Nestled in the Ashanti region of southern Ghana, the small town of Obuasi is encircled by hills, largely forested but bearing scars from open-cast and illegal mining. Eighty kilometres south of the country’s second city, Kumasi, it is a community of subsistence farmers and miners.
One of the world’s largest gold mines, it has been quarried since the 1890s. But right now the underground drills are silent and a quieter operation is underway, digging out one of the world’s smallest but most deadly predators: the malaria mosquito.
Ghana has one the world’s fifth worst malaria burden. It is the number one reason outpatients go to hospital. But from 2004, this rural community began a turnaround that others now want to emulate. Key to the change was a partnership between a mining company, the local community and the government that led to a 75% drop in malaria cases in the Obuasi mine area in just eight years.
Such was the impact that the programme has been extended to the north of the country, where malaria is most problematic.
“Malaria used to be a very serious situation in this community,” says Nana Ewaitemaa Adam II, community leader – or “queen mother” – of the settlement of Adansi-Odumase. “Children were dying. Adults were dying. But now they come to spray and the incidence has gone down. I don’t remember the last time I had malaria.”
According to the World Health Organization (WHO), nearly half the world’s population is at risk of malaria. About 90% of cases – and deaths – occur in sub-Saharan Africa.
In the past 10 years, Ghana has made progress. Deaths have gone down from 2,200 in 2014 to 599 last year. Yet malaria remains the leading cause of illness and death in children under five. In 2015, about 38% of outpatient visits, 27.3 % of admissions in health facilities, and 48.5 % of under-five deaths were due to malaria.
Despite these advances, countries like Ghana are being challenged by increased resistance to pesticides and drugs, as well as funding pressures.
Approximately $2.7bn (£2.03bn) was spent on malaria control and elimination efforts globally in 2016, significantly less than the $6.5bn annual investment required for the WHO’s global malaria strategy.
Countries that have eliminated malaria in recent years have tended to be subtropical or islands, like Sri Lanka.
In addition to the risk of death, the economic cost of malaria is also high. As far back as 2001, research by John Luke Gallup and Jeff Sachs estimated the economic burden of malaria on African countries to be up to $12bn annually.
In northern Ghana, research showed that while malaria care took up 1% of wealthier families’ income, the comparable toll on poor households was 34%. If people have to resort to cashing in savings, or selling off limited assets to pay for treatment, poverty reduction and development efforts are also hit.
“Currently we get funding from the government of Ghana, from the Global Fund, from the President’s Malaria Initiative and partners like Unitaid through the subsidy that we get on the IRS [spraying] programme,” says Dr Kezia Malm, national malaria control programme manager for Ghana Health Services.
“Funding is dwindling everywhere, but one thing we are really working on is to increase domestic resources, because it’s the only way we can sustain our gains.”
A 2006 World Economic Forum report, Business and malaria: a neglected threat?, sought to catalyse private sector interventions against malaria. Some, like the mining company in Obuasi, have taken up the challenge.
A 2016 study on the effect of malaria on private companies in Ghana – covering agriculture, services and mining – showed 3,913 workdays and $6.58m were lost between 2012-14 due to staff falling ill with the disease, both managers and junior workers.
In 2005, the AngloGold Ashanti mine was losing 7,500 shifts a month due to malaria, affecting more than 30% of the 8,000-strong workforce. Treatment costs were averaging $55,500 a month.
The turning point came the year before, when malaria was formally identified as a risk to operations, and the mine committed to a deeper development partnership with both the community of Obuasi and the government.
Today, the company states that “communities and societies in which we operate will be better off for AngloGold Ashanti having been there” – a bold claim in an industry with evident environmental impact.
“We were getting a lot of manpower challenges through malaria incidents. Our hospital was recording high numbers in malaria and this was a big threat to operations, so we commissioned a malaria outreach programme at an initial cost of $1.5m in 2006. By 2008 malaria had been reduced by almost 74% at the hospital, and it tells you that the hospital and the community received the desired effect that the mine wanted,” says Nana Ampofo-Bekoe, the company’s sustainability manager.
The resulting malaria control programme, AngloGold Ashanti Malaria Control Ltd, or AGAMal, had a small administrative team, with support from mine managers for financial control, planning, logistics, laboratory facilities and strategy. The mine funds salaries, office space and operations.
This investment in quality facilities and staff – $15,447m since 2004 – together with determined prevention and treatment in the community, was spotted by the Global Fund to Fight Aids, Tuberculosis and Malaria. A $138m expansion grant enabled AGAMal to scale up operations beyond the initial mining region and to offer indoor preventative spraying in northern districts with the highest malaria rates.
AGAMal’s modern insectary and laboratory has now become central to Ghana’s fight against malaria. Alongside the national research centre, the Accra-based Noguchi Memorial Institute for Medical Research, it provides a satellite centre for academics and public agencies.
But in 2104, a classic private sector problem put the company’s contribution at risk. Facing a crisis of profitability, operations halted, significant restructuring started, and the mine was placed in care and maintenance mode. Now, following lengthy negotiations with the government – hampered by an invasion of a part of the mine by illegal miners in 2016 – it awaits permission to reopen, potentially this year.
As part of the company’s reorganisation, “non-core” units like the hospital, school, sawmill and football club were split off and are now independently managed. Under the terms of the Global Fund grant, AGAMal became a wholly owned subsidiary.
The company has maintained its support of the malaria programme.
The mine’s economic viability affects many residents’ livelihoods. Even since suspending operations, the company is the largest employer in Obuasi district, with 300 employees and 350 third party contractors. Its redundancy bill totalled $240m.
Underemployment remains a daily challenge for many here. Through the spraying programme and community advocacy that supports it, many local people have received high-quality training and regular stints of employment.
It is not only the direct prevention and improved treatment of malaria in which Obuasi can find cause for celebration. School attendance and performance rates have also improved.
“Everybody in Ghana is at risk of malaria, irrespective of whether you work in the private or public sector,” says Malm. “The Anglo Gold malaria programme started from a private company initiative, and it’s brought something on to the plate that is taking care of the public sector too.
“For us to really win the war against malaria in this country, we need both the private and the public sector. We are looking to Obuasi to drive elimination and use this as a model to learn.”