Ceilings, Doors and Floors

Is the malaria house in order? NGOs worry about donor funding ceilings that affect their own funding floors, agencies distributing nets need to unlock store room doors and net recipients look at their ceilings and wonder how to hang their nets. This is some of the news that threatens success of efforts to achieve universal coverage.

One man’s ceiling is another man’s floor – so the saying goes. One would hope that support from the Global Fund, The World Bank, US Government and DfID, among others, would be a sturdy floor or foundation on which governments in endemic countries could build a strong malaria control program.

It becomes evident reading an article posted at World Sentinel that if donors to the Global Fund actually succeed in setting funding ceilings, the financial floor to control malaria in endemic countries will become less stable. Specifically, “NGOs are outraged at developments of the current Board meeting of the Global Fund Board to Fight AIDS, Tuberculosis and Malaria, taking place in Geneva, Switzerland. Many donor governments are promoting the establishment of a ceiling on the next round of disease fight grants to developing countries.”

This ceiling would stifle innovation, dampen country ambitions and cost lives according to the Global AIDS Alliance. We have discussed concerns that not all endemic governments are making a serious financial commitment to malaria control, and if the donors’ ceiling drops and their own floor falls, who will make up the funding gap?

dscn2551-sm.JPGAn equally frightening part of the ‘malaria house’ becomes evident “even as donations roll in and millions of bed nets pile up (behind the doors of) warehouses across Africa, aid agencies and non-governmental organizations are quietly grappling with a problem.” But even when these nets are released, they may not be used.

“Data suggest that, at least in some places, nearly half of Africans who have access to the nets refuse to sleep under them,” according to the Los Angeles Times. Why are nets not hanging from all ceilings?

The LA Times article gives some reasons why villagers won’t hang nets in their houses: perceived poor ventilation when sleeping under nets, not being sure how to hang them over sleeping mats, and not viewing malaria as a serious enough threat to warrant the inconveniences of hanging and using one. Clearly education on net use has not often gone together with getting the distribution numbers higher. As Sonia Shah says, nets may be “‘gifts’ that many neither want nor use.”

Maybe if we convince donors and governments that nets and other malaria commodities are being used, they will remove their funding ceilings and give us a chance to eliminate malaria from all houses in endemic countries.

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