Mark Grabowsky makes the important point that coordinated and systematic malaria program monitoring and surveillance is needed so that we are not ‘flying blind‘ in our efforts to control the disease. Being blind is not an option when billions of dollars are at stake and drug and insecticide resistance, among other problems, is continuous a threat to success. Grabowsky in the journal Nature, explains that countries like Uganda are now getting adequate resources for control services, but “The challenge is to scale-up those services.” Scale-up without systematic monitoring and surveillance will leave us in the dark in terms of knowing whether we are progressing towards targets or need to make adjustments in strategies.
An editorial in Nature commenting on these observations charges that not only are programs not spending the needed money on surveillance but that the international malaria effort “is actually a hotch-potch of fragmented, country-level projects funded by multiple donors, with little regional and international coordination.” The authors revive a criticism was leveled in the same journal in 2004 that, “the WHO-led Roll Back Malaria initiative is mired in bureaucracy and anything but effective.”
The editorial diagnoses the perceived problem thus: “The international malaria effort is still geared towards maintaining donor support instead of getting teams into the field gathering data and delivering basic items such as bed nets.” This continued effort at advocacy, the editorial explains, was valuable ten years ago, but “With money now flowing in, the fight against malaria must shift from advocacy to getting results.
Obviously the authors of this editorial feel confident that the flow of malaria money will only increase and that donor fatigue will not set in.Â True, donors do lose interest when they do not see results.Â That is why the Monitoring and Evaluation Reference Group of the Roll Back Malaria Partnership has developed guidelines for countries and the partnership in providing technical support through its sub-regional networks to countries to strengthen monitoring.
Advocacy is a ongoing process because policy makers, donors and program managers have shifting interests and demands on their time and the resources under their control.Â Collecting monitoring and surveillance results by itself will not sustain malaria control programs.Â A full definition of advocacy therefore does include gathering and using data gained through monitoring and research to educate donors and policy makers about program effectiveness and gain their continued commitment to the fight against malaria.