The Sierra Leone Web



25 April 2000


Mr. Chairman,
Your Excellencies:

I stand before this august gathering with a heavy heart. The people of Sierra Leone whom I represent are painfully grieved. Last Tuesday, the people of Nigeria and Sierra Leone lost a son of the soil, a hero, and a true patriot. General Maxwell Khobe, my Chief of Defence Staff, and close confidant, passed away and left a void in the hearts of all Sierra Leoneans. I will have a more appropriate opportunity to pay a fitting tribute to our dear late brother, a professional soldier extraordinaire. Meanwhile, Mr. Chairman, please allow me to convey to you sir, the people and Government of Nigeria, and the family of General Khobe, the heartfelt sympathy of the entire people of Sierra Leone. May his soul rest in perfect peace.

Mr. Chairman, it is always rewarding to come to Abuja, the Federal capital of this great African nation of Nigeria. Abuja has lent its name to a number of important African instruments aimed at strengthening inter-African and regional cooperation and integration in the economic, social and political fields. From the Treaty establishing the African Economic Community, to the Declaration of a Moratorium on Importation, Exportation and Manufacture of Light Weapons, Abuja has become one of the leading centres for the harmonization of African aspirations and objectives.

Today we are here to lay the foundation of another instrument which will morally binding on us African leaders to remove one of the most stubborn impediments to African productivity in our time. Malaria is a health problem. Malaria is also a human resources problem, and therefore a development problem. As the Director-General of the World Health Organization (WHO), Dr. Gro Brundtland said two years ago when she launched "Roll Back Malaria", it is not only the single most prevalent disease in Africa, it is also the primary cause of poverty in the Continent.

We in Sierra Leone can speak from experience. We know at first hand the debilitating effects of the disease. The anopheles mosquito, the main carrier of the disease, has been one of the most menacing problems in our public health sector for centuries.

Malaria is not new to Sierra Leone. We know the toll it has taken on the lives and livelihood of our people. It is currently the leading cause of morbidity and mortality, and accounts for about 48 (forty-eight) per cent of the total outpatient morbidity. In the main childhood referral hospital, malaria accounts for fifty (50) to sixty (60) per cent of all admissions, with a case fatality rate of between sixteen (16) to thirty-three (33) per cent. The most vulnerable groups are, as one should expect, are the "under-fives" and pregnant women. At the same time, malaria related anaemia has manifested itself as a serious public health problem in those vulnerable groups.

A recent survey conducted by UNICEF in collaboration with our Ministry of Health and Sanitation on anaemia among pregnant women in Sierra Leone, revealed a prevalence level of as much as eighty-seven (87) per cent. Of course we recognise that all problems of anaemia could not be attributed to malaria. However, the fact is that malaria is one of the main contributing factors associated with the high prevalence of anaemia. In short, as in other affected countries, malaria contributes to the low quality of life in Sierra Leone, a high expenditure of family income for treatment, high absenteeism from work and school, and a heavy burden on our health services.

Self-medication, including the administration of traditional herbs, constitute a significant proportion of malaria treatment. This notwithstanding, the incidence of the disease is increasing at an alarming rate. There are still misconceptions about the cause, prevention measures and treatment of the disease, due mainly to ignorance. Poverty itself contributes to the inability of most people in both urban and rural areas to purchase drugs. The lack of health facilities is also another contributing factor to the increasing number of cases of malaria. Of course, the rebel war has added its own impact on the prevalence of the disease throughout the country.

In our view, "Roll Back Malaria" is not a health campaign, nor, in the words of Dr. Brundtland, a revamped vertical programme. It is a new strategy, one which should be an integral part of our overall development strategy. Having recognised the destructive effects of the disease, and inspired by the main objectives of the "Roll Back Malaria" initiative of the World Health Organization, my government has decided that more financial human and other resources should be channeled to this new strategy to control the disease. The idea is to take a more coordinated and concerted approach to the problem.

We are pleased to inform this gathering that through "Roll Back Malaria" malaria control has become one of the priorities in the core programmes of our Ministry of Health and Sanitation. Malaria control has been integrated into our Primary Health Care activities. The National Malaria Control Programme is entrusted with the responsibility of developing policy and treatment guidelines. It supervises, monitors and evaluate implementation of all malaria control activities in the country. We have thus put in place a well-established structure in support of the effort to combat the disease. There is a multi-sectoral task force with representatives from all stakeholders operating in the health sector. Although the deteriorating security situation in recent years had slowed down implementation of the programme, with the gradual return to normalcy the activities are being extended to all accessible areas of the country.

Mr. Chairman, the situation in Sierra Leone is not unique. However, I think other malaria effected countries can benefit from our experience in trying to roll back the disease. We have also learned a number of lessons which I would like to briefly share with you.

During the experimental stages of the implementation of our National Malaria Control Programme, we have found out five main ideas:

  1. That community participation is crucial, due to the widespread misconceptions about the disease, as well as the large-scale practice of self-medication in the community
  2. Training of community health workers in displaced camps has the potential of a multiplier effect on the return of the internally-displaced (IDPs) to their original locations
  3. Senior level personnel need to be trained on the proper case management of severe malaria
  4. Given their strategic positions on first point of contact for most patients, druggists, pharmacists and patent drug merchants need to be trained on malaria control
  5.  There should be an aggressive campaign on the efficacy of chloroquine as the first line drug of choice, especially among medical specialists and private practitioners who put a lot of premium on the prescription of expensive commercial brands of anti-malaria medications of sometimes doubtful quality and efficacy.

Mr. Chairman, if malaria kills so many of our people, most of whom are already impoverished; if malaria slows down the annual economic growth rate of many of our nations by as much as 30%; and if it makes us about $2 billion poorer each year, we should as part of our obligations to our respective nations, assume a leading role in the effort to roll back and subsequently eradicate the disease. This is why I am glad to be in this summit, to join other African Heads of State in giving a new political momentum to the "Roll Back Malaria" initiative.

If, as medical and health institutions, including those engaged in research activities have assured us, it is possible under the Roll Back Malaria strategy to improve health systems and reduce malaria deaths by 50% in ten years, I strongly believe that the five-year targets we are setting ourselves in the Abuja Declaration, are by no means unrealistic. They are rightly aimed at the most vulnerable groups – children, especially the "under-fives", and pregnant women. The Plan of Action attached to the Declaration testifies to our commitment to intensify our individual and collective efforts to eliminate this menace to public health and sustainable development.

On behalf of all the victims and potential victims of malaria in Sierra Leone, I pledge the support of my Government for the principles and objectives contained in the Abuja Declaration, and our determination to institute necessary health systems reforms which will facilitate a speedy and effective implementation of this important document.

I thank you for your attention.