Joy Phumaphi, African Leaders Malaria Alliance: Malaria is an all of society challenge

Summary

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The Interview – BBC World Service

Guest: Joy Phumaphi, Executive Secretary, African Leaders Malaria Alliance (ALMA)
Host: Daniel Dazzi
Episode Theme: Malaria Is an All-of-Society Challenge
Release Date: March 25, 2026

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Overview

This episode features a frank and wide-ranging conversation with Joy Phumaphi, Executive Secretary of the African Leaders Malaria Alliance (ALMA), on the continent’s struggle against malaria. Phumaphi discusses the crisis outlined in ALMA’s 2025 report: a “perfect storm” of rising costs, declining funding, and new challenges such as climate change and drug resistance. She explains why eradicating malaria by 2030—a target set by ALMA—remains out of reach for most African countries, and calls for an all-of-society approach that places greater responsibility on not just governments, but also private sector actors and communities.

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Key Discussion Points and Insights

The Malaria Crisis in Africa

• Statistics & Scale
  • Africa accounted for 96% of global malaria cases and 97% of deaths in 2024 (01:50).
• ALMA’s Role & Ambition
  • An alliance of leaders from 55 African states, ALMA aims for malaria eradication by 2030 but only a handful of countries will meet this goal (01:50, 20:03).

Barriers: The "Perfect Storm"

• Multi-Factorial Challenges
  • Phumaphi likens the anti-malaria effort to a vehicle facing numerous breakdowns: “You cannot isolate a particular issue in this perfect storm of challenges and say, this is what is holding us back.” (05:57)
  • Issues include:
    • Shrinking funding and ODA (Official Development Assistance)
    • Climate change and extreme weather (floods create new breeding sites)
    • Drug and insecticide resistance
    • Rapid population growth, but not matching investment in prevention tools (e.g., bednets)
• Resource Gaps
  • “There are very few countries that are reaching more than 60% of the population that needs to be covered… we are talking here about a massive gap that would be required. So it is not just that there's lack of political will or that people are not budgeting enough, but the resources required are massive.” (02:43, 13:02)
  • Funding shortfall is estimated at $6 billion annually. (02:43, 13:02)

Funding and Fiscal Space

• Declining Development Assistance
  • “There's been a 70% decline in ODA for health in Africa over the past five years. And then you see a 30% funding reduction could lead to 146 million additional cases.” (06:20)
• GDP Impact
  • “The result of that 30% reduction would also be a loss of 37 billion in Gross Domestic product.” (06:40)
• Origins of Funding Difficulties
  • The Abuja Declaration once targeted 15% of national budgets for health, but international funding led many governments to reduce their own commitment:

    “Most countries never achieved that targeted budget allocation... ministries of finance then looked at [outside funds] as a replacement for the commitment that we have made.” (06:40)

  • Fiscal space remains limited due to debt, competing demands, and economic constraints.

Solutions & Innovations

• Domestic “Anti-Malaria Funds” and Multi-Sector Councils
  • ALMA advocates for national health funds, managed by councils composed of government, private sector, civil society, religious, and traditional leaders (08:20).
  • These councils use digital progress-tracking tools and oversee efficient allocation at national and sub-national levels.
  • Example: Zambia’s council purchased bicycles for health workers and funded seasonal malaria chemoprevention for children (09:45-10:33).
• Private Sector Engagement
  • “What the private sector is actually doing is targeting CSR funds… now they are sitting on the board of the council and they are able to monitor effective use of the resources so there is less wastage and there's proper targeting.” (10:55)
• Subnational Tailoring & Technology
  • Interventions are increasingly tailored to regions with the highest need.
  • In Rwanda, drones spray rice paddies with larvicide to target mosquito breeding at the source:

    “This has really brought down the incidence of malaria in the region... they actually are taking the breeding at source and stopping it in its tracks.” (11:30)

Accountability and Political Will

• Council Adoption and Progress
  • Only 12 of 55 African countries have launched malaria councils; just five are on track for target reductions (12:31).
• Political Will vs. Money
  • “You need both, you need both political will and you need money…” (13:02)
• Mainstreaming Responsibility
  • Infrastructure and industry (e.g., mining, agriculture) must integrate vector-borne disease prevention in planning and budgeting as part of environmental impact assessments (14:10).
  • “Here you are not just protecting the environment, you are protecting the human beings who live in that environment.” (14:50)
• Societal Engagement
  • “It is not just the responsibility of these heads of state, it is all of society that have a responsibility to fight malaria.” (18:05)

