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Senegal: Music to Fight Malaria

AfricaFocus Bulletin
Apr 27, 2011 (110427)
(Reposted from sources cited below)

Editor's Note

Music may seem an unlikely way to fight malaria. But Senegal's highly successful program has relied not only on medical expertise but also on the star power of Youssou N'Dour and a national song competition called "Xeex Sibbiru" (Let's Beat Malaria). Support from prominent figures in the society, including religious leaders as well as music stars, has helped to dramatically increase prevention and treatment coverage.

Among the results:

  • More than 80% of households with at least one insecticide-treated mosquito net.
  • The rate of preventive treatment for pregnant women increased from 13% in 2005 to 52% in 2008/2009.
  • The under-five mortality rate was reduced by 30% between 2005 and 2008/2009.

This AfricaFocus Bulletin contains excerpts from the 56-page Roll Back Malaria report on Senegal, prepared in conjunction with Senegal's National Malaria Control Program and released in November 2010. The full report, with detailed documentation, photographs, tables, and graphs, is available on /
direct URL:

For Djibril Diop's winning performance from the Xeex Sibbiru Song Contest in Dakar, Senegal, June 9, 2010, and other related vidos, see

For previous AfricaFocus Bulletins on health issues, visit

For previous AfricaFocus Bulletins on Senegal, as well as additional background links, visit

++++++++++++++++++++++end editor's note+++++++++++++++++

Focus on Senegal

Roll Back Malaria
Progress & Impact Series, Number 4

November 2010

Ministède la Santé et de la Prevention Programme National de Lutte contre le Paludisme

[Excerpts only. The full report is available on /
direct URL:]

The data provided in this report were gathered during the months of June, July and august 2010. ...

This report was co-authored by Eric Mouzin (RBM Partnership Secretariat, Geneva), Pape Moussa Thior and Mame Birame Diouf (Senegal National Malaria Control Programme, Dakar) and Bakary Sambou (World Health Organization [WHO], Dakar).


Executive Summary

Progress and impact of malaria control in Senegal at a glance

* Since 2005, Senegal has built an effective malaria control programme based on strong management and well-defined plans.

* Implementation of best practices and strategic planning have attracted external partners and financial resources. as a result, more than us$ 130 million was mobilized between 2005 and 2010 to scale up the fight against malaria to the national level.

* These funds were used to deploy various malaria prevention and treatment interventions, with the following results:

- nearly 6 million insecticide-treated mosquito nets will have been distributed by the end of 2010.

- More than 300 000 household rooms have been sprayed with insecticide.

- all of the country's 14 regions have received free intermittent preventive treatment for pregnant women, rapid diagnostic tests, and artemisinin-based combination therapies.

- 1 million rapid diagnostic tests and 1.5 million artemisinin-based combination treatments have been distributed.

- 17 000 health workers have been trained to use these tests and dispense these treatments. -support for community associations was extended to all of the country's 69 districts.

* Thanks to active planning, the methodical deployment of interventions has resulted in good coverage rates at the national level:

- In 2010, 82% of households own at least one insecticidetreated mosquito net, representing a 36% increase in less than two years.

- 45% of children and 49% of pregnant women in the general population (regardless of mosquito net ownership) had used an insecticide- treated mosquito net the night before the postcampaign survey in early 2010. These rates went up 40% in one year.

- 52% of pregnant women received at least two doses of sulfadoxine-pyrimethamine during antenatal medical consultations in 2008/20091, compared with 13% in 2005.

- 86% of patients presenting with a potentially malarial fever were screened with a rapid diagnostic test in 2009.

* The high rate of coverage, for its part, provided a way to make an impact on health, to reduce the prevalence of the illness, and to save lives.

In particular:

- under-five mortality was reduced by 30% between 2005 and 2008/2009.

- Moderate anaemia (between 7 and 10 g/dl) in children under five dropped from 55% to 48.5% between 2005 and 2008/2009.

- The number of confirmed cases of malaria decreased by 41% in one year.

