Joy Phumaphi, African Leaders Malaria Alliance: Malaria is an all of society challenge

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0:30the highest B2B return on ad spend of major ad networks. Spend$250 on your first campaign on LinkedIn ads and get$250 credit for the next one. Just go to linkedin.com slash broadcast. That's linkedin.com slash broadcast. Terms and conditions apply. Self-directed investing, trading, full-service wealth management, automated investing, financial planning, thematic investing, retirement planning. Phew. And to think, that's just a small taste of what Schwab offers because Schwab knows that when it comes to your finances choice matters no matter your goals, investing style, life stage or experience Schwab has everything you need all in one place so you can invest your way visit schwab.com to learn more Hello, I'm Daniel Dazi, BBC presenter and this is the interview from the BBC World Service the best conversations coming out of the BBC, people shaping our world from all over the world.

1:32If you're not a little bit afraid, then you're not paying attention. We have never seen a people so united. Do not make that boat crossing. Do not make that journey. Being born in America, feeling American, having people treat me like I'm not. We're more popular than populism. For this interview, I met Joy Pumapi, Executive Secretary of the African Leaders Malaria Alliance, or ALMA, in Addis Ababa's Plush Radisson Blue Hotel. Africa was home to 96 % of global cases of malaria in 2024 and 97 % of deaths. ALMA brings together the leaders of 55 African countries, currently led by President Boko of Botswana, and was founded with the clear goal of eradicating malaria across Africa by 2030.

2:21But Joy Pomapi tells me only a few member states will hit this target. She describes a perfect storm of factors, including drug resistance and climate change, as well as the risk that private sector development projects like road construction and mining sites, for instance, can become breeding grounds for mosquitoes, all of which add to spiraling costs of malaria prevention. If I can just show you what type of gap we are trying to target here, In terms of coverage with effective prevention interventions, there are very few countries that are reaching more than 60 percent of the population that needs to be covered.

2:58So when we talk about we are spending three billion, four billion here, the gap is actually in the region of six billion. So we are talking here about a massive gap that will be required. So it is not just that there's lack of political will or that people are not budgeting enough, but the resources required are massive. Welcome to the interview from the BBC World Service with Joy Pumapi. So in this perfect storm crisis that you describe in the 2025 Alma report, you mentioned funding shortfalls, climate change, extreme weather events, insecticide and drug resistance, and humanitarian crises. Yes.

3:45Out of these issues, which would you say is the heart of, if you are talking about what is causing this perfect storm? I think perhaps we should look at it from this perspective. Look at it as a, let's say, a vehicle that we are trying to drive. We're trying to get a vehicle and we're getting to this destination of a malaria-free world. Our destination is 2030. But in order to get there, you need a sound vehicle. And what is the sound vehicle? The sound vehicle is the tools that you are going to use to get there. It is the human resources that you are going to use to deploy these tools. It is the finance that you will need, first of all, to acquire and deploy the tools and also to compensate the human resources.

4:44As you are traveling on this journey to 2030, you encounter challenges. So it is, and the challenges could be, we talked about the flooding that creates breeding sites for mosquitoes. We talked about the fact that if you look at the population of the African continent, let's say in 1994, when I first became a member of parliament, it has doubled since then, the population of the African continent. But if you look at the interventions that we have been deploying since the beginning of the century, like insect treated mosquito nets, we have not really been able to double the number of nets that we have had, that we are using.

5:33Why? Because every time you have a new commodity, it is more expensive. And because the ODA that we've been receiving, the budget allocation that we've been making to health and to malaria, in terms of purchasing power, has not really increased. So what I'm trying to say here, let's look at it as a complete vehicle. We cannot isolate one particular issue and say, no, this is what is delaying us. Because if you are hit by a storm on the journey, you have to stop. If one part of your car stops working, you have to stop. So we cannot isolate a particular issue in this perfect storm of challenges and say, this is what is holding us back.

6:20But you do mention in your report that there's been a 70 % decline in ODA. that is official development assistance for health in Africa over the past five years. And then you see a 30 % funding reduction could lead to 146 million additional cases. We need money. We definitely need money. And the result of that 30 % reduction would also be a loss of$37 billion in gross domestic products. So we need the money. But I think the question here is, where does the money come from? We have not really substantially increased budget allocation to health as a whole since 2000, you know, when we had this Abuja declaration.

7:10And I used to be proud that I was actually chairing the committee of ministers that designed that clause in the declaration. about 15 % budget allocation. But at that time, when that clause was developed, the Global Fund was not there. Unitaid was not there. And PEPFA was not there. The U.S. President's Malaria Initiative was not there. Now, unfortunately for us in these areas, whether it's HIV, AIDS, tuberculosis, or malaria, when these funds were created, our ministries of finance then looked at them as a replacement for the commitment that we have made. So the budget, most countries never achieved that targeted budget allocation.