Target Realism and Adaptation

• Why the 2030 Goal Won’t be Met
  • Obstacles not anticipated when the goal was set include:
    • Climate change, which has caused malaria to appear at higher altitudes in East Africa.
    • Rapid population increase.
    • Erosion of donor support, declining ODA for over a decade.
    • Insecticide resistance (notably to treated nets), requiring newer, more expensive tools (20:03–22:00).
    • “So we have to build our resilience systems ourselves.” (20:59)
• Lessons & Forward Steps
  • “Our plan was not future proof… Now we want resilience. Africans must realize that we are the ones who are responsible for developing this continent. Nobody's going to do it for us.” (20:59)
• Responsibility: ALMA & WHO
  • Phumaphi clarifies that technical guidance on interventions is the role of the WHO, but heads of state bear ultimate responsibility:

    “Absolutely. So that, that one there's no doubt about. So what I'm trying, what I'm saying here is that it was not anticipated that climate change would be this bad… So yes, there are lots of factors here which we are not anticipated. And yes, we can blame the technical agencies like WHO and others for not being able to predict this. But my question is, what benefit is it for us to be pointing fingers? Because what we need to do now is find the solutions and implement those solutions with the countries.” (23:31–24:47)

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Notable Quotes & Memorable Moments

• On the scale of challenges:

  “If you are hit by a storm on the journey, you have to stop. If one part of your car stops working, you have to stop. So we cannot isolate a particular issue in this perfect storm of challenges and say, this is what is holding us back.” (05:57, Joy Phumaphi)

• On funding shortfall:

  “We are talking here about a massive gap... it is not just that there's lack of political will or that people are not budgeting enough, but the resources required are massive.” (02:43, 13:02, Joy Phumaphi)

• On missed targets:

  “We are not ending malaria by 2030. A few countries will… but most of our countries are not.” (21:26, Joy Phumaphi)

• On future-proofing:

  “The plan was not future proof. And that is why we are saying now we want resilience. Africans must realize that we are the ones who are responsible for developing this continent. Nobody’s going to do it for us.” (20:59, Joy Phumaphi)

• On who bears responsibility:

  “It is not just the responsibility of these heads of state, it is all of society that have a responsibility to fight malaria.” (18:05, Joy Phumaphi)

• On action vs. blame:

  “But my question is, what benefit is it for us to be pointing fingers? Because what we need to do now is find the solutions and implement those solutions with the countries.” (24:47, Joy Phumaphi)

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Timestamps for Major Segments

• Introduction & Malaria in Africa – 01:50
• Definition of the “Perfect Storm” – 02:43–06:20
• Funding Challenges Discussed – 06:20–09:45
• Domestic Funds / Multi-sector Councils – 08:20–10:33
• Private Sector, Drones, Innovations – 10:55–11:30
• Accountability and Political Will – 12:31–14:50
• Society-wide Responsibility – 18:05–19:54
• 2030 Goal, Resilience, and Future-proofing – 20:03–21:26
• Challenges of Insecticide Resistance – 21:26–22:51
• Questions of Blame and Solution Focus – 22:51–24:47

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Summary

This episode is a frank assessment of why malaria eradication in Africa remains elusive, despite decades of effort and innovation. Joy Phumaphi highlights that success is hindered by a confluence of funding shortfalls, new environmental threats, and systemic limitations. She stresses that malaria is a challenge for all of society, not just politicians or development agencies, and calls for resilience, innovation, stronger accountability, and domestic ownership of the malaria fight. While the ambition for 2030 will not be met for most countries, the conversation points towards adaptive, whole-of-society solutions as the only way forward.

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Transcript

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[Daniel Dazzi]

Hello, I'm Daniel Dazzi, BBC presenter, and this is the interview from the BBC World Service. The best conversations coming out of the BBC people shaping our world from all over the world. If you're not a little bit afraid, then you're not paying attention.

[Joy Pomapi]

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[Joy Pomapi]

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[Daniel Dazzi]

For this interview, I met Shoi Pumapi, Executive Secretary of the African Leaders Malaria alliance, or ALMA, in Addis Ababa's plush Radisson Blu Hotel. Africa was home to 96% of global cases of malaria in 2024 and 97% of deaths. ALMA brings together the leaders of 55 African countries currently led by President Boko of Botswana and was founded with the clear goal of eradicating malaria across Africa by 2030. But Joy Pomapi tells me only a few member states will hit this target. She describes a perfect storm of factors including drug resistance and climate change, as well as the risk that private sector development projects like road construction and mining sites, for instance, can become breeding grounds for mosquitoes, all of which add to spiraling costs of malaria prevention.

