific Objectives: Identify the major Health Sector Development challenges in taking malaria interventions to scale effectively at country level, within the context of RBM.

Major Issues:

How can RBM operate effectively within the overall context of health sector development;
What capacities needed;
How are these influenced by health sector reforms:
Can normal malaria control programmes offer these capacities:
If not, how can partners based on their comparative advantages, contribute to capacity building at country level;
How can we focus on RBM without taking resources from other priority interventions and other key health sector development efforts;
How can we build the capacity of countries to effectively co ordinate and implement RBM, within the overall context of health sector development; and
How can we link RBM activities at country level of overall human development.

2. General Objective

What are the present and potential roles of the partnership and actors at country level (including role of WHO at all levels)? What are the options for mechanisms and other ways of organising our selves?

Specific issues to inform discussion on item 1 & 4:

2.1 Define the critical HSD partners and their potential roles in RBM at the country level.

2.2 Outline potentials for supporting health sector development efforts at country level through RBM

2.3 Outline different approaches and mechanisms for effective partnership in RBM within the context of HSD

3. General Objective

Are there other examples and lessons that we can draw on from the health and non-health sectors?

Specific issues to inform discussion on Item 1 & 4:

3.1 Assess the impact (positive or negative, intended or unintended with examples) of recent global health programmes on health sector development.

3.2 Assess the impact (positive or negative, intended or unintended with examples) of recent health reforms on outcomes of priority health programmes.

3.3 Explore examples of projects targeted at human development and poverty reduction for lessons for RBM.

4. General Objective

What do we need to do in the next 6 months and the following two years (2000-2001)? How could this action be monitored and by whom?

Specific objectives:

4.1 Based on above discussions propose a concrete changes to approaches to HSD and malaria control at country, regional and global levels.

4.2 Outline the action to be taken in the next 6 months and the following two years (/by whom, where, with what)?

Tasks:

Outline concrete steps in implementing RBM at country levels by applying the principle of strengthening health sector development efforts in general (RBM as a pathfinder in health sector development).

FULL TRANSCRIPTS OF FINDINGS UNAVAILABLE.

GROUP 2

Working groups on public private partnerships and intersectoral collaboration to Roll Back Malaria.

Terms of Reference:

Findings:

Two working groups, one francophone and one anglophone, met independently to discuss the challenges of stimulating, informing and maintaining public private partnerships and inter-sectoral collaboration to Roll Back Malaria. The two groups were then convened to share observations and make recommendations to the RBM Global Partnership. The Group exercise was developed by Dr. John Paul Clark and Dr. Lucien Manga. Dr. Manga served as facilitator of the group working in French and Dr. Dennis Carroll, USAID served as facilitator of the group working in English and the combined working group.

The objectives of the working group exercise were:

To identify potential Roll Back Malaria Partners in the private sector and non-health public sectors.
To explore and discuss the incentives for the private and non-health public sectors to form partnerships and collaborations to roll back malaria
To identify potential mechanisms for and obstacles to public private partnerships and inter-sectoral collaboration.
To identify priority actions for the RBM Global Partnership or its individual or organisational members in the immediate and short term.

Participants in group work were asked to draw on personal knowledge and experience to identify examples of inter-sectoral collaboration and public private partnerships as a basis for group discussion.

Outputs of Group Discussion

Potential Roll Back Malaria Partners in the private sector and non-health public sectors.

A large array of private sector and non-health public sector entities must be considered. The private sector is not homogenous and includes multiple interest groups and potential partners. The private sector may include both for profit and not for profit entities. The non-specificity of the term private sector has hindered effective dialogue. A more useful categorisation of private sector entities is needed. The working groups felt that there was a public-private sector continuum with grey areas which made it very difficult to categorise certain entities, in response the group employed a scheme which categorised entities in relation to the health sector and malaria. This scheme may also be applicable to quasi private, quasi public and non-health public sector entities:

I. Health Sector

For profit and not-for-profit providers of health services
Entities engaged in the development, manufacture, promotion or distribution of health commodities

II. Non-health sectors

Entities whose activities are affected by malaria. This includes companies with operations in malaria endemic or epidemic prone areas
Entities whose activities affect the transmission of malaria. This may include commercial entities as well as publicly funded infrastructure and economic development activities.
Entities that have global markets or a sense of social responsibility.

The groups concluded that RBM should seek collaboration across the non-health public sector. Potential for inter-sectoral collaboration to roll back malaria may involve (among others) Ministries of Education, Agriculture, Environment, Foreign Affairs and the military. The group noted that Linkage between inter-sectoral collaboration and public private partnership are needed. Although there are opportunities for partnership strictly between the health sector and another public sector or between the health sector and one interest group in the private sector, to reach the objectives of RBM, multi-party, multi-sectoral partnerships may be indispensable.

The groups also concluded that public private partnerships and intersectoral collaboration should fully engage communities in the partnership. Communities are not simply the beneficiaries of successful partnerships, but full participants in the partnership.

Incentives for the private and non-health public sectors participate in Roll Back Malaria.

In formulating partnerships it is very important to understand what motivates each party to be involved, this helps define the objectives and attributes of the collaboration and partnerships. Several parties with very different incentives can and do share concrete and common objectives.

The groups examined incentives in some detail, with a primary focus on private sector entities. The general conclusion was that the private sector will be motivated to participate in partnerships to roll back malaria by profit, public relations, and commitment to public well being and to promote a supportive regulatory environment. One example examined by the groups looked at incentives for a commercial enterprise with a large employee base in a malaria endemic region to roll back malaria through workplace based preventive and curative services. The group concluded that the commercial enterprise could have several incentives: productivity and cost/effectiveness, image as a 'social employer', general public relations and goodwill building , local and global, response to government regulations, employee motivation and loyalty

The group also discussed the fact that certain private sector entities were moving well beyond the assumed short term profit motivation to thinking strategically about the long term, economic development and community well being. Through foundations and other mechanisms these entities were establishing the corporate 'donor' role.

Potential mechanisms for and obstacles to public private partnerships and inter-sectoral collaboration

A wide variety of mechanisms for collaboration and partnerships exist or are under development. Each has different attributes based on the specific member ship, objectives and constraints. We must look at what works based on experience, but we must also be prepared to innovate. It is most clearly in the quest for mechanisms, that the group recommended that RBM collect and analyse case studies for guidance. To this end, a number of examples of public private partnership and intersectoral collaboration efforts in process were discussed. These included the Malarone Donation Programme, the Medicines for Malaria Venture, social marketing of insecticide impregnated materials, orphan drug legislation, and health impact assessments development projects such as the Lubombo project in Souhtern Africa.

