Africa Matters is a blog that follows the news and offers analysis of African affairs. Our aim is to delve deeper into the issues of African politics and development. We don’t presume to be experts, and we don’t presume to have all the answers—we are just trying to ask the right questions.

Saturday, March 17

Rolling backwards on malaria

Malaria sucks. The disease kills 3,000 children every day. Of the 350 million people who contract Malaria each year, 90 percent live in Africa. International organizations are rallying around campaigns to fight the disease, such as Roll Back Malaria (RBM). But with infection rates increasing in Africa, malaria keeps on rolling.

The World Health Organization, in conjunction with the UNICEF, UNDP, and the World Bank, launched the Roll Back Malaria campaign to provide a coordinated approach to fighting malaria. RBM’s goal is to halve the number of Malaria related deaths by 2010.

A graph distributed at the Roll Back Malaria board meeting at the mid-way point of the campaign in 2004 showed that the annual number of deaths worldwide from malaria was higher in 2004 than in 1998. Although reported deaths have decreased in countries such as Angola and Malawi, reported malaria deaths increased at an alarming rate in countries such as the Democratic Republic of Congo, where reported malaria deaths spiked from 1,928 in 2002 to 16,289 in 2003. This increase in malaria death rates has been caused by growing mosquito vector populations, which are developing resistance to antimalarial drugs such as chloroquine.

The main barrier to fighting malaria is lack of funding. The WHO announced that between US$ 2 billion and US$ 3 billion is needed to achieve RBM targets. However, a Harvard Medical Journal report found that international assistance for malaria through RBM was actually only about US$ 100 million per year from 2000 to 2003. International donors have a history of being more generous with pledges than with money. But even if more funding comes in, RBM needs to spend it more wisely and consider the social context of its recommendations.

First, RBM is wasting resources. Donors continue distributing ineffective drugs such as chloriquine and SP in many countries, leading to avoidable deaths and wasted resources. The effective antimalarials, called combination ATCs, have replaced these failing drugs only 42 out of 82 malaria-endemic countries

Second, better education needs to accompany RBM campaigns. Insecticide treated nets (ITN) can be effective when communities use them- net coverage for children under five reached 54 percent in Malawi in 2004, significantly reducing the number of malaria deaths. However, in other countries nets are misused. Africa Fighting Malaria reports that people are using ITNs as fishing nets, not only washing the insecticide off them and making them ineffective, but also contaminating rivers and lakes. WHO officials and environmental activists fiercely debated the use of indoor DDT spraying, a pillar of the RBM strategy, without acknowledging the strong stigma attached with any type of household spraying in Africa.

Donors should keep their promises to fund the program they committed to in 1998. The amount of funding RBM calls for is relatively small. The movie Titanic had a production budget twice as much as the worldwide total of international aid for malaria control last year. Diverting funding from, say, agriculture subsidies in the European Union, Japan or the United States (at $106 billion, $59 billion, and $95 billion, respectively), could yield the US$ 2.5 billion that it costs to save half a million lives a year. But more importantly, RBM needs to stop distributing out-of-date and useless drugs. RBM should reconsider its strategies with attention to what people actually do in Africa. Not only has RBM failed to meet its target, but malaria deaths have actually increased since it began its efforts. With three years remaining, RBM needs to start getting it right.


Aaron said...

Just a small addition to this post:

Like Caitlin mentions, bed nets are considered one of the most effective tools for combatting malaria—because malarial mosquitoes tend to come out at nighttime, treated nets can reduce drastically the chances of getting bitten in the first place. But, as she also mentions, the trick is getting the nets to people, and then getting recipients to use the nets as bed nets, rather than fishing nets, and keeping people from reselling them on the black market.

William Easterly, in his book The White Man's Burden, notes the work of Population Services International, which, instead of giving nets away, sells them to mothers for 50 cents apiece at antenatal clinics. As pregnant mothers and children are those most at risk, this tactic ensures the ones who need the nets most will get them, and charging a small price makes sure they will be valued and used for their intended purpose. Additionally, the nurse who distributes them gets nine cents off each sale, ensuring the nets are always kept in stock. PSI also sells nets at higher prices to wealthier people in the cities, using the profits to subsidize the rural distribution programs, thereby rendering the program completely self-sustaining.

PSI's program started in Malawi, which Caitlin notes has been one of the countries most successful in combating malaria, and this particular program is in large part responsible for the country's success, increasing the nationwide average of children under five sleeping with bed nets from 8% in 2000 to 55% in 2004, with similar results among pregnant women. A survey found that nearly everyone who paid for the nets used them, versus a program in Zambia that distributed them for free, where only 40% of recipients used the bed nets.

Perhaps the most novel aspect of PSI's program in Malawi is that it was designed and implemented by the local, mostly Malawian staff, not far-off planners in London or Washington, DC.