[Joy Pomapi]

If I can just show you what type of gap we are trying to target here in terms of coverage with effective prevention interventions, There are very few countries that are reaching more than 60% of the population that needs to be covered. So when we talk about we are spending 3 billion, 4 billion here. The gap is actually in the region of 6 billion. So we are talking here about a massive gap that would be required. So it is not just that there's lack of political will or that people are not budgeting enough, but the resources required are massive.

[Daniel Dazzi]

Welcome to the interview from the BBC World Service with Joy Pomapi.

[Interviewer]

So in this perfect storm crisis that you Describe in the 2025 Alma report, you mentioned funding short force climate change, extreme weather events, insecticide and drug resistance, and humanitarian crises.

[Joy Pomapi]

Yes.

[Interviewer]

Out of these issues, which would you say is the heart of. If you are talking about what is causing this perfect storm, I think perhaps

[Joy Pomapi]

we should look at it from this perspective. Look at it as a, let's say, a vehicle that we are trying to drive. We are trying to get to a vehicle and we are getting to this destination or of the malaria free world. Our destination is 2030. But in order to get there, you need a sound vehicle. And what is the sound vehicle? The sound vehicle is the tools that you are going to use to get there. It is the human resources that you are going to use to deploy these tools. It is the finance that you will need, first of all to acquire and deploy the tools and also to compensate the human resources. As you are traveling on this journey to 2030, you encounter challenges. And the challenges could be. We talked about the flooding that creates breeding sites for mosquitoes. We talked about the fact that if you look at the population of the African continent, let's say 94, when I first became a member of parliament, it has doubled since then, the population of the African continent. But if you look at the interventions that we have been deploying since the beginning of the century, like insect treated mosquito nets, we have not really been able to double the number of nests that we have had that we are using. Why? Because every time you have a new commodity, it is more expensive. And because the ODA that we have been receiving, the budget allocation that we have been making to health and to malaria, in terms of purchasing power, has not really increased. So what I'm trying to say here is let's look at it as a complete vehicle. We cannot isolate one particular issue and say, no, this is what is delaying us. Because if you are hit by a storm on the journey, you have to stop. If one part of your car stops working, you have to stop. So we cannot isolate a particular issue in this perfect storm of challenges and say, this is what is holding us back.

[Interviewer]

But you do mention in your reports that there's been a 70% decline in ODA, that is official development assistance for health in Africa over the past five years. And then you see a 30% funding reduction could lead to 146 million additional cases. We need money.

[Joy Pomapi]

We definitely need money. And the result of that 30% reduction would also be a loss of 37 billion in Gross Domestic products. So it's, it's, we need the money. But I think the question here is where does the money come from? We have not really substantially increased budget allocation to health as a whole since 2000, you know, when we had this Abuja declaration. And I used to be proud that I was actually chairing the committee of ministers that designed that declaration, that, that clause in the declaration about, about a 15% budget allocation. But at that time when, when that clause was developed, the Global Fund was not there, UNITAID was not there and PEPFAR was not there. The US President's Malaria Initiative was not there. Now, unfortunately for us in these areas, whether it is hiv, aids, tuberculosis or malaria, when these funds were created, our ministries of finance then looked at them as a replacement for the, for the commitment that we have made. So the budget, most countries never achieved that targeted budget allocation. But what we have done in alma, appreciating that creating fiscal space is extremely difficult in our economies because we have resource constraints, we are overstretched in terms of debt, the debt burden that we carry. So there's a very limited fiscal space. And even when consensual funding is secured, like for ida, the demand is massive for IDA resources. So what we have been recommending in each country is that the country set up health funds. We have, because we are focusing on malaria, we have called them anti malaria funds. Now the mechanism for administering these funds is a multi sectoral council comprising captains of industry from the private sector, sectoral ministries that, that contribute towards the fight against malaria or contribute towards spreading malaria like agriculture through the big irrigation screens, you know, environment when there is a flooding, which we spoke about earlier. But education is critical for all of health. The ministries that are responsible for the mining sector, for example, infrastructure, those create huge bridging sites for malaria. So we have them all as members of this council at either Director General or ministerial level. And then we have captains of industry, we have religious leaders, we have traditional leaders, we have civil society, we have the domestic partners that are partners of the Ministry of Health. Now all of them use a digital tool that we have developed to actually assess progress in the fight against malaria, where the bottlenecks are and then see how they can Step in to support government. The N Malaria Council in Zambia, for example, has purchased bicycles for community health workers because those are so critical for primary health care. They have funded seasonal malaria chemo prevention for all the children under the age of five. We have. I can give you so many examples of what malaria councils are doing. So this is one approach that we are recommending.

[Interviewer]

Yeah.