The group discussed in detail corporate models for efficient distribution such as use of existing private sector transport infrastructure for distribution of health products. It was noted that a number of factors, including public relations and marginally enhanced profits could serve as incentives for private sector collaboration in such an undertaking, but there would be preconditions to targeting this kind of mechanism such as an existing distribution systems for household level products with excess capacity.

Priority actions for the RBM Global Partnership

Document exemplary case studies of public private partnerships and intersectoral collaboration.
Identify the major global consumer product distributors and develop outreach strategies to engage them in RBM.
Develop a strong RBM image PARTNERSHIP WIDE not just at the level of the WHO RBM Cabinet Project.
Develop promotional incentives for performance of private sector partners.
Look for synergies and dual benefits for private and public sector co-operation (e.g. Engaging private distributors in public sector product distribution).
Business/Professional associations and other NGOs need to be engaged to identify opportunities for public private partnership and intersectoral action.
Identify legal framework and regulatory adjustments at international and national levels to promote more investment
Identify large PR firms to engage them in image building, possibly on a pro-bono basis.
Improve the logo of RBM – link to a strong image with a consistency at the global level and flexibility to go to Regional levels.
Strategic public/Donor fund use for demand creation and strengthening private sector capacity.
Develop guidance and support for countries to engage in public private partnerships and intersectoral collaboration. Partnerships and collaboration are most important and most difficult to maintain at country level. Many partners involved in RBM have both country presence and international/transnational characteristic. It may be essential to the functioning of intersectoral collaboration and private public partnerships at country level, that there efforts be supported (and echoed) at the international level.

GROUP 3:

Functions and challenges for country Partnerships to support and catalyse community level action

1. Introduction

Hitherto, efforts addressing malaria in Africa were fragmented an uncoordinated. These uncoordinated efforts and initiative, despite the number and scope, could not meet the challenges for effective action against malaria in Africa. As a result, partners who could contribute, especially at country and community levels, were not engaged, or inadequately engaged, in the process and this lead to non-rational use of available resources. This contributed to actions against malaria in Africa not to have had the expected results and impact.

Based on this experience, one of the main areas of work for Roll back Malaria is Building and Sustaining Partnerships, especially at country and community levels.

The Group Work will discuss the key issues related to the functions and challenges for country partnerships with the aim of supporting and catalysing community action for rolling back malaria.

2. Objectives For The Group

2.1 Identify key issues related to the functions and challenges of present and potential partners for rolling back malaria at country level.

2.2 Identify and discuss present and potential mechanisms for supporting and catalysing community action for rolling back malaria.

2.3 Discuss mechanisms for Roll Back Malaria country partnership co-ordination.

3. Expected Results

3.1 Functions and challenges of present and potential partnerships to roll back malaria at country level identified.

3.2 Mechanisms for supporting and catalysing community action for rolling back malaria identified.

3.3 Mechanisms for RBM country partnership co-ordination agreed upon.

4. Key Issues On Functions

4.1 Role of country partnerships in stimulating and supporting community level activities

4.2 Identify effective strategies leading to sustained community level outcomes

4.3 Elements of establishing purposeful societal movements to roll back malaria

4.4 How to ensure that the non-health sector is engaged at the community level?

4.5 Contribution of new ideas and test new approaches for community level action

4.6 Provision of wide range of institutional mechanisms of working at the community level.

4.7 How to ensure that partners work in concerted manner, with countries in the lead?

5. Key Issues On Challenges

5.1 Who are the county level partners?

5.2 How to ensure that partners contribute to Roll Back Malaria according of their in country comparative advantages at the community level?

5.3 How can partnerships best be made effective at supporting and catalysing community level action and reduce people's malaria (and other disease) burdens?

5.4 Which are the best ways to catalyse and support community level effort?

5.5 What are the options related to effective funding mechanisms for rolling back malaria at country level?

5.6 What are desirable community level outcomes?

Findings Group 3

Functions and challenges for Country Partnerships to support and catalyse community action

I. Identification of Partners at country level:

A. Government

Ministry of Health, Ministry of Agriculture and Water, Ministry of Information/Education, Ministry of Planning/Finance, Ministry of Social Services Ministry of Trade

B. Other National Country Partners

i) international organisations

UN Agencies (UNICEF, WHO, UNDP, FAO, UNHCR, UNFPA, UNEP)
Bilateral (USAID, DFID, CIDA-Canada, CIDA-Swis, Italian Cooperation, Spanish Cooperation, GTZ)
Development agencies (World Bank, African Development Bank, AfDB, KFW, Arabian Development Bank)
Multilateral partners (IFRC, EU, MSF, Oxfam, etc.)

ii) National organisations

Parliament, Research Institutions and Universities

iii) NGOs

NGOs indigenous/international: their inputs maybe different Service clubs (Rotary, Lions, etc.)

iv) Civil Society

II. Community level

Partners present at country level
Community-based organisations

Women's Groups, Cultural Groups, Coops, etc., Traditional and private practitioners, Chiefs, religious leaders, teachers.

Health system: Local public health structures, Private health structures, Traditional healers.
Local industries: Private companies (Seneca, Mining companies, sugar companies, etc.).
Community based distributions system, Shopkeepers, Drug vendors.

Outcome:

Positive individual and community behaviour change that improves the health of the community,
Improved the knowledge of the community about malaria,
Motivation for action—to do something about their own malaria situation,
Programs at the community should be owed by the community.

Co-ordination of partners:
Government should develop the framework for co-ordination.
Three levels of Co-ordination: National/District/Community/Top down and bottom up communication.
The co-ordination mechanism should represent all potential partners in country under an umbrella organisation: To do that we need to identify: 1) What structures are there for co-ordination? 2) What mechanisms are there for co-ordination? 3) What are the synergistic linkages between the different organisations co-ordination? 4) What are structures that reach the community.
Intrasectoral/intersectoral co-ordination.

Roles of Different Partners
Ministry of Health

Policy development and Co-ordination

Ministry of Agriculture

Extension work, control and handling of insecticides

Ministry of Information/Education

IEC

Ministry of Planning and Finance

Budgetary commitments in line with political commitments, review of taxation

Ministry of Social Services

Working with communities

Ministry of Trade

ITN, drugs, etc.

