The power of advocacy – Curtailing rising malaria cases in Cape Coast, Ghana

Several years ago, a young boy gained admission into high school.

He bought everything he needed except an insecticide-treated mosquito net to protect him from malaria.

One morning, he woke up feeling severe headache, weakness, chills and shivering.

But he chose not to report to the housemaster thinking he would be fine.

An attempt to get out of bed to visit the bathroom nearly sent his head straight to the cemented floor of the dormitory but for the swift intention of his mates who came to grab him by the hands.

After reporting to school authorities, he was taken to the hospital and diagnosed with malaria.

Treatment followed with the administration of medication which helped him to regain his health.

This young boy is Michael Korsah Jr, a final year Bachelors in Engineering (BEng) Electrical/Electronic Engineering student who is now a trained Youth Leader for Health.

Additionally,  Michael is the founder of a youth-focused NGO called OguaaAid. This organization seeks to imbibe in children and young people the need to have a clean and healthy environment to help achieve the sustainable development goal 3 (Good Health and Wellbeing) and 6 (Clean Water and Sanitation).

In 2019, Michael was heading from his residence at Ayensu in the Cape Coast Municipality to Accra when he experienced another bout of malaria reminiscent of his high school days.

He arrived at his destination, feeling a throbbing headache. The next day, it got worse with dizziness, nausea, cloudy vision and weakness – he wasn’t okay.  He went straight to the nearest pharmacy to do a Rapid Diagnostic Testing (RDT) for malaria. The test confirmed malaria parasites, and he purchased medication recommended by a health practitioner.

In that particular year, the WHO posted an estimated 229 million cases of malaria worldwide in its ‘World Malaria Report 2019’. The estimated number of malaria deaths stood at 409 000.

Children aged under five years were the most vulnerable group, and they accounted for 67% (274 000) of all malaria deaths worldwide.

The WHO African Region carried a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of malaria cases and deaths.

Of the 10 highest-burden countries in Africa, Ghana and Nigeria reported the highest absolute increases in cases of malaria in 2018 compared with 2017.

WHO estimates total funding for malaria control and elimination at an estimated US$ 3 billion in 2019.

Contributions from governments of endemic countries amounted to US$ 900 million, representing a meagre 31% of the total funding.

Therefore, a key objective of malaria youth advocates is to get the governments of the respective countries to increase the budgetary allocation to fight malaria by 20% within the next three years.

Youth Leaders in Health advocacy training programme

Michael is representing the Central Region of Ghana and championing malaria awareness and education vigorously.

His was part of 10 youth leaders selected out of over 200 applicants to represent various zones in Ghana.

A total of 24 youth leaders from 3 African countries participated in a 5-day advocacy workshop in Addis Ababa, Ethiopia.

The programme is spearheaded by Results – UK and WACI Health in collaboration with Hope for Future Generations (Ghana), CISMAT-SL (Sierra Leone), Health Promotion Tanzania – HDT.

Michael remembers being in a never-ending lecture bored, almost falling asleep when a call finally came through congratulating him for being selected.

The training Michael received has changed his approach to life.

Being a member of the Youth Leaders for Health has given him the added confidence to talk about health, focussing on malaria and all the precursors to getting malaria such as poor hygiene and cleanliness, poor sanitation and water.

It was a great learning experience for him. He learnt about health advocacy and skills in engaging political leaders. He met youth leaders from other African countries,  officials working at the African Union Commission (AUC), the Ambassador of Ghana to Ethiopia and was inspired by policy experts such as Dr Elvis Eze, Dr Sylvia Anie, Rev. Dr Bujari, Rosemary Mburu and Pushpanath Krishnamurthy whilst experiencing the life and culture in a different country.

His favourite quotations from the training which he still recalls 11 months later include- from  Pushpanath “Africa is the best storytelling continent, and we need to tell our own story. When writing a story, we should think of the heart of the matter and the punch in the end”…from Dr Sylvia Anie who said “in advocacy, we are driven by context and need, target your audience and let your messaging respond appropriately” and by Prof. Sarah Agbor (AU Commissioner) who remarked, “tomorrow belongs to those who prepare for today”.

Malaria is still a problem in Ghana because unreported cases are more than the reported cases; there is low usage of insecticide-treated mosquito nets.

Some people resort to local and self-mediation, dwindling funds and lack of quality care due to patient to nurse ratio is also not helping matters.

Advocacy initiatives after training

Advocacy has not been smooth for Michael as the COVID-19 pandemic disrupted his plans.

He had met the Central Regional Director of Health and the Central Regional Malaria Focal Person and had prepared to hit the ground.

But Ghana was faced with a two-edged problem and needed to fight COVID-19 and malaria simultaneously.

The Ghana Health Service recorded at least 54 deaths from malaria between January and March 2020. Sixteen of the deaths occurred among children under five years, as one million people tested positive for malaria within the period. Out of this, 21,201 were children under five years, and 28,764 were pregnant women.

In the pandemic chaos, the alarming figures of malaria spurred Michael to lead massive clean-up exercises and education on the improvement of sanitation in some 10 basic schools located in Cape Coast.

Social distancing, lockdowns and other restrictions meant improvised outreaches via online platforms.

Michael decided to train a second generation of advocates to carry on the sensitization and education on malaria in the community after the situation eased.

In the darkness, there is light

Michael hopes to engage in targeted advocacy in meeting with people living in areas with high records of malaria to work together in achieving zero malaria cases.

He intends to meet with political and policy officials to collectively work towards increased funding to strengthen Ghana’s health system and to halve malaria infections by 2023.