Roll Back Malaria: Why it has far failed What should be done

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Roll Back MalariaWhy it has far failed?What
should be done?

• Dr A Kochi
• Director, Global Malaria Programme
• WHO/Geneva

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Trend of Malaria Deaths
3.0
2.0
Annual Deaths from Malaria (millions)
1.0
(R.Carter,1999)
0.1
1900 1930 1950
1970 1990 2000
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Malaria cases by region in 2002 (estimates)
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The RBM Partnership (history)
Roll Back Malaria - launched in 1998 as a high
profile health initiative by founding partners
WHO, UNDP, UNICEF and the World Bank With the
primary goal of halving the mortality by 2010 and
75 by 2015
www.rbm.who.int
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What has happened since 1998

• New tools (ACT, LLITN, RDT, etc.)
• Increasing visibility and Money
• UK 60M to RBM/WHO, a big amount of money to
  AFRO/WHO, etc.
• Increase in research money (Gates Foundation,
  NIAID, bilateral funds...)
• GFATM
• Bilateral (Japan, Italy, US)
• World Bank

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Abuja Targets

• Abuja coverage targets, from the African Summit
  on Roll Back Malaria, April 2000, by 2005
• At least 60 of those suffering from malaria
  should be able to access and use correct,
  affordable and appropriate treatment within 24
  hours of the onset of symptoms.
• At least 60 of those at risk of malaria,
  particularly pregnant women and children under 5
  years of age, should benefit from suitable
  personal and community protective measures such
  ITNs.
• At least 60 of all pregnant women who are at
  risk of malaria, especially those in their first
  pregnancies, should receive IPT.
• At least 15 of government budget should be
  allocated to health sector

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Where are we now?

• Very weak monitoring and evaluation
• Only Eritrea seems to be achieving targets
• Many African countries are far short
• Southern African countries started progressing
  partly due to Global Fund money and WHO's
  technical assistance

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Access to Prompt and Effective Treatment

• CoverageChildren under 5 medium 50 (3-69)
• Based on 35 national surveys (1998-2004)
• Most of the treatments could not be considered
  effective
• (chloroquine, after 24 hours, incorrect dosage)

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Insecticide-treated bednets (ITN)

• Children under 5 (coverage as found in 45
  country surveys)
• Eritrea 81
• Togo 63
• Other countries 3
• But coverage of any net (untreated) could be up
  to 30.
• Pregnant women
• ITN coverage (8 national survey) 3

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Indoor Residual Spraying (IRS)

• Implemented in 17 Southern and West African
  countries
• Coverage
• 2.7 million households (1999)
• 4 million households (2003)

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Intermittent Preventive Therapy (IPT) in pregnancy

• 29 countries adopted IPT policy
• 22 countries are implementing IPT
• 6 countries achieved more than 60 coverage

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Why did RBM fail to achieve its goals?

• Weak WHO leadership / dysfunctional RBM
  Partnership
• Wrong Technical Policy (monotherapy with CQ, SP
  versus ACT ITN, IRS)
• Lack of "clear" strategy
• Limited technical expertise in countries and
  internationally
• No effective monitoring and evaluation

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What should be done?

• Strong WHO leadership
• Right technical policy
• Treatment done
• IRS coming soon
• ITN coming soon
• Develop "clear" strategies including simple but
  effective Monitoring and Evaluation System and
  "ideology-free" programme management

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What should be done?

• Develop the critical mass of technical expertise
  (national and international)
• to effectively implement the strategy
• Opportunistic but strategic allience between
  technical expertise, money, and politics for
  country operations 15 TB model
• Research to be expanded, more focused and
  innovative
• Partnership fix the current one orcreate a new
  one?

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How UK can help?

• Current situation in the UK (my understanding)
• Big money for GFATM
• Big money for RD for malaria
• No malaria specific bilateral health projects
• No malaria specific financial support to
  technical agencies
• Attempt to fix the current RBM Partnership

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