Call to counter-attack malaria in Pakistan

Saleem Shaikh

DAWN.COM, April, 27, 2011

The World Malaria Day was marked by civil society organisations and provincial governments on April 25 across the country. In this context, different programmes were arranged to highlight the significance of the day, raise awareness among masses about the disease and underline the need for its prevention.


The theme of this year’s World Malaria Day was ‘Achieving Progress and Impact’. The theme called for the global community’s renewed efforts to make progress towards zero malaria deaths by 2015.

In Pakistan, around 0.5 million malaria cases are reported every year. However, given the realisation, malaria has been declared as a life threatening disease and one of the major health challenges of the 21st century.
The major developments in the industrial sector without proper sewerage, unplanned and unsustainable urbanization and bad sanitary conditions have made the conditions favourable for the expansion of malaria.
The key interventions to fight the scourge of malaria include early diagnosis and prompt treatment of cases, use of long-lasting insecticide treated bed nets (LLINs), elimination of mosquito breeding sites by drainage, filling of wastewater bodies with earth, cleaning of drains and clearing vegetation.
According to WHO reports, due to a countrywide malaria eradication drive launched in 1961, malaria was almost eliminated in the country during the 1960s with a reported figure of some 9,500 in year 1967. However, financial and administrative constraints resulted in the resurgence of malaria in the 1970s, which touched epidemic proportion in 1972-73.
Later in 1975, the strategy switched from eradication to control when malaria control interventions was integrated into the primary health care system. Since then, the health malady persists to be a major public health hitch in the country.
In most parts of the country, the transmission season is post-monsoon, occurring from July through November.
The MDG Pakistan 2010 Report notes that malaria continues to be an endemic disease in large areas of the country. However, the malaria related issues call for attention as the proportion of population in malaria risk areas using effective measure has increased slightly by 10 points from 20 to 30 during 2001 to 2009.
Different reports indicate that the disease is now rising as a grave health problem in Balochistan, FATA and in parts of Punjab and Sindh.
According to MDG Pakistan 2010, the proportion of population facing malaria risk using effective malaria prevention and treatment measures in 2004-05 was 30 per cent, which fell to 25 per cent in 2006-07. But, latest figures of 2009-10 show that there has been a reversal and the number has increased to 50 per cent.
However, there is a mounting concern about the rapidly aggravating situation of malaria in all parts of the country.
Achieving the 75 per cent proportion of population facing malaria using effective malaria prevention and treatment measures by 2015 is the eighth MDG target. But, it is difficult to achieve this unless increased investment in water supply infrastructure is made. Health development experts say that in view of the current depressing trends and the country’s current financial problems it is hardly possible to meet the target.
“Today, only one in four malaria sufferers in Pakistan actually gets treated for the disease. When it comes to malaria treatment, only about 25 per cent of patients infected approach public-sector hospitals. The rest turn to quack [unqualified] doctors and self-medication,” IRIN reported quoting Muhammad Mukhtar, a research officer at the national malaria control programme.
Health experts believe that people can be treated for malaria with easily available medicines, if diagnosed properly. But, a fragile health infrastructure, deepening poverty, inadequate number of doctors and paramedical staff and bad or no monitoring system for mortality rate from the malaria.

Weblink: http://www.dawn.com/2011/04/27/call-to-counter-attack-malaria-in-pakistan.html

SACOSAN ends with pledges

Saleem Shaikh | DAWN.COM

April 10, 2011

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Photo Caption: Sri Lankan President Mahinda Rajapaksa addresses SACOSAN Ministrial Summit in Colombo. Minister of States and Frontier Regions Engineer Shaukat Ullah is also seen. – Photo by Saleem Shaikh

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COLOMBO: The heads of the delegations from the eight South Asian countries here on Thursday adopted the ‘Colombo Ministerial Declaration’ at the concluding session of the fourth South Asian Conference on Sanitation (SACOSAN IV).

They affirmed in the declaration the value of the SACOSAN process in maintaining political momentum to tackle the sanitation crisis and renewed their joint commitment to invest in the people of the region through policies and programmes that deliver sustainable sanitation and hygiene to all.

