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Funding &Monitoring Bill Brieger | 21 Apr 2010 08:01 am

When counting malaria out are we counting the right things?

RBM’s second report in the Progress and Impact Series provides us with the following data:

  • Annual donor support for malaria control has increased dramatically (approximately 10-fold) between 2004 and 2009, estimated to have reached nearly $1.8 million in 2009
  • Global production of ITNs has increased 5-fold since 2004, rising from 30 million to 150 million in 2009
  • Six of the eleven countries with data collected in 2008 or 2009 showed >50% household ownership of nets, although the highest was 62%
  • Averaging across 26 African countries (with 71% of <5 year child population), use of ITNs by children rose from 2% in 2000 to 22% in 2008

impact-series-2.jpgWhat do these figures tell us? First, money and commodities do not translate easily into indicators of success. Even household possession of the commodities does not guarantee use. And the best net coverage results achieved in 2008 or 2009 barely reach the RBM target of 60% for 2005, let along the 80% goal for 2010.

Some malaria community members have become cynical. “‘These are meaningless input measures that tell us only (the UN) is effective at spending other people’s money,’ said Philip Stevens, a health-policy expert at the London think-tank International Policy Network.”

C.Health also reports that, “Richard Tren, director of Africa Fighting Malaria, an Africa and US-based advocacy group, said measuring malaria spending and the numbers of drugs bought did not always mean more Africans had access to them.”

Obviously inputs are needed, but UNICEF reports that “available funds are still far short of the estimated $6 billion needed worldwide for effective malaria control in 2010.”

Partners are anxiously considering that the ‘Decade to Roll Back Malaria‘ comes to a close on 31 December 2010 and hope for success, but so far only Eritrea, Ethiopia, Equatorial Guinea’s Bioko island, Gambia, Ghana, Zambia, the Tanzanian island of Zanzibar and Sao Tome and Principe have scaled up malaria interventions and have observed marked reduction (30-95 percent) in morbidity and mortality indicators.

What can we expect from high burden countries like Nigeria and DRC where over a third of Africa’s malaria occurs? Nigeria is in the midst of distributing over 60 million LLINs, although there is still a gap of 9 million. Preliminary reports shared at a recent debriefing session on malaria progress in Abuja estimated that up to 25% of LLINs were ‘lost’ during distribution in one state.

Clearly nets produced for and acquired by countries is not the ultimate indicator we need to determine a decade’s success. We should not feel guilty about ‘spending other people’s money’ to eliminate malaria, but we should be accountable.

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