Africa is grappling with managing diseases like malaria, HIV/AIDS, and tuberculosis as health systems that are unable to cope with both this and the coronavirus pandemic. Sleeping under a net and taking antimalarial pills helps prevent malaria. Credit: Mercedes Sayagues/IPS

By Busani Bafana
BULAWAYO, Zimbabwe, May 11 2020 (IPS)

Experts across Africa are warning that as hospitals and health facilities focus on COVID-19, less attention is being given to the management of other deadly diseases like HIV/AIDS, tuberculosis and malaria, which affect millions more people.

“Today if you have malaria symptoms you are in big trouble because they are quite close to COVID-19 symptoms, will you go to the hospital when it is said we should not go there?” Yap Boum II, the regional representative for Epicenter Africa, the research arm of Doctors Without Borders, told IPS.

“Hospitals are struggling because they do not have the good facilities and equipment; it will be hard to take in a patient with malaria because people are scared. As a result the management of malaria is affected by COVID-19,” Boum, who is also a Professor of Microbiology at Mbarara University of Sciences and Technology in Uganda, said, pointing out that HIV/AIDS and tuberculosis were also being ignored.

In fact, the World Health Organisation (WHO) has warned that four times as many people could die from malaria than coronavirus.

“With COVID-19 spreading, we are worried about its impacts on health systems in Africa and that this may impact negatively on the delivery of routine services, which include malaria control. The bans on movement will affect the health workers getting to health facilities and their safety from exposure,” Akpaka Kalu, team leader of the Tropical and Vector-borne Disease Programme at the WHO Regional Office for Africa, told IPS.

The WHO has urged member countries not to forget malaria prevention programmes as they race to contain the COVID-19 spread. Without maintaining prevention programmes, i.e. should all insecticide-treated net campaigns be suspended and if access to effective antimalarial medicines is reduced because of lockdowns, malaria deaths could double to 769,000 in sub-Saharan Africa this year.  At the same time the agency has predicted that some 190,000 people could die of COVID-19.

According to the WHO, as of today, May 11, Africa has recorded over 63,000 confirmed COVID-19 cases with 2,283 deaths in 53 affected countries in the region.

• Though preventable and treatable, Africa is battling to eliminate malaria despite a decline in cases over the last four years.
• The continent has the highest malaria burden in the world, accounting for 93 percent of all cases of the disease.
• Malaria is one of the top ten leading causes of death in Africa, killing more 400 000 people annually.

Poorly equipped and understaffed national health services in many countries in Africa could compromise efforts to eliminate the malaria scourge, noted Kalu.

Africa must cope with COVID-19 without forgetting malaria

Mamadou Coulibaly, head of the Malaria Research and Training Center at the University of Bamako, Mali, concurred that the pandemic was straining health systems in developing countries. He urged malaria-endemic countries not to disrupt prevention and treatment programmes.

“To avoid this catastrophic scenario, countries must tailor their interventions to this challenging time, guaranteeing prompt diagnostic testing, treatment, access and use of insecticide-treated nets,” Coulibaly, who is also the principal investigator of Target Malaria in Mali, told IPS. 

Mali is one of the top 10 African countries with the high incidence of malaria.

Malaria needs more national money

Kalu stressed that domestic financing for malaria was needed. He commended the Global Fund to Fight AIDS, Tuberculosis and Malaria and other private sector partnerships that have provided funds for malaria. But he pointed out that this was neither ideal nor sustainable unless national governments contributed a lion’s share to malaria control.

• There is a $2 billion annual funding gap when it comes to malaria prevention, which should be closed to sufficiently protect people in malaria affected countries, according to the RBM Partnership to End Malaria, a global private sector initiative established in 1998. The partnership has sourced funding and equipment for malaria prone countries, providing mosquito nets, rapid diagnostic tests and antimalarials.

More action, less talk

While pleased with progress made towards eliminating malaria in Africa since 2008 when the Abuja Declaration on Health investment was signed, Kalu said Africa could do better.

• In 2001 African governments drew up the Abuja Declaration to invest 15 percent of the national budgets in improving health care services.

• Nearly 20 years later, a handful of countries such as Swaziland, Lesotho, Ethiopia, Liberia and Burundi have invested in building their health systems, according to 2016 WHO assessment report on public health financing for health in Africa. Many African countries have reduced their spending in health as a percentage of total public expenditure than they did in the early 2000s.

• For every $100 that goes into an African nation’s state coffers, on average $16 was allocated to health. Of this amount  only $10 was spent, with less than $4 going to the right health services.

“For the first time in our lifetime, the human being and the world is realising that the most important thing we have is our health,” said Boum, questioning why African governments have all not prioritised health spending despite the Abuja Declaration.

“With our borders closed we are all being taken care of in the poor health system that we have built,” Boum, told IPS. “There is no more flying to India, London or the United States. We are all in the same boat because we have not invested what we were supposed to invest and I hope beyond the pandemic, we will make health care a just cause and even manage to go beyond the 15 percent health investment agreed upon.”