The signatories of the declaration also recognised the potential of sanitation to empower communities and to be a powerful entry–point for development.

They committed to work progressively to realise the ‘right to sanitation’ in programmes and projects and eventually in legislation in their respective countries; develop time-bound plans and allocate as well as mobilise resources for delivering on all previous SACOSAN commitments; design and deliver context-specific equitable and inclusive sanitation and hygiene programmes including better identification of the poorest and most marginalised groups in rural and urban areas; raise the profile of water, sanitation and hygiene (WASH) in schools; set up one national body with responsibility for coordinating sanitation and hygiene, involving all stakeholders including those responsible for finance, health, public health, environment, water, education, gender and local government at national, sub-national and local levels; establish specific public sector budget allocations for sanitation and hygiene programmes; to recognise the importance of people’s own contribution towards sanitation; develop harmonised monitoring mechanisms with roles and defined responsibilities, using agreed common indicators that measure and report on processes and outcomes at every level; include in monitoring mechanisms specific indicators for high priority measures such as WASH in schools, hand washing and menstrual hygiene; and adopt participation, inclusion and social accountability mechanisms from planning to implementation in all sanitation and hygiene programmes.

The heads of the regional countries’ delegations further called on development banks, external support agencies and the private sector to increase their support to provide financial and technical assistance for sanitation and hygiene in South Asia.

The four-day SACOSAN IV which began under the theme ‘Sanitation Enhances Quality of Life’ concluded on April 7. It was attended by 450 delegates, 320 foreign delegates, ministers, policy makers, senior civil servants, grass-roots activists, professionals from academia, NGOs, development partners and the private sector from South Asian and other regions.

The SACOSAN is a government-led biennial convention held on a rotational basis in each South Asian Association of Regional Countries (SAARC).

Inaugurating the ministerial summit, president of the Democratic Socialist Republic of Sri Lanka Mahinda Rajapaksa underlined the need for political will of the respective countries to implement the commitments on sanitation and water, especially with regards to schools, poor section of people and the differently able people.

He said: “Safe sanitation, hygiene and provision clean drinking water are the key to overall socio-economic uplift. However, it is need of the hour to divert colossal funds being wasted on wars and conflicts to development research and technology to fight poverty and ease suffering.”

“Public expenditure on rural centric initiatives and on farmers, on children and similar expenditures on the provision of water, sanitation and clean environment are more productive and beneficial to the welfare of the citizens. Thus, at a ministerial conference such as this, our determination should be to appeal to the world to divert their defence expenditure to development” the Sri Lankan president said.
He urged the South Asian governments to strive for achieving the Millennium Development Goals (MDGs) within the stipulated time of 2015.

The heads of delegations, experts on water and sanitation, international donor organisations including United Nations, World Bank, Unicef, WHO, WaterAid, Freshwater Action Network South Asia (FANSA) and government representatives from South Asian countries, key leaders of other national and international civil society organisations agreed on the need for more spending on increasing access of safe sanitation, hygiene and drinking water and water infrastructure development, to the people of the region.

After extended and in-depth deliberations, discussions and meetings at the South Asia Conference on Sanitation IV, they concluded that no country can achieve sustainable economic growth without improving its sanitation, water, education and health profiles.

The countries in the region sustain significant economic losses equal to at least 5.8 per cent of the total regional GDP due to poor sanitation.

“Most shockingly, children and adults are still dying needlessly. Since the last SACOSAN, about 750,000 of South Asia’s children have died of diarrhoea,” said Amarananda Abeygunasekara, Sri Lankan secretary in the Ministry of Water Supply and Drainage.

Earlier, Pakistan’s Minister for States and Frontier Regions Engineer Shaukat Ullah, in the country progress report ‘The MDG of Sanitation for SACOSAN IV’, said that 60 per cent of the total number of child mortality cases in Pakistan are caused by water and sanitation related diseases and 20-40 per cent of hospital beds in the country are occupied by patients suffering from such diseases.

