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Senegal: Music to Fight Malaria
AfricaFocus Bulletin
Apr 27, 2011 (110427)
(Reposted from sources cited below)
Editor's Note
Music may seem an unlikely way to fight malaria. But Senegal's
highly successful program has relied not only on medical
expertise but also on the star power of Youssou N'Dour and a
national song competition called "Xeex Sibbiru" (Let's Beat
Malaria). Support from prominent figures in the society,
including religious leaders as well as music stars, has helped
to dramatically increase prevention and treatment coverage.
Among the results:
- More than 80% of households with at least one insecticide-treated
mosquito net.
- The rate of preventive treatment for pregnant women
increased from 13% in 2005 to 52% in 2008/2009.
- The under-five mortality rate was reduced by 30% between
2005 and 2008/2009.
This AfricaFocus Bulletin contains excerpts from the 56-page
Roll Back Malaria report on Senegal, prepared in conjunction
with Senegal's National Malaria Control Program and released
in November 2010. The full report, with detailed
documentation, photographs, tables, and graphs, is available
on http://www.rollbackmalaria.org /
direct URL: http://tinyurl.com/3rcqhot
For Djibril Diop's winning performance from the Xeex Sibbiru
Song Contest in Dakar, Senegal, June 9, 2010, and other
related vidos, see http://www.youtube.com/watch?v=0ylO0bJWsLo
For previous AfricaFocus Bulletins on health issues, visit
http://www.africafocus.org/healthexp.php
For previous AfricaFocus Bulletins on Senegal, as well as
additional background links, visit
http://www.africafocus.org/country/senegal.php
++++++++++++++++++++++end editor's note+++++++++++++++++
Focus on Senegal
Roll Back Malaria
Progress & Impact Series, Number 4
November 2010
Ministède la Santé et de la Prevention
Programme National de Lutte contre le Paludisme
[Excerpts only. The full report is available on
http://www.rollbackmalaria.org /
direct URL: http://tinyurl.com/3rcqhot]
The data provided in this report were gathered during the
months of June, July and august 2010. ...
This report was co-authored by Eric Mouzin (RBM Partnership
Secretariat, Geneva), Pape Moussa Thior and Mame Birame Diouf
(Senegal National Malaria Control Programme, Dakar) and Bakary
Sambou (World Health Organization [WHO], Dakar).
...
Executive Summary
Progress and impact of malaria control in Senegal at a glance
* Since 2005, Senegal has built an effective malaria control
programme based on strong management and well-defined plans.
* Implementation of best practices and strategic planning have
attracted external partners and financial resources. as a
result, more than us$ 130 million was mobilized between 2005
and 2010 to scale up the fight against malaria to the national
level.
* These funds were used to deploy various malaria prevention
and treatment interventions, with the following results:
- nearly 6 million insecticide-treated mosquito nets will have
been distributed by the end of 2010.
- More than 300 000 household rooms have been sprayed with
insecticide.
- all of the country's 14 regions have received free
intermittent preventive treatment for pregnant women, rapid
diagnostic tests, and artemisinin-based combination therapies.
- 1 million rapid diagnostic tests and 1.5 million
artemisinin-based combination treatments have been
distributed.
- 17 000 health workers have been trained to use these tests
and dispense these treatments. -support for community
associations was extended to all of the country's 69
districts.
* Thanks to active planning, the methodical deployment of
interventions has resulted in good coverage rates at the
national level:
- In 2010, 82% of households own at least one insecticidetreated
mosquito net, representing a 36% increase in less than
two years.
- 45% of children and 49% of pregnant women in the general
population (regardless of mosquito net ownership) had used an
insecticide- treated mosquito net the night before the postcampaign
survey in early 2010. These rates went up 40% in one
year.
- 52% of pregnant women received at least two doses of
sulfadoxine-pyrimethamine during antenatal medical
consultations in 2008/20091, compared with 13% in 2005.
- 86% of patients presenting with a potentially malarial fever
were screened with a rapid diagnostic test in 2009.
* The high rate of coverage, for its part, provided a way to
make an impact on health, to reduce the prevalence of the
illness, and to save lives.
In particular:
- under-five mortality was reduced by 30% between 2005 and
2008/2009.
