By the time you finish reading this article, malaria will have killed five children. Malaria kills an estimated 660,000 people every year of which some 85% are children under five years of age. That is roughly one death every minute of every day. Neatly 3.3 billion people, half of the world’s population, are at risk of acquiring malaria. In 2010, there were over 219 million cases of malaria. Eighty percent of all cases occurred in just 17 countries with forty percent occuring in only three countries- the Democratic Republic of the Congo, India, and Nigeria.

Although malaria is most common in Africa, it is endemic in many Asia-Pacific countries including Papua New Guinea. Eighteen percent of all deaths at PNG hospitals are malaria-related. With 90% of the country at risk, approximately 800 Papua New Guineans die from malaria each year.

Malaria is a preventable and curable disease. However, many countries do not have the funding or access to the prevention services, early diagnosis, or treatments that could save thousands of lives. On World Malaria Day, April 25, we reflect on the severity and cruelty of this disease but also recognize the progress we have made towards defeating one of the world’s greatest killer diseases.

Malaria is caused by parasites that are transmitted to people through the bite of an infected mosquito (specifically the Anopheles genus). Effective prevention involves the use of insecticide-treated bed nets (ITNs) which act as a barrier between an uninfected person and a malarial mosquito. ITNs have been shown to reduce all-cause mortality in children under 5 by about 20 percent and malarial illnesses among children under 5 and pregnant women by up to 50 percent. An additional preventive measure is the use of indoor residual spraying, which repels and kills mosquitoes. The Global Fund to Fight AIDS, Tuberculosis, and Malaria has provided malaria-endemic countries with some 310 million insecticide-treated bed nets and provided indoor residual spraying units to 44 million buildings.

Malaria is curable and there have been recent advances in treatment. Artemisinin-based combination therapies (ACTs), the most effective antimalarial drugs, have been increasingly available worldwide. The number of ACT treatment courses acquired by public health authorities increased from 11.2 million in 2005 to 76 million in 2006, and 181 million in 2010. The Global Fund has played a critical role in the introduction and expansion of coverage of ACTs in many countries where resistance to older malaria drugs has increased. In addition to financing treatment for 260 million cases (cumulatively) of malaria by mid-2012, the Global Fund has been piloting a pioneering financing mechanism to improve access to ACTs by making them more affordable.

With the Global Fund’s new US$15 billion replenishment target for 2014-16, announced in Brussels earlier this month, we have every hope that malaria will soon be a problem of our past. We have come a far way in treatment and prevention of malaria, but with a child dying every minute, we clearly still have a long way to go.

Shawn Clackett

Papua New Guinea marked World Tuberculosis Day 2013 with events across the country.

Port Moresby’s walkathon saw hundreds of people walking through the streets of the city advocating for ‘Stop TB in my lifetime’. A number of dignitaries walked alongside the public including:

-          Mr Powes Parkop, National Capital District Governor

-          Her Excellency Ms Deborah Stokes, Australia’s High Commissioner to PNG

-          Dr Geoff Clark, PNG Program Director for Health and HIV

-          Mr James Gilling, Australia’s Ambassador for HIV/AIDS, TB and Malaria

-          Dr Curt von Boguslawski, World Vision PNG Country Director

-          Dr Laura Gaurenti, World Health Organisation Maternal Child Health Advisor

At the conclusion of the walk, entertainment, TB awareness and formalities took place for attendees, including a keynote address from PNG Government Minister for Health, the Honourable Michael Malabag. Proceedings were broadcast on local radio and captured for the country’s TV news programs.

Corporate sponsors joined dignitaries at a corporate dinner to hear from the PNG Government’s Minister for Health among other National TB Program partners, on the successes of the program in the country and the way forward to ensure that TB is eradicated in the coming decades.

The theme for this year’s World TB Day, ‘Stop TB in my lifetime’, was a consistent message throughout the events. There was strong advocacy on the symptoms of TB and spreading the message that the disease is both curable and treatment is free in all healthcare facilities in the country.

The PNG National TB Program uses the WHO recommended DOTS (Directly Observed Treatment, Short Course) strategy. One key feature of the DOTS strategy is the use of treatment supporters to significantly boost the cure rate among TB patients. Treatment supporters visit TB patients regularly to ensure they take their medication. The effective DOTS strategy is already being implemented nation-wide, across all 22 provinces in PNG.

The World TB Day events displayed the cohesion of partners, with increased government commitment and dedication by implementing organisations in the fight against TB. Strong partnership has been and will continue to be pivotal to see effective and increased awareness, detection and treatment of TB across PNG.

The success to date of TB detection, treatment and cure rate in PNG will only be strengthened with the greater commitment from the PNG Government and dedication of the National TB Program partners. PNG is set to see a continued reduction of the TB burden and is well on the way to achieving global standards for treatment success.