Other ministries

Supportive role

UN Agencies (UNICEF, WHO, UNDP, FAO, UNHCR, UNFPA, UNEP)

Introducing health education messages/modification of curriculum
Provide funding
Help with capacity building
Facilitate with community groups
Provision of TA
Issues related to epidemiological surveillance/information sharing inside and between countries
Emergency preparedness
Data collection and analysis
Commodity and drug supply
National policy review
Advocacy

Bilateral (USAID, DFID, CIDA-Canada, CIDA-Swiss, Italian Co-operation, Spanish Co-operation, GTZ)

Bilateral agencies should support approaches that address local needs
Funding
Help to apply national guidelines
Capacity building/Building South-to-South Partnerships
Development/water/schools/latrines
Provide TA
Provide human resources
Facilities and logistics
Pooling resources

Development agencies (World Bank, African Development Bank, AfDB, KFW, Arabian Development Bank)

Capacity building
Environmental & health impact assessment of funded projects

Parliament

Advocacy, lobbying, budget allocation

Research Institutions and Universities

OR for RBM
Community based research

NGOs

National /International service clubs:

Introduce malaria control
Mobilize resources

Indigenous/International NGOs

Civil society

Social mobilisation
Creating awareness
Capacity building
Community sensitisation

B. Partners Present At Country Level

Community-based organisations

Planning, implementation, monitoring and evaluation

Health system

Integrate RBM, service provision and co-ordination

Local industries

Dependent on the context of the community
Provision of services and outreach
Provision of TA and training
Mobilisation of commodities
Financial support

Community-based distribution system

Service provision

I) Actual overall functions of the partnerships

Build partnerships at local level:

using existing structures (district development associations)
joint planning and evaluation
information sharing
joint missions
strengthen integration

Consultation, sensitisation, mobilisation of communities
Participatory situation assessments
IEC- involve health education specialists in TOT for other health personnel
Capacity building
Resources mobilisation

collectively design a resource mobilisation plan
communities to mobilise resources and raise own funds
joint resource mobilisation: to be linked to other services and approaches not only malaria e.g. IMCI.

Time frame : give adequate time for results to show
Sustainability of community action to Roll Back Malaria

community to be in the forefront
accountability and transparency
sustain positive effects of the programme
continuous human capacity building
adequate budget
mechanisms for change in management
motivation (Innovation ways of motivating communities to be worked out)
strengthen integration

II. Strategy for non-sector involvement

National effort to get all sectors to state what they can do to roll back malaria
IEC : other sectors getting involved in educational materials production e.g. posters on use of ITNs.

How to ensure real benefits within malaria-affected communities and households?

Building the capacity of the primary health worker to work with communities

Options for effective funding mechanisms of community activities

Develop precise process indicators to measure whether community work is indeed functioning

Target setting so we know if we are getting there

Community participation in planning, implementation and evaluation of programs

Identification and sharing of lessons learned

Critical role of women must be highlighted/empowerment

Build on experiences from different communities, sectors and countries

Reinforce the supervision and monitoring of health services with the community

Regular negotiation and consultation with the community

III. Recommendations:

Assess the resource needs (both financial and human)
Hold first national RBM co-ordinating meeting
Make account of potential partners and identify their possible roles

GROUP 4

Financing issues for rolling back malaria at country
Level and country resource mobilisation indifferent settings

Terms of Reference

Financing of health services in most African countries are plagued by a number of constraints:

The inefficient distribution of scarce resources – hospital care for example still consumes most expenditures, salaries absorb the lion share of recurrent costs, and urban areas get more resources than rural areas,

Poor systems for budgeting, for disbursing, for purchasing, and for monitoring expenditures that have failed to achieve an equitable distribution of scarce health care resources,

Lack of access to health care for populations that re disadvantaged because of such factors as location, age, sex, poverty, unavailability of services, unemployment, and bad planning or management of services,

Services that do not respond adequately to local needs, For example the poor quality of many services leads to under-utilisation, unmotivated and poorly trained staff, long waiting periods, inadequate drug supplies, financial exploitation by the private sector among others.

All of these are occurring at a time when people are increasingly becoming aware that quality health services need to be provided more efficiently and equitably to larger constituencies of people, and when demographic patterns and diseases are changing –urbanisation, the emergence of HIV AIDS, the resurgence of diseases such as tuberculosis, and the rising incidence of non communicable diseases and diseases attributable to lifestyle – thereby placing increased and different demand o n health services than in the past. Economic recession in most countries have also lead to cutbacks in recurrent expenditures and a severe decline in capital development.

All countries face serious financial constraints in their efforts to mobilise and sustain additional resources for health. In most African countries, expenditures on health as a percentage of GNP is still very low. In addition, and more importantly, many African governments have reduced their per capita health sector expenditures.

It is under this scenario that the partnership to Roll Back Malaria will operate at the global, regional and country levels. The partnership is expected to provide a mechanism through which resources can be made available for health sector action that will contribute to rolling back malaria.

The critical challenge for RBM is how it will enhance efficiency in the use of currently available resources and how the movement will mobilise additional resources in a sustainable manner.

General objectives:

Discuss briefly the potential that this "topic" offers to roll back malaria in countries and in which specific areas. Focus on how this potential could b harnessed and taken forward at country level.

What are the present and potential roles of the partnership and factors at country level (including role of WHO at all levels)? What are the options for mechanisms and other ways of organising ourselves?

Are there other examples and lessons that we can draw upon from the health and non-health sectors?

What are the major things we want to achieve in the next six months? The next two years? How could this action be monitored and by whom?

Specific Group Objectives:

To identify the challenges to financing RBM actin at the country level and mobilising additional resources.
To discuss options for financing RBM that ensures the greatest impact at the country level
To discuss the present and potential roles of partners in financing RBM action

Some Issues for consideration:

What are the main issues partners need to consider (i.e. source of funds, absorptive capacity, harmonisation, etc.) with respect to financing.
How can we make better use of existing resources? Allocative and technical efficiency.
How should RBM action at the country level be financed? What roles should partners play?
Do options exist to mobilize additional resources internally?
How could country RBM actions be financed in different settings?

