PHA-Exchange> Roll Back Malaria: a failing global health campaign

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 from Dr Rana Jawad Asghar <jawad at alumni.washington.edu> -----

Roll Back Malaria: a failing global health campaign
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Only increased donor support for malaria control can save it

BMJ 2004;328:1086-1087 (8 May), doi:10.1136/bmj.328.7448.1086
http://bmj.bmjjournals.com/cgi/content/full/328/7448/1086

Roll Back Malaria was launched in 1998 bringing together multi-
lateral, bilateral, nongovernmental, and private organisations.
It made a clear pledge-to halve deaths from malaria by 2010. Af-
rican heads of state endorsed the pledge at a summit in Abuja,
Nigeria, in 2000.[1] This endorsement was vital because 90% of
the one million annual deaths from malaria are in Africa, mostly
in young children and pregnant women.[2] With just six years to
go we have reached the halfway point since the pledge. How is
Roll Back Malaria doing?

A graph distributed at the most recent Roll Back Malaria board
meeting in New York, based on data from the World Health Reports
1999-2003, shows that the annual number of deaths worldwide from
malaria is higher now than in 1998 (see bmj.com). The Africa Ma-
laria Report 2003, published by Unicef and the World Health Or-
ganization, two of the biggest players in Roll Back Malaria, ad-
mits that "Roll Back Malaria is acting against a background of
increasing malaria burden."[3] This statement is passive, and
seems to absolve the campaign of responsibility. A more active
statement is this-Roll Back Malaria is currently a failing
health initiative.

The question now is whether the campaign can be saved. We have
the three tools we need to curb malaria deaths-bed nets, effec-
tive combination treatment based on artemisinin, and insecti-
cides. What we urgently need to do is make these tools much more
widely available to affected communities, which are almost al-
ways too poor to pay for them themselves.

In this issue Molyneux and Nantulya focus on the first of these
tools-the distribution of insecticide treated bed nets-a key
strategy in the Roll Back Malaria campaign (p 1129).[4] A sys-
tematic review found that such nets are highly effective in re-
ducing childhood mortality and morbidity from malaria.[5] But
even with Roll Back Malaria's best efforts, only about one in
seven children in Africa sleep under a net, and only 2% of chil-
dren use a net impregnated with insecticide.[3]

About $1bn a year of new international aid will pay for artemis-
inin based combination therapies for around 60% of those who
need it.[7] Yet researchers at Harvard estimated that total in-
ternational aid for malaria control in 2000 was just $100m.[8]
Although annual spending on malaria has increased since then as
a result of the creation of the Global Fund-for example, the
fund had disbursed $37.3m to malaria programmes as of 23 October
2003 (Jon Liden, personal communication, 2004)-this is still no-
where near the amount that is needed. Some donors, like the
United States Agency for International Development, spend noth-
ing at all on malaria drugs. Unicef spent just $1m in 2003 on
procuring artemisinin based treatments.

The ball is now in the donors' court. Raising serious money to
buy nets, insecticides, and effective drugs is the only way for
Roll Back Malaria to get back on target. Donors must hugely in-
crease their support for the Global Fund, which provides the
best funding mechanism for the rapid procurement of malaria
tools. As the health economist Jeffrey Sachs has repeatedly
pointed out, when it comes to malaria "if you invest money, you
get results."


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