Back in December, an editorial in The Lancet praised the first two operational years of the US President’s Malaria Initiative (PMI). Various supporters and critics were quoted as favoring the approach that was heavy on basic malaria control interventions and light on consultants.
At the same time, PMI leaders themselves recognized that many national health systems with which PMI works are weak and need strengthening. There was also recognition that PMI must work with the broader health system in order for its interventions to have the broadest effect on maternal, child and even national health. Clearly there is little value pouring funds and commodities into national health systems that cannot absorb or manage them.
The editorial did point out that the current US effort includes support for procurement, supply, education and monitoring, which are essential components of efforts to strengthen a health system. Although sometimes criticized for selecting countries that already have other international malaria support, PMI views this also in the context of systems strengthening. For example, countries have the option of including health systems strengthening components in their Global Fund proposals (though this aspect need MUCH more attention).
Spending all money on high priced consultants is certainly a problem. Spending some money on reasonably priced consultants that can address health systems bottlenecks is a good investment.