Q&A: Tackling two deadly diseases one health system at a time

Amref Health Africa CEO Dr. Githinji Gitahi with community health worker Margaret Kilonzo at the Kibera informal settlement in Nairobi, Kenya. Photo by: Amref Health Africa

Pharmaceutical giant GSK has teamed up with Amref Health Africa to reduce malaria and tuberculosis deaths in Ethiopia and Kenya by 80% over the next two years, while simultaneously strengthening the countries’ health systems.

According to the World Health Organization, globally 409,000 people died in 2019 as a result of malaria. The Africa region was home to 94% of those deaths. Meanwhile, over 25% of global TB deaths occur in the region.

“The challenge is that these two are preventable diseases and therefore the loss of life is unacceptable,” Dr. Githinji Gitahi, CEO of Amref Health Africa, said.

The new tackling malaria and TB in Kenya and Ethiopia program, three-fold in its purpose, plans to reduce the burden of these diseases, reverse any setbacks caused by COVID-19, and then accelerate the gains in tackling the two.

It will do so by leveraging Amref’s expertise in community engagement and GSK’s research and development strengths, Gitahi said. The plan is to make robust, cross-sectional, and horizontal changes to health systems to overcome the challenges that malaria and TB present and achieve sustainable, lasting health change for communities, he added.

“We look forward to working closely with all our partners — specifically governments and communities in these two geographies — and learning together and adapting … to ensure that every life has equal value and every life is protected from preventable death and disease.”

Speaking to Devex, Gitahi explained why building robust health systems is a key component of their approach, the need for a focus on Ethiopia and Kenya, and the lessons they hope will stand them in good stead.

This conversation has been edited for length and clarity.

What are the barriers to tackling malaria and TB and how can these be overcome?

The biggest barriers to the control of TB and malaria have to do with the three legs of primary health care because these are primary health care conditions. To actually tackle primary health care adequately, you need one: a multisectoral approach to control and management.

When we’re looking at malaria, we’re looking at water and sanitation, at garbage collection, at waste management, at how people drain water and clear bushes from the communities, at controlling the vectors generally from not only a health point of view, but a multisector point of view. This also applies to TB, because TB has a lot to do with nutrition for example.

The second [aspect] is to look at community engagement and empowerment … For example, we know that when you empower women through education, you're able to nourish the children and communities and [lessen] spread of TB … It's only by educating women that you can ensure that families are obeying the public health measures that are needed. Therefore making sure there is full community engagement and empowerment is a key player in health care [and] control of malaria and TB.

[Next], primary care [must] include integrated community case management. When you have robust primary care built on strong community health systems, that means children who may have malaria are identified early and treated at the household level using community health workers.

And finally, you [must] have a good ecosystem of health workers and financing to ensure that these services are continuously available to the entire community. These are the challenges that we've been trying to overcome.

The Youtube video https://www.youtube.com/watch?v=clT9yNyuXFU is not available.
Dr. Githinji Gitahi, CEO of Amref Health Africa. Via YouTube.

As the new program between GSK and Amref works to overcome these barriers, how can others in the global health community support your work?

No single individual corporate government and no single partnership can work on its own. We also realize that for us to assist others to come in, we must be able to collect enough data to inform our approaches and impact so we can show what the minimum viable interventions are that they can pick up and scale. So within this project, we’ve made sure that the area of research and documentation of impact is central. We’re going to share our learnings with others so that together we can actually do more.

We’re also leveraging other global health partners like The Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. Agency for International Development and looking forward to — once we share the research and impact — others join[ing] so that we can continue to scale the results of this program.

Everyone realizes that, in this era as we look forward to achieving the Sustainable Development Goals by 2030, we cannot do so if we don't actually go together. There’s a popular saying that “if you want to go fast, go alone, but if you want to go far, go together.” So how do we go far to ensure that by 2030, all the goals of ending preventable suffering are actually achieved and that we do that with others as reflected clearly in SDG 17?

Dr. Githinji Gitahi, CEO at Amref Health Africa. Photo by: Amref Health Africa

Are there any lessons learned from other work in this area that you'll take into this effort?

Yes, many and some of these have to do with the fact that if you don't measure you don't learn. We’ve had many partnerships with GSK and others and we have seen that one of the most important things is to learn as you do. We call it execution as learning. We also know that if you’re going to do the same thing over and over and expect different results, that is described as insanity so we tend to say we want to do things in new ways so that we learn more and we implement more scalable solutions. What we have learned is that measurement is important so we’re going to measure as we go.

Secondly, we have to be ready to make mistakes. We’ve learned that in many projects and interventions we do, if you don't continuously learn what mistakes you've made and reiterate from them, then you don't implement sustainable programs. Learning is most impactful when you learn from the communities. The people who have lived experiences are the ones that we need to learn from.

The next thing is that we have learned that you might adopt technology. In previous interventions we've had with GSK, we've brought in technology in big ways … So we have to learn, we have to adopt technology, we have to adopt innovation, and we have to recognize mistakes when they happen and make sure that when we fail, we fail fast.

How might this work also impact the effects of COVID-19?

Health systems that are resilient, that serve everyone — which is the goal of achieving universal health coverage — are the same health systems needed for health security and emergencies. COVID-19 — and as was demonstrated earlier by Ebola — is reliant on resilient, equitable health systems. Whenever we have seen that we don't have resilient, equitable health systems, the impacts of health emergencies like COVID-19 become even more severe, disrupting the social and economic fabric of society.

So we know that when we work on TB and malaria — not as a vertical intervention, but horizontal interventions where we build community health systems and policy intervention — we’re building systems that last beyond these two interventions in Kenya and Ethiopia … We’re seeing this intervention not in its limitation of the two geographies and the two vertical interventions, but as something horizontal that will affect other interventional areas and build health systems for the future and for the next pandemic beyond COVID-19.

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