Fifty Years – independence and malaria in Africa

dscn7335-sm.JPGThe New York Times points out that “17 African countries, including Nigeria, gained independence in 1960.” Apparently there are few major commemorations. The Times quotes Ibrahima Thioub, a Senegalese historian, who said, “It’s tough to mobilize people for celebrations, because the flowers of independence have faded. The last 50 years have not at all met the people’s hopes and expectations.”

Have these 50 years brought Africa any closer to independence from malaria? It was during those years in the late 1950s and early 1960s when most countries were gaining independence that the first effort to eradicate malaria failed. We have had twelve years of rolling back malaria now – are the critical factors in place to ensure that eliminating the disease is feasible now?

The New York Times article addresses critical factors – ranging from weakness of institutions like parliaments to gaps in civil society engagement – that would impede  public health and social welfare programs including malaria control. African intellectuals quoted in the article bemoan that “democracy is held hostage by elites,” and the public accepts that “power is a matter of essences, a heritage, something in the blood, that what is normal for a state is unlimited monarchy.”  While both power and malaria may be ‘in the blood’, the former does not appear to be as easily transmissible or shareable, making the latter all the less easy to control.

The Times notes that, “… there is the reliance on heavy inflows of foreign aid, which equaled a quarter to nearly a third of government spending in countries like Burkina Faso, Cameroon and Mali in 2008.” Clearly this includes inputs from the Global Fund, The World Bank Booster Program and the US President’s Malaria Initiative (PMI). What aspects of health programming are not covered by aid is often paid out of pocket by the public, which is already impoverished by diseases like malaria.

Although there have been recent worries about both the level of donor funding moving forward and the willingness of countries to sustain programs should donor funding collapse, there are some positive signs from the donor side.  The US Government is increasing its malaria focus beyond the 15 PMI countries to include at least Burkina Faso, Burundi, Nigeria, Democratic Republic of the Congo and Sudan, and the Global Fund is embarking on a new ‘grant architecture.’

Known as ‘single stream funding’ the new Global Fund grant architecture “will shift the Global Fund towards a more program-based approach, with significantly improved harmonization and alignment, improving its support of holistic health planning and implementation,” to each principle recipients. This should simplify management, provide continuity, and reduce transaction costs – so even if funding does not increase as desired, there still may be savings and efficiencies for the allocated resources.

There are signs that we may get closer to independence from malaria this year as strides are being made to achieve universal coverage of malaria interventions. It may take another 50 years to see whether malaria can truly be eradicated. Hopefully when many endemic African countries will be observing their 100th year of independence, malaria will have become a thing of the past.

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