With the current level of investment in health systems, the WHO fears Africa will not achieve the United Nations Sustainable Development Goals (SDGs), particularly SDG3 on ensuring healthy lives and wellbeing for all and ending malaria by 2030.

“We do not want a situation where we are protecting people from COVID-19 and they die of malaria and other diseases,” Kalu told IPS.

“We are not asking governments to put money in malaria alone but in national health systems. COVID-19 is showing that Africa needs facilities and equipment which it does not currently have to effectively deal with the pandemic.”

When Veronika Sintsova was diagnosed with tuberculosis in 2009, she spent six months in hospital before being discharged and allowed to continue treatment as an outpatient.

Today clear of the disease, the 35-year-old former drug user from Kaliningrad says the fact that she beat tuberculosis (TB) is not because of, but rather in spite of, the way many people with tuberculosis are treated in Russia.

“I think it would be fair to say that Russian authorities don’t take the problem of tuberculosis seriously,” she told IPS.

Tuberculosis is a major health threat in Russia, where it is the leading infectious disease killer.The country has the highest rates of multi-drug resistant (MDR) and extremely drug resistant (XDR) tuberculosis in Europe and the third highest in the world. And those rates are climbing.Tuberculosis exploded in Russia after the collapse of the Soviet Union as health care infrastructure crumbled, the country was thrown into economic crisis and crime and poverty soared, leading to overcrowded penal institutions.

It also has the 11th highest burden of all TB in the world, according to the World Health Organisation (WHO), which just last week said that parts of the country were “disaster areas” for the disease.

Tuberculosis exploded in Russia after the collapse of the Soviet Union as health care infrastructure crumbled, the country was thrown into economic crisis and crime and poverty soared, leading to overcrowded penal institutions.

But, say NGOs in Russia and international groups working to combat the disease, the continued use of outdated and inefficient approaches to the disease are still fuelling its spread.

Long stays in health facilities filled with people with TB were a cornerstone of the Soviet health care system’s approach to the disease, and have remained, even though they were abandoned years ago in the West because they were seen as contributing to the spread of the disease.

But it is not just in health care facilities where people with TB are being failed. The disease is rife in Russian jails. Overcrowding, poor conditions and bad nutrition all contribute to high infection rates with one in seven prisoners having active TB, according to the Russian Federal Penitentiary Service.

The way prisoners with TB are treated typifies the general approach to the disease by authorities. Sintsova said that although she was treated well by doctors, it was during a sixth month spell in prison for a drug offence that she had what she says was “the worst experience” of all the time she had the disease because fellow inmates and wardens took no pity on her when she left her cell.

“They would shout out ‘tuberculosis sufferer on a walk’ as I went along. That really hurt me. It was probably the worst thing I experienced in all the time I had tuberculosis,” she told IPS.

And this abuse is typical, she said, of the way many people with the disease are viewed in Russia. TB is common among those at the margins of society – drug users, alcoholics, people with HIV and those in dire poverty. “In our society, a drug user is not a person and their death from tuberculosis is seen as something they deserve,” Sintsova, who herself has HIV, told IPS.

Third sector groups working with TB sufferers say approaches towards such people need to be changed. Anya Sarang, president of the Andrei Rylkov Foundation for Health and Social Justice, has previously told local media that the “unjustified imprisonment of Russian people, especially drug users, leads to prison overcrowding” which in turn fuels continued TB infection.

Others point to the need to provide integrated care for people with co-infections, such as HIV and hepatitis C. Oksana Ponomarenko, Russia country director for the U.S. organisation Partners in Health (PIH) which works with TB patients in Russia, said on the group’s website: “The biggest problem lies in the fact that each health system in Russia is vertical and operates separately –TB, drug addiction services, HIV care, psychiatric services, among other health programs.

“At federal level and in individual regions these programs are not connected. Often, clinicians in one programme will not have complete information on other nearby services and programmes.”

PIH and other local organisations have started programmes to try and provide integrated treatment to people with TB in some cities, including a mobile clinic.

Some success has been reported in a scheme in the city of Tomsk where prisoners with TB are all housed in one facility. If released before their treatment has finished, they are placed straight into hospital to prevent infecting others when they return to wider society.

PIH says that its methods have been adopted as official state policy on TB and legislation was recently brought in to emphasise the importance of ambulatory, rather than institutional, care in TB treatment. The government has also increased spending on TB in recent years, modernised diagnostic equipment and overhauled research institutes specialising in TB.

But what worries many working with TB patients is the Kremlin’s approach to some of the biggest international funders of TB projects. It recently decided to reject money from the Global Fund for Aids/TB and Malaria, justifying the move by saying that Russia is now a donor to the Global Fund and that it would be wrong for it to continue to take money from it.

Some see the move as entirely political and part of attempts by the Kremlin to crack down on foreign NGOs operating in Russia. Another major funder of groups working on TB programmes, USAID, was expelled from the country in 2012 and forced to stop operating, on the grounds that it was interfering in Russian politics.

Some projects, including a few run by PIH, have already been affected.