PORT MORESBY, PNG (THE NATIONAL) —- Two Papua New Guinea government ministers have commended the efforts of the Global Fund in combating HIV/AIDS, tuberculosis and malaria in the country.

Foreign Affairs and Immigration Minister Rimbink Pato and Minister for Health and HIV/AIDS Michael Malabag both acknowledged the support during a breakfast with Global Fund’s deputy executive director Dr Debrework Zewdie in Port Moresby last week.

The two ministers said the Global Fund had made a meaningful contribution towards achieving the government’s national and millennium development goals.

Pato assured Zewdie that bilateral relations between Papua New Guinea and the Global Fund would be maintained.

Malabag briefed her on the government’s efforts to address the three diseases – HIV/AIDS, TB and malaria – and other key health issues.

Zewdie assured the ministers that Papua New Guinea was important to the Global Fund.
She said the fund was eager to continue its efforts help the PNG government to implement its national health plan.

She commended the government’s commitment towards increasing funding for the diseases and the TB fixed dose combination drugs, anti-retroviral treatment for HIV and for driving forward the free health care policy.

Since 2003, Papua New Guineans have benefited from US$150 million (K319 million) from the Global Fund through various grants and initiatives, which have produced some positive outcomes.

Rotarians Against Malaria, Population Services International PNG, Oil Search Foundation and World Vision are some partners that are currently working alongside Global Fund to support health services in the country.

Access to Life, a powerful photographic exhibition created by Magnum Photos in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria. The exhibition, which has moved millions of people around the world through its touching images of AIDS-affected communities, is being held 30 years after the first case of HIV was diagnosed in Australia.

The exhibition launch was celebrated by over 300 guests, including Mr Simon Bland, Chair of the Global Fund to AIDS, Tuberculosis and Malaria; Mr James Gilling, Australia’s Ambassador for HIV/AIDS, Tuberculosis and Malaria; The Hon Jillian Skinner MP, NSW Minister for Health & Medical Research; and Mr Peter Botten CBE, Managing Director of Oil Search Limited.

For the first time, a series of new photos from Papua New Guinea  was unveiled at the exhibition at the Powerhouse Museum. These photographs were taken by acclaimed British photographer Chris Steele-Perkins and will join the photographic case studies from Russia, Swaziland, India, Haiti, Vietnam, Mali, South Africa and Peru.

Access to Life was launched yesterday in Sydney in time for World AIDS Day 2012, which coincides with 30 years since the first case of HIV was diagnosed in Australia. The Australian response and approach to HIV and AIDS will be told in a new display, HIV & AIDS 30 years on: the Australian story, a compelling exhibit that beautifully accompanies Access to Life.

The opening of the exhibitions was attended by former Australian Health Minister Mr Neal Blewett and Professor Ron Penny, two instrumental individuals that were instrumental to Australia’s successful response to the HIV outbreak in the 1980s.

Both Access to Life and HIV & AIDS 30 years on: the Australian story open today to the general public. They will remain at the Powerhouse Museum till mid 2013.

In its latest response to HIV in Papua New Guinea, the Oil Search Health Foundation has received endorsement from the PNG Department of Education (DoE) to facilitate a teacher training and mentorship program. Oil Search has had a successful HIV program since 2007, primarily focusing on supporting healthcare services in the Southern Highlands (inset). This new venture aims to strengthen the education sector’s approach to teaching personal-development, which includes the vital topic of HIV prevention. The program forms part of the Health Foundation’s implementation of the Global Fund to Fight AIDS, Tuberculosis and Malaria Round 10 HIV grant. This Global Fund grant, which began in March 2012, aims to strengthen the capacity of HIV prevention, treatment and support systems across Papua New Guinea.

Scheduled to begin this month, the school mentorship program will work with secondary school teachers in Morobe and Hela to deliver high quality lessons that covers issues of HIV, sexual and reproductive health and rights. Through a series of workshops and in-class teaching, the program will enable personal-development teachers to receive specialised training in accordance to the national personal-development curriculum.  The school mentorship program comes at an opportune time; whilst life-skills based HIV education are part of the DoE curriculum, it has been estimated that only 21.9% of young women and men in Papua New Guinea aged 15-24 can correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission.

One of the organisations involved in the summit will be the Papua New Guinea Institute for Medical Research (PNGIMR), PNG’s leading medical scientific research institute. PNGIMR drives a strong PNG based research agenda, which identifies appropriate solutions for scientifically-informed responses to malaria in the Pacific region. In its most recent reports PNGIMR has urged funders to seriously consider the challenging setting that PNG provides in implementing malaria treatment and prevention programs.

