As I reflect on recent visits to our country teams and programme activities in Uganda, Ethiopia and Nigeria – my last visits in my role as Chief Executive of Malaria Consortium – it seems to me to reflect precisely the mission that Malaria Consortium started out with almost 20 years ago and what drew to me the organisation.

Charles Nelson with Malaria Consortium Nigeria staff

Originally, a small operation with a few passionate, highly expert individuals, Malaria Consortium was an organisation in a position to utilise our technical leadership and competence, to build on great science delivered with humility and serve communities to rapidly improve access to services adapted to the local contexts, through partnerships forged with ministries of health and the communities themselves. I joined at a point in our history as an organisation when we had grown bigger, with ambition to serve more, and we believed we had the credibility – assuming we could find the funding – to reach many more people with innovative, effective interventions.

The priorities and values present when I joined are the same that the team here have endeavoured to demonstrate in the last ten years; to make a tangible difference to the health outcomes of people living with a high burden of disease, leveraging our expertise to ensure that evidence is the driver of our programming and strengthened by our collaborative relationships and contextual awareness. It is exactly this that I have seen demonstrated over the years, on an almost daily basis, working with teams in the countries where Malaria Consortium has, or had, a presence.

In Uganda, I visited four of the eight districts in the Karamoja region where Malaria Consortium is currently working with the Ministry of Health to deliver seasonal malaria chemoprevention (SMC), using sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) drugs in combination. This is a highly effective intervention to save lives by preventing children under five (the group where the greatest number of deaths occur) from getting malaria by delivering medicine during the rainy season, in four or five 28-day cycles, when transmission is at its peak. While Uganda is a new geography for SMC, Malaria Consortium was involved right from the trial stages of SMC, in 2013, after the World Health Organization recommended it for use exclusively in the Sahel region of Africa – this recommendation based on the knowledge that the parasite had developed resistance to SP as a treatment in East and Southern Africa. Nine years later, having worked with suppliers and partners to produce and deliver dispersible, child-friendly products, it is proven as a safe intervention across more than 10 countries and many millions of children. Based on emerging evidence, despite the potential issues of resistance, we believed it could have a similar degree of impact in other regions too and were able to embark on phased trials in Mozambique and Uganda, to demonstrate exactly that.

Charles Nelson visiting SURMa project, Uganda

Gladly, it has proven effective. Having the privilege of travelling again following the COVID-19 pandemic, I have been reminded of the impact effective interventions can have. As just one example in Karamoja – the caseload of malaria has plummeted and there are few, or no children under five with malaria in outpatients or admitted to hospital. Everybody said the same – their children are not getting sick and are not dying following the administration of SMC. This could mean as many as 2,700 children alone did not die this year, in this region.

This year, our SMC programme is set to reach around 24 million children across six countries, meaning not only better health for them but also improved livelihoods for their family, who won’t have to miss work to take them to the nearest health facility, or pay for the necessary treatment or transport to get them there. We are trying to work out how best to capture these additional impacts in the thinking about ‘effectiveness’ of interventions – they are truly lifesaving and life-changing for many. It is this that matters most.

As I take my leave of Malaria Consortium, I am left with many great memories. I have had the privilege of leading many extraordinary people with depth of passion, skill and capability that makes us who we are, overseen by an impressive group of Trustees who have given their time freely and generously. I have learnt so much, but there is always more to learn. I have watched (as I wasn’t able to do anything else for a while) the amazing commitment from dedicated staff who, when faced with an unprecedented global pandemic, responded with courage, agility and insight to ensure health services continue to be delivered where they were needed most. Nobody succeeds alone… thank you to all who have served with me… I certainly couldn’t have fulfilled my role without you.

I cannot conclude here without mentioning Sylvia Meek. She was one of the founders of Malaria Consortium, and our former Technical Director, who demonstrated better than anyone the love she had for those we served, and the power of great science, delivered with humility. It was an honour to have worked with her before her untimely death in 2016, and a source of hope to see her legacy continuing in the strength in depth she made possible in our teams around the world.

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