8:02But what we have done in ALMA, appreciating that creating fiscal space is extremely difficult in our economies because we have resource constraint. We are overstretched in terms of debt, the debt burden that we carry. So there's a very limited fiscal space. And even when consensual funding is secured, like for IDA, the demand is massive for IDA resources. So what we have been recommending in each country is that the country set up health funds. Because we are focusing on malaria, we have called them end malaria funds. Now the mechanism for administering these funds is a multi-sectoral council comprising captains of industry from the private sector, sectoral ministries that contribute towards the fight against malaria, or contribute towards spreading malaria, like aggregation through the big irrigation schemes, environment when there's flooding, which we spoke about earlier.

9:21But education is critical for all of health. The ministries that are responsible for the mining sector, for example, infrastructure, those create huge bridging sites for malaria. So we have them all as members of this council. at either director general or ministerial level. And then we have captains of industry. We have religious leaders. We have traditional leaders. We have civil society. We have the domestic partners that are partners of the Ministry of Health. Now, all of them use a digital tool that we have developed to actually assess progress in the fight against malaria, where the bottlenecks are, and then see how they can step in to support government.

10:06And the End Malaria Council in Zambia, for example, has purchased bicycles for community health workers because those are so critical for primary health care. They have funded seasonal malaria chemoprevention for all the children under the age of five. We have, I can give you so many examples of what the End Malaria Council are doing. So this is one approach that we are recommending. And we are looking at this as part of the big push to engage everybody in the fight against malaria. My question is, who funds, where's the source of money for the funds that these councils sit on? Because you started by saying that there's very little fiscal space.

10:53We have to face that reality. So where do they get the money from? The private sector. There are corporate social responsibility. So what the private sector is actually doing is targeting CSR funds and they're targeting it in a different way from the way they normally do because now they are sitting on the board of the council and they are able to monitor effective use of the resources. So there is less wastage and there is proper targeting. What countries are now doing is what we call subnational tailoring. If you do subnational tailoring, then you can target specific interventions to high bedding areas or areas where that type of intervention would be most useful and then use other interventions in other areas.

11:39So this subnational tailoring has actually performed miracles. In Rwanda, for example, they are using drones to do spraying with lavisite over the rice paddies because rice paddies are ideal breeding sites for mosquitoes. And this has really brought down the incidence of malaria in the region. So you can see here, instead of waiting for malaria outbreak or just distributing nets or saying we'll have rapid diagnosis tests and treat people quickly, they actually are taking the breeding exos and stopping it in its tracks. So this is the sort of sub-national tailoring that we are talking about. so i keep hearing you mentioning these examples of success stories yes but i look at your reports and i find that if you look at end malaria councils and funds for instance 12 countries have launched them out of 55 at the very top only five countries on the continent are on tracked to me is the malaria incidence reduction targets laid out in the EU catalytic framework.

12:55My question is, is it simply a lack of money or is it a lack of political will? You need both. You need both political will and you need money. If I can just show you what type of gap we are trying to target here. in terms of coverage with effective prevention interventions we are not there there are very few countries that are reaching more than 60 percent of the population that needs to be covered and so when we talk about we are spending a three billion four billion here the gap is actually in the region of 6 billion. So we are talking there about a massive gap that will be required. So it is not just that there's lack of political will or that, you know, people are not budgeting enough, but the resources required are massive.

13:57And that is why what we are saying is that one of the reasons why I was giving you an example of what Rwanda is doing is a partnership between the Ministry of Health and the Ministry of Agriculture. If you look, so we are saying let us do things a little bit differently here because the resources required are huge. We are saying to the Ministry of Infrastructure Development, for example, when you do your environmental impact analysis before you actually, as you design the project and you bring in companies to do major infrastructure projects or even mining or whatever, factor in vector-borne diseases like this and the impact this project is going to have on them and make that part of the budget for the project because that is the whole purpose of an environmental impact analysis so that you can actually budget for it and protect the environment.

14:56Here, you are not just protecting the environment, you are protecting the human beings who live in that environment. So this will then spread the cost. This$6 billion gap will become much, much narrower. And the health will then be only required to intervene when people start getting sick. You're listening to The Interview from the BBC World Service.

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16:41Plus, it actually tastes delicious. No fillers, no nonsense. Just the good stuff your body craves. And for the times you feel like switching it up, you've got seven flavors to choose from. All with the highest quality ingredients. Treat yourself to the flavor and nutrition your body craves. Go to Kachava.com and use code NEWS. New customers get 15 % off their first order. That's K-A-C-H-A-V-A dot com code NEWS. Joy Pomapi is not your typical politician. She started out as an auditor in the 90s and somehow ended up running two ministries in Botswana. As Minister of Health, she rolled out what is known to be Africa's first universal public sector antiretroviral programme for people living with HIV.

17:28She then went on to hold posts like Assistant Director General at WHO and Vice President at the World Bank. It's the kind of career that usually produces cautious, heavily polished public figures. But not this one. She spoke to us with the frankness of someone who has spent a lifetime dealing with problems directly, not dancing around them. She laughed easily, answered plainly, and seemed entirely uninterested in the usual performance of political poise. Okay, let's return to my conversation with Joy Pumapi. You are the African Leaders Malaria Alliance. Alliance, yes. Peopled by 55 African leaders.