- The lives of 26,800 children under five have been saved since 2001, according to the lives saved Tool (LIST estimation model).

* These health interventions and achievements have reached the most economically disadvantaged rural communities and have helped to improve both the health system and maternal and child health programmes.

* Now that these control and prevention measures have proven to be effective, we must maintain the human and financial resources to keep rolling back malaria. complacency will result in a rapid resurgence of this terrible disease.

* The next phase will require considerable effort, which will produce less spectacular results. If managed well, however, this phase may be the forerunner of an era in which malaria prevalence becomes negligible and its elimination within reach.

Box 1: The extent of malaria in Senegal

Malaria in Senegal at a glance
  • Senegal has 12.5 million inhabitants.
  • Malaria is endemic and transmission is stable, with a seasonal peak from July to December.
  • Epidemiological variations are Sahelian and hypo-endemic in the north, Guineo-Sudanese and hyper-endemic in the south.
  • In 2005 there were about 2 million suspected cases of malaria and 2,000 deaths attributable to malaria.
  • Malaria is responsible for more than 20% of deaths among children under five.

The population of Senegal is approximately 12.5 million. The country is divided into 14 regions and 46 departments. The health system follows these administrative divisions, with a medical officer responsible for each region; some of the 69 health districts cover an entire department, while others cover only a part thereof. each health district is placed under the authority of a chief medical officer. The health pyramid rests upon 913 health posts (placed under the responsibility of a head nurse) and 1383 health huts (managed by community health workers who report to the head nurse).

Malaria in Senegal is defined as endemic/stable with seasonal peaks. The rainy season lasts from July to October. as a result, malaria peaks between July and December.


Malaria has been a longstanding public health problem for the people of Senegal:

  • In 2005, approximately 2 million cases of malaria (confirmed or not) were recorded at the national level, as were more than 2000 deaths attributable to the disease (NMCP, 2006).
  • Malaria is responsible for 32% of outpatient consultations and more than 20% of deaths in children under five.
  • The human and economic impact of the disease is a serious curb to economic development, either directly -- through the costs of health care and hospitalization -- or indirectly, through work days lost to personal illness or to caring for a sick child.


Box 2: Youssou N'Dour: On the front lines of the fight against malaria in Senegal

The fight against malaria has a heavy hitter in Senegal: superstar musician Youssou N'Dour. already involved with UNICEF and the RBM Partnership, N'Dour joined forces with the NMCP early on in the belief that bringing the fight down to the grassroots level was the best way to achieve tangible, lasting results and support from partners.

In 2005, N'Dour headlined AFRICA LIVE: The Roll Back Malaria concert, a star-studded event that reached an estimated billion people worldwide with both music from top African artists and messages about malaria, thanks to the concerted efforts of a diverse range of Roll Back Malaria partners. "Music can accelerate the rhythm of the movement to fight malaria," said N'Dour at the time.

In keeping with that sentiment, N'Dour and his brother Boubacar created Senegal Surround Sound, a communication and education initiative designed to reduce the burden of malaria in Senegal.

To reach the public, Senegal Surround Sound, in association with the NMCP and the American nongovernmental organization (NGO) Malaria No More, launched a national campaign in 2009 called Xeex Sibbiru ("let's beat malaria" in Wolof). The campaign, which calls upon every segment of Senegalese society, is intended to inform the general public and to prompt them to take responsibility for protecting themselves from malaria. The message gets through to all audiences: business and sports personalities, the media, and religious leaders have all provided support to the campaign.

The Xeex Sibbiru campaign, an innovative public- private partnership, uses multiple communication channels to drive home its malaria prevention messages, including a national singing competition, the network of community health workers, and the mobilization of civil-society partners.

