David Reiff, in reviewing the book Famine and Foreigners: Ethiopia Since Live Aid by Peter Gill, quoted William Easterly, who argues “not only that much aid is wastedâ€”about this optimists and skeptics largely agreeâ€”but that, after five decades, outside aid, whether given by governments or by the increasingly important philanthropic sector … has done little to alleviate the condition of the worldâ€™s poor.”
This view provides an interesting contract to a review by Steketee and Campbell entitled “Impact of national malaria control scale-up programmes in Africa: magnitude and attribution of effects.” These two authors report on studies occurring up to the end of 2009, that identified a three-fold increase in ITN household ownership (34 studies) and in malaria-endemic countries in Africa, with at least two estimates – pre-2005 and post-2005 when massive scale-up started.
Another key finding of the scale-up review was child “mortality declines have been documented in the 18 to 36 months following intervention scale-up.” They concluded that while, “Several factors potentially have contributed to recent health improvement in African countries, but there is substantial evidence that achieving high malaria control intervention coverage, especially with ITNs and targeted IRS, has been the leading contributor to reduced child mortality.”
In contrast to the pessimism of the wider development Aid Community, Steketee and Campbell stress that, “The documented impact provides the evidence required to support a global commitment to the expansion and long-term investment in malaria control to sustain and increase the health impact that malaria control is producing in Africa.”
Reiff also refers to James Grant, the former Unicef Executive Director who “was as unyieldingly optimistic about human possibility as he was clear-eyed about the extent of human suffering among the bottom half of the worldâ€™s population.”Â The fact that Grant’s “optimistic scenario for what could be achieved has not come to pass does not necessarily mean that Grant was wrong to say – as, were he alive today, he almost certainly would say – that there was every reason to believe that it could do so.”
The political factors described by Gill that have ‘created’ modern famines are also likely to affect development work as it relates to malaria. Ironically Ethiopia, the scene of this famine narrative is also one of the success stories in malaria control. Were he here today James Grant might look at the unfolding malaria story and find support for his optimistic views of development.
That said, the ultimate success of malaria control rests in free, open societies where equitable access to all malaria interventions is possible for all citizens.