The World Bank failed to follow through on its pledges to spend up
to $500 million to combat malaria, let its staff working on the disease
shrink to zero, used false statistical data to claim success and wasted
money on ineffective medicines, according to a group of public health
experts writing in the British medical journal The Lancet.
The experts, in an article to be published online today, argue that
the bank should relinquish the money it has to fight malaria, which
kills an African child every 30 seconds, and instead let the Global
Fund to Fight AIDS, Tuberculosis and Malaria distribute the bank's
The World Bank conceded in a written reply to the article that its
malaria programs were understaffed and underfinanced, but denied using
false statistics or paying for obsolete medicines. It said that in the
past year it had revitalized its malaria program.
Bank officials said in an interview on Monday that the number of
staff members working on malaria had grown from none to more than 40 in
the past year, while $62 million in new spending had recently been
approved, an amount expected to rise to $190 million by June. The
Global Fund does not have staff on the ground in Africa to monitor how
the money is spent, while the World Bank does, bank officials said in
their written reply.
"The story captures a lot of the bank's shortcomings from a year
ago," Suprotik Basu, a public health specialist in the bank's malaria
program, said yesterday. "But now we've had a year of progress."
In 1998, when the bank began the Roll Back Malaria campaign, it
promised to spend $300 million to $500 million to help halve the number
of malaria deaths in a decade. More than a million people die of
malaria each year, mostly African children.
But just four years after its commitment, the number of bank staff
working on malaria fell to zero from seven, a fact Mr. Basu
acknowledged. Bank employees, sensing the lack of commitment, left the
program and were not replaced, he said.
The bank's own estimates of its spending since 1998 have ranged from
$100 million to $450 million, according to Amir Attaran, a biologist
and constitutional lawyer at the University of Ottawa who is the
article's lead author. He and his co-authors found it disturbing that
the bank did not know how much it had given or lent for malaria
"That the bank's management tolerates such vague accounting when
serving its clients, the African states to whom it pledged an increase
in malaria control funds, is extraordinary," they wrote.
In its reply, the bank said it and other donors often provided money
as general support to public health services, making it difficult to
track how much of the bank's money went to malaria. Under its new
president, Paul D. Wolfowitz, the bank has instituted a new system for closely monitoring spending, Mr. Basu said.
The authors also accused the bank of medical malpractice for
spending about $1.8 million to buy more than 100 million tablets of
chloroquine for India, even though a deadly species of the malaria
parasite had developed a resistance to the medicine at levels that
exceeded the acceptable failure rate of 15 percent set by the World
The bank replied that about half the confirmed cases of malaria in
India were caused by a different malaria parasite that generally
responded to chloroquine, which it said was one-tenth to one-twentieth
cheaper than combination drug therapies.
"On the basis of available information, India stood to get good
value for money by spending scarce resources wisely in accordance with
local realities," bank officials wrote.