“Nevertheless, Pakistan is committed to extending improved sanitation facility to 67 per cent of population by 2015. Review of sanitation date of government indicate that the use of latrines has increased significantly from 57 per cent in 2001-2002 to 78 per cent in 2008-09 and open defecation has decreased from 43 per cent to 22 per cent during this period,” he said.

And given this baseline, the country has progressed and succeeded in providing access to improved sanitation to 45 per cent of the population by 2008-09 that brings it closer to the attainment of MDG of Sanitation by 2015, Shaukat Ullah said confidently.

He said, “The government is engaged with international partners and donor agencies to accelerate the implementation of the sanitation agenda. Besides, projects worth US$ 61 million are under implementation at different stages in the implementation cycle. The National Disaster Management Authority (NDMA) has in the pipeline US$ 244 million worth of projects under WASH cluster.”

Talking about impacts of the projects and interventions for promotion of safe sanitation and hygiene, Head of WaterAid – Pakistan, Abdul Hafeez, said that interventions and projects aimed for safe sanitation, hygiene and clean drinking water have followed different trajectories, which have produced divergent outcomes.

Weblink: http://www.dawn.com/2011/04/10/colombo-declaration-adopted-amid-pledges-to-invest-more-in-sanitation.html

South Asians call for equitable sanitation programmes

Saleem Shaikh | DAWN.COM

April 4, 2011

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Photo Caption: Participants of the pre-meeting SACOSAN IV lined up outside makeshift toilet as symbol to highlight sanitation crisis in South Asia –Photo by Saleem Shaikh

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COLOMBO: Civil society members at an international consultative meeting, just ahead of the fourth South Asian Conference, on Sanitation (SACOSAN), in Sri Lanka, called upon their respective governments to hammer out viably equitable and inclusive sanitation and hygiene programmes.

They strongly urged for a time-bound action plan for delivering the previous SACOSAN commitments made in Dhaka, Islamabad and Delhi.

The four-day fourth SACOSAN, to be held from Monday in Colombo is expected to focus on safe sanitation and hygiene issues. The ministerial level meeting will conclude on April 7.

Talking during a post consultative meeting press conference, Freshwater Action Network South Asia (FANSA) convener Ramisetti Murali said despite commitments during last SACOSAN, the South Asian countries have not made progress in providing basic sanitation, due to which millions of the people in these countries are suffering.

“I visited Hyderabad Dakhan last year where 12 people reportedly died of contaminated water due to the absence of basic sanitation system in the area, but it is not the only example, official data reveals that around 750,000 children have so far reportedly died due to the diarrhea since last SACOSAN and that is an alarming figure,” he said.

He said that although the South Asian countries have rectified the United Nations declaration that states sanitation as a basic human right, all these countries have so far not made it as party of country constitution.

He said that sanitation is also related to health and the worst sanitation causes an increase in the cost of health budget.

“Poor sanitation now stands as a major obstacle in the fight to reduce child mortality in Bangladesh, India, Nepal and Pakistan,” he said.

Governments of South Asian countries must be held accountable to the commitments they made at the SACOSAN, said Ceridwen Johnson, FAN Global Network and Communications Manger.

Around 140 representatives from civil society groups from the South Asian countries that included Bangladesh, India, Pakistan, Sri Lanka, Maldives, Nepal, Bhutan and Afghanistan, and from international organisations working in the region, gathered in Colombo to exchange experiences and draft peoples’ demands from the governments of South Asian Countries for the betterment of the sanitation crisis.

The Delhi Declaration 2008 set out clear commitments and milestones for tackling the crisis. It also recognised that access to safe sanitation and drinking water is a basic right and in particular that national priority to sanitation is imperative. This reaffirmed the commitment to achieving millennium development goals on sanitation by 2015.

Non-government organisations—Freshwater Action Network, South Asia, Water Supply and Sanitation Collaborative Council and Water Aid jointly organised the two-day consultation meeting that began Friday.

Weblink: http://www.dawn.com/2011/04/04/south-asians-call-for-equitable-sanitation-programmes.html