In a working paper for the Center for Global Development, Nancy Birdsall challenges some of the basic assumptions of development aid/assistance.Â She identifies 24 African countries that are â€˜aid-dependentâ€™, deriving more that 10% of their gross national income from international assistance. Â The results of this situation need to be monitored, according to the working paper, so that aid providers â€˜do no harm. Â Problems of aid potentially include poaching of skilled workers by aid agencies, decreased government accountability when income comes from non-indigenous sources and even macroeconomic effects like pressure on currency appreciation.
What does this have to do with malaria?Â Obviously national malaria programs are receiving aid in a variety of forms from large scale efforts like the Global Fund to fight AIDS, TB and Malaria, the Presidentâ€™s Malaria Initiative and the World Bank Booster program.Â Following the White House Summit on Malaria, many organizations from traditional development NGOs to sports groups have jumped on the bandwagon to assist in the fight against malaria.Â Financial aid for malaria, though still far from what is needed to control the disease, has increased by leaps and bounds. Â Besides providing bed nets and malaria medicines, what else is this aid doing?
Ideally assistance from sources like GFATM should be used to supplement or compliment national malaria control program efforts. Unfortunately, one often sees that the only resources going to buy Artemisinin-based Combination Therapy (ACT) drugs or Long-Lasting Insecticide-treated Nets are in fact donor funds. Â Visits to district health facility medical stores may show a large supply of nets in stock. Many may have been given out to children under five years of age in conjunction with a recent measles campaign. The remainder might be sent to antenatal clinics to give to pregnant women. Â When asked what will happen when the stock of donated nets is finished â€“ i.e. what to do next year when there are a new set of pregnant women and a new set of infants in need of nets, the health staff canâ€™t answer. Districts do not have in their budget funds for serious malaria control, and thus the short term gifts are not backed by a commitment to long term sustainability.
What about ACTs? Most aid is used to buy and give ACTs free to children under five years of age. What happens to older children and adults who have malaria? Â Again, district health departments often have not planned in a comprehensive way to provide up-to-date malaria treatment for the population, but just rely on the targeted donations for a specific age group. Embarrassed health workers have been known to give two packets of the child medicines to adult clients in need. Â Furthermore, if the grant or program has targeted only 20% or 50% of children under five, when the ACTs on hand finish after a few months, there are none available even to treat the children until the next yearâ€™s donor supplies arrive.
In many cases therefore, donor supported malaria programs are not really strengthening and supplementing a local program. They are simply providing a stopgap for a portion of the population for a few short years. Â Malaria aid without national and district political commitment in endemic countries and comprehensive forecasting and planning is not going to save lives in the long run.