Under Health Sector Development Programmes including SWAps…common basket
Vertical financing

How should funds flow form global partnership to countries? From national to district level?
What mechanisms could we consider to manage funds?

Harmonisation of funding cycles of partners
Absorptive capacities of countries
Transparency and accountability, etc.

Can we tap resource from other sectors for RBM action?
How can we harness and make effective use of the resources coming from the private sector (including out-of-pocket expenses of households)?
How can we engage the private sector – corporation industries- to participate in RBM?
How can partners best ensure that efforts to roll back malaria are properly financed so that the poor and poor countries enjoy sustained benefits?
What key things do we want to put in place in the next six months to ensure that sufficient resources are available to support country action?
How do we maintain in the long-term, resources flow to countries to support RBM action?

Group 4 Findings

Financing Issues for Rolling Back Malaria at Country Level and Country Resource Mobilisation in Different Settings

Participants:

Group 4a (Anglophone); Facilitator - J. McLaughlin; Participants - F. O' Brien (Irish Aid), A.R Noormahomed (Mozambique); Maeresera (Zimbabwe); P. Mkanda (Malawi); A. Kone (BASICS) ; T. Corella (Spain); and M. Ettling (USAID).

Group 4b (Francophone); Facilitator - P. Kuruneri; Participants – V. Vemba (Angola); K Moussa (Cote D'Ivoire); Sambou (Senegal); P.Eozenou (France); O. Noba (Senegal); and Ouedraogo (Burkina Faso).

Summary of Discussions:

Two groups examined the theme assigned to Group 4. Group designation of t was determined on the basis of working language. There was notable consistency between the two groups' perspectives on financing issues at country-level, both in terms of opportunities and constraints, affecting most African countries with exception of countries in states of conflict and emergency. The working group sessions were guided by the following objectives:

to identify the challenges to financing RBM actions at the country level and mobilizing additional resources;
to discuss options for financing RBM the ensure the greatest impact at the country level; and
To discuss the present and potential roles of partners in financing RBM action.

The methodology employed by the two groups facilitated the review of existing mechanisms and structures to effectively manage and coordinate resources required to implementation RBM. The summary below is a consolidation of the deliberations of the two groups that meet to jointly prepare recommendations for plenary discussion. Group discussions reflected on prevailing financing issues with the view that RBM presents a new perspective on the implementation of malaria control since most countries are already engaged in varying degrees of control interventions.

1. Resource Identification and Opportunities

A variety of resources were noted as being available at country-level that could be mobilized for the implementation of RBM. National budgets for health and non-health sectors (i.e. education and agriculture) were cited as the first sources of finance that should be mobilized for national malaria control programs. Additional funding resources from development agencies, non-governmental organizations and the private sector were seen as essential to advance the overall objectives of RBM at country-level.

There was much discussion on the process that countries should engage in mobilizing additional resources to boost malaria control operations. Recognizing that RBM is not a prescription for vertical programming, there was consensus on the need for efficient use of existing resources from health and other sectors for malaria control. Within the health sector, other programs such as IMCI and maternal/reproductive health programs were noted as having potential resources for malaria control interventions. At community level, the Bamako Initiative and community-insurance schemes were seen as also presenting opportunities through which to implement RBM.

Discussions on the mobilization of additional resources focused on the opportunities that RBM presents for countries to strengthen efforts to improve overall health sector financing agendas. However, countries need to prioritize malaria control within their sector development plans and expenditure programs. As such the working group concluded that financial resources from development agencies would be important not only to contribute to malaria control but also strengthen the delivery of integrated health services particularly at districts and community level. Efficiency in national capacities to mobilize, allocate and use additional financial resources arising from the RBM movement underlined discussions. In this regard, coordination mechanisms, being developed at country level, were noted as essential for coordinating inputs from multiple financiers (including national government).

The WHO RBM Project was noted as having the responsibility to assist countries to prioritize malaria control objectives, use available technical interventions, define resource requirements and monitor the integrated implementation of the RBM agenda. Th e working group called for caution in implementing RBM stressing that the process should be slow and allow for the incorporation of required inputs into national plans and expenditure programs.

2. Management of Resources

It was noted that the capacity of governments to manage financial resources varied by type of resource (i.e. national or external); this was cited as having direct implications on the accessibility of funds necessary to advance RBM. The main concerns were the accessibility of national budget allocations (i.e. for health), and bi- and multi-lateral funding, and related administrative procedures. National health systems in the process of being decentralised were noted as presenting additional management issues mainly regarding planning and budgeting capacities as well as funding availability for RBM related interventions at district and community level.

The working group assessed management issues taking into consideration the circumstances that result in under-funding as well as under-utilisation of funds (where absorptive capacity is a problem). It was proposed that malaria control interventions should be supported and delivered within context of defined national minimum packages of health care. The use of existing mechanisms (i.e. planning, budgeting, co-ordination) was highlighted as important means through which RBM could reinforce/strengthen ongoing health sector development measures. Particular concern was raised on the need to ensure that RBM financing does not undermine sector-wide development efforts.

Communication between providers of resources - government ministries such as Finance, and development agencies among others, as well as between central and district levels was cited as essential for efficiency in securing and utilising resources necessary for RBM. Co-ordination mechanisms need to be worked-out on a country-by-country basis to facilitate timely flow of resources.

The WHO RBM Project technical support to countries for RBM was seen as essential for advocacy, inception planning, situation analysis and sensitisation for which financial resources are required. Strong links with the community was noted as necessary given existence of cost recovery schemes, i.e. Bamako Initiative that can contribute to sustaining control efforts.

3. Constraints and Challenges

RBM was accepted as a process that could strengthen institutional structures to mobilise and manage resources for health sector development. The main challenge is to access the range of resources that are often not utilised for health programmes for RBM. Considerable constraints were cited, but its was acknowledge that most constraints in implementing RBM are the same as those affecting other health sector activities taking place at national, district or community levels. Among the constraints are those which relate to administration, resource mobilisation, and absorptive capacity:

- Administrative constraints: National budgetary allocations for health are often not released in full; the flow of required financial resources from central to district level are not timely due to cumbersome treasury procedures; funding can not be carried-over beyond a fiscal year even when budgetary releases are delayed; and transparency of procedures used for cost recovery are not always clear particularly at the community level and result in the misappropriate use of funds

- Resource mobilisation constraints: The process of mobilising resources from bi- and multi-lateral sources is complicated by varying budget cycles, and financial management and reporting requirements; the common funding basket, often proposed for sector-wide programmes, is difficult to implement due to issues pertaining to funding objectives and accountability of development agencies; and in cases where development agencies do not have country offices communication on the above issues is difficult.

