The Multilateral Initiative on Malaria therefore has the following challenges to face if it is to attain a high level of achievement of its goals and objectives.
The most important challenges of each objective are as follows.
1.3.1 Objective 1: Raise Awareness of the Problem of Malaria and Identify Key Research Priorities with a View to Mobilising Necessary Resources and Actions
• What will be effective strategies to raise awareness of the problem to a level that will facilitate fund mobilisation? This poses several additional questions: What strategies will be used? Will the strategies depend on the target group?
• How will the research priorities be identified and who will be the partners identifying such priorities when it comes to traditional (alternative) medicine?
• What actions should be taken, and with what resources, to ensure that poor and isolated populations can access better medicaments and malaria treatment services at affordable costs?
The Multilateral Initiative on Malaria will find it hard to achieve the first objective without seriously considering the identification, promotion, and provision of evidence-based traditional medicines and practices at affordable costs.
Currently, most of the new antimalarials are beyond the affordability of much of the sub-Saharan populations living in malaria endemic zones.
If these same populations have been using traditional antimalarials for a long time and knowledge of these uses have been passed from generation to generation, this indicates that there must be some empirical evidence for their safety and efficacy.
The challenge to MIM will be how to raise sufficient funds for research aimed at confirming the safety and efficacy of these medicaments and to support production of standard treatment packages using these medicaments.
1.3.2 Objective 2: Develop Research Capacity in Africa through Facilitating a Global Partnership
The major challenge to MIM is how to develop research capacity to screen and identify efficacious medicaments and carry them through toxicological and safety studies (preclinical and clinical) and develop usable products.
This requires strong partnership between the North and the South since much of this knowledge and capacity for this activity are northern based. It will require recognition of the value of improving the health of the poor for global peace and prosperity and the willingness of the North to share and transfer this knowledge to the South.
It is a formidable challenge that requires particular strategies to change the current attitudes that the South can be fed and does not need to know how to grow the food it requires. Support must be given to create southern-based capacities and southern-produced medicaments that will be affordable to the majority poor.
Creation of southern-based industries will greatly help to reduce poverty and enhance development by providing employment and income to farmers who will be encouraged to grow the necessary medicinal crops. This will at the same time provide sure means of ensuring preservation of rare crops from extinction and protection of biodiversity in African forestry.
1.3.3 Objective 3: Promote Communication, Coordination, and Collaboration between Individuals and Organisations Involved in Malaria Research Activities in Order to Maximise the Impact of These Activities
MIM must foster communication and exchange of information between the established capacities in Africa and ensure that they are supported to have better South-South and North-South links and do not feel isolated. MIM must promote the exchange of knowledge so that newly developed capacities do not suffer isolation and neglect. The existence of an international network on traditional antimalarial methods (Research Initiative on Traditional Antimalarial Methods, or RITAM) whose objective, among others, is to foster collaboration among those working in traditional antimalarials is a positive aspect, which is complementing the efforts of MIM. It is therefore important that the network is recognised and supported accordingly.
The challenge is how to use science to evaluate the current knowledge and promote what is scientifically valid as safe and efficacious medication. The guidelines in other chapters of this book aim to provide a starting point for such scientific evaluation.
An additional challenge is how to educate traditional medical practitioners about modern treatments that are superior to their practices, and encourage them to accept and introduce modern medicine in their package for better disease management. If most of the traditional medical practitioners would refer cases with convulsions (cerebral malaria) for fast administration of quinine, mortality due to such a complication would be considerably reduced. There is also the additional challenge of educating modern medical practitioners to accept that traditional medicine may play an important role in disease management, rather than outright discrediting it.
1.3.4 Objective 4: Strengthen Bridges between the Research and
Implementation Communities to Ensure the Research Leads to Practical Benefits
The challenge is how to create effective links between modern and traditional medical practitioners in order to foster better education, and to agree on effective practices to be implemented by both parties. In this process confidence and partnership must be built between the parties, rather than exploitation being the driving attitude.
MIM must collaborate with other organisations to ensure that the research conducted on indigenous knowledge is not pirated but is used to support and develop the communities from which it was derived.
The issue of property rights is critical. Strategies should be made to ensure that the providers of traditional medicines are involved and own the benefits of the research and are not merely used to provide information. Indeed, Section 8j of the Convention on Biological Diversity states that the traditional use of a product by a community contributes to ownership of such a product by the community. This must be strongly supported and advocated as a universal binding principle to be respected by all nations (Convention on Biological Diversity, 2001).
MIM must also ensure that there are effective strategies to involve industry and the private sector without making the end product unaffordable to the populations from which knowledge was derived.
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