Indeed, malaria continues to be a significant public health challenge in Papua New Guinea. The disease is the country’s most common outpatient diagnosis, with the World Health Organisation reporting approximately 1.36 million cases per year. This makes malarial infection the second-highest leading reason for hospital admission. Approximately 90% of the population is at risk of infection with some 800 malaria-related deaths in 2011; most of these being children under the age of five.

Participants at today’s National Malaria Summit will include the Oil Search Health Foundation, Rotarians Against Malaria and Population Services International. In partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria, these organisations have been instrumental in assisting the Papua New Guinea National Department of Health in adopting of the PNG Malaria Control Program. The collaborative nature of the program itself has achieved impressive results, and since 2007 has seen over 5.5 million insecticide treated bed nets distributed and resulted in a reduction in the incidence of malarial infections within the community from 13% in 2009 to 6.5% in 2011 (PNGIMR, forthcoming).

The address of malaria as a significant public health burden in Papua New Guinea and other countries in the Asia-Pacific region will also form the basis of high-level discussions in the upcoming 2012 International Malaria Summit, which will be held in Sydney and hosted by AusAID in late October this year.

Walking into the Public Health Division of the National Department of Health in Port Moresby, Papua New Guinea, is akin to entering the central nervous system of the country’s health system. Here a group of committed public servants, technical advisers and international partners tap away at their computers planning and coordinating the response to the country’s priority diseases. It is challenging work, but the biggest challenge still remains in service delivery and ensuring that sufficient financial resources are made available to implement programs to scale.

The initial grants disbursed by the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2004, heralded a new opportunity to address both the financial and service delivery issues, pumping resources into diseases long forgotten after the dismantling of the public health programmes in the early 1980’s. It offered the chance to reverse the increasing rates of malaria, tuberculosis, and address the emerging threat of HIV and AIDS. Significant gains were made during this period, the National Department of Health (NDOH) as the Principle Recipient (PR) distributed over 2 million treated bed nets, introduced the Fixed Dose Combination Treatment and Directly Observed Treatment Strategy for TB, and introduced Anti-Retroviral Treatment at 55 clinics and scaled up HIV counselling and testing in over 400 centres across the country.

However, the increasing burden of Global Fund grant management began to place great stress on the already fragile internal systems, which were not designed to manage such large amounts of funds. A complex period in 2011 with internal restructuring and insufficient capacity to manage the grants, the Secretary of Health at the time, made a tough but courageous decision to relinquish the Global Fund grant management. This would allow for the Department of Health to focus on its core business: technical support, policy and leadership, and give way for future grants to managed by organisations that routinely manage. Dr Paison Dakulala, the Deputy Secretary commented to the CCM at the time of decision “the Global Fund is like a super tanker pulling up to a  small wooden wharf, what we need is the super tanker to go offshore for a time to give us the space to build a concrete wharf in order to unload the cargo.”

Despite this, an opportunity to change the way of doing business for the Department emerged and the Secretary endorsed a progressive partnership model, which would see that the NDOH would very much remain the lead on the grants both on the technical and programmatic sides, but effectively outsource the financial and grant management aspects. This aligns very closely to the National Health Plan 2011-2020, the most clearly articulated plan for the Health System in over 30 years, and links directly to the Key Result Area 2: Strengthen partnerships and coordination with stakeholders. In 2012, the Secretary of Health, Mr Pascoe Kase signed a Memorandum of Agreements with both the Oil Search Health Foundation and World Vision International, which sets out the process for the new way of doing business. Secretary Kase states that best thing about the new arrangement is “that the NDOH can have confidence that critical activities are delivered in a timely manner with partners that we can trust who have a demonstrated track record. Thus leaving the dedicated staff at the NDOH to get on do what they do best, providing the technical and policy leadership, along with planning and coordinating the response to these priority diseases.”

Before the arrival of HIV in Papua New Guinea, the extended family provided a sound support base to care for the children of family members who passed away.  However due to the large number of people living with HIV and AIDS in PNG, estimated to be 60,000 people, extended family support mechanisms are struggling to cope with the rising numbers of children that need care and support following the death of their parents or primary caregiver.

There has been little focus on the children of the HIV epidemic. There is little understanding of their situation and few people are working with them. Some of these children are infected, all are affected. They face many problems. One overwhelming problem is the likely loss of an education, which has serious ramifications for their futures. Children whose parents are infected are often lost to school long before their parents die: tension in the family, unaffordable school fees, family breakdown, a parent leaves or dies, they are stripped of their inheritance, of land or home, and more.

In 2008, as a young Australian entrepreneur, Craig McMahon donated $250,000 to the Asia Pacific Business Coalition on AIDS (APBCA). APBCA immediately consulted with its national affiliate, the PNG Business Coalition Against HIV and AIDS (BAHA) and following further consultations, realised the gap in support for children made vulnerable by the epidemic.  Shortly after, the Serendipity Educational Endowment Fund was established with the original $250,000 donation and has now grown and receives funds from the Myer Foundation and the PNG Sustainable Development Fund.

