African Summit on Roll Back Malaria
Summary Report

The African Summit on Roll Back Malaria was held in Abuja, Nigeria on the 25^th of April 2000. It reflected a real convergence of political momentum, institutional synergy and technical consensus on malaria (and, to some extent, other infectious diseases issues).

Forty four of the fifty malaria-affected countries in Africa attended the summit. Nineteen country delegations were led by the Heads of State, while the remaining delegations were led by senior government officials including the Vice President, Prime Minister or, in some cases, the Minister of Health. The Summit was also attended by the senior officials from each of the four founding agencies -- Director General of the WHO, Vice President of the World Bank, Executive Director of UNICEF, and Director of UNDP Africa, as well as other key partners including UNESCO, the African Development Bank, USAID, DFID, CIDA, and the French Co-operation. The Heads of State and other delegates reviewed evidence, debated options and ratified an action-oriented declaration with strong follow-up processes. WHO, UNICEF, the World Bank, the African Bank, CIDA, DFID, USAID and other development partners worked as one in supporting the preparation and the Summit itself. The next stage for RBM in Africa will be intense: catalyzing more effective activity within communities, strengthening capacity in countries, managing expectations and finding mechanisms to ensure support for malaria actions within evolving health sector and human development strategies.

We sense that there really has been a step-up in prospects for the next decade: it certainly felt like it in Abuja as Heads of State, supported by Jeffrey Sachs, invited us all to re-appraise past thinking about the costs for Africa's development associated with ill health, and the benefits of global support for effective interventions, in Africa.

Technical Briefing

Preceding the summit, a technical session was held at the same venue on the 24^th of April 2000. Ministers of Health, senior Ministry of Health officials and malaria control programme managers, attended the technical session. Participants heard presentations on:

• Overview of malaria in Africa (significance of RBM),
• Burden of malaria,
• Evaluation of different intervention measures for malaria control in Africa,
• Health systems reform, policies and resource mobilization for malaria control,
• Use of insecticide treated nets (UNICEF experience in five African countries),
• Home management of malaria,
• Malaria vaccine development and field evaluation in Africa, and
• Malaria research in Africa.

Finally, the draft Declaration and the Plan of Action were thoroughly reviewed and debated. In closing the session, a task committee was established to strengthen the draft Declaration and Plan of Action in preparation for the Heads of State Summit.

African Summit on Roll Back Malaria

His Excellency, Chief Olusegun Obasanjo the President of Federal Republic of Nigeria, chaired the Heads of State Summit. The Summit ran the full day on the 25^th April 2000 from 8:00 AM to 19:00 PM. Delegates heard speeches from the Heads of State (or delegation), and the partner agencies. The Summit concluded with the review and signing of the Declaration and the Plan of Action (all countries present signed the Declaration).

By signing Declaration, the African leaders rededicated themselves to the principles and targets of the Harare Declaration of 1997. They committed themselves to an intensive effort to halve the malaria mortality for Africa's people by 2010, through implementing strategies and actions for Roll Back Malaria, as agreed at the Summit. In addition, they agreed:

• to catalyze actions at regional level to ensure implementation, monitoring and management of Roll Back Malaria;
• to initiate actions at country level to provide resources to facilitate realization of RBM objectives;
• to work with partners towards stated targets, ensuring the allocation of necessary resources from private and public sectors and from non-governmental organizations; and
• to create an enabling environment in their countries which will permit increased participation of international partners in malaria control actions.

The Leaders resolved to initiate appropriate and sustainable action to strengthen the health systems to ensure that by the year 2005:

• at least 60% of those suffering from malaria have prompt access to, and are able to correctly use, affordable and appropriate treatment within 24 hours of the onset of symptoms,
• at least 60% of those at risk of malaria, particularly children under five years of age and pregnant women, and benefit from the most suitable combination of personal and community protective measures such as insecticide treated mosquito nets and other interventions which are accessible and affordable to prevent infection and suffering, and
• at least 60% of all pregnant women who are at risk of malaria, especially those in their first pregnancies, have access to chemoprophylaxis or presumptive intermittent treatment.

The Heads of State called upon all countries to undertake and continue health systems reforms which will promote community participation and joint ownership of Roll Back Malaria actions to enhance their sustainability. Health systems should make diagnosis and treatment of malaria available as peripherally as possible, including home treatment, and accessible to the poorest groups in the community. In addition, countries must continue to maximize vigilance to prevent the re-emergence of malaria.

Development partners were called upon to cancel in full the debt of poor and heavily indebted countries within Africa in order to release resources for poverty alleviation programmes, such as Roll Back Malaria and to allocate substantial new resources of at least US$ 1 billion per year to Roll Back Malaria. Additional resources are also needed to stimulate the development of malaria vaccines appropriate for Africa and to provide similar incentives for other anti-malaria technologies. The collaboration between research institutions within Africa and partners throughout the World should be strengthened and sustained to ensure the full utilization of research knowledge and programme experience.