[Joy Pomapi]

And we are looking at this as part of the big push to engage everybody in the fight against malaria.

[Interviewer]

My question is, who funds, where's the source of money for the funds that these councils sit on? Because it started by saying that there's very little fiscal space, we have to face that reality. So where do they get the money

[Joy Pomapi]

from the private sector, their corporate social responsibility. So what the private sector is actually doing is targeting CSR funds and they're targeting it in a different way from the way they normally do because now they are sitting on the board of the council and they are able to monitor effective use of the resources so there is less wastage and there's proper targeting. What countries are now doing is what we call sub national tailoring. If you do subnational tailoring, then you can target specific interventions to high burden areas or areas where that type of intervention would be most useful and then use other interventions in other. In other areas. So this sub national tailoring has actually performed miracles. In Rwanda, for example, they are using drones to do spraying with lavicide over the rice paddies because rice paddies are ideal breeding sites for mosquitoes and this has really brought down the incidence of malaria in the region. So you can see here, instead of waiting for malaria outbreak or just distributing nets or saying we'll have rapid diagnosis, test and treat people quickly, they actually, you know, are taking the breeding at source and stopping it in its tracks. So this is the sort of sub national tailoring that we are talking about.

[Interviewer]

So I keep hearing you mentioning these examples of success stories.

[Joy Pomapi]

Yes.

[Interviewer]

But I look at your report and I find that if you look at N malaria councils and funds, for instance, 12 countries have launched them out of 55 at the very top. Only five countries on the continent are on track to meet the malaria incidence reduction targets laid out in the AU catalytic framework. My question is, is it simply a lack of money or is it a lack of political will?

[Joy Pomapi]

You need both, you need both political will and you need money. If I can just show you what type of gap we are, we are, we are trying to target here in terms of coverage with effective prevention interventions. We are not there, there are very few countries that are reaching more than 60% of the population. That needs to be covered. And so when we talk about we are spending 3 billion, 4 billion here, the gap is actually in the region of 6 billion. So we are talking here about a massive gap that would be required. So it is not just that there's lack of political will or that, you know, people are not budgeting enough, but the resources required are massive. And that is why what we are saying is that one of the reasons why I was giving you an example of what Rwanda is doing is it's a partnership between the Ministry of Health and the Minister of Agriculture. If you look. So we are saying let us do things a little bit differently here because the resources required are huge. We are saying to the Ministry of Infrastructure Development, for example, when you do your environmental impact analysis before you actually as you design the project and you bring in companies to do major infrastructure projects or even mining or whatever factor in vector borne diseases like this and the impact this project is going to have on them and make that part of the budget for the project because that is the whole purpose of an environmental impact analysis so that you can actually budget for it and protect the environment. Here you are not just protecting the environment, you are protecting the human beings who live in that environment. So what? So this will then spread the costs, this 6 billion gap will become much, much narrower and the health will then be only required to intervene when people start getting sick.

[Daniel Dazzi]

You're listening to the interview from the BBC World Service.

[Joy Pomapi]

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[Daniel Dazzi]

Joy Pomapi is not your typical politician. She started out as an auditor in the 90s and somehow ended up running two ministries in Botswana. As Minister of Health, she rolled out what is known to be Africa's first universal public sector antiretroviral program for people living with hiv. She then went on to hold posts like Assistant Director General at WHO and Vice President at the World Bank. It's the kind of career that usually produces cautious, heavily polished public figures. But not this one. She spoke to us with the frankness of someone who has spent a lifetime dealing with problems directly, not dancing around them. She laughed easily, answered plainly, and seemed entirely uninterested in the usual performance of political poise. Okay, let's return to my conversation with Joy Pomapi.

[Interviewer]

You are the African leaders Malaria Alliance.

[Joy Pomapi]

Alliance, yes.

[Interviewer]

Peopled by 55 African leaders. Yes, of course. Led by Botswana at the moment. My question is, doesn't the accountability come back to your organization? Because it's the job of these 55 gentlemen and ladies to ensure that it's not malaria or healthcare challenges don't exist in their countries in the first place. So why are you telling us you should be taking your drug?

[Joy Pomapi]

Precisely. We are telling you because we believe malaria is an all of society challenge. When you look at the environmental issues, addressing the breeding sites, you know, for mosquitoes, it's an all of society issue. If you look at the right now we are saying we want our economies to be driven by the private sector. The major private sector projects that needs to be undertaken by the private sector and by the people, not by the government, can become huge vectors for spreading, spreading malaria. So what we are saying is that it is not just the responsibility of these heads of state, it is all of society that have a responsibility to fight malaria. And that is why we are making this call to action. Is a call to action? Yes, to the heads of state. And President Boko made it very clear that he's asking every head of state to engage actively.

