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

Dr A KochiDirector,

Global Malaria ProgrammeWHO/Geneva

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Trend of Malaria Deaths

1900 1930 1950 1970 1990 2000

China

N.America & Europe

Africa

An

nu

al D

eath

s fr

om

Mala

ria

(

mill

ion

s)

(R.Carter,1999)

Central & S.America

Asia

0.1

1.0

3.0

2.0World

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Malaria cases by region in 2002 (estimates)

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000non-falciparumfalciparum

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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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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

What has happened since 1998

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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 womenITN 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?

1. Weak WHO leadership / dysfunctional RBM Partnership

2. Wrong Technical Policy (monotherapy with CQ, SP versus ACT; ITN, IRS)

3. Lack of "clear" strategy

4. Limited technical expertise in countries and internationally

5. No effective monitoring and evaluation

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What should be done?

1. Strong WHO leadership

2. Right technical policy

Treatment done

IRS coming soon

ITN coming soon

3. Develop "clear" strategies including simple but effective Monitoring and Evaluation System and "ideology-free" programme management

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4. Develop the critical mass of technical expertise (national and international)to effectively implement the strategy

5. Opportunistic but strategic allience between technical expertise, money, and politics for country operations

1~5 TB model

6. Research to be expanded, more focused and innovative

7. Partnership: fix the current one orcreate a new one?

What should be done?

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How UK can help?

Current situation in the UK (my understanding)

Big money for GFATM

Big money for R&D 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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