THE WORLD BANK BOOSTER PROGRAM FOR MALARIA CONTROL IN AFRICA Update on The Booster Program for...

THE WORLD BANK BOOSTER PROGRAM FOR MALARIA CONTROL IN AFRICA

Update on The Booster Program for Malaria Control in Africa

Scaling-up for Impact

Maryse B. Pierre-Louis, MD, MPH, MS/HSAMaryse B. Pierre-Louis, MD, MPH, MS/HSA

Lead HNP Specialist, Coordinator

May 10, 2007RBM Board Meeting, Geneva


Presentation Outline

Overview of the Booster Program for Malaria Control in Africa

Progress to Date

Partnership Work

Challenges and the Way Forward


The World Bank Response in the Fight Against Malaria

• Previous approach of WB (1998-2005 focusing primarily on health systems strengthening) did not yield the intended results for malaria control and reductions in child mortality

• WB revised its strategy for and recommitted itself to malaria control in a major media event attended by five WB Vice-Presidents in April 2005

• The Africa Region launched the Booster Program for Malaria Control in September 2005 in a major event attended by all key partners


Malaria Control is Central to the Bank’s Development Agenda in Africa

• The Africa Action Plan (AAP) target of reducing child mortality will not be achieved without a focused and significant effort to control malaria

• Malaria is a leading cause of death among African children under five years of age

• Promoting the use of insecticide-treated mosquito nets has been shown to reduce all-cause child mortality by 20%-25%†

I. ACCELERATING SHARED GROWTH

Drivers of Growth9. Scale up Human Development

HIV/AIDs Malaria Primary education and gender

equality in education

AAP PILLARS

8. Strengthen national health systems to prevent and treat malaria and HIV/AIDS

FLAGSHIP BUSINESS LINES

Anti-malaria drugs and bed-nets used for families with children under 5

ReducedChild

Mortality

†Source: Lengeler, C. 2004. Insecticide-treated bednets and curtains for preventing malaria. Cochrane Database of Systematic Reviews

2004, Issue 2.


Booster Program Objective: Support Countries to Support Countries to Achieve their Malaria Control ObjectivesAchieve their Malaria Control Objectives

The Booster Program for Malaria The Booster Program for Malaria Control in Africa:Control in Africa:

• Contribution not attribution

– National Strategic and Operational Plans

– Accelerate progress toward the achievement of the Abuja targets by 2008

– Joint effort with all Roll Back Malaria partners in the country


Key Features of the Booster Program• Two pronged approachTwo pronged approach:

– Support rapid scale-up of proven interventions

– Strengthen health systems

• FlexibleFlexible: No one size fits all

• Country-ledCountry-led

• Strong results focusStrong results focus

• Emphasizes partnershipEmphasizes partnership

• Supports Capacity Building

• Integrated Approaches

• Cross-Sector and Public-private-NGO partnerships

• RegionalRegional:

Country Lending Approach*

EritreaHIV/AIDS/STDs, TB, Malaria and

Reproductive Health Project

DRCHealth Sector

Rehabilitation Support Project

Zambia Stand Alone Operation

Niger Health SWAp

Burkina Faso Health SWAp

Ethiopia (MDG TF)Protection of Basic Services/MDG Fund

Benin Stand Alone Operation

Senegal River Basin (Regional)

Sub-Regional Infrastructure Project

MalawiHealth SWAp (additional

financing linked to SWAp)

Senegal Nutrition Project (PRN)

Nigeria Stand Alone Operation

DRCEmergency Urban and Social

Rehabilitation Project

*Board-approved Projects


Phases of the Booster Program

US$500 million target (IDA)

Support rapid scale-up of proven interventions

Design programs to compliment efforts to improve health systems performance

Expand / maintain key intervention coverage levels and systems performance

Focus on sustainability

2005 2015Multi-Year Horizon

Phase I: Intensive Phase(FY06-FY08)

Phase II: Consolidation Phase(time period and focus to be

defined)


Progress to Date:A Dedicated Team for Malaria In AfricaA Dedicated Team for Malaria In Africa

