World Bank steps up malaria-control effort

Christine Dell'amore | 29 Apr 2006
Monsters and
On the eve of Africa Malaria Day, the World Bank has announced its pledge of $62 million toward fighting malaria in four countries -- although critics maintain the international lending institution is incompetent and has failed to deliver on its promises.

The Bank`s Booster Program for Malaria Control, a 10-year malaria-prevention initiative launched on the 2005 Africa Malaria Day, aims to reinvigorate existing regional and local malaria programs. Planners intend to roll back half of malaria cases by 2010, and then halve that number by 2015.

'Nothing brings to us the urgency of malaria than the statistic that every 30 seconds a child dies from it,' Gobind Nankani, vice president for the Bank`s Africa Region, said at a briefing Monday at the World Bank headquarters in Washington. 'But it is curable and preventable -- that is the tragedy we must come together and defeat.'

Malaria -- the world`s most common life-threatening infection -- kills 1.1 million people per year, mostly African children. For those who survive with the disease, the cost of lost productivity to the African continent is estimated at $12 billion a year, according to the Bank. The disease can be prevented by avoiding bites of infected mosquitoes and taking anti-malarial drugs.

Historically, the Bank has done limited work on malaria, focusing mainly on stemming severe epidemics. But faced with climbing rates of infection, in recent years African countries appealed to the institution to take action, inspiring the Booster Progam, Nankani told United Press International.

'We took a critical look at ourselves,' Yaw Ansu, a sector director in the Bank`s Africa Programs, told UPI. 'We looked at what had been achieved and (decided) to kick-start an effort to help energize our partnerships.'

In its initial, three-year intensive phase of 2006-2008, the program will assist up to 17 sub-Saharan countries. The Bank has already assembled 13 task teams in African regions, which work within already-established, country-led programs. The teams are also aided by non-governmental organizations and other international groups, including the United Nations World Health Organization.

In the most recent allocation of funds, The Congo received $30 million; Eritrea, $2 million; Niger, $10 million; and Zambia, $20 million. Another $130 million to countries including Benin, Burkino Faso and Ethiopia, among others, is expected by June, Nankani said.

In Zambia, malaria is still the leading cause of death and illness, although the switch from chloroquine to artemisinin-based combination therapies, or ACTs, has slowed the rate of infection in 2005, said Dr. Mabvuto Kango, the malaria coordinator at Zambia`s Ministry of Health. A combination of drugs mounts a better attack against malaria and delays resistance. Even still, many parents do not have the resources to obtain a diagnosis and drugs that often cost no more than $1 a dose. 'The access to treatment is a human right,' Kango said via satellite from Zambia.

Kango said his government is employing a 'multi-prong' approach to malaria control, spraying houses with insecticides and providing insecticide-treated bed nets.

Even so, a human-resource crisis in Zambia has undercut an otherwise strongly managed program, Kango said. Since malaria requires more prevention strategies, it places more stress on health facilities than HIV outreach, said Kent Campbell, director of the Malaria Control and Evaluation Partnership in Africa. The briefing came amidst criticism of the bank for botching its malaria-control efforts, a charge outlined in the April 25 The Lancet.

A group of public-health experts assert the bank has run an incompetent campaign against malaria, accentuated by a downsize of malaria experts from seven to none at all, a failure to deliver on a promise of $300 million to $500 million for malaria control in Africa and a reliance on false epidemiological statistics to prove success where it doesn`t exist.

'My opinion of the World Bank is good, but they do not have the competence to run disease control,' Roger Bate, a health economist and director of the Washington and Johannesburg-based organization Africa Fighting Malaria, told UPI. Bate is an author on the Lancet paper.

Bate explained the World Bank`s specialty is in health system development -- building clinics and training doctors -- and not in disease control, which is better handled by the World Health Organization. But the temptation of tangible results often attracts agencies into endeavors they aren`t quite ready for, and the World Bank is a case in point, Bate said.

Citing the Bank`s minimal expertise in malaria, authors in the Lancet paper, led by Amir Attaran, recommend the institution relinquish its funding to other agencies better equipped to control the disease.

In a Lancet news release the Bank`s Jean-Louis Sarbib and colleagues admit their institution should have done more to target malaria in the past, but they say the charges of the authors are ill-founded and that increased staffing and financing is now occurring.

At the Monday briefing Bank officials repeatedly stressed commitment to results as key.'We have a unique window of opportunity,' Maryse Pierre-Louis, coordinator of the Booster Program, told UPI. 'We don`t have the right to drop the ball on this one.'