Fragile States, Fragile Malaria Control

When the Roll Bank Malaria Partnership was launched 13 years ago, one of the basic tenents of the effort was that malaria control could not succeed without a concurrent reform and strengthening of health systems.  It was health systems weaknesses (in addition to pesticide resistance) that led to the failure of the first campaign to eradicate malaria.  But, strong health systems cannot exist in weak states.

photo-anthony-morland-irin-car-infrastructure-destroyed.jpgIn one example, IRIN reported this week that, “After decades of political violence, displacement and insecurity caused by clashes between rebel groups and government forces, as well as armed bandits, thousands of people in Central African Republic (CAR) are vulnerable to disease and have little access to health services, aid agencies say.”

In particular, IRIN noted that, “Malaria remains the leading cause of morbidity, accounting for 13.8 percent of deaths,” in CAR. Immunization coverage has also dropped since 2006 due to population displacements. “Uder-five mortality is 176 deaths per 1,000 live births and infant mortality 106 deaths per 1,000 live births. The country also has the highest maternal mortality rate in Africa, with 1,355 deaths per 100,000 live births.”

Last month IRIN asked whether Côte d’Ivoire was ‘heading for bust’ as a result of the political instability following the controversial presidential elections.  There is general disorder, and “banks are closing because banks don’t like Kalashnikovs; money doesn’t like disorder.”  People don;t have access to cash and have to make hard choices between paying bills and getting treatment for illnesses like malaria that don’t stop just because the country is in conflict.

Not only banks, but donor agencies do not like disorder. IRIN also disclosed that, “Support from another key donor, the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has approved grants worth more than US$290 million to Côte d’Ivoire, has also been affected by the crisis. Contacted by IRIN in Geneva, the Fund confirmed that: “Due to the political instability the Global Fund has taken measures to safeguard its stocks and funds in Ivory Coast, but continues allowing procurement and distribution of life saving drugs against HIV virus and malaria.” The Global Fund is also authorizing implementers to carry on essential operational activities on a case-by-case basis.”

When fragile states cannot control their malaria stituation, their neighbors are at risk. For example, USAID observed that, “Due to prevailing instability in Darfur and CAR, the voluntary repatriation of the estimated 323,280 refugees currently residing in eastern and southern Chad is unlikely in 2011, according to the U.N.” The CAR refugees are located in a highly malaria endemic area of Chad and pose an additional burden to Chad’s already stretched health care system.

The United Nations and the African Union should see the link between conflict/insecurity and malaria/death. When a country is in disorder, mortality often comes more from disease than bullets.

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