Malaria: no time to pass the buck

Richard Tren | 22 Nov 2006
Business Day (South Africa)
This week, Southern African Development Community (SADC) countries are marking Malaria Week by holding a ministerial conference in Namibia. The theme of the conference is Scaling up Indoor Residual Spraying (IRS) with DDT. IRS involves spraying small amounts of insecticide inside houses and although it is highly effective in malaria control, it was shunned by most donors and for years. It was also discouraged by the World Health Organisation (WHO) to avoid environmental and political scorn, not for scientific reasons. Now the tide has turned and the emphasis on IRS is encouraging. However, SADC and other African countries have to get a lot more right before they can beat malaria.

The prospects for malaria control have improved recently. Earlier this year the WHO explicitly endorsed the use of DDT for malaria control and the US Agency for International Development has now, for the first time in more than a decade, purchased DDT for malaria control in Africa. New long-lasting insecticide-treated nets are being bought and distributed throughout the continent. The price of the new highly effective artemesinin-based combination therapies for treating malaria has been falling and more countries are making these drugs available. We are now closer to a viable, effective vaccine than ever before, though it will be several years before the best candidate is available.

Yet every day hundreds of people still die from malaria. The policies for malaria control have improved, but financing and managing malaria control lags. Recently, the Global Fund to fight AIDS, TB and Malaria announced the results of the round 6 applications for funding to fight these diseases. While more TB projects were funded than ever before, fewer than a third of the applications for malaria control projects were funded. The Global Fund's technical review panel noted that good technical assistance from the WHO and the Stop TB partnership to applicant countries was a primary reason for the success of TB applications. Poor technical assistance from the UN-led Roll Back Malaria partnership (RBM) accounts for the paltry funding of malaria projects.

At a recent RBM Partnership meeting in Geneva, the partners recognised their failure and pledged to do better for the next round of Global Fund applications. Ensuring that RBM provides useful technical assistance is essential. Perhaps more important will be to ensure that the WHO's Global Malaria Programme is well funded and able to support malaria programmes around the world. Since taking control of the programme, Dr Arata Kochi has improved malaria control policies by providing much-needed leadership. The WHO is the world's premier public health policy organisation and it is appropriate that Dr Kochi's department provides technical assistance to member countries.

Ultimately, however, responsibility for malaria control must rest with malarial countries, and the same is true for all health problems in poor countries. In April 2001, African heads of state met in Abuja, Nigeria, and among other things pledged to devote at least 15% of their total national budgets to improving health care. The heads of state also called upon donor countries to increase assistance for disease control. According to the WHO's World Health Report 2006, only one country, Liberia, has achieved the 15% target. Many public health advocates, myself included, wish to see increased resources to fight malaria as the disease is considered to be a good public health investment — for a relatively small investment, many lives can be saved. But the hypocrisy of African countries pleading for more funds for disease control when they themselves do not prioritise health care persists.

Malarial countries should step up their own support for malaria control not only to look good for donors, but because funding that is detached from donor agency strings can lead to better malaria control. One of the reasons that SA maintains a successful malaria control programme is that it introduced DDT spraying and new effective drugs years before the various United Nations organisations and donors endorsed them. Independent funding ensures that local malaria scientists are better able to implement policies that are correct for their needs. Increased local funding will also guard against fickle donor agencies that may well withdraw funding when they become tired or bored with malaria control.

We can and should expect more from African countries and should hold them to the pledges they make. Anything else would smack of what US President Bush once termed the "soft bigotry of low expectations".

Tren is a director of Africa Fighting Malaria.