Draft:Alliance for International Medical Action (ALIMA)

ALIMA (The Alliance for International Medical Action) is a humanitarian medical organization that provides free, quality health care to people and communities during emergencies and crises.

ALIMA's model is based on partnership with national humanitarian actors, local health staff, and communities on the ground. ALIMA's goal is to transform emergency medical assistance and humanitarian medicine by conducting research and introducing innovative projects that improve impact.

Since its inception in 2009, ALIMA has treated over 10 million patients and launched research projects on malnutrition, malaria, the Ebola virus, COVID-19, and Lassa fever. Its actions during Ebola outbreaks in Guinea and the Democratic Republic of the Congo received several international awards, including the 2015 “Health Prize” from the European Union. and the 2019 “Game-Changing Innovator” award from Bill Gates for the development of the CUBE (Biosecure Emergency Care Unit for Epidemics) technology.

ALIMA is a 501(c)(3) registered nonprofit organization with its operational headquarters located in Dakar, Senegal. ALIMA has additional offices in Paris, France, and New York, NY, and is a registered charity in the United Kingdom, Australia, and Kenya.

History

ALIMA was founded in 2009 by a group of senior medical and humanitarian aid experts from Médecins Sans Frontières (MSF). ALIMA’s founders witnessed how unequal access to medical advances impacts health outcomes. They decided to create a new model of humanitarian medical action based on working with local NGOs, collaborating closely with communities, and implementing research projects to transform humanitarian medicine.

ALIMA began its first programs in Niger, working with the local medical NGO BEFEN (Bien Être de la Femme et de l’Enfant au Niger/Well-being of Women and Children in Niger) in response to an alarming peak of acute malnutrition and increasing infant mortality rates, coupled with a lack of operational health facilities in the country. In 2008, many international NGOs had been expelled from Niger, and the remaining local NGOs lacked the resources to deal with the increased need for medical assistance. ALIMA decided to forge alliances with Ministries of Health, national and international NGOs, research institutes, and donors. This partnership model is still used by ALIMA today.

ALIMA partners with local organizations, and employs and trains local health workers: 98% of ALIMA’s employees are from countries where ALIMA works.

Countries of operation

ALIMA currently operates in 12 countries in sub-Saharan Africa: Burkina Faso, Cameroon, Central African Republic, Chad, the Democratic Republic of the Congo, Guinea, Mali, Mauritania, Niger, Nigeria, South Sudan, and Senegal. ALIMA expanded operations to Ukraine in 2022, in response to the humanitarian crisis as a result of the Russo-Ukrainian War. ALIMA’s areas of operation evolve in response to medical needs within countries experiencing humanitarian crises. These crises include conflict, population displacement, disease outbreaks, and high rates of maternal and child mortality.

ALIMA has mounted strong responses to deadly epidemics such as Ebola in Guinea (2014-2016) and DRC (2018-2020), or Lassa fever in Nigeria (2018-2019). In 2019, more than 1,000 ALIMA staff were mobilized in response to the Ebola epidemic in the DRC. In response to the COVID-19 pandemic, ALIMA provided emergency medical assistance to communities in need, and launched a community-based vaccination campaign, successful in administering over 1 million doses in its countries of intervention.

New major medical crises may lead ALIMA to extend its work to new countries. For example, the health crisis caused by the civil war in South Sudan prompted the NGO to expand its work there in 2017. In April 2022, ALIMA began operations in Ukraine in response to humanitarian needs as a result of the Russo-Ukrainian War. In Ukraine, ALIMA supports 20 hospitals and health structures, deploys mobile clinics to bring health care to difficult-to-access areas, raises awareness on sexual and gender-based violence, and provides psychological support to communities affected by the war.

Operational Model

Partnership

ALIMA is based on an alliance and partnership model with national medical actors. Five African NGOs are an integral part of ALIMA’s partnership model: BEFEN (Well-being of Women and Children) in Niger, AMCP-SP (Medical Alliance Against Malaria - Population Health) in Mali, KEOOGO and SOS Medecins-BF in Burkina Faso, and Alerte Santé in Chad. ALIMA’s governance is shared with these organizations. At the project level, activities are co-managed; at the strategic level, the partner NGOs are all represented on ALIMA’s Board of Directors.

Research and Innovation

ALIMA conducts operational and medical research programs including clinical trials for vaccines and treatments in coordination with research institutions to address health issues in sub-Saharan Africa, including hemorrhagic fevers, such as Ebola and Lassa, malnutrition, childhood mortality, malaria, and COVID-19. Through collaboration with researchers, health professionals, and local NGOs, ALIMA develops solutions to improve the effectiveness of emergency medical operations and influence the evolution of medical practices within the humanitarian sector.

CORAL, a Research Alliance

In 2016, ALIMA and the Inserm-1219 team created CORAL (Clinical and Operational Research Alliance), a platform to address existing and emerging health threats in Africa. This platform integrates several teams from A, researchers from the National Institute of Health and Medical Research (Inserm), the University of Bordeaux and the Institute of Research for Development (IRD) as well as researchers from the Abidjan PAC-CI program.

ALIMA is part of the ALERRT consortium (African Coalition for Epidemic Research, Response, and Training), composed of 20 European and African universities. In addition, since 2015 ALIMA has worked closely with the NIH (US National Institutes of Health).

Following the 2014-2016 West Africa Ebola epidemic, ALIMA developed, in conjunction with the biosecurity company Securotec, a Biosecure Emergency Care Unit for Epidemics, known as the CUBE. The CUBE is an autonomous and easily transportable intensive care unit for highly infectious diseases. With its transparent walls equipped and intramural arm sleeves, it allows medical teams to access patients without health staff having to use cumbersome Personal Protective Equipment (PPE).

