Policy Implementation Challenges At Work: A Case Study Of Malaria Alliance

THE African Leaders Malaria Alliance (ALMA) is an organization established in 2009 to actualize an effective response to the scourge of malaria and push African leaders to join the global movement in reducing the morbidity and mortality rate due to malaria and other endemic diseases.

It comprises the Government and Head of states in the Africa Union, aimed at increasing the knowledge and awareness of citizens in member countries to neglected tropical diseases, malaria, nutrition, reproductive, maternal, neonatal, child and adolescent health (RMNCAH).

The vision of this alliance is to achieve the Agenda of the Africa union in 2063, creating “the Africa we want” and the organization works to improve accountability from the continental level to community levels respectively. Additionally, ALMA works to assist governments sustain their commitments to healthcare across the African Union while identifying bottle necks and solving health dilemmas.

ALMA partners with the Bill and Melinda Gates Foundation, United States Agency for International Development, United Nations Children’s Fund, World Health organization, Norad, The Global Fund to fight AIDS, Tuberculosis and Malaria, Comic Relief, Malaria No More, SpeakUpAfrica, Uniting To Combat Neglected Tropical Diseases, Children’s Investment Fund Foundation, Asia Pacific Leaders Malaria Alliance, Elimination 8, Economic Community of West African States, Partnership To End Malaria amongst others to help member countries reach the sustainable development goals .

Several years ago, ALMA elected its ambassadors, however, they are yet to be fully integrated into government organizations in their home countries especially those institutions concerned with the health of citizens which has a big effect on the processes involved in policy implementation across Africa. Policy design, strategic planning and policy monitoring are important pillars in implementing accepted policies at any level of ALMA.

I have been working with the African Leaders Malaria Alliance on the policy implementation chain as a country Ambassador and the coordinator of ALMA members in Ekiti state, Nigeria. Ambassadors across Africa have successfully taught and are still teaching members how to use the score card which is effective in monitoring, evaluating and accountability of health systems performance.

A policy is a vison put into words which cannot be implemented without the right people, machineries, environment, and funding. The political challenges faced by ALMA are webbed in structural and cultural segments of policy implementation.

The lessons for current Global health advocates invested in policy advocacy and implementation are decision making strategies from the state to country level, then regional level which is usually hectic with every country trying to take the lead in policy design and implementation.

The policies are often adopted but not necessarily implemented, new policies designed for a country from international Non-Governmental Organizations (NGOs) sometimes challenge the policies available, especially those from local non-governmental organizations. Moreover, old Non-Governmental Organizations focused on elimination of malaria and neglected tropical diseases might get better support while NGOs such as ALMA have officials who are still adjusting to the new roles, positions and duties created to improve productivity.

Furthermore, deliberation of programs can only be carried out in most countries with the approval and engagement of officials from the Ministry of Health. The time lag waiting for feedback from ALMA secretariat before policy implementation delays a lot of projects which should have improved the health sector of member countries.

In addition, NGOs with the same aims as ALMA are hesitant to collaborate as they want to execute projects independently and receive accolades solely. On the contrary, ALMA has more than enough human resources which is sometimes a disadvantage due to too many hands-on different projects instead of tackling one at a time.

The subregions of ALMA under every member state of African Union pass timely policies which must be organized and sometimes too many pathways of execution which are not integrated affects the success or final output of a particular policy. What works in Nigeria might fail in Kenya due to different socio-political and cultural-political aspects in each country.

The visa application to some member states under ALMA is hectic, travel restrictions also occur as seen in Ugandans not been able to migrate to Rwanda by road recently, the use of different currencies because ECOWAS is yet to announce a valid formal legal tender which can be used in its member countries, has a resultant effect on procurement, logistics and implementation of projects.

Nevertheless, wars as seen in Somalia and recurrent terrorism in Nigeria has affected health systems performance via policy implementation.

Notwithstanding, the global health representatives who are invested in policy implementation should know that monthly, quarterly, and annual feedback from beneficiaries at any level or supposed partners is crucial to improve the health system performance.

Acquiring the right information and data from reliable sources will help ALMA ambassadors and leaders know how much they’ve impacted the health sector and what is left to be done which can proffer solutions for the organization on any policy to be put into practice.

Some of the contract awards which have been implemented by ALMA includes provision of access to Global Health Solutions, prioritizing malaria on the political and policy agenda, improving reproductive, maternal, newborn and child health through the use of country-led scorecards and action trackers for accountability, a government-level engagement in support of the malaria and neglected tropical diseases elimination and eradication agenda, achieving health and nutrition outcomes for mothers, babies and adolescents through improved accountability among others.

Lastly, more online banking systems should be adopted to improve logistics and procurement across member countries with integration of policies from different regions in Africa, so that implementation of one policy, improves the health system performance in all member states. Communication strategies should also be improved via online and physical town hall meetings, conferences and seminars at community, state, and country levels respectively.

The level of consultation by ALMA should also be improved, relevant stakeholders in the country or region should be in the know of new policies designed to help citizens either short or long term, aimed at achieving consensus. Although Ambassadors are always trained on new projects or scorecards, members should also know their input on policy implementation is important to aid smooth execution of projects.

Policy implementation cannot be termed as successful without excellent monitoring and evaluation tools which should be updated regularly. Outdated tools used in implementation strategies cannot give the desired results -to a higher percentile.

In conclusion, policy implementation is affecting health systems performance not just in Africa but globally due to feedback and implementation strategies which are not sustained. The leadership of ALMA at all levels needs to be enhanced politically to be able to fund, implement and track its projects, policies, and impact across Africa.

Azeezat is of Women in Global Health (Nigeria Chapter).

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