- Moderate anaemia (between 7 and 10 g/dl) in children under
five dropped from 55% to 48.5% between 2005 and 2008/2009.
- The number of confirmed cases of malaria decreased by 41% in
one year.
- The lives of 26,800 children under five have been saved
since 2001, according to the lives saved Tool (LIST estimation
model).
* These health interventions and achievements have reached the
most economically disadvantaged rural communities and have
helped to improve both the health system and maternal and
child health programmes.
* Now that these control and prevention measures have proven
to be effective, we must maintain the human and financial
resources to keep rolling back malaria. complacency will
result in a rapid resurgence of this terrible disease.
* The next phase will require considerable effort, which will
produce less spectacular results. If managed well, however,
this phase may be the forerunner of an era in which malaria
prevalence becomes negligible and its elimination within
reach.
Box 1: The extent of malaria in Senegal
Malaria in Senegal at a glance
- Senegal has 12.5 million inhabitants.
- Malaria is endemic and transmission is stable, with a
seasonal peak from July to December.
- Epidemiological variations are Sahelian and hypo-endemic in
the north, Guineo-Sudanese and hyper-endemic in the south.
- In 2005 there were about 2 million suspected cases of
malaria and 2,000 deaths attributable to malaria.
- Malaria is responsible for more than 20% of deaths among
children under five.
The population of Senegal is approximately 12.5 million. The
country is divided into 14 regions and 46 departments. The
health system follows these administrative divisions, with a
medical officer responsible for each region; some of the 69
health districts cover an entire department, while others
cover only a part thereof. each health district is placed
under the authority of a chief medical officer. The health
pyramid rests upon 913 health posts (placed under the
responsibility of a head nurse) and 1383 health huts (managed
by community health workers who report to the head nurse).
Malaria in Senegal is defined as endemic/stable with seasonal
peaks. The rainy season lasts from July to October. as a
result, malaria peaks between July and December.
...
Malaria has been a longstanding public health problem for the
people of Senegal:
- In 2005, approximately 2 million cases of malaria (confirmed
or not) were recorded at the national level, as were more than
2000 deaths attributable to the disease (NMCP, 2006).
- Malaria is responsible for 32% of outpatient consultations
and more than 20% of deaths in children under five.
- The human and economic impact of the disease is a serious
curb to economic development, either directly -- through the
costs of health care and hospitalization -- or indirectly,
through work days lost to personal illness or to caring for a
sick child.
...
Box 2: Youssou N'Dour: On the front lines of the fight against
malaria in Senegal
The fight against malaria has a heavy hitter in Senegal:
superstar musician Youssou N'Dour. already involved with
UNICEF and the RBM Partnership, N'Dour joined forces with the
NMCP early on in the belief that bringing the fight down to
the grassroots level was the best way to achieve tangible,
lasting results and support from partners.
In 2005, N'Dour headlined AFRICA LIVE: The Roll Back Malaria
concert, a star-studded event that reached an estimated
billion people worldwide with both music from top African
artists and messages about malaria, thanks to the concerted
efforts of a diverse range of Roll Back Malaria partners.
"Music can accelerate the rhythm of the movement to fight
malaria," said N'Dour at the time.
In keeping with that sentiment, N'Dour and his brother
Boubacar created Senegal Surround Sound, a communication and
education initiative designed to reduce the burden of malaria
in Senegal.
To reach the public, Senegal Surround Sound, in association
with the NMCP and the American nongovernmental organization
(NGO) Malaria No More, launched a national campaign in 2009
called Xeex Sibbiru ("let's beat malaria" in Wolof). The
campaign, which calls upon every segment of Senegalese
society, is intended to inform the general public and to
prompt them to take responsibility for protecting themselves
from malaria. The message gets through to all audiences:
business and sports personalities, the media, and religious
leaders have all provided support to the campaign.
The Xeex Sibbiru campaign, an innovative public- private
partnership, uses multiple communication channels to drive
home its malaria prevention messages, including a national
singing competition, the network of community health workers,
and the mobilization of civil-society partners.
