AFM statement to the Southern Africa Malaria Control Meeting, Lusaka Zambia. July 2003

Scaling up malaria control

Private sector and public sector responsibility

There have been several notable successes in malaria control in recent years, particularly in South Africa, Mozambique and Zambia. Yet these initiatives must be sustained and expanded to provide the many millions of people in southern Africa proper protection against malaria.

In order to scale up malaria control, we should take into account certain fundamental issues. First and foremost is the link between poverty and disease. Poor country governments are less likely to be able to sustain scaled up malaria control and individuals in those countries will be unable to afford personal protection and treatment.

Governments therefore should concentrate on ensuring that they enact policies that foster economic growth. These include stable and accountable government, the rule of law, strong protection of property rights, open trade policies and low taxes, duties and tariffs. In addition government interference, restrictions and other inhibitors of economic growth should be minimised or eliminated.

We need to recognise that the production, distribution and marketing of many of the tools needed to combat malaria is best done by the private sector. In addition we must recognise the important role that the private sector has already played in developing and marketing products. Creating a profitable and viable business plan will be essential in order to encourage further development of products and malaria control technologies.

Competition between suppliers will be essential in order to ensure price reductions. Policies should be in place to ensure that malaria control products will be purchased from low cost suppliers, provided quality is ensured. Policies that guarantee to purchase from local suppliers will not necessarily ensure lowest cost or highest quality and could undermine local development by encouraging inefficient industries.

Governments should recognise the important role that intellectual property (IP) protection plays in encouraging new research. Where IP laws do not exist, governments should consider providing such protection so as to encourage research and development in Africa. As the evidence mounts that IP is seldom a barrier to drug access, the arguments against such laws are increasingly redundant.

The important contributions from the private sector in the form of donations, discounted prices, logistical support and advice and other corporate social responsibility activities should be further encouraged and expanded in order to effectively scale up programmes.

No expansion of programmes will be possible without the recognition that many households will be unable to afford insecticide treated nets (ITNs), drugs and other tools. Governments and donor agencies need to commit the necessary funding to support the poor and provide low cost or free treatment and vector control where appropriate. Relying on mechanisms, such as voucher schemes that can benefit from the advantages of private sector distribution and marketing should be encouraged. Vouchers that can be exchanged at shops for bed nets or other public health tools allow individuals to make more choices and give them more power over public funds.

No statement on private sector responsibilities, however, would be complete without a statement on public sector responsibilities.

AFM calls on all governments, public sector bodies, UN agencies and donor agencies to:

• Reduce bureaucratic impediments to producing, importing, distributing and marketing anti-malaria products and drugs. This includes working with the Medicine Control Councils (MCC) in various countries to ensure that registration times for new drugs are reduced. We call on these MCCs to make real steps towards greater cooperation, streamlining, efficiency and recognition of registrations in other countries.
• Reduce barriers to the use of DDT in malaria control. Many countries use DDT to save lives and reduce morbidity, yet the bureaucratic barriers to trading this insecticide are considerable. This leads to delays in importing which seriously hampers malaria control, particularly during epidemic conditions. All SADC countries should therefore streamline and simplify their regulations over DDT handling and trade and should apply to UNEP/WHO for exemption from these requirements if and when the Stockholm Convention comes into force.
• Remove barriers to trade, such as poorly enforced tenders and trade agreements, burdensome import and export regulations and corruption.
• Remove taxes and tariffs on ITNs, drugs and other malaria control equipment. Taxing life saving equipment and drugs is indefensible and there will be no substantial scaling up of services with these barriers in place.
• Understand the constraints and limitation of the private sector. The private sector needs certain guarantees and assurances that orders will be placed and requires notice when delivery of malaria control products is required. To this end, the public sector should improve their coordination and communication with the private sector. More effective this communication will lead to more effective malaria control and sustained scale up.