Malaria Dollars and Sense

A year ago The Economist remarked that there was “More Money than Sense” do deal with the world’s public health problems. But then below the headline we see that, “The money is there. So why is it not being spent? That is the big puzzle about the rich world’s efforts to improve health in poor countries.” This ties in with a current study by Robert Snow and colleagues that concludes not enough is being spent on malaria to reach the Millennium Development Goals in 2015.

african-money-sm.jpgSnow is quoted in The Guardian as saying, “What we have done in this paper is try to estimate how much money is awarded to countries according to how many people live at risk. What we can say at this stage is there isn’t enough for a minimum package of interventions … They are often getting much less than a dollar per person at risk and we know that you need at a bare minimum $4.”

After costing the basic package of malaria interventions at 80% coverage, the authors concluded that, “Using the range of predicted annual needs we estimate that there remains a 50%–450% shortfall of funding to achieve the scaling up of malaria control required worldwide.”

Although this publication would not have benefited from knowledge of the recent G8 Summit, the lack of news-breaking financial commitments for health at Hokkaido is unlikely to influence their conclusions.

Scientific American shows that reputationa are on the line. “The stakes are exceedingly high. Not just millions of lives but also the very capacity of the world to take on big and crucial goals is at stake. In the case of malaria, we can restore health and unleash massive economic gain, but only if countless agencies, dozens of countries and hundreds of millions of individuals can effectively take a shared action.”

We can also throw inequities into the mix. The Guardian explains that, “funding was not spread evenly, with some countries receiving far less per person at risk of the disease than others.” Mathanga and Bowie show that inequitable distribution of malaria interventions also occur at the country level. In Malawi, “Overall ITN coverage increased from 5% in 2000 to 35% in 2004. However, there was a disproportionate concentration of ITNs amongst the least poor compared to the poorest group… The present distribution strategies for ITNs are not addressing the needs of the vulnerable groups, especially the poor. Increasing access to ITNs by the poor will require innovative distribution models which deliberately target the poorest of the poor.”

Finally, Scientific American points out that the problem is more than cash: “Still, the timing will be very tight and will require an unprecedented degree of coordination among financing, training, monitoring and logistics. Each sub-Saharan country will need to adopt, vet, fund and monitor a scaled-up antimalaria plan very quickly. The major global manufacturers of commodities such as bed nets, antimalaria drugs and diagnostics will have to raise production to hundreds of millions of units. Tens or hundreds of thousands of community health workers will need weeks of training.” The list goes on, but do the donations and contributions?

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