Activities orchestrated by this campaign include:
- Support for the national ITN distribution campaign: This
insecticide-treated mosquito net (ITN) campaign opened with a
concert broadcast nationwide to promote the distribution of
2.2 million ITNs. community health workers used radio
commercials featuring celebrities, songs, and certificates
signed by Youssou N'Dour to promote the distribution and use
of the nets. N'Dour's song, Xeex Sibbiru, written for the
occasion, was recorded in three languages- -Wolof, Pulaar, and
Serer- -and was broadcast on the air and in more than 1300
health huts.
- Commitment from religious leaders and the private sector:
During Ramadan 2009, N'Dour and the Xeex Sibbiru team went to
Senegal's main spiritual centers to receive blessings from the
country's religious leaders and to confirm their commitment to
encouraging their fans to use the ITNs. In the same timeframe,
national and international companies like africa cola,
exxonMobil, and senegal's economic and social council joined
the campaign as sponsors to help reach the target audiences.
- Xeex Sibbiru singing competition: The Xeex Sibbiru singing
competition took place from March to June 2010. More than 1000
contestants took part, and related events were held in
senegal's 14 regions. To qualify, contestants had to
demonstrate their knowledge of malaria, submit an original
song about the disease, and work side-by-side with health
educators to educate their communities. Publicity campaigns
were held in every health hut, post, and centre around the
country. eight regional concerts were given, with the
participation of artists including N'Dour and Viviane. The
competition's final- -broadcast on national television- -took
place on 9 June 2010 in Dakar and was attended by
representatives from Senegal Surround Sound, the NMCP, Malaria
No More, and the RBM Partnership. The winner, Djibril Diop,
recorded his song against malaria with N'Dour and Viviane, and
will continue to lend his voice to the fight against malaria.
The Senegal Surround Sound approach for the Xeex Sibbiru
campaign
The right message: Knowledge, attitude, and Practice surveys
helped determine the content of the messages to be used.
Public figures like Youssou N'Dour worked with the NMCP to
adapt the messages to be sure they would be "punchy" enough to
reach the target audiences.
Well-known messengers: a
quantitative survey was used to determine which spokespeople
would be the most effective in each region. Famous musicians,
religious leaders, athletes, and actors thus came to represent
Xeex Sibbiru in the public eye.
Multi-sector participation: Well-known spokespeople and highprofile
events helped the campaign to recruit key partners in
religion, health, sports, the media, and business to expand
the audience and boost impact.
...
This strategy has spawned spin-offs. In April 2010, N'Dour
went to Cameroon to explore the possibility of launching
Cameroon Surround Sound to attempt to replicate the outcome of
the Senegalese campaign. other countries could follow.
Two questions for Youssou N'Dour
What advice would you give to countries inspired by what you
have built in Senegal?
Use the talent and wealth of your local culture. International
donors contribute very generously to improving life in Africa,
but only Africans can create the lasting cultural
transformation that is needed to win the fight against
malaria. no one else can live our lives and understand our
realities. as my brother Boubacar likes to say, "If we can get
everyone in Senegal to know 500 songs by heart, we should be
able to educate people about malaria!"
Is it important to involve private-sector partners, faithbased
organizations, and the media?
It's crucial! We're lucky that international donors are
interested in malaria for now, but the fight against malaria
will be a marathon. In the long term, we will need the
resources, talent and commitment of all sectors of Senegalese
society if we want to maintain our success and eradicate
malaria. It won't be easy and it won't be quick, but together
we can make it happen.
Box 3: Interview with Dr Pape Moussa Thior, National Malaria
Control Programme (NMCP) coordinator in Dakar
The National Malaria Control Programme in Senegal is often
cited as a success story for its achievements in reducing
malaria-related morbidity and mortality. How did you achieve
these reductions?
I think that for us, in Senegal, the wake-up call came when
our first-round grant from the Global Fund was cancelled in
2004. Those involved at the political and technical levels
realized that a great opportunity was being lost. The
programme's management was evaluated, revealing major
weaknesses. The programme was completely overhauled. With
support from the Global Fund, we were able to hire new staff
members and the programme grew from a team of 5 to 32. We
established a clear, functional organization chart with
detailed, precise job descriptions.
For me, the keys to success lie in programme management,
decentralization, and our involvement in the field, as
evidenced by the high number of kilometres travelled each year
by our staff and our vehicles!