18:09Yes. Of course, led by Botswana at the moment. My question is, doesn't the accountability come back to your organization? Because it's the job of these 55 gentlemen and ladies to ensure that it's not malaria or healthcare challenges don't exist in their countries in the first place. So why are you telling us you should be taking your drug? Precisely. We are telling you because we believe malaria is an all-of-society challenge. When you look at the environmental issues, addressing the breeding sites for mosquitoes, it's an all-of-society issue. If you look at the right now, we are saying we want our economies to be driven by the private sector.

18:57the major private sector projects that need to be undertaken by the private sector and by the people, not by the government, can become huge vectors for spreading malaria. So what we are saying is that it is not just the responsibility of these heads of state. It's all of society that have a responsibility to fight malaria. And that is why we are making this call to action. It's a call to action, yes, to the heads of state. And President Boko made it very clear that he's asking every head of state to engage actively. Are they engaging actively? Some are engaging actively, yes. But I think what we also need to appreciate is that the reason why ALMA was created is to have an accountability mechanism that they can use to hold each other accountable.

19:46So that those who are not doing what they need to do will be able to see what they need to do and be motivated to take action. That is where we develop the digital tools. and that is why we actually produce a report and a scorecard for every country. You are able to open the scorecard and you are able to see how each country is doing every quarter. We send the heads of state a report every single quarter so they can see where they are. So it's a mechanism really for holding them accountable. But the action that needs to be taken is the responsibility of all of society, of course led by the heads of state themselves.

20:24So you started by saying that we are sitting in a car getting somewhere. You defined our destination by no malaria by 2030. Yes. That's four years away. Exactly. How far are we in the car? We are very far. We are very far. I mean, there have been so many stumbling blocks. When this particular target was set, we did not have the huge challenges that we currently have with climate change. The population growth was not as explosive as it is now. We did not have the major financial challenges that we have because it was not anticipated that in the middle of the SDGs, suddenly ODA will start declining.

21:05And ODA has been declining for the past 10 years. So since the beginning of the SDGs, there's been a decline. I mean, there is particular notice now because some partners are announcing that they are reducing ODA. But the ones who started reducing ODA 10 years ago did not announce to anybody. They simply just started reducing. So the plan was not future proof. The plan was not future proof. And that is why we are saying now we want resilience. Africans must realize that we are the ones who are responsible for developing this continent. Nobody is going to do it for us. So we have to build our resilience systems ourselves.

21:48Sorry, if our plan to end malaria by 2030 was not future-proof, that means we are not to end malaria by 2030? We are not ending malaria by 2030. A few countries will. And in the report, President Boko actually listed those countries that are on track to end malaria. But most of our countries are not. But one thing that we did not factor in again, future-proofing, as you say, is resistance. The resistance to the main tool that we use for vector control, that is the insecticide to dead nuts, has been massive. And we did not anticipate at that time that we would be dealing with this level of resistance.

22:39So because we had this huge level of resistance to insecticide-treated nets, even the areas where there was huge distribution of nets, there were continue to have major outbreaks of malaria. Now, a new tool has been developed, which is a dual insecticide-treated net, but it is much more expensive. And it's taking time to roll it out. Right. Because the factories now have to re-engineer, including bringing in new equipment in order to be able to produce these new types of nets. And they are more expensive. So some of these challenges that we are currently facing were not anticipated. What would you say to those who would say that it's your organization and it's MIMES who should be held responsible?

23:28First of all, for putting together a plan that was not future-proof. and secondly, for not pivoting in time so that at least we are closer to solving this challenge. What would you say to those who would hold your organization and its members responsible? Well, I think it's a good point, except that it is not our responsibility. That is the WHO responsibility to develop the technical tools and to assess the effectiveness and to recommend to countries what interventions to put in place. It's not our responsibility. But it's the leader's responsibility to protect their citizens. Is the leader's responsibility to protect the citizens?

24:04Absolutely. So that one, there's no doubt about. So what I'm saying here is that it was not anticipated that climate change would be this bad. where we have, there are areas, for example, I gave you an example of Rwanda. It's one of the countries I can give an example of again, where people who used to live on higher altitudes did not have malaria. But now with the rise in temperature that is now associated with climate change, which has hit East Africa more than a lot of other parts of the continent, malaria is now endemic in those areas. So the times when they were planning for elimination of malaria, they've not taken that factor at the technical duration.

24:47So the level of resistance had not been factored in. The fact that there's going to be a rise in temperature had not been factored in. And all of these now are affecting the cost of responding to malaria and the burden as well. So yes, there are lots of factors here which were not anticipated. And yes, we can blame the technical agencies like WHO and others for not being able to predict this. But my question is, what benefit is it to us to be pointing fingers? Because what we need to do now is find the solutions and implement those solutions with the countries.

25:32Thank you for listening to the interview. You'll find more in-depth conversations on the interview wherever you get your BBC podcasts, including episodes with Duma Boko, Botswana's President, Hassan Sheikh Mahamud, President of Somalia, and UN Secretary General Antonio Guterres. Until next time, bye for now.

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