The US President's Malaria Initiative: 2 years on

Samuel Loewenberg | 08 Dec 2007
The Lancet
Improving public health is about more than technical know-how and money. The real struggle is in creating efficient systems, working with local governments, and making sure that programmes are fully implemented. None of this happens without the political will to do so. Even with the best intentions, massive, multination health efforts have had a troubled history. These range from, at best, huge wastes of money, and at worst, unintended side-effects as severe as the problems they had set out to solve.

So far, the USA's antimalaria programme, known as the President's Malaria Initiative (PMI) and now in its second year of implementation, seems to be avoiding the pitfalls of its predecessors. Rather than spending money on high-priced consultants, the programme is focusing on implementation: indoor spraying with dichlorodiphenyltrichloroethane (DDT), distribution of insecticide treated bednets, distribution of effective drugs, and building local capacity.

The PMI is even winning qualified plaudits from critics of past US aid efforts, who praise its methodical approach, transparency, and collaborative design. "It shows what government can do when there really is monitoring and pressure to perform", said Roger Bate, an economist at the American Enterprise Institute, a thinktank based in Washington, DC.

Bate, who has been a frequent critic of US foreign assistance programmes, recently did a study comparing the effectiveness and transparency of wealthy countries malaria-control programmes. The PMI "is making sure that it is not just spending money, but that the drugs are actually getting out in the field to save lives", says Bate.

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