Canucks Against Malaria

Richard Tren | 18 Dec 2007
American.com
While in Tanzania recently, Canadian Prime Minister Stephen Harper announced a bold new foreign aid program called "The Initiative to Save a Million Lives." He also promised that the Canadian International Development Agency (CIDA) would double its assistance to Africa by 2008-09. In all likelihood, a good portion of the money will be allocated to fight malaria, the number one killer of African children. Unfortunately, the CIDA's track record on malaria is patchy at best, and it has much to learn from America.

Malaria is a preventable and entirely curable disease: the new artemisinin-based combination therapies mean that no one need die from it. Yet due to poor healthcare systems and extreme poverty, millions of malaria sufferers do not have access to these life-saving drugs, which cost around $1 per treatment. Effective anti-malaria strategies in the developing world must focus on prevention first, which means shielding people from the deadly Anopheles mosquito, carrier of the malaria parasite. One of the best ways to repel these mosquitoes is to spray tiny amounts of an insecticide, such as DDT, on the inside walls of houses. This proven method of malaria control has long been neglected by donor agencies, partly due to pressure from anti-insecticide environmentalists, and partly because spraying programs require infrastructure and personnel, which donors have been reluctant to fund.

Most donors have instead focused their malaria prevention efforts on providing insecticide treated bednets (ITNs) for people to sleep under. ITNs work well and are a recommended method of malaria control. But because they require a high degree of personal compliance and education, they have not been as successful as originally hoped. On a hot and humid night, sleeping under a net can be uncomfortable. Also, because many malaria control programs expect people to buy their own nets, coverage rates remain low.

The CIDA should be commended for supporting the Canadian Red Cross's free distribution of ITNs along with vaccinations. Thanks to the CIDA's $26 million donation to this program, tens of thousands of African lives have been saved. Yet instead of expanding this successful model, in 2006 the CIDA inexplicably cut funding to the Red Cross. Perhaps even more worrisome, the CIDA has confined its anti-malaria efforts to funding ITNs and has ignored indoor spraying with insecticides. Among the G7 countries, only Germany contributes less to the United Nations-backed Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria than Canada does.

Last year, the World Health Organization's Global Malaria Program director, Dr. Arata Kochi, called upon the international community to boost support for indoor spraying. Since its inception two years ago, President Bush's $1.2 billion anti-malaria initiative has been funding the full range of interventions, including ITNs, indoor spraying, diagnosis, and treatment. The Bush administration has been relatively transparent and open about how it is using taxpayer money, and America has gone further than almost any other country to measure the success of its anti-malaria spending in terms of lives saved.

It wasn't always such a pretty picture. Several years ago, U.S. government officials could not account for how malaria funds were being spent and gauged success purely in terms of dollars spent, not results achieved. So it's clear that donor agencies can reform themselves.

That's what the CIDA needs to do right now. In April 2007, the nonprofit health advocacy group Africa Fighting Malaria, which I direct, produced a scorecard ranking donor agencies on their openness and transparency. The CIDA's score was among the lowest in our survey, given that they barely acknowledged requests for information let alone responded to the questions we had about their programs.

The Canadian government must enhance its oversight of the CIDA. (The Canadian Medical Association Journal revealed recently that the CIDA has used taxpayer money to fund a factory that produces, among other things, "open-concept swimming pools"—whatever they may be—in Egypt.) In the meantime, there are practical steps the CIDA can take to improve its image. It should increase the budget of the Red Cross and boost funding for its successful ITN program. It should also support indoor spraying programs and (like the U.S. government) purchase DDT for those countries that want and need it. The CIDA should contribute to the WHO's Global Malaria Program, which, under the leadership of Dr. Kochi, has compiled an impressive record of reforming policies on treatment and prevention.

In their campaign to curb the spread of malaria, the CIDA and the Canadian government can and should demonstrate how to spend donor money efficiently. Right now they are not, which has bred cynicism among Canadian taxpayers who are tired of the empty, unfulfilled promises that characterize so many foreign aid programs. Making the CIDA more open and transparent won't change things overnight, but it will be a good start.

http://www.american.com/archive/2007/december-12-07/canucks-against-malaria