Like other diseases, malaria takes advantage of natural and human disasters. Pakistan may be the latest example. UN Radio reports that, “Cases of suspected malaria are increasing in the flood-affected provinces of Sindh and Balochistan in Pakistan, according to the World Health Organization (WHO). The agency says malaria is adding to the already increasing trends of water and vector-borne diseases, especially in Sindh and Punjab provinces.”
While WHO is providing treatment kits with artemisinin-based combination therapy (ACT) medicines, a bigger challenge may be destruction of infrastructure, including health services. Jhpiego explains that, “In 2005, northern Pakistan was struck by a massive earthquake, destroying 80% of the structures in that region and reducing the quality of, and access to, primary health care services.” Similar problems are expected because of the floods.
After the 2005 quake, USAID funded Primary Healthcare Revitalization, Integration and Decentralization in Earthquake-affected areasÂ or the PRIDE Project for 2006-10, which involved improving primary health care services at 94 health care facilities.
Pakistan experiences both P. falciparum and P. vivax malaria. The Demographic and Health Survey reports that the transmission pattern is a combination of stable and unstable malaria with low to moderate endemicity, with epidemic breakouts in Punjab and Sindh provinces. “The disease is now emerging as a prominent health problem in Balochistan and the Federally Administered Tribal Areas (FATA).” That 2006-07 DHS showed very low utilization of insecticide-treated bednets and low uptake of malaria medicines by children and pregnant women.
Pakistan has received three rounds of malaria grants from the Global Fund. A combination of Global Fund and government support was trying to address the 30 most highly endemic districts in the country. Although the latest grant performance report gave Pakistan an ‘A2’ grade, other news reports paint a different picture.
According to IRIN, “Pakistan’s Roll Back Malaria (RBM) strategy is lagging far behind the international goal of reducing the disease worldwide by 50 percent by 2010, mainly because of a lack of skilled staff and a shortage of funding.” A health official explained that “existing surveillance system is the major challenge at the moment, since we do not have accurate data.” This information pre-dated the flooding, and consequently the health system is in even less of a position to respond to malaria challenges now.
Pakistan needs appropriate emergency response to a potential malaria epidemic, but eyes should also be focused on the longer term need for reconstruction and strengthening of the health system. Otherwise malaria cannot be eliminated.