[Interviewer]

Are they engaging actively?

[Joy Pomapi]

Some are engaging actively, yes. But I think what we also need to appreciate is that the reason why ALMA was created is to have an accountability mechanism that they can use to hold each other accountable so that those who are not doing what they need to do will be able to see what they need to do and be motivated to take action. That is why we develop the digital tools and that is why we actually produce a report and a scorecard for every country you are able to open the scorecard and you are able to see how each country is doing. Every quarter, we send the heads of state a report every single quarter so that they can see where they are. So it's a mechanism really for holding them accountable. But the action that needs to be taken is the responsibility of the all of society, of course, led by the heads of state themselves.

[Interviewer]

So you started by saying that we are sitting in a car getting somewhere. You define our destination by no malaria by 2030.

[Joy Pomapi]

Yes.

[Interviewer]

That's four years away.

[Joy Pomapi]

Exactly how far are we in the car? We are very far. We are very far. I mean, there have been so many stumbling blocks when this particular target was set. We did not have the huge challenges that we currently have with climate change. The population growth was not as explosive as it is now. We did not have the major financial challenges that we have because it was not anticipated that in the middle of the SDGs, suddenly ODA will start declining. And ODA has been declining for the past 10 years. So since the beginning of the SDG, there's been a decline. I mean, there is particular notice now because some partners are announcing that they are reducing ODA, but the ones who started reducing ODA 10 years ago did not announce to anybody. They simply just started reducing.

[Interviewer]

So the plan was not future proof.

[Joy Pomapi]

Was not future proof. And that is why we are saying now we want resilience. Africans must realize that we are the ones who are responsible for developing this continent. Nobody's going to do it for us. So we have to build our resilience systems ourselves.

[Interviewer]

Sorry. If our plan to end malaria by 2030 was not future proof. That means we are not to end malaria by 2030.

[Joy Pomapi]

We are not ending malaria by 2030. A few countries will. And in, in, in the report, President Boko actually listed those countries that, that are, you know, on track to end malaria. But most of our countries are not. One thing that we did not factor in, again, future proofing, as you say, is resistance. The resistance to the main tool that we use for vector control, that is the insecticide treated nuts, has been massive. And we did not anticipate at that time that we'd be dealing with this level of resistance. So because we had this huge level of resistance to insecticide treated nets, even the areas where there was huge distribution of nets, they would continue to have major outbreaks of malaria. Now a new tool has been developed which is a dual insecticide treated nets, but it is much more expensive and it's taking time to roll it out. Right, because the factories now have to re, re engineer, including bringing in new equipment in order to be able to produce this new type of, these new types of nets, and they are more expensive. So some of these challenges that we, we are currently facing, we're not anticipated.

[Interviewer]

What would you say to those who, who would say that it's your organization and its members who should be held responsible, first of all, for putting together a plan that was not future proof, and secondly, for not pivoting in time so that at least we are closer to solving this challenge. What would you say to those who would hold your organization and its members responsible?

[Joy Pomapi]

Well, I think it's a good point, except that it is not our responsibility, that is the WHO responsibility, to develop the technical tools and to assess the effectiveness and to recommend to countries what interventions to put in place. It's not our responsibility, but it's the

[Interviewer]

leader's responsibilities to protect their citizens.

[Joy Pomapi]

Is the leader's responsibility to protect the citizens? Absolutely. So that, that one there's no doubt about. So what I'm trying, what I'm saying here is that it was not anticipated that climate change would be this bad. Where we have, there are areas, for example, I gave you an example of one that is one of the countries I can give an example of again, where, you know, people who used to live on higher altitudes did not have malaria. But now with the rise in temperature that is now associated with climate change, which has hit East Africa more than a lot of other parts of the continent, that malaria is now endemic in those areas. So the times when they were planning for elimination of malaria, they had not taken that factor that into consideration. So the level of resistance had not been factored in. The fact that there's going to be a rise in temperature had not been factored in. And all of these now are affecting the cost of responding to malaria and the burden as well. So yes, there are lots of factors here which we are not anticipated. And yes, we can blame the technical agencies like WHO and others for not being able to predict this. But my question is, what benefit is it for us to be pointing fingers? Because what we need to do now is find the solutions and implement those solutions with the countries.

[Daniel Dazzi]

Thank you for listening to the interview. You'll find more in depth conversations on the interview wherever you get your BBC podcasts, including episodes with Jumapoko, Botswana's President Hassan Sheikh Mohammed, President of Somalia, and UN Secretary General Antonio Guterres. Until next time, bye for now.

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