Investing in Malaria is the Start of Something Big

London, 2 June: Here in the UK, we welcome a new incumbent to the role of Secretary of State for International Development, Andrew Mitchell. Mr Mitchell takes over the reigns of a department that is underpinned by one key commitment – one that he has said he has every intention of keeping.

That commitment is to stay on schedule to allocate 0.7% of Gross National Income for overseas aid by 2015 - a target which, incidentally, will be 45 years old by then. Mr Mitchell has certainly set the bar high for his department in his first public statement: “Our bargain with taxpayers is this: in return for contributing your hard-earned money to helping the world’s poorest people, it is our duty to spend every penny of aid effectively.” His top priority, he added, would be to get the best value by demanding “greater transparency, rigorous independent evaluation and an unremitting focus on results” on UKaid money spent.

Malaria is an appalling disease that mostly affects the poor and causes so many deaths annually that it warranted a specific mention along with HIV/AIDS and tuberculosis in the most recent set of development targets, the Millennium Development Goals. These eight goals which relate variously to reductions in poverty and disease, and improvements in maternal and child health, education, environmental sustainability, gender equality and global partnership, are due to be met by 2015. Progress towards achievement of some is better than for others, but there is still a long way to go to meet many of the targets.

Efforts to control malaria, although more emphatic in some countries than others, are successfully pushing the developing world closer to meeting the relevant MDG targets for the disease, largely due to an increased interest in supporting anti-malaria interventions from international donors. Much of this interest is the result of the pleasing realisation that if you use existing effective tools such as insecticide-treated mosquito nets on a large scale and teach people living in a malaria endemic area how to use them properly, there is a very reasonable chance most will be protected from contracting malaria. This simple cause and effect provides a relatively instant and quantifiable win for those in the business of dispersing aid funds, especially those who are demanding “an unremitting focus on results”.

This is not as cynical as it sounds as there is no doubt that providing people with insecticide-treated mosquito nets really does save lives. Understandably, therefore, there has been huge interest in funding the mass delivery of mosquito nets to those who are most at risk. Providing prompt diagnosis and treatment is equally important and a great deal of progress has been made in recent years to make available diagnostic kits and effective artemisinin-based combination drugs in endemic countries.

In Nigeria, the entire country is at risk. Malaria accounts for nearly 110 million diagnosed cases per year, with at least 300,000 child deaths and 11% of maternal mortality attributable to the disease. It is unsurprising therefore that it is a primary target for malaria interventions and Malaria Consortium, the world's leading non-profit organisation dedicated to the comprehensive control of malaria, is in the process of helping to manage a vast $1 billion global initiative to get mosquito nets to every Nigerian that needs them. Needless to say, in country of 151 million where around 71% live below the poverty line, that is a huge undertaking. But it is working and so are the mass net distributions taking place in most sub-Saharan countries in Africa.

But what happens next? Insecticide-treated nets and other mosquito control measures as well as treatment of cases with effective medicines are the frontline defence against malaria, but it is critical that donors don’t sit back after these large-scale interventions and think it a job well done and move funding into new areas. Mosquito nets only last about three years, drugs and diagnostic kits run out, and malaria will not simply go away in the meantime. Without appropriate and sustained measures to curb infection rates, the death toll will rise again. Donors must look beyond mosquito net distributions and focus on the longer-term issues to ensure malaria is permanently controlled, if not eliminated.

However, malaria is not a money pit. It needs both greater and more far-sighted investment before such financing can begin to decrease - and not just for malaria. Investment in managing malaria is a leading wedge in the treatment of a range of childhood illnesses and if efforts are made not only to control it but also understand the strengths and weaknesses in current activities, then there will naturally be a positive knock-on effect on other febrile diseases.

Historically, most children with a fever were given anti-malarial drugs on the assumption that in endemic countries, it is more likely than not that the fever is a symptom of malaria.

Recent treatment guidelines recommend diagnosis using either microscopy or rapid diagnostic tests to be carried out in all cases of suspected malaria first wherever possible. This would help prevent the millions of unnecessary treatments and, more critically, it would save thousands of lives by reducing the delay for those with other dangerous illnesses, such as pneumonia, receiving the correct drugs. As yet, however, diagnostic capacity of community health workers and health centres, the front-line in primary health care for those in rural areas, remains severely limited in many countries. According to WHO, just 22% of suspected malaria cases were tested in 18 of 35 African countries reporting in 2008 – although this has since improved.

There is no doubt that it will take incredible commitment and resources to beat malaria, but in the process great advances will be made in other areas such as child and maternal health, and health systems strengthening.  This requires clear global commitment to increase malaria control activities to encompass the broader, outstanding issues, so what has been gained so far, will not begin to slide back. The UK government has indicated its commitment to beating malaria and we hope it will show leadership in Europe as well as globally in showing how investment in malaria should continue and that if it is done thoughtfully and consistently, it is actually an investment in much more than just the management of a single disease.

First published on eGovMonitor on 1st of June 2010

For more information, please contact Diana Thomas [email protected]