Tropical Health Matters

[This posting was developed for and simultaneously appears in TropIKA.net’s blog today]

Since the World Malaria Report 2010 was published, the main news reports have focused on the numbers – including increases in malaria programme financing, numbers of people protected by malaria interventions, number of cases confirmed through parasitological diagnosis, and number of artemisinin combination therapies (ACTs) procured.

Key reductions were reported in the number of confirmed malaria cases and malaria mortality and burden. There is a recognition that not all locations experienced the positive trends. Quoting the report: “There was evidence of an increase in malaria cases in three countries in 2009 (Rwanda, Sao Tome and Principe, and Zambia). The reasons for such resurgences are not known with certainty. The increases in malaria cases highlight the fragility of malaria control and the need to maintain control programmes, even if numbers of cases have been reduced substantially.” The report stressed the importance of surveillance systems in detecting these challenges.

These contrasting findings show that we need to identify the factors responsible for fragility or strength in health systems in order make malaria control progress possible. The 2010 World Malaria Report differs little from its predecessors in that it does not provide much of substance to document which health systems interventions have made gains possible and retreats unfortunate.

For example, the report lets us know generically that, “Much of the support for malaria control activities derives from existing health systems in countries. This is true especially for the treatment of acute disease – where health workers, hospitals, clinics and other infrastructure are typically provided by the national governments or supported by non-governmental organizations.” We also find statements such as, “The monetary value of such benefits (from increased diagnostic testing) is uncertain, but there is consensus that these are worthwhile objectives for health systems”.

Concerning country case studies, we are told that, “…they reflect the burden that malaria places on the health system. Changes in the numbers of cases and deaths reported by countries do not, however, necessarily reflect changes in the incidence of disease in the general population, because …” of inadequacies in health information systems. It would be most helpful to share examples and evidence of health information systems that actually work to help countries target interventions more effectively.

Again the obvious is stated … “Policies may vary according to the epidemiological setting, socioeconomic factors and the capacity of the national malaria programme or country health system. Adoption of policies does not necessarily imply immediate implementation, nor does it indicate full, continuous implementation nationwide.”

We would love to see evidence of successfully implemented policies that have made a difference.

We have a belief that health systems reform and health systems strengthening are important aspects of achieving universal coverage of malaria interventions. We would really like to have our belief backed by evidence presented in future World Malaria Reports.

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