The Serendipity Fund supports families all over PNG by providing funds to enable children affected by HIV to complete their education. The program covers the cost of schools books, uniforms and fees. The average cost of a child’s education in PNG is $3,000. Without a parent or guardian to cover these costs, most leave school and work to contribute to the extended family household.

Australian film-director Kasimir Burgess has made a short film about the Serendipity Fund, called “Hope for Life”. The film provides a rare opportunity to hear the stories of children whose lives have been affected by HIV.

The Serendipity Educational Endowment Fund provides funding for a quality, sustainable education to children living in the region whose lives have been affected by AIDS. Serendipity benefits children who have lost one or both parents to AIDS, children whose parents are living with HIV and the children of families providing support. This program is currently operating in PNG, where approximately 200 children are receiving financial support to continue their education.

For more information about the Serendipity Fund and how to contribute, go to www.apbca.com

Follow Pacific Friends with live updates of the workshop symposium between 11-13th July on Facebook and Twitter.

The strengthening of these national PNG authorities will be assisted by the work of bodies such as World Vision PNG; which are already delivering positive results in the area of treating and monitoring existing TB cases. Following a recent handover from the Queensland and the Australian Federal Governments, concern has been raised that that the closure of Australian clinics in the Torres Strait at the end of this month may be premature and that there may be no guarantee that services in Daru and surroundings will be accessed by PNG nationals.

Having advocated on the issue of tuberculosis for some years, grassroots anti-poverty organisation RESULTS International (Australia) hopes that success in this initiative will help to generate improved management of TB across the country.

National Manager, Maree Nutt, said:

RESULTS members will continue to monitor the situation to ensure that communication pathways are open between PNG clinicians and those who have been managing TB in the Torres Strait, to facilitate a sharing of skills, advice and experience. [These] improved hospital facilities, faster diagnostic tools (such as Gene Xpert) and health workers to supervise the long course of drug treatment are all essential for treating and minimizing the threat of TB and drug resistant TB.

The strengthening of national services will enable clients to better access to life-saving TB treatment as well as being a significant safeguard against the threat of drug-resistant TB to the Australian border. The issue of TB and drug resistant TB is not only a concern for the Western Province, but also for PNG more broadly. Recently ABC’s 7:30 Report warned of the threat of drug-resistant TB to Australian borders. Now, with improved health care facilities and increased capacity to treat TB, existing cases will be effectively managed on the PNG side of the border. Moreover, this will prevent PNG citizens from accessing treatment across the border, which is likely to result in irregular treatment and the development of drug-resistant forms of the disease.

As key organisation managing TB programs in PNG, World Vision PNG is one of the principal recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Over the last three years of the implementation of their DOTS project, World Vision has seen an improvement in the detections of TB from 21% to 81% of cases. The World Vision DOTS program coincides with the National TB Program, and provides feedback to the National Department of Health through provincial offices. World Vision PNG remains optimistic on the issue of integrating new patients into national programs in the effort to fight TB and its drug-resistant forms. World Vision PNG is mobilising its Stop TB Program in the Western Provinces, a program designed to forge a partnership between World Vision, AusAID, the Western Province Health Division and the National TB Program and utilise the skills and resources of each agency and maximize these for the benefit of the Western Province people so that TB services and case management can be dramatically improved in the region.

World Vision commented:

World Vision recognises that multi drug resistant TB on Australia’s border poses a major risk of the disease spreading further. However, like all issues it is important to locate these threats within a broader context. TB is clearly not a disease that is limited by provincial or international boundaries. When reviewing the broader TB landscape in PNG it is important to note that Western Province comprises just 1.7 percent of the total cases, with more than a third of the cases coming form Port Moresby. With this in mind it is important that we continue to push for nation-wide strengthening of TB services so that an inconsistency of care, such as that experienced on the Western Province Border, is not repeated.

World Vision views its work in Western Province as a high priority and is critically aware of how the often negative political debate around this cross border issue has the potential to have real ramifications on patient well being. From World Vision’s experience in managing TB across the country we know that if patients have to travel to receive TB treatment their likelihood of defaulting (stopping medication prematurely) increases significantly and the rise of drug resistant cases is only a matter of time. Therefore, with this injection of funding (AusAID), we believe that treating Western Province TB patients on the PNG side of the border, is not only within our technical capacity but also the only just way of providing TB care to these patients – the only way that is likely to provide increased cure rates.

The work of World Vision PNG and other PNG authorities remains a key force in identifying and treating TB in the Pacific region, and with the announced $8 million plan to better address the burden of TB in PNG, it will reduce the threat of the disease crossing the Australian border.