Activities orchestrated by this campaign include:

  • Support for the national ITN distribution campaign: This insecticide-treated mosquito net (ITN) campaign opened with a concert broadcast nationwide to promote the distribution of 2.2 million ITNs. community health workers used radio commercials featuring celebrities, songs, and certificates signed by Youssou N'Dour to promote the distribution and use of the nets. N'Dour's song, Xeex Sibbiru, written for the occasion, was recorded in three languages- -Wolof, Pulaar, and Serer- -and was broadcast on the air and in more than 1300 health huts.
  • Commitment from religious leaders and the private sector: During Ramadan 2009, N'Dour and the Xeex Sibbiru team went to Senegal's main spiritual centers to receive blessings from the country's religious leaders and to confirm their commitment to encouraging their fans to use the ITNs. In the same timeframe, national and international companies like africa cola, exxonMobil, and senegal's economic and social council joined the campaign as sponsors to help reach the target audiences.
  • Xeex Sibbiru singing competition: The Xeex Sibbiru singing competition took place from March to June 2010. More than 1000 contestants took part, and related events were held in senegal's 14 regions. To qualify, contestants had to demonstrate their knowledge of malaria, submit an original song about the disease, and work side-by-side with health educators to educate their communities. Publicity campaigns were held in every health hut, post, and centre around the country. eight regional concerts were given, with the participation of artists including N'Dour and Viviane. The competition's final- -broadcast on national television- -took place on 9 June 2010 in Dakar and was attended by representatives from Senegal Surround Sound, the NMCP, Malaria No More, and the RBM Partnership. The winner, Djibril Diop, recorded his song against malaria with N'Dour and Viviane, and will continue to lend his voice to the fight against malaria.
The Senegal Surround Sound approach for the Xeex Sibbiru campaign

The right message: Knowledge, attitude, and Practice surveys helped determine the content of the messages to be used. Public figures like Youssou N'Dour worked with the NMCP to adapt the messages to be sure they would be "punchy" enough to reach the target audiences.

Well-known messengers: a quantitative survey was used to determine which spokespeople would be the most effective in each region. Famous musicians, religious leaders, athletes, and actors thus came to represent Xeex Sibbiru in the public eye.

Multi-sector participation: Well-known spokespeople and highprofile events helped the campaign to recruit key partners in religion, health, sports, the media, and business to expand the audience and boost impact.


This strategy has spawned spin-offs. In April 2010, N'Dour went to Cameroon to explore the possibility of launching Cameroon Surround Sound to attempt to replicate the outcome of the Senegalese campaign. other countries could follow.

Two questions for Youssou N'Dour

What advice would you give to countries inspired by what you have built in Senegal?

Use the talent and wealth of your local culture. International donors contribute very generously to improving life in Africa, but only Africans can create the lasting cultural transformation that is needed to win the fight against malaria. no one else can live our lives and understand our realities. as my brother Boubacar likes to say, "If we can get everyone in Senegal to know 500 songs by heart, we should be able to educate people about malaria!"

Is it important to involve private-sector partners, faithbased organizations, and the media?

It's crucial! We're lucky that international donors are interested in malaria for now, but the fight against malaria will be a marathon. In the long term, we will need the resources, talent and commitment of all sectors of Senegalese society if we want to maintain our success and eradicate malaria. It won't be easy and it won't be quick, but together we can make it happen.

Box 3: Interview with Dr Pape Moussa Thior, National Malaria Control Programme (NMCP) coordinator in Dakar

The National Malaria Control Programme in Senegal is often cited as a success story for its achievements in reducing malaria-related morbidity and mortality. How did you achieve these reductions?

I think that for us, in Senegal, the wake-up call came when our first-round grant from the Global Fund was cancelled in 2004. Those involved at the political and technical levels realized that a great opportunity was being lost. The programme's management was evaluated, revealing major weaknesses. The programme was completely overhauled. With support from the Global Fund, we were able to hire new staff members and the programme grew from a team of 5 to 32. We established a clear, functional organization chart with detailed, precise job descriptions.

For me, the keys to success lie in programme management, decentralization, and our involvement in the field, as evidenced by the high number of kilometres travelled each year by our staff and our vehicles!

What are the main strengths of the National Malaria Control Programme in Senegal today?