- Absorptive capacity constraints: Under-utilisation of available funding occurs where there are weak institutions often lacking the human resource complement with sound management and planning skills; steering committees, at national and district levels, are often not established to monitor resource flow, management and utilisation.

The WHO RBM Project has an important role to play in building better understanding of the constraints faced by countries as part of the process of enhancing national government capacities (i.e. Ministries of Finance) and others (i.e. development agencies, NGOs, private sector) seeking to resolve obstacles in implementing RBM.

4. Actions

It was generally agreed that the process of implementing health reforms should be accelerated as the RBM objectives would be addressed within this context. The WHO RBM Project will be a catalyst for actions at country level. As such different actions are required, from countries and the WHO RBM Project secretariat, for the period leading up to launching RBM in January 2000, and over the first two years of implementation. Sound planning and participatory approaches were viewed as essential to develop the partnerships needed to mobilise both available and new resources for RBM. Actions required are as follows:

4.1 Country Level Actions

Within 6 months (By January 2000)

Consolidation of resources;
Advocacy;
Integration of RBM in national disease control programs; and
Organization of inception meetings (launch RBM concept) - national and district;

Over the First 24 Months (2000 – 2002)

Development of national intersectoral collaboration involving Ministries other than the Ministry of Health;
Enhancement of national capacity to mange resources in collaborative manner;
Strengthening of cross-border cooperation;
Reinforcement of management and implementation capacities at district level;
Development of operational research capacity at district level; and
Empowerment of community structures to promote RBM initiatives involving NGOs, private sector among others.

4.2 WHO RBM Project Actions

Within 6 months (By January 2000)

Clarification of the functions/role of the WHO/RBM Teams at Headquarter, regional and country level in supporting countries;
Development/dissemination of RBM/Geneva and RBM/AFRO plan of actions including corresponding budget to assist country capacity to

Sensitize governments on the importance of addressing the issues on malaria control ;
Incorporate malaria control interventions into sector development plans and budgets; and
Foster demand for inputs (i.e. new tools) to achieve RBM objectives.

ANNEX III

2^ND MEETING OF THE RBM GLOBAL PARTNESHIP
ROLLING BACK MALARIA IN AFRICA

Harare, Zimbabwe
30 June - 1 July 1999

List of Participants

United Nations Family

OCP - Dr Komla Siamevi, Onchocerciasis Control Progrramme, B.P. 549, Ougadougou, Burkina Faso, Tel: 266 30 23 01/12/13, Fax: 226 30 21 47, Email: siamevi@ocp.oms.bf

IFRC - Dr Raul Galegos, IFRC Regional Delegation, 9 Cox Well Road, Milton Park, Harare, Zimbabwe, Tel: 263 4 88 51 73, Fax: 263 4 70 87 84

FAO - Mr G. Codija, Nutrition Officer, FAO Sub-Regional Office for Africa P.O. Box 3730 Harare, Zimbabwe Tel: 263-4 791407, Email: Georges.Codjia@fao.org

UNICEF
Dr Kopano Mukelabai, Senior Health Adviser, Health Section, Programme Division, UNICEF House, 3 United Nations Plaza, New York, NY 10017, USA, Tel: 1 212 824 6318, Fax: 1 212 824 6460, Email: kmukelabai@unicef.org

Dr. Kasa Pangu, Regional Adviser Health, ESARO, UNICEF Regional Office, P.O. Box 44145, Nairobi, Kenya, Tel: 254 2 622 664, Fax: 254 2 622 567-8, Kpangu@unicef.org

Dr Boniface Manyame, Health Project Office, UNICEF, Box 1250, Harare, Zimbabwe, Tel: 263 4 703 941/2, Email: bmanyame@unicef.org

Dr Flora Ndlovu, Project Officer, Reproductive Health, UNICEF, No. 6, Fairbridge Avenue, Belgravia, Harare, Zimbabwe

WORLD BANK

Dr Ok Pannenborg, Human Development, Africa Region, The World Bank, 1818 H.Street N.W, Washington, D.C.20043, USA, Tel: 1-202-473 4415 , Fax: 1-202-473 8107, Email: opannenborg@worldbank.org

Dr Julie McLaughlin, Public Health Specialist, Africa Region, The World Bank, 1818 H. Street N.W., Washington, D.C. 20043, USA, Tel: 1 202 458 4679, Fax: 1-202-473 8107, Email: jmclaughlin@worldbank.org

Dr Ousmane Bangoura, Health Specialist, Human Development II, Africa Region, The World Bank, 1818 H. Street N.W., Washington, D.C. 20043, USA, Tel: 1 202 473 4004, Fax: 1-202-473 8216, Email: Obangoura@worldbank.org

BILATERAL ORGANIZATIONS

Australia – AUSAID, Dr Bongiwe Moyo, Australia AID, AUSAID, Australia High Commission, 4^th Floor, C/o Karigamombe Centre, 53 Samora Machel Avenue, P.O. Box 4541, Harare, Tel: 263 4 757 23, Fax: 263 4 757 774/5.

Canada – CIDA, Ms Sylvia Barrow, Health Specialist, Africa & Middle-East Branch, Canadian International Development Agency, 200 Promenade du Portage, Hull, Quebec K14 OG4, Canada, Tel: 1 819 953 0732, Fax: 1 819 – 997 5453, Email: sylvia_barrow@acdi-cida.gc.ca

Denmark – DANIDA, Dr Jens Byskov, Health Adviser, DANIDA, Epidemiological Department, Ministry of Health & Child Welfare, Royal Danish Embassy, 1^st Floor, UDC Centre, 59 Union Avenue, P.O. Box 4711, Harare, Zimbabwe Tel: 263 4 75 81 85, Fax. 263 3 75 81 89 or 75 81 89, Email: jbyskov@samara.co.zw

France – French Cooperation, Dr Pierre Eozenou, Responsable, Chargé des maladies transmissibles, Ministère des Affaires Etrangères, DCT/HS, 20 rue Monsieur, Paris 75007 07SP, France, Tel. 01 53 69 31 85, Fax: 33 1 53 69 37 19,