What are the main strengths of the National Malaria Control
Programme in Senegal today?
Above all, political support. To be able to count on
unwavering support from the Ministry, to be encouraged in our
work, to work together to overcome obstacles. Next, the
internal organization of our structure, based on properly
assigned, specific tasks. The renewed support of our partners
provides us with vital resources and expertise, and helps us
to target interventions within an agreed framework. Finally,
commitment from active, well-organized communities provides
essential local support. Without these invaluable actors on
the ground, none of our activities would have made an impact.
On the other hand, what weaknesses do you see?
I have long been disappointed in the insufficient involvement
of the private sector (aside from NGOs). The private medical
and paramedical sector springs to mind first; we will try to
reopen and strengthen our lines of communication with doctors'
and pharmacists' unions to obtain their active participation
in our work. next, private companies. They have done many
useful things, but not enough. The telecommunications company
Sonatel comes to mind- -they helped to deliver free
intermittent preventive treatment to pregnant women- -as does
Total Senegal, which participated in distributing insecticidetreated
mosquito nets.
The private sector could play a much larger role, joining
wider civil society in the fight against this disease.
What next steps do you envisage?
We are in an evaluation phase, but are also expanding and
intensifying the programme.
We were able to carry out the performance review for our
programme according to WHO's new directives, then draft a new
strategic plan (2011?2015), and finally submit a grant
proposal to the Global Fund for Round 10. These successive
accomplishments gave us a chance to reflect upon our strengths
and weaknesses and to consider the work that lies ahead in
years to come.
It seems to me that given Senegal's particular geographic and
epidemiological situations, two main strategies must be
adopted:
-The first strategy - - for the northern areas, which are in
the pre-elimination phase - - must focus on strengthening
monitoring: active, real-time detection of suspected malaria
cases, with immediate intervention to try to stop
transmission. We need to invent flexible, reactive, and fast
strategies. Why not, for example, take a page from the SMS for
Life initiative tested in Tanzania by the swiss Tropical
Institute and combine ACT inventory management and rapid case
detection?
The second -- for the southern regions with high malaria
prevalence -- will require targeting increased access to
treatment through home-based care, improving communication,
and working towards universal ITN coverage. These districts
will remain in an intensified control phase.
<
What advice or suggestions do you have for fighting malaria
across the region?
Mosquitoes don't stop at borders, so we need to have an
integrated, cross-border approach. I think it is essential to
share ideas, strategies, and research protocols.
That's what we are trying to do with the Transgambian
Initiative for Malaria Elimination (TIME project), which
includes Senegal, The Gambia, Guinea-Bissau, Mauritania, and
Mali. The member countries work together on operational
research, whose results serve to define a pre-elimination
strategy. We will need the same approach for epidemiology and
specific malaria-control interventions, with support from RBM,
WHO, the West African Health organization, and all our
partners.
The biological confirmation of malaria diagnosis using rapid
diagnostic tests is now a must for all malaria control
programmes. We can no longer treat all cases of fever as cases
of malaria. using the experience acquired by a few, we must
support all countries to scale up rapid diagnostic test use
across Africa. We must be bold, innovative, and avoid
complacency. only thus will we make significant progress in
the fight against malaria.
...
b. Securing funding
Outside funding for malaria control in Senegal at a glance
- Various partners have committed more than us$ 130 million to
the malaria prevention and control programme in Senegal. * In
2004, external funding amounted to US$ 1 million, as compared
with us$ 30 million committed for 2010 by the Global Fund and
US-PMI.
- Other partners, like the World Bank, WHo, unIceF, and the
Islamic Development Bank, are actively involved and making
growing contributions.
The reorganization of the NMCP and the commitment of the
Senegalese government quickly came to fruition. The
implementation of good practices and the plans established
attracted increasing numbers of partners and resources. as a
result, after a positive evaluation in Round 4 of the global
Fund, external funding increased rapidly and substantially.
The Senegalese government's funding of malaria- control
interventions began intensifying, and its health budget jumped
from 36 billion CFA francs (US$ 40 million) in 1998 to 90.5
billion CFA francs (US$100million) in 2008. Today, health
represents about 10% of the federal budget. The share of this
budget that is earmarked for malaria is difficult to estimate,
since it includes support for health workers and structures
(hospitals; health centres, posts, and huts; laboratories)
providing most of the care.