Above all, political support. To be able to count on unwavering support from the Ministry, to be encouraged in our work, to work together to overcome obstacles. Next, the internal organization of our structure, based on properly assigned, specific tasks. The renewed support of our partners provides us with vital resources and expertise, and helps us to target interventions within an agreed framework. Finally, commitment from active, well-organized communities provides essential local support. Without these invaluable actors on the ground, none of our activities would have made an impact.

On the other hand, what weaknesses do you see?

I have long been disappointed in the insufficient involvement of the private sector (aside from NGOs). The private medical and paramedical sector springs to mind first; we will try to reopen and strengthen our lines of communication with doctors' and pharmacists' unions to obtain their active participation in our work. next, private companies. They have done many useful things, but not enough. The telecommunications company Sonatel comes to mind- -they helped to deliver free intermittent preventive treatment to pregnant women- -as does Total Senegal, which participated in distributing insecticidetreated mosquito nets.

The private sector could play a much larger role, joining wider civil society in the fight against this disease.

What next steps do you envisage?

We are in an evaluation phase, but are also expanding and intensifying the programme.

We were able to carry out the performance review for our programme according to WHO's new directives, then draft a new strategic plan (2011?2015), and finally submit a grant proposal to the Global Fund for Round 10. These successive accomplishments gave us a chance to reflect upon our strengths and weaknesses and to consider the work that lies ahead in years to come.

It seems to me that given Senegal's particular geographic and epidemiological situations, two main strategies must be adopted:

-The first strategy - - for the northern areas, which are in the pre-elimination phase - - must focus on strengthening monitoring: active, real-time detection of suspected malaria cases, with immediate intervention to try to stop transmission. We need to invent flexible, reactive, and fast strategies. Why not, for example, take a page from the SMS for Life initiative tested in Tanzania by the swiss Tropical Institute and combine ACT inventory management and rapid case detection?

The second -- for the southern regions with high malaria prevalence -- will require targeting increased access to treatment through home-based care, improving communication, and working towards universal ITN coverage. These districts will remain in an intensified control phase.


What advice or suggestions do you have for fighting malaria across the region?

Mosquitoes don't stop at borders, so we need to have an integrated, cross-border approach. I think it is essential to share ideas, strategies, and research protocols.

That's what we are trying to do with the Transgambian Initiative for Malaria Elimination (TIME project), which includes Senegal, The Gambia, Guinea-Bissau, Mauritania, and Mali. The member countries work together on operational research, whose results serve to define a pre-elimination strategy. We will need the same approach for epidemiology and specific malaria-control interventions, with support from RBM, WHO, the West African Health organization, and all our partners.

The biological confirmation of malaria diagnosis using rapid diagnostic tests is now a must for all malaria control programmes. We can no longer treat all cases of fever as cases of malaria. using the experience acquired by a few, we must support all countries to scale up rapid diagnostic test use across Africa. We must be bold, innovative, and avoid complacency. only thus will we make significant progress in the fight against malaria.


b. Securing funding

Outside funding for malaria control in Senegal at a glance

  • Various partners have committed more than us$ 130 million to the malaria prevention and control programme in Senegal. * In 2004, external funding amounted to US$ 1 million, as compared with us$ 30 million committed for 2010 by the Global Fund and US-PMI.
  • Other partners, like the World Bank, WHo, unIceF, and the Islamic Development Bank, are actively involved and making growing contributions.

The reorganization of the NMCP and the commitment of the Senegalese government quickly came to fruition. The implementation of good practices and the plans established attracted increasing numbers of partners and resources. as a result, after a positive evaluation in Round 4 of the global Fund, external funding increased rapidly and substantially.

The Senegalese government's funding of malaria- control interventions began intensifying, and its health budget jumped from 36 billion CFA francs (US$ 40 million) in 1998 to 90.5 billion CFA francs (US$100million) in 2008. Today, health represents about 10% of the federal budget. The share of this budget that is earmarked for malaria is difficult to estimate, since it includes support for health workers and structures (hospitals; health centres, posts, and huts; laboratories) providing most of the care.