Email. pierre.eozenou@diplomatie.fr

Germany – GTZ, Dr Thomas Kirsch-Woik, German Agency for Technical co-operation (GTZ), Dep 4320, P.O. Box 5180, 65726 Eschborn, Germany, Tel: 49 6196 79-0, Fax. 49 6196 79 7104, Email: Bergis.Schmidt-Ehry@gtz.de or Albert.Kilian@gtz.de

Ireland – Irish Aid, Mr Finbar O'Brien, Programme Officer, Irish Aid, Embassy of Ireland, 6663 Katima Mulilo Road, PO Box 34923, 10101 Lusaka, Zambia, Tel: 260 1 292 288, Fax: 260 1 290 482

Japan - Mr Takeshi Kasei, International Infectious Disease Advisor, Deputy Director, Infectious Disease Control Division, Health Service Bureau, Ministry of Health and Welfare, 1-2-2 Kasumigaseki, Chiyoda-Ku, Tokyo 100-45, Japan, Tel: 81 3 3595 2263, Fax: 81 3 3581 6251Email: TK-NLR@mhw.go.jp

Netherlands - Dr Theo Pas, Royal Netherlands Embassy, Royal Netherlands Embassy, 2 Arden Road, Highlands, Harare, Zimbabwe

Dr Richard L.M. Peeperkorn, First Secretary, Regional Health Adviser, Royal Netherlands Embassy, Box 31905, Lusaka, Zambia, Tel: 260 1 253590, Fax: 260 1 253 733, Email: Peeperkorn@lus.minbuza.nl

Norway – NORAD, Ms Eldrid Roine, Embassy Secretary, Embassy of Norway, NORAD, Harare, Zimbabwe

Portugal – Portugese Co-operation, Dr José Manuel Costa, Tropical Medical Speciality, Portugese Co-operation, R. Carvalho Araujo, N.95, RIC RSQ, 1900 138 Lisboa, Portugal, Tel: 01 814 3169, Fax: 01 814 3169, Email jcosta@ip.pt

Spain – Spanish Co-operation, Ms Teresa Corella Rodrigo, Head of Spanish Co-operation in Mozambique, Spanish Agency for International Co-operation (AECI), Spanish Embassy, av. Eduardo Mondlane, 677, Maputo, Mozambique, Tel: 258 1 492 053, Fax: 258 1 492 055, e-mail: coordaeci@mail.garp.co.mz

UK - DFID
Dr Julian Lob-Levyt, Department for International Development, PO Box 3110, Harare, Zimbabwe, Tel: 263 4 707120, Fax: 263 4 725 360

Dr Caroline Sergeant, Department for International Development, PO Box 30465, Nairobi, Kenya, Fax: 254 27 19 112

USA - USAID
Dr Dennis Carroll, Global Bureau, Center for Population, Health and Nutrition, USAID, 1300 Pennysylvania Ave., N.W. Washington DC 20523-3700, USA, Fax: 1 202 216 3404

Dr Sergio René Salgado, Senior Technical Officer, Coordinator, IMCI, BASICS Project, USAID, 1600 Wilson Boulevard, Suite 300, Arlington, Verginia 22209, USA, Tel. 1 703 312 6800, Fax: 1 703 312 690, Email: rsalgado@basics.org

Dr Hope Sukin, Africa Bureau, USAID, 1300 Pennsylvania Ave., N.W., Washington DC 20523-3700, USA, Fax: 00 1 202 216 3373

Dr Mary Ettling, Malaria Adviser, Bureau for Africa, USAID, 1325 G. Street N.W., Suite 400, Washington DC 20005, USA, Tel: 1 202 219 0486, Fax: 1 202 219 0507, Email: mettling@afr-sd.org

Dr Adama Kone, Regional Director, BASICS Project, Rue 2 x Blvd 5 st. Point E. B.P. 3746, Dakar, Senegal, Tel: 221 825 3047, Fax: 221 824 2478, Email: koneb@telecomplus.sn

NGO ASSOCIATIONS

Bangalore, Community Health Cell - Dr Ravi Narayan, Community Health Cell, 367, Srinivasa Nilaya, Jakkasandra - 1st Main, Koramangala, 1st Block, Bangalore – 560034, Karnataka, India, Tel: 91 80-553 1518/552 5372, Fax: 91 80- 552 5372,
E-mail: sochara@blr.vsnl.net.in

Ghana, CENSUDI - Mrs Beatrice Anderson, Regional Public Health Nurse, CENSUDI, Commercial Street, TUC Building, P.O. Box 134, Bolgatanga, Upper-East Region, Ghana. Fax: 233 71 230 36

Kenya , AMREF - Dr Some Eliab Seroney, Technical Manager, Strategic Planning and Evaluation, African Medical and Research Foundation, AMREF Kenya Country Programme, P.O. Box 30125, Wilson Airport, Nairobi, Kenya. Tel: (254 2) 501 301, Fax: 254 2 506 112 or 609518, 502984, 336886, Email: amreficco@africaonline.or.ke

Thailand, SEAMEO-TROPMED - Professor Sornchai Loorareesuwan, Director, SEAMEO-TROPMED, TROPMED Central Office, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailande Fax: 00 66 2 2471688, Fax: 00 66 2 2471688, Email: tmslr@mahidol.ac.th

KEY PRIVATE SECTOR ASSOCIATION

AgrEvo Insecticide manufacturers - Dr John Goose, AgrEvo U K Limited, Hauxton, Cambridge CB2 5HU, UK Tel: 44 1223 252342 or 870312, fax 44 1223 252175, Email: john.goose@agrevo.com

Elomark - Mr David Zinyengere, Eloimark Ltd, P.O. Box 2699, Harare, Tel: 263 4 620 191-4, Fax: 263 4 620 196, Email: david@ecomedzw.co

ENI - Dr Vincenzo Boffi, Head of Corporate Giving, ENI S.p.A, Piazzale E. Mattei I, 00144 Rome, Italie, Tel: 39 06 598 25441, Fax. 39 06 598 222832, Email: vincenzo.boffi@eni.it

Glaxo Wellcome - Dr Sheila D'Souza , Co-ordinator, Malverone Donation Programme, Corporate Affairs Manager, Glaxo Wellcome, Berkeley Avenue, Greenford, Middlesex, UB6 ONN, UK, Tel: 44 181 966 8935, Fax: 44 181 966 8827, Email: sds6880@GlaxoWellcome.co.uk

