Author: Dr. Michel ODIKA - January 15, 2015.
Thought and theory must precede all salutary action, yet action is nobler in itself than either thought or theory (Virginia WOOLF).
Fight the good fight (Timothy 6:12).
Why a renewal of the malaria response? why do malaria-affected countries critically need new institutional landscapes? In many regards, such questions go well beyond what can be answered by tracking routine data (1), which is what most conventional health informations systems focus on...
Today, the multiplication of information users implies that the way malaria-related information is generated, used and shared also has to evolve. This critically depends on accessibility and transparency, for example, by making all crucial information (2) readily accessible via the Internet - as in some countries, where effective communication (3,4) is considered both an outcome and a motor of their "Regime of Explicit Health Guarantees" (5).
In many countries, the response to malaria seems to be drifting from one short-term "priority" to another, increasingly fragmented and without a strong sense of preparedness for what lies ahead. Today, the area where new opportunities are appearing is in the institutional capacity for developing malaria responses that are aligned with the 2015 Millennium Development Goals. In many malaria-affected countries, unfortunately, "purely medical approaches" remain the primary repositories of technical expertise for public health, but also, more broadly, for environmental safety and sustainability. Increasingly, however, the health sector in these countries is unable to cope with the multiple and complex demands for adequate policies and strategies to promote a multisectoral response to malaria. Not surprisingly, this is leaving traditional national institutes of public health with an oversized and under-funded mandate, which poses problems of dispersion and difficulties in assembling the critical mass of diversified and specialized expertise.
In the face of all this, two tracks offer potential for significantly improving the response to malaria:
I) Merging the Ministries of Health and Environment;
II) Developing open and collaborative models, such as "Malaria Observatories", by creating space for "multi-stakeholder partnerships and networks".
In Congo-Brazzaville, my native country (Central Africa), there are promising opportunities to build upon the "second track". Otherwise said, Congo-Brazzaville is (possibly?) on track to become the world's first country to establish a Malaria Observatory. What does it mean in concrete terms?
The increasing cross-sector exchange of experience and expertise - e.g. health professionals, environmentalists, NGOs, etc. -, combined with a real interest in scaling up the response to malaria, is taking hold and, therefore, creating new opportunities - not just in order to prepare professionals in more adequate numbers but, above all, professionals with a broader outlook and who are better prepared to address malaria as a human development issue as significant as any confronting Africa.
Dr Michel ODIKA (Congo-Brazzaville)
1. For example, routine data from traditional health information systems often fails to respond to the rising demand for malaria-related information from a multitude of constituencies - see Advocacy for Health Information Systems Instrumental to Institutional Reforms. Health professionals need better information to improve the quality of their work. Civil society organizations need better information to protect their members' health, reduce exclusion and promote equity. Research centres need better information about the progress being made in the malaria response. Politicians need better information on how well the malaria response is meeting society's goals - i.e. justice, social cohesion, sustainable and equitable development, etc. - and on how public money is being spent.
2. From a policy point of view, the crucial information is that which allows identification of the operational and systemic constraints.
3. How to build a critical mass of capacity for positive change? The institutional capacities to enable institutional reforms are not a given. They are typically weak in countries where, by choice or by default, "laissez-faire" dominates the approach to policy formation in health. Even in countries with mature and well-resourced health systems there is scope, and need, for more multisectoral, coordinated and integrated approaches - e.g. negotiation between health authorities and professional institutions is often well-established, but is much less so with other stakeholders involved in the malaria response. Globally, experience from countries that have been able to accelerate institutional reforms always suggests three common elements: I) the importance of making strategic information instrumental to institutional reforms; II) systematically harnessing innovations; and III) sharing lessons on what works and on what doesn't.
4. How to institutionalize the multisectoral response to malaria? Institutional reforms critically need to be informed, not just by better data, but also by strategic information obtained through a departure from the traditional views on the clients (Ministries of Health), the scope (routine data related to morbidity, resource allocation and service delivery) and the architecture of national health information systems. For example, many national health information systems that are used to inform the malaria response can be characterized as "closed administrative structures" through which there is a limited flow of malaria-related data on resource use, services and health status. They are often only used to a limited extent by officials at national and global level when formulating policy reforms, while little use is made of critical information that could be extracted from other tools and sources - i.e. research centres, academic institutions, NGOs, etc. -, many of which are located outside the public system or even outside the health sector.
5. Critical need for a paradigm shift in thinking about malaria... Today, institutional reforms call for open and collaborative models - see Malaria Observatory: Human Development Project - to ensure that all the best sources are tapped and malaria-related information flows quickly to those - e.g. health authorities, health professionals, environmentalists, decision-makers, etc. - who can translate it into appropriate action. Thus, open and collaborative structures offer specific models of complementing routine information systems, by diretly linking the production and dissemination of strategic intelligence on malaria to policy-making and to the sharing of best practices. In this regard, they simply reflect the increasing value given to cross-agency work and evidence-based policy-making. For example, they bring together various constituencies around a shares agenda. Unlike "closed administrative structures", ultimately, open and flexible configurations provide continuity in settings where policy continuity may be affected by a rapid turnover of... decision-makers.