Outside support grew considerably when the global Fund awarded grants in 2005 (Round 4) and 2008 (Round 7), and gained momentum when Senegal was included among the countries supported by the us President's Malaria Initiative (us-PMI), whose first funds were made available in 2006 and whose support became decisive in 2007.

Other partners joined them. The World Bank financed a malaria control project along the Senegal River basin. several organizations provided technical contributions, advocacy, or reinforcement for services at the local level, especially WHO, UNICEF, and the Islamic Development Bank.

The Global Fund Country Coordinating Mechanism (CCM) was also restructured in 2005. Presided over by Professor Doudou Ba, Vice President of Senegal's academy of science and Technology, its 47 members represent all parties involved in programme implementation. Through quarterly meetings and field trips, the CCM oversees activities, providing advice and ensuring correct implementation to produce results. It has close ties to both the Ministry of Health, with which it maintains close contact, and the programme coordinators- - all CCM members- - who provide progress updates at each quarterly meeting.


Box 4: The home-based care programme (PECADOM)

Most cases of fever are not evaluated in the context of the health system. Indeed, the last national survey on malaria (Senegal MIS-II), held in 2008/2009, revealed that of the 52% of febrile patients who received some form of health evaluation, 35% were seen outside a hospital or health centre/post. This is mainly due to distance.

To solve this problem, Senegal introduced a new kind of health worker, the DSDOM or dispensateur de soins à domicile (homebased care provider), thus allowing for home-based care (known as PECADOM, for prise en charge à domicile) in the event of a fever. The home-based care provider reports to the nearest health hut. The network of health huts has already resulted in improved coverage in areas without a health post close by; home-based care improves this coverage even further.

Home-based care providers are selected in their own villages and trained in diagnosis using rapid diagnostic tests (RDTs) and treatment with artemisinin-based combination therapy (ACT). upon completion of their training, they receive a kit including ACTs, RDTs, a recycling container for sharp objects, data collection forms, two T-shirts, two baseball caps, two vests, a case, a satchel, a torch, and a box of gloves. The home visit, the RDT, and any necessary ACT treatment are provided free of charge. Home-based care providers can refresh their supplies of ACTs and RDTs at the health post upon presentation of their latest case log. supervision is provided at several levels. on one level, the health-post nurse directly supervises the home- based care provider; on another level, the district medical team provides quarterly supervision; and, finally, the National Malaria Control Programme team holds twice-yearly inspections. The home- based care providers are all volunteers, but they receive a daily stipend during the training sessions, which serves as an incentive.

In 2009, of the 7,198 patients seen by home-based care providers and suspected of having malaria, 6,707 (93%) were tested with an RDT. of the 2300 cases of malaria thus confirmed, 2,226 (97%) were treated with ACT at the community level, and the recovery rate for cases of simple malaria was 100%. The remaining 74 patients (or 3%) had to be referred to the next level of the health system for more specialized medical care. no deaths attributable to malaria were recorded in the target villages.


Effects on the health system

The training of thousands of health workers in the context of the fight against malaria has helped to strengthen the Senegalese health system as a whole.

But perhaps the most important contribution made by the NMCP to relieving the pressure placed on the health system is the reduction of malaria cases. By drastically reducing the number of malaria cases, and by using early diagnosis to provide better treatment of malaria as well as non- malarial fevers, the NMCP not only strengthens the health system, but lightens its load.

Indeed, the number of malaria cases in children under five dropped from 400,000 suspected cases in 2006 to 78,000 confirmed cases in 2008, then to 30,000 confirmed cases in 2009. This shows both the reduction in the number of confirmed cases as a result of the malaria programme (from 78,000 to 30,000 cases in a single year, for example), and the impact (not quantified here) that early diagnosis of suspicious fevers (whether malarial or not) can have in children, likely leading to faster recovery and reduced mortality.


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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