Illovo Sugar Ltd. - Dr Sean Cheevers, Medical Services, Illovo Sugar Ltd, P.O. Box 194, Durban 4000, South Africa, Tel: 27 31 508 4469, 27 83 303 4008 (mobile), Fax: 27 31 508 4528, Email: seanc@illova.ca.sa, scheevers@illova.co.za & cheevers@icon.co.za

Smith Kline Beecham - Dr John Horton, Smith Kline Beecham, S.B. House (L.2), Great West Road, Brentford, Middlesex, TW8 9DB, United Kingdom, Tel. 44 181 975 3638, Fax: 44 181 975 3514, Email: john.horton@sb.com

PSI - Dr Kyle J. Peterson, Country Director PSI/Zimbabwe, 4 Rocklands Road, Hatfield, Harare, Zimbabwe, Tel: 263 4 572347/850/613/614/600, Fax: 263 4 572856, email: kpeterson@psi-zim.co.zw

ZENECA

Mrs Martha Mpisaunga, Public Health Manager, ZENECA, P.O. Box 1008, 26 Nuffield Road, Harare, Zimbabwe, Tel: 263 4 663 590, mobile: 263 91 420 474, Email: marthampisaunga@zeneca.co.zw

Mrs Nam Chalmers, Regional Public Health Manager, ZENECA, PO Box 1088, Harare, Zimbabwe, Tel: 263 4 91 402 476, Fax: 263 4 614041,l Email: namchalmers@zeneca.co.zw

R&D AND ACADEMIC ORGANIZATIONS

CDC
Dr Steve Blount, Centers for Disease Control and Prevention, National Centres for Disease Control & Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA, Fax: 00 1 404 639 7111

Dr Bernard Nahlin, Centres for Disease Control & Prevention, Kisumu, Kenya, Fax: 254 35 21442

Malaria Consortium, UK - Dr Sylvia Meek, Head, Malaria Consortium, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK, Tel: 44 171 927 2439, Fax +44 171 580 9075, Email: S.Meek@lshtm.ac.uk

MARA/ARMA - Mrs Marlies Craig, MARA/AMRA Project, National Malaria Research Programme, South African Medical Research Council, 771 Umbilo Road, Congella, 4013 Durban, South Africa, Tel: 27 31 20 51 481, Fax. 27 31 2051498, Email: craigm@mrc.ac.za

Swiss Tropical Institute - Dr Christian Lengler, Swiss Tropical Institute, Department of Public Health and Epidemiology, Socinstrasse 57, P.O. Box, 4002 Basel, Tel : 41 61 284 82 21, Fax : 41 61 271 79 51, Fax : 41 61 271 79 51, Email: lengeler@ubaclu.unibas.ch

INTERGOVERMENTAL ORGANIZATIONS

African Development Bank - Ms Patience Kuruneri, Principal Social Sector Specialist, African Development Bank, B.P. 1387, Joseph Andma Avenue, 01 Abidjan, Cote d'Ivoire, Tel:(225) 20 45 69, Fax: 225 20 59 91, Email: P.KURUNERI@AFDB.ORG

OAU - Dr Laban O. Masimba, Chief of Nutrition, Organization of African Unity, PO Box 3243, Addis Ababa, Ethiopia Tel; 251 1 51 59 71, Fax: 251 1 518 744 or 512 743

SADC
Dr Thuthula Balfour, Director SADC Health Sector Co-ordinating Unit, Private Bag X828, Room 1830, Civitas Building, CNS Struben/Andries Street, Pretoria 0001, Republic of South Africa, Tel: 27 12 312 0901, Fax: 27 12 324 7616, Email: thuthb@hltrsa2.pwu.gov.za

Ms Lebese SADC Health Sector Co-ordinating Unit, Private Bag X828, Pretoria 0001, Republic of South Africa Fax: 27 12 324 7616

West African Health Community - Dr Kabba T. Joiner, Executive Director, West African Health Community, 6 Taylor Drive, PMB 2023, Yaba, Lagos, Nigeria, Tel: 234 1 862 324/800140, Fax: 234 1 862 324, Email: wahclg@infoweb.abs.net

Multilateral Organizations

European Commission - Dr Julian Lob-Levyt, Regional Health Adviser, European Commission, EC Delegation, 6^th Floor Construction House, Leopold Zatzawira, Harare, Tel: 263 4 707 120, Email: julian@zol.co.zw

COUNTRY GOVERNMENTS

Angola
Dr Maria Rosario Fatima Madeira Rita, Health Ministry of Angola, Rua Broz Tito, No. 16-3⁰ B, Luanda, Angola, Tel: 344 059 or 09 50 9898

Dr Vita Vemba Lubanzu, Director of Medicine, Health Ministry of Angola, Rua Broz Tito, No. 16-3⁰ B, Luanda, Angola, Tel: 33 9454.

Burkina Faso
Dr OUEDRAOGO Boureima, Directeur général de la Santé Publique, Ministère de la Santé, BP 7009, Ouagadougou 03, Burkina Faso, Tel: 226 315 440, 324 175, Fax: 226 315 440

Dr CABORE W. Joseph, Coordonnateur Programme National de Lutte contre le Paludisme, Ministère de la Santé, 04 BP 8046, Ouagadougou, Burkina Faso, Tel: 226 32 47 28, Fax: 226 33 49 38, Email: DMP@fasonet.bf

Cote d'Ivoire
Dr Kone Moussa, Inspecteur, Ministère de la Santé, B.P. V4, Abidjan, Cote d'Ivoire, Tel: 225 21 26 36

Dr Niangue Joseph, Directeur Executif Programme Paludisme, Ministère de la Santé Publique, 06 B.P. 861, Abidjan 06, Cote d'Ivoire, Tel: 225 22 39 32, Fax: 225 21 47 06, Email: pnlp-ci@africaonline.co.ci

Ethiopia - Dr Daniel Kebede, Head, Malaria and other vector-borne disease control unit, Ministry of Health of the Federal Democratic Republic of Ethiopia, P.O. Box 1234, Addis Ababa, Ethiopia, Tel: 251 1 159551, Fax: 251 1 519 366

Malawi
Dr Pascal Mkanda, Head of Epidemiology Unit, Ministry of Health, PO Box 30377, Lilongwe, 3, Malawi, Tel: 265 744 882, Email: chsu@malawi.net

