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Dr Lali Chania

IMA Tanzania Country Director

People living in fragile settings are the most at risk of contracting malaria and NTDs yet they are the least likely to have access to adequate health care.


Building the capacity of local health facilities and community health workers to prevent, diagnose and treat malaria and NTDs in fragile settings can lead to more resilient health systems and greater global health security overall.

According to Dr Lali Chania, Tanzania Country Director of IMA World Health: “Health systems in fragile settings, if they exist at all, are beset by external and internal challenges, including but not limited to violence, lack of infrastructure and resources, corruption, access inequities, weak governance and limited human capital. Yet fragile settings have a higher disease burden than other low-income countries.”

Poor public health perpetuates the cycles of poverty and fragility and vice versa. As the number of fragile settings increases, so too does global insecurity and economic instability. That is why IMA World Health is committed to health systems strengthening in fragile settings.

Building on malaria and NTD programming successes

“The local partnerships, trust and capacities we have built through our malaria and NTD programming in fragile settings are key for any health systems strengthening efforts to be successful in these complex environments,” says Chania.

In the Democratic Republic of the Congo and South Sudan, the organisation has collaborated with local health facilities to improve access to malaria prevention, diagnostic and treatment services for more than 11.4 million people.

Poor public health perpetuates the cycles of poverty and fragility and vice versa

Across Tanzania and Haiti, 28.8 million people are no longer at risk for lymphatic filariasis since IMA has strengthened the capacity of local health systems to sustainably administer NTD control measures. IMA’s health partners in these fragile settings are leveraging these capacities to meet other critical health care needs.

Dr Chania suggests: “The surveillance and case-based notification and response capacities required to eliminate malaria and NTDs are also what is required to stop epidemics from becoming pandemics, like COVID-19. Integrating those capacities into health systems will not only improve that system’s resilience to the shocks common in fragile settings, it will improve global health security.”

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