Good news and bad news in Botswana

Richard Tren

Last week malaria control program managers, public health experts, UN agencies and the private sector are meeting in Gaborone, Botswana to discuss malaria control in Southern Africa. 

The meeting has produced both good and bad news for the millions of Africans at risk from malaria.  As so often seems to be the case with malaria, however, the news has more to do with politics and power than with mosquitoes or parasites.   

The good news for those suffering from malaria in the region is that the Southern Africa Development Community (SADC) will be more active in coordinating future malaria control efforts.  The even better news is that the SADC governments saw off WHO and UN agencies’ attempts to play a larger role in that coordination. 

Most of SADC countries know what makes for good malaria control in their region –spraying insecticides on the inside walls of houses to kill adult mosquitoes and distributing the new highly effective artemesinin based combination therapies. 

The World Health Organisation and some of its key partners in Roll Back Malaria, such as the US Agency for International Development (USAID) and UNICEF, however, have ignored at best - and at worst have actively frustrated - the adoption of these life saving tools. 

Roll Back Malaria’s aim is to halve malaria deaths by 2010, yet since its inception in 1998, RBM has presided over an increase in malaria cases and deaths.  The principle reason for this is purely political. RBM will not support the two interventions (insecticide spraying and new drugs) that work best, preferring solely to foist insecticide treated mosquito nets on countries. 

Nets are an important tool in malaria control, but nets alone cannot halve malaria deaths.  No single tool can.

It is good news indeed that the people affected by malaria, the regional control programs, will have a greater say in regional malaria control. 

Had the folks from Geneva gained more power and control, they probably would have reversed the gains made by Zambia, Mozambique, South Africa and other malarial countries.

The bad news revolves around USAID – an agency that is supposed to help rather than hinder malaria control. At the meeting allegations were circulating that USAID was putting pressure on Madagascar’s government to finance an American contractor who is overcharging some of Africa’s poorest people for insecticide treated netss.

Madagascar’s government recently learned that this contractor, Population Services International (PSI), is offering to distribute ITNs at a cost of 200% or more of what it costs the government to do.  While the government normally favours giving away ITNs for free, PSI prefers to sell those same ITNs to people who often live on $1 a day.

In a situation like this, one might expect USAID to come to the rescue of the African malaria sufferer.  But instead it is defending PSI.  Madagascar has gone back to the original source of the aid funds, the Global Fund for AIDS, Tuberculosis and Malaria, pleading for help to fight off USAID’s shenanigans. 

Fortunately, the Global Fund’s sympathetic officials will probably agree.  Unlike USAID, they subscribe to the radical notion that foreign aid money should give priority for poor people, and not the aid-industrial complex of American contractors who devour most of USAID’s malaria budget. 

Is high time that US taxpayers and the Congress that represents them start to question the way in which USAID spends its money.  Congress needs to ask if whether USAID is more interested in supporting its beltway contractors than in controlling malaria.  Until they do this, donor politics will continue to kill Africa’s most vulnerable people.

Tren is a director of the South Africa based health advocacy group Africa Fighting Malaria. 

Business Day