Outside support grew considerably when the global Fund awarded
grants in 2005 (Round 4) and 2008 (Round 7), and gained
momentum when Senegal was included among the countries
supported by the us President's Malaria Initiative (us-PMI), whose first
funds were made available in 2006 and whose support became
decisive in 2007.
Other partners joined them. The World Bank financed a malaria
control project along the Senegal River basin. several
organizations provided technical contributions, advocacy, or
reinforcement for services at the local level, especially WHO,
UNICEF, and the Islamic Development Bank.
The Global Fund Country Coordinating Mechanism (CCM) was also
restructured in 2005. Presided over by Professor Doudou Ba,
Vice President of Senegal's academy of science and Technology,
its 47 members represent all parties involved in programme
implementation. Through quarterly meetings and field trips,
the CCM oversees activities, providing advice and ensuring
correct implementation to produce results. It has close ties
to both the Ministry of Health, with which it maintains close
contact, and the programme coordinators- - all CCM members- -
who provide progress updates at each quarterly meeting.
...
Box 4: The home-based care programme (PECADOM)
Most cases of fever are not evaluated in the context of the
health system. Indeed, the last national survey on malaria
(Senegal MIS-II), held in 2008/2009, revealed that of the 52%
of febrile patients who received some form of health
evaluation, 35% were seen outside a hospital or health
centre/post. This is mainly due to distance.
To solve this problem, Senegal introduced a new kind of health
worker, the DSDOM or dispensateur de soins à domicile (homebased
care provider), thus allowing for home-based care (known
as PECADOM, for prise en charge à domicile) in the event of a
fever. The home-based care provider reports to the nearest
health hut. The network of health huts has already resulted in
improved coverage in areas without a health post close by;
home-based care improves this coverage even further.
Home-based care providers are selected in their own villages
and trained in diagnosis using rapid diagnostic tests (RDTs)
and treatment with artemisinin-based combination therapy
(ACT). upon completion of their training, they receive a kit
including ACTs, RDTs, a recycling container for sharp objects,
data collection forms, two T-shirts, two baseball caps, two
vests, a case, a satchel, a torch, and a box of gloves. The
home visit, the RDT, and any necessary ACT treatment are
provided free of charge. Home-based care providers can refresh
their supplies of ACTs and RDTs at the health post upon
presentation of their latest case log. supervision is provided
at several levels. on one level, the health-post nurse
directly supervises the home- based care provider; on another
level, the district medical team provides quarterly
supervision; and, finally, the National Malaria Control
Programme team holds twice-yearly inspections. The home- based
care providers are all volunteers, but they receive a daily
stipend during the training sessions, which serves as an
incentive.
In 2009, of the 7,198 patients seen by home-based care
providers and suspected of having malaria, 6,707 (93%) were
tested with an RDT. of the 2300 cases of malaria thus
confirmed, 2,226 (97%) were treated with ACT at the community
level, and the recovery rate for cases of simple malaria was
100%. The remaining 74 patients (or 3%) had to be referred to
the next level of the health system for more specialized
medical care. no deaths attributable to malaria were recorded
in the target villages.
...
Effects on the health system
The training of thousands of health workers in the context of
the fight against malaria has helped to strengthen the
Senegalese health system as a whole.
But perhaps the most important contribution made by the NMCP
to relieving the pressure placed on the health system is the
reduction of malaria cases. By drastically reducing the number
of malaria cases, and by using early diagnosis to provide
better treatment of malaria as well as non- malarial fevers,
the NMCP not only strengthens the health system, but lightens
its load.
Indeed, the number of malaria cases in children under five
dropped from 400,000 suspected cases in 2006 to 78,000
confirmed cases in 2008, then to 30,000 confirmed cases in
2009. This shows both the reduction in the number of confirmed
cases as a result of the malaria programme (from 78,000 to
30,000 cases in a single year, for example), and the impact
(not quantified here) that early diagnosis of suspicious
fevers (whether malarial or not) can have in children, likely
leading to faster recovery and reduced mortality.
...
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AfricaFocus Bulletin is edited by William Minter.
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