AFM welcomes the work that the UK's All Party Parliamentary Group on Malaria (APPMG) does to increase the profile of the disease in the UK and improve malaria control and treatment. The APPMG's July Statement, "Focus on Delivery to Achieve Sustained Impact" rightly recognizes the problems of many malarial countries as "weak health systems and limited numbers of skilled health workers." However AFM is concerned that the Responses that the APPMG has detailed will be insufficient to tackle these problems.
The APPMG Statement rightly recognizes that the challenge for malaria control is to deliver 50 million long lasting insecticidal nets (LLINs), diagnose and treat up to 500 million cases of malaria and to assist countries to run indoor residual spraying (IRS) programs. However the responses given by the APPMG in the Statement deal only with LLINs and treatment and not with IRS.
IRS programs require a significant investment in personnel and equipment and IRS is certainly not applicable everywhere. However the intervention is remarkably effective and thanks to the use of long lasting residual insecticides, it has kept millions of people around the world safe and free from the burden of malaria. Some governments, with very limited infrastructure and skilled health workers, have delivered effective and sustainable malaria control by building up an IRS program. The well documented successes in malaria control in southern Mozambique are a case in point. Through the US President's Malaria Initiative (PMI) IRS programs are being supported in at least 10 African countries.
AFM considers that the APPMG should work to provide a specific plan of action to support countries that wish to implement IRS programs. Such a plan would include budget lines for insecticides and spray equipment, personnel, entomological studies, training of entomologists and sprayers and an IRS endowment fund that would provide guaranteed funding for several years of spray activities. The plan would also provide assistance with the management of insecticides and information, education and communication programs to ensure high acceptance of IRS. In assisting to build up an IRS spray program in a malarial country, the APPMG will see how it is contributing to the health system and the training of health workers.
The APPMG rightly recognizes the importance of malaria advocacy. Advocacy is required to sustain budgets for malaria control and ensure that the disease, which is widely recognized as a good public health investment, does not drop off the global agenda. However AFM believes that advocacy should be about more than just raising funds for malaria control, but should challenge the donor agencies and malarial countries alike to improve their performance with malaria control and overcome the bottlenecks and obstacles that prevent effective malaria control and treatment. More aggressive and challenging advocacy is required if the current policy problems are to be solved before budgets increase further.