April 25th marks Africa Malaria Day, a day to ponder the havoc malaria wreaks upon Africa, killing over a million people a year and crippling economies on that continent alone. If this were not sad enough, April 25th has now also become day to consider how Roll Back Malaria (RBM), an organization founded to control malaria, has aided and abetted this destruction through a combination of bad policy and negligible leadership. After five years of failure, RBM needs to put up or shut up. Unfortunately it seems unlikely to do either. Instead it will molder on, drawing in money but failing to help those in need.
At the turn of the millennium, RBM -- a consortium of different organizations dedicated to reducing malaria's burden around the world -- announced that an important and worthy goal: halving malaria deaths in the world by 2008. Halfway to that year, however, RBM has done much less than that. Malaria cases have risen rather than declined under RBM's watch.
In August the scientific journal Nature reviewed the state of malaria in the world. It concluded that in the war against malaria, malaria was winning, in part because international organizations such as Roll Back Malaria ignore effective tools for controlling malaria, waste money, and fail to provide leadership. In a blistering editorial published a few days ago, The Lancet echoed these concerns. "The partnership's 'loose association' structure, billed as a way of avoiding the constraints of a strict management hierarchy, actually inhibited decisionmaking and limited accountability." As a result The Lancet notes darkly, "it is clear that not only has RBM failed in its aims, but it may also have caused harm."
The Lancet believes RBM could still be effective if it changes its ways, but RBM is unlikely to change as a result of mere criticism. In a letter responding to Nature, RBM didn't argue that it was actually doing a good job -- some facts are apparently too hard to dispute -- nor did it make its traditional argument that now that all the mechanisms are in place RBM will start leading an effective fight against malaria. No, RBM chose a new defense:
"...we are concerned that there is a fundamental misunderstanding expressed
in the supplement about the nature of the RBM Partnership which is, today,
a global movement, broad based and including research and development
agencies, the private sector, endemic countries, foundations, donor
countries and funding agencies such as the Global Fund to Fight AIDS, TB
and Malaria and the World Bank, academia and UN agencies including
WHO, UNICEF and the UNDP. All partners have a role to play in the fight to
roll back malaria and we in the RBM Partnership Secretariat facilitate and
coordinate those efforts."
To summarize: everyone's involved, so there's no one to blame.
This is, literally, a childish excuse: "But everyone else was doing it." In the world of adults, however a different rule applies: if everyone is involved, then they're all culpable.
Some, however, may be more culpable than others. When a group of children misbehaves, the child pegged as the ringleader is assigned a higher degree of responsibility. All that facilitating and coordinating meant that the ringleader has a clearer picture of the matter than the general participants. With knowledge comes responsibility.
So it is with RBM. As the facilitator and coordinator of efforts, RBM has a heightened responsibility to make sure that the actions undertaken in the name of RBM are effective, responsible, and responsive. This it has not done. Instead of acting as a corrective, RBM has continued to perpetuate the bad practices made by some of its participants.
RBM has ignored malarial countries' requests for malaria control techniques such as the indoor spraying of residual pesticides like DDT and instead foisted RBM's preferred method of control, insecticide treated bednets (ITNs), upon countries. ITNs play a useful role in malaria control, but ITN use alone won't cut malarial deaths in half by 2008. Malaria is a complex disease that needs to be controlled by using all available methods. To exclude viable methods as RBM has chosen to do is irresponsible and unacceptable.
So what's to be done with RBM? We may not be able to stand a Secretariat in the corner, but we can cut its allowance. More money needs to be spent on malaria, but it shouldn't go to RBM or to the participants in RBM that propagate unacceptable policies and refuse to consider new ones. Instead it should go to participants, like the Global Fund, that have shown themselves to be adult enough not only to take criticism, but also act upon it. No more money for RBM, until it decides to grow up.
Miss Zambone works for the health advocacy organization Africa Fighting Malaria.