The Leaders themselves pledged:

• to implement the agreed Plan of Action within their own countries;
• to develop mechanisms to facilitate the provision of reliable information on malaria to decision-makers at household, community, district and national levels, to enable them take appropriate actions;
• to reduce or waive taxes and tariffs for mosquito nets and materials, insecticides, anti-malarial drugs and other recommended goods and services that are needed for malaria control strategies,
• to allocate the resource required for sustained implementation of planned Roll Back Malaria actions;
• to increase support for research (including operational research) to develop a vaccine, other new tools and improve existing ones;
• to commemorate this summit by declaring April 25^th each year as African Malaria Day;
• to call upon the United Nations to declare the coming decade 2001-2010, a decade for Malaria, explore; and
• to develop traditional medicine in the area of Malaria control.

The Leaders mandated the Government of Nigeria to report the outcome of this Summit on Roll Back Malaria to the next OAU summit for follow up action. In addition, they requested the Regional Committees of the African and East Mediterranean Region to follow up the implementation of this Declaration and regularly report to the OAU and seek collaboration with UN agencies and other partners.

The Summit host, His Excellency Olusegen Obasanjo, President of Nigeria, in his closing remarks observed, "Today we have begun to write the final chapter of the history of malaria. We have raised the hopes and expectations of our people - we must not let them down. We cannot afford to let them down. May malaria be rolled out and development rolled in all African countries."

Reflections on Next Steps for the Global Partnership

The Abuja summit has provided both the momentum and tools required to transit into scaling up phase at country level. The RBM partnership should take advantage of this opportunity to provide much more clear information on available resources and procedures for accessing them, to swiftly and systematically bring to conclusion the inception phase with the necessary drama for partnership building, and to mount a concerted effort for inter-country activity.

1.     Strengthening of country level resource base.

Several partners used the Summit as an opportunity to pledge additional resources to rolling back malaria. The Secretariat should work with these partners to make these resources available, informing countries as to the best method to access the resources.

2.     Swift and Systematic conclusion of the inception phase with country-level joint missions and round table discussions

The RBM partnership should take advantage of the momentum generated by the Abuja summit to launch scaling up activity in over 30 malaria affected countries. This should be in line with agreed strategies, plans of work, milestones, resource management mechanisms and monitoring and evaluation frame and systems. This process has been facilitated by the adoption of the action plan, targets and monitoring frame by the 44 country delegations that signed the declaration.

The inception process has already led to: broad-based consensus within countries, structured situation analyses, and, in some cases, additional resources. The RBM partnership, working through a series of rapid consultations, could, for each country, agree:

1. Base-line situation in relation to the indicators agreed in Abuja
2. Milestones for scaling up of malaria interventions and strengthening of systems using the framework agreed in Abuja, and the draft strategy and situation analyses prepared by country partnerships
3. Resources and sources to be committed in each country
4. Financing arrangements and essential management capacities (paying particular attention to resource absorption issues) suited to each individual country scenario to ensure that the resources pledged in Abuja are disbursed efficiently and effectively.

It may be possible to stagger the commencement of the implementation phase across Africa:

1. June - July 2000

Country tracking information indicates that Botswana, Namibia, South Africa, Kenya, Ghana, Ethiopia, Eritrea, Mozambique, Mali, Zimbabwe, Sudan, Zambia, Uganda, have either finalized or are about to finalize their national strategy documents. These countries would then be ready to bring the inception phase to a close and allow the partnership to commence the implementation of activities for scaling up. This could take place in June - July 2000 in these countries.

2. October 2000

By August 2000, Senegal, Mauritania, Burkina Faso, Tanzania, Niger, will have completed situation analysis and will be ready for implementation. A second round could take place in October 2000.

3. November - December 2000

By October 2000, Benin, Côtè d'Ivoire, Togo, Gabon, Cameroun, Gambia, Tchad, Nigeria, Djibouti will have completed situation analysis and should be ready for implementation which could take place in the November-December 2000 period.

4. January - February 2001

Angola, DRC, Sierra Leone, Liberia have already initiated intensive activity for rolling back malaria in a combination of approaches with some areas covered by government led partnerships and other through NGO activity. It should be possible working through the complex emergency network to mount a series of consultations towards more structured exercises for scaling up RBM activity by the beginning of next year.

Within the next nine months, scaling up activity could therefore be launched in over 30 malaria affected countries in line with agreed strategies, plans of work, resource management mechanisms, and monitoring and evaluation systems.

3.     Scaling up of inter-country activity

The Declaration explicitly calls for neighboring countries to work together on cross border strategies. A plan for strengthening the existing multi-country initiatives should immediately be developed. In addition, other countries should be encouraged to explore areas/issues for inter-country cooperation and collaboration. Partners could work together intensively to plan a facility that will make this possible, establishing institutional mechanisms to manage it, new approaches to enabling poor people to access goods and services, and mobilizing the necessary resources for this purpose.