Malaria, human rights and gender equality
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Key populations are at higher risk of malaria
The concept of key populations in the malaria response is relatively new and so not yet fully defined, but those that fall within the definition include:
- asylum seekers, refugees and other migrants, and
- indigenous populations in malaria-endemic areas.
Poverty, marginalization and lack of access to basic resources heighten vulnerability to malaria.
Populations most affected by malaria are also those that are often disproportionately affected by poverty, social inequality and political marginalization.
However, in most of Africa, where malaria is a leading cause of death, the marginalized status of populations such as pregnant women and children, migrants, refugees, prisoners, rural populations and indigenous populations, means that these populations often lack basic resources—such as safe and secure housing, water and sanitation—to promote their health and well-being. Additionally, malaria prevention and treatment services are available, but socioeconomically and politically marginalized populations struggle to access services. They do not get the necessary health information and services, cannot afford preventive insecticide-treated bed nets and malaria treatment and cannot always protect their rights to voluntary and informed prevention, diagnosis, treatment and care.
Eight Facts: Malaria Prevention and Treatment is available, but not to all in need
- The number of malaria deaths globally fell from an estimated 839 000 in 2000 to 438 000 in 2015, a decline of 48%, mainly due to improved prevention and treatment.
- Still in 2016, there were 216 million cases of malaria in 91 countries, 5 million more than the 211 million cases reported in 2015.
- Malaria continues to claim a significant number of lives: in 2016, 445 000 people died from malaria globally, compared to 446 000 estimated deaths in 2015.
- Children under 5 are particularly susceptible to malaria. The disease claims the life of a child every 2 minutes.
- Fifteen countries, all but one in sub-Saharan Africa, carry 80% of the global malaria burden.
- The African Region continues to bear 90% of malaria cases and 91% of malaria deaths worldwide. i
- Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include pregnant women, infants, children under 5 years of age, patients with HIV, as well as non-immune migrants, mobile populations and travellers.
- Access to prevention and treatment is still a challenge. In sub-Saharan Africa, 12 countries had populations with less than 50% access to Insecticide-treated bed nets in 2016.
Evidence shows that protecting and promoting the rights of affected populations reduces malaria-related morbidity and mortality.
Control and Prevention of Malaria (CAP-Malaria), a USAID-supported project, that implemented malaria prevention and treatment interventions in the border regions of Thailand, Cambodia and Burma, has been used to engage with the mobile and migrant populations (MMPs) at high risk of malaria.
The vast number of MMPs living in the in the border regions complicate national containment efforts, as they move through high-risk transmission areas and are difficult to diagnose, treat and track due to routine traveling. Furthermore, MMPs also often avoid interaction with public services because of undocumented status or the informal or illegal nature of their work. Additionally, frequent movement often leads to increased risk due to language barriers, legal status issues, and lower socioeconomic status which prevent MMPs from receiving insecticide-treated bed nets (ITNs) and prompt treatment for fever.
The CAP-Malaria project identified hot spots and touch points to communicate with its prioritized groups. For example, to reach populations connected to the agriculture sector, CAP-Malaria developed partnerships with private sector companies. Insecticide-treated bed nets (ITNs) lending schemes were developed to encourage farms and plantations to expand net coverage to highly mobile employees for the duration of their stay, expanding coverage to those not reached by universal campaigns. Beyond prevention, CAP-Malaria activities focused on expanding access to testing and treatment as well. CAP-Malaria accomplished this by designing activities that coordinated between sedentary populations and MMP sub-groups they interact with. For example, CAP-Malaria worked with employers to identify and train non-registered private health providers, who were often the first people MMPs or villagers would go to for treatment.
Successes detailed in CAP-Malaria’s fifth year work plan include a decrease in incidence, from 22.3 cases per 1,000 in 2011 to 11.4 in 2014 for CAP-Malaria’s target areas.
The Roll Back Malaria Partnership: United Nations Action on malaria
The Roll Back Malaria Partnership is a global framework for coordinated action against malaria. Initially started as a partnership with WHO, UNICEF, UNDP and the World Bank, it now consists of hundreds of partners.
The partnership provides global strategy through Action and Investment to Defeat Malaria 2016-2030 (AIM) which outlines strategic approaches to building investment in malaria, promoting an inclusive approach, creating supportive elements such as strengthening the enabling environment, and ensuring progress and accountability.
WHO’s Global Technical Strategy for Malaria 2016-2030 complements the global strategy and outlines a strategic framework with a focus on universal access to malaria prevention, diagnosis and treatment, transforming and improving surveillance efforts, harnessing innovation, strengthening the enabling environment through stronger health systems and promoting inventions that act as an entry point to maternal and child health programmes, among other initiatives.
Other key documents, such as the Strategic Framework for Malaria Communication at the Country Level and the Multisectoral Action Framework for Malaria also developed through the Roll Back Malaria Partnership, provide programmatic guidance. The Action Framework analyses the social and environmental determinants of malaria at societal, environmental, population group, and household level and advocates for financing for:
- conventional malaria interventions such as long-lasting insecticidal bed nets, indoor residual spray and diagnostics and treatments
- addressing the determinants of malaria within health and non-health sectors
- malaria interventions at the household and individual level such as housing improvements and malaria-smart practices in the household
The Global Fund Working Group on Malaria sets out programmatic responses to malaria, human rights and gender equality
In 2016, a group of experts convened by the Global Fund for the first time defined concrete programmes and approaches to reducing human rights and gender-related barriers to malaria services, as outlined in the Malaria, Gender and Human Rights Technical Brief. It notes that human rights and gender assessments of malaria-related risks and vulnerabilities should be undertaken, meaningful participation of affected populations should be ensured and access to malaria services for refugees and others affected by emergencies improved.