ALIMA’s Charter

ALIMA’s charter was written and unanimously adopted by the members of the association during the General Assembly in Dakar, Senegal, on October 21, 2017. ALIMA’s Charter is built around seven principles:

1. Putting the patient first
2. Transforming humanitarian medicine
3. Responsibility and freedom
4. Improving the quality of our actions
5. Placing trust
6. Collective intelligence/partnerships
7. Environmental responsibility

Areas of Expertise

Response to disease outbreaks, epidemics and health emergencies

Since its creation in 2009, ALIMA has been deploying medical assistance in humanitarian emergency situations.

One of ALIMA’s earliest emergency operations was its response in Haiti in January 2010, the day after the 7.0 magnitude earthquake struck, killing more than 250,000 people and injuring more than 300,00 people. In partnership with the French NGO, ‘La Chaîne de l’Espoir,’ ALIMA carried out an evaluation of Haiti’s need for medical resources, and provided logistical, technical, and operational support to the Lambert clinic in Port-au-Prince, allowing more than 1,500 wounded patients to receive surgical care. As part of this project, ALIMA launched its first research project, SuTra, which analyzed the effects of amputation versus limb preservation in patients with severe limb trauma following a natural disaster. In 2012 and in 2013 in Haiti, ALIMA responded to two successive cholera outbreaks and cared for more than 20,000 patients.

Following its intervention in Haiti, ALIMA has primarily focused on providing medical care to vulnerable communities in areas of conflict throughout sub-Saharan, as well as those populations affected by disease outbreaks. Notable emergency responses include ALIMA’s operations in the Democratic Republic of the Congo in 2011 in response to a cholera outbreak; in the Central African Republic in 2013 to support populations displaced by the conflict; and in Guinea from 2014-2016, in response to the West African Ebola outbreak, where ALIMA opened an Ebola Treatment Center in Nzérékoré, the epicenter of the epidemic. ALIMA's response to the Ebola epidemic in West Africa was rewarded with the European Union Health Award and in 2019, ALIMA received Reaching the Last Mile’s Game-Changing Innovator Award, presented by Bill Gates, for the development of its innovative CUBE (Biosecure Emergency Care Unit for Epidemics).

When the COVID-19 pandemic reached Africa in March 2020, ALIMA set up a two-pronged response: supporting patient care for suspected and confirmed COVID-19 cases in six countries (Senegal, the Democratic Republic of the Congo, Burkina Faso, Cameroon, Chad, and Guinea), and implementing Infection Prevention and Control (IPC) measures and training, to protect patients and health workers within non-COVID-19 programs, in all countries of its operation. In 2020, ALIMA cared for more than 20,554 patients with COVID-19. As of 2022, ALIMA had administered over 1 million vaccine doses.

ALIMA provides health services in conflict zones, including northern Mali in the Timbuktu region, in northeastern Nigeria in the Borno state, in the Central African Republic in the towns of Boda and Bimbo, in South Sudan’s Northern Bahr el Ghazal State, Burkina Faso’s northern and Sahel regions, and in the Mykolaiv and Kherson Oblasts in Ukraine.

Malnutrition, and reduction of infant and child mortality

ALIMA and its partners develop curative and preventive medical programs to reduce acute malnutrition in its countries of operations and to prevent seasonal peaks of malnutrition. For example, since 2011, beginning with a trial study in Niger, ALIMA has been training mothers to regularly screen their children for malnutrition at home using a simple, tri-colored MUAC (Mid-Upper Arm Circumference) bracelet. This program, now known as MUAC for Mothers, leads to earlier detection of malnutrition, particularly in areas where health workers cannot perform regular screenings, and reduces the risk of hospitalization, by taking a preventative approach. This strategy has since been adopted by several local authorities in Niger, as well as in other countries, and by international organizations, such as UNICEF, and other NGOs.

ALIMA implements malnutrition projects such as:

• 1,000 Days: Through the 1,000 Days program, ALIMA offers a free, comprehensive health care package to pregnant women and their children from conception until the age of two. Results of the 1,000 Days program have shown fewer children are hospitalized, there are fewer admissions to malnutrition programs, and nearly 90% of children enrolled in the program are fully vaccinated by 12 months of age.

• OptiMA (Optimizing Malnutrition Treatment): OptiMA is a program that facilitates admission of children into malnutrition treatment programs and reduces costs of treatment by gradually reducing therapeutic food rations as the child’s health improves. Since 2017, ALIMA has been conducting studies in five countries in West and Central Africa to measure the effectiveness of OptiMA

Maternal health

ALIMA medical teams currently provide maternal health services to women at the community level in seven countries including Nigeria, Central African Republic, Democratic Republic of the Congo, Niger, Chad, Cameroon, and Mali. This includes prenatal consultations and pregnancy monitoring, assisted deliveries, and postnatal consultations.

Training and Capacity Building

ALIMA’s humanitarian medical interventions require staff that are trained to respond to a variety of contexts, emergencies, and outbreaks. Due to this need, ALIMA prioritizes the development of local staff and health workers, both within ALIMA and with partnering organizations including ministries of health and local NGOs. ALIMA has trained nearly 5,000 ALIMA and partner organization staff to date, at over 400 different health structures. ALIMA offers international training scholarships to its employees, as well as practical training in the field, including individual and group training sessions. ALIMA expanded its training program in 2015 with the introduction of specialized training courses within the “URENI-schools” (Intensive Nutritional Rehabilitation and Education Units) in Mali, Chad, Cameroon, and Nigeria to train health workers in the management of complications related to severe acute malnutrition in children, and again in 2020 with the development of “Maternity Schools” to better train health professionals in maternal health.