Mrs Doreen Ali, Deputy Malaria Control Programme, Manager, Community Health Sciences Unit, Private Bag 65, Lilongwe, Tel: 265 740 702, Fax: 265 740 702, Email: malariacontrol@malawi.net

Mali
Dr Sira Mama Diallo DIAKITE, Coordinatrice National Programme Paludisme, Direction Nationale de la Santé Publique, Division de l'Epidémiologie, BP 2, Bamako, Mali, Tel: 223 22 64 97, Fax: 223 22 64 97

Dr Mamadou Adama KANE, Directeur National de la Santé Publique, Ministère de la Santé, des personnes agées, et de la solidarité, Direction Nationale de la Santé, Bamako, Mali, Tel: 223 22 45 97, Fax: 223 23 24 74

Mozambique
Dr Abdul Razak Noormahomed, Deputy Minister, Ministry of Health, P.O. Box 264, Maputo, Mozambique, Tel: 258 1 42 67 40, Fax: 258 1 427 133, Email: abdrazak@tropical.co.mz

Dr Samuel Mabunda, National Malaria Control Programme Manager, Ministry of Health, Maputo, Mozambique

Nigeria - Dr Mujdat Ekundayo Mosanya, Manager, National Malaria Control Programme, Federal Ministry of Health, Malaria & Vector Control Division, P.M.B. 2104, Lagos, Nigeria, Tel/Fax: C/O WHO, Nigeria

Senegal
Dr Ousseynou NOBA, Chef du Service National de l'Hygiene, Ministere de la Santé, Immeuble Vendome, Zone B, Dakar, Senegal, Tel: 8247 549, Fax 824 7549

Dr Bacary SAMBOU, Coordinateur du Programme National de Lutte contre le Paludisme, Service National des Grands endémies, Ministere de la Santé, Dakar, Senegal, Tel: 824 74 34, Fax: 824 35 32, email: rdiouf@telecomplus.sn

Sudan - Dr Omer Zaid Baraka Admed, Director, National Malaria Administration, Khartoum, Sudan, Tel: 249 11 776 809, Fax: 249 11 770 397, Email: malarsud@hotmail.com

Tanzania - Dr Alex Mwita, Programme Manger, Malaria, Ministry of Health, P.O. Box 9083, Dar es Salaam, United Republic of Tanzania,Tel: 255 51 450 479, Fax: 255 51 450 404, Email: mmcp@twiga.com

Yemen - Dr Saleh al-Dobahi, National Center, RBM, Ministry of Public Health, Sana, Yemen, Tel: 00 976 2 613258, Fax: 00 976 2 613394, Email: dobahi@y.net.ye

Zimbabwe
Dr T.J. Stamps, Honorable Minister of Health, Ministry of Health & Child Welfare, P.O. Box CY 1122, Causeway, Harare, Zimbabwe, Tel: 263 4 730 011, Fax: 263 4 729 154.

Dr Paulinus.L.N. Sikosana, Secretary for Health, Ministry of Health and Child Welfare, PO Box CY 1122, Harare, Zimbabwe, Tel 263 4 729 195, Fax 263 4 720 119, Email: sikosana@africaonline.co.zw

Dr Batsirai Makunike, Director, Epidemiology and Disease Control, Ministry of Health, PO Box CY 1122, Causeway, Harare, Zimbabwe, Tel 263 4 729 032, Fax 263 4 793 634, Email: bmakunike@healthnet.zw

Dr Karigomba Happymore, Economist, Ministry of Finance, P.O. Box 7705, Causeway, Harare, Zimbabwe, Tel: 263 4 739 371, Fax: 263 4 706 856

Dr Eleanor Magresera, Principal Economist, Ministry of Finance, Domestic & International Finance, Harare, Zimbabwe, Tel: 263 4 739 371, Fax: 263 4 706 856

WHO SECRETARIAT

Roll Back Malaria, Headquarter, Geneva, 20 Avenue Appia, 1211 Genève 27, Tel: 41 22 791 2111,
Fax: 791 4824

Dr David Nabarro
Dr James Banda
Ms Malayah Harper
Dr John Paul Clark
Dr Fred Binka,
Dr Mohammadou Kabir Cham
Ms Geraldine Farrell,
Dr Murtada Sesay
Dr Maire Connolly
Dr Jorn Heldrup
Dr Charles Delacolette,
Dr Robert Bos
Ms Debbie Bryant

Roll Back Malaria, Regional Office AFRO , P.O. Box BE 773, Belvedere, Harare, Zimbabwe, Tel: 1 407 733 9341, Fax: 733 9012

Dr Ebrahim Samba, Regional Director, AFRO
Dr A. Kabore, Director a.i., Division of Prevention and Control of Communicable Disease
Dr R. Tshabalala, Division of Reproductive Health
Mr B. Chandra, Director, Administration & Finance
Prof. Doyin Oluwole, IMCI Unit, WHO/AFRO C/O WHO, Lomé, Togo, Tel: 228 223112, Fax: 228 222 952, doluwole@rdd.tg
Dr A. Etukudo, Resource Mobilization
Dr Y. Kassankogno, Regional Adviser, Malaria
Dr E. Afari, Malaria Action Plan
Dr O. Walker, Malaria Drug Policy
Dr A. Robb, Malaria Unit
Dr R. Gbary, Epidemiologist, Roll Back Malaria
Dr M. George, Health Sector Development, Roll Back Malaria
Dr T. Okorosobo, Health Economist, Roll Back Malaria
Dr James Mwanzia, Regional Adviser a.i. District Health Systems, Email: mwanziaj@whoafr.org
Dr Bokar Toure, Regional Adviser, National Health Systems, Email: toureb@whoafr.org
Dr S. Murugasampillay, Malaria Southern African Inter-country Team
Dr A. Birkinesh, Southern African Inter-country Team
Dr Alexis Bagalwa Ntabona, Regional Adviser for Reproductive Health
Dr D. Barakamfitiye, WR/Zimbabwe
Mr H. Dibi, Malaria Technical Officer
Mrs E. Nganongo, Administrative Assistant, Malaria
Mrs Y. Mongo, Secretary Malaria
Mrs P. Chigudu, Secretary, Malaria
Mr E. Koussounga, Conference Officer
Mr A. Matselele, Technician