World Bank accused of deception over malaria funding

Sarah Boseley | 25 Apr 2006
Guardian Unlimited
The World Bank, a leader in the global effort to control malaria, has been accused of deception and medical malpractice by a group of public health doctors for failing to carry out its funding promises and wrongly claiming its programmes have been successful at cutting the death toll from the disease.

The serious charges are levelled by Amir Attaran, a professor at the Institute of Population Health and faculty of law of Ottawa University, and colleagues from around the world. Writing in an online publication for the Lancet medical journal, they say the World Bank is unfit to lead global efforts to control the disease, which kills around 1 million people a year - most of them small children.

They argue that the World Bank has not delivered the $300m-$500m (£168m-£280m) funding it promised to Africa when it launched the ambitious global Roll Back Malaria campaign in 1998, which was intended to halve malaria deaths this decade. They add that it has not been open about the amounts it is spending on malaria and that it has wasted money and endangered lives by allowing countries to buy malarial drugs that no longer work.

In a response, also published online, the Bank acknowledges that it should have done more in the past but says its current programmes are well-funded, well-staffed and delivering results.

Professor Attaran and colleagues say the new plan "is inadequate to reverse the Bank's troubling history of neglect for malaria". The Bank at first refused to disclose how much it had spent on malaria in each country, say the authors, but eventually published accounts in April 2005 showing that in the previous five years it had committed $100m-$150m to malaria programmes. It had also spent non-earmarked funds on malaria it says are "difficult to quantify", says the article.

"The most disturbing fact, however, is that the Bank actually does not know, and at best guesses, how much money it spends or loans for malaria," say the authors. "No commercial high-street bank could keep such imprecise accounts for its clients without running a serious risk of civil or criminal illegality."

In 1998 the Bank had seven staff dedicated to malaria. By 2002 it had none. "Without even a single worker, the malaria programme could do little ... we cannot know what lay behind the downsizing of the Bank's malaria team and whether the reduction in staff is explained by careless management or an intention to renege on the funds pledged to Africa. Regardless, funds stalled just as Africa's malaria cases rose sharply, destroying several million children's lives and deepening the poverty the Bank had promised to ameliorate," they write.

The Bank says malaria cases in Brazil dropped by 60% between 1989 and 1996 as a result of its programmes there. Prof Attaran and colleagues say the figure was 23%. The Bank claimed malaria deaths in three Indian states, Gujarat, Maharashtra and Rajasthan, dropped by 58%, 98% and 79% between 2002 and 2003. The authors obtained statistics from India's directorate of national vector-borne diseases control programme. In that year, "far from malaria cases declining in the three states the Bank names, actually the numbers rose sharply in all of them", they write.

The Bank, they conclude, "remains unfit for any operational role whatsoever in malaria control". They call for its role to be passed to other agencies, principally the Global Fund to fight Aids, Tuberculosis and Malaria.

Jean-Louis Sarbib and colleagues, for the World Bank, say it is difficult to be specific about the sums spent on malaria, some of which will have gone to improve healthcare systems, the training of staff and the provision of drugs for a variety of diseases, not just one. They reject accusations the Bank has funded chloroquine for areas of India where it no longer works because of resistance that has built up in the parasite which causes the disease.

Mr Sarbib and colleagues say the World Bank is dedicated to fighting malaria. "Paul Wolfowitz has put the full weight of his leadership behind the Bank's renewed commitment to malaria," they say.

But the Lancet points out that "malaria was absent from Wolfowitz's policy speech on April 11 ... instead, he emphasised reducing corruption in recipient governments by increasing the Bank's department of integrity staff from 53 to 65". If the Bank is serious about results, the journal says, it needs to focus on the Abuja 2000 target of halving mortality by 2010.

Parasite facts

· Malaria is caused by a parasite passed by an infected female Anopheles mosquito. There are four species of parasite, of which the two most common are Plasmodium falciparum and Plasmodium vivax.

· Symptoms include extreme exhaustion with high fever, sweating, shaking chills and anaemia.

· Patients need treatment within 24 hours to avoid risk of severe disease, which has a high fatality rate.

· Resistance to commonly used drugs has grown rapidly. The new hope is the artmisinin compounds, derived from a Chinese herb.,,1760528,00.html