World Bank Failed in Fight Against Malaria, Health Experts Say

Celia Dugger | 25 Apr 2006
New York Times
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 malaria funds.

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 programs.

"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 Health Organization.

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.