The Malaria Implementation Resource Team (MIRT)

established November 2005

The Malaria Implementation Resource Team (MIRT)

established November 2005

Africa RegionObiageli Ezekw esili

Vice-President

Africa Region Human Development

Yaw Ansu Director

MIRT Anne M. Pierre-Louis

Coordinator

Suprotik BasuPublic Health Specialist

John Paul ClarkSr. Technical Specialist

Jumana QamruddinOperation Officer

Joseph ValadezSr. Monitoring and

Evaluation Specialist

Moussoukoro SoukouleSenior Program

Assistant

•Pesticide Management and Supply Chain Management Specialists available part-time Pesticide Management and Supply Chain Management Specialists available part-time

•Booster projects prepared by Task Teams with advice, technical and operational support from MIRTBooster projects prepared by Task Teams with advice, technical and operational support from MIRT

•Pesticide Management and Supply Chain Management Specialists available part-time Pesticide Management and Supply Chain Management Specialists available part-time

•Booster projects prepared by Task Teams with advice, technical and operational support from MIRTBooster projects prepared by Task Teams with advice, technical and operational support from MIRT


MIRT Mandates

• (i) support to task teams with plamming and implementation

• (ii) overall M&E / quality assurance

• (iii) internal (with other sectors) and external partnerships; and

• (iv) knowledge generation and sharing


Approved Projects in the Booster to DateApproved Projects in the Booster to DateKey Accomplishments to Date: Approved and Pipeline Booster ProjectsApproved and Pipeline Booster ProjectsApproved Projects in the Booster to DateApproved Projects in the Booster to DateProgress to Date: Approved and Pipeline Booster ProjectsApproved and Pipeline Booster Projects

Board Approved Amount (US$)Board Date

Eritrea 2 million Jun. 2005

DRC 30 million (Grant) Aug. 2005

Zambia 20 million Nov. 2005

Niger 10 million Jan. 2006

Burkina Faso 12 million Apr. 2006

Ethiopia (MDG TF) 20 million (Grant) May 2006

Benin 31 million (Grant) Jun. 2006

Senegal River Basin (Regional)

42 million Jun. 2006

Malawi 5 million July 2006

Senegal 5 million Nov. 2006

Nigeria 180 million Dec. 2006

DRC 13 million (Grant) Mar. 2007

TOTAL TO DATE 370 million

FY2007 and FY 2008 Pipeline (indicative amounts subject to change)

Tanzania 25 millionToday2007

Ghana 10 millionJun. 2007

Mozambique 10 millionDec. 2007

Kenya 14.4 million TBD

Sudan (southern) (MultiDonor TF)

16.5 million TBD

TOTAL TOTAL FY06-08FY06-08

445.9 445.9 millionmillion

Estimated population living in Board-approved Project areas

Total population: 180 millionChildren under five: 31.5 million

Pregnant women: 7.6 million


US $446 million

US $370 million

US $167 million

US $2 million

US $50 million

0

50

100

150

200

250

300

350

400

450

500

FY00-05 (Pre Booster)*

June 2005 FY06 FY07 (to date)

FY08 (expected)

Cu

mu

lati

ve B

oar

d-a

pp

rove

d B

oo

ster

Pro

gra

m C

om

mit

men

ts(U

S $

mill

ion

s)

IDA commitments for malaria control in Africa have increased by over 7-fold since the start of the Booster Program

*Prior to the Booster Program, malaria-specific financing was not tracked, so only very rough regional estimates are available.

Progress to Date:Backing Promises with ActionsBacking Promises with Actions


Malaria Control Commodities: LLINs and ACTs LLINs and ACTs

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

16,000,000

18,000,000

Nu

mb

er

of

Co

mm

od

itie

s (

Ne

ts, D

os

es

)

Long Lasting Insecticide Nets (LLINs)

Artemisinin-based combination therapies (ACTs)

Over 21 million long-lasting insecticide-treated mosquito bednets (LLINs) and over 42 million doses of ACTs will be distributed over the life of the Booster Program

(IDA only, Board-approved projects to date)


Partnership for ResultsBooster Country

World Bank

Global Fund

USG†

Benin PMI R3

Burkina Faso

DR Congo USAID

Eritrea

Ethiopia PMI R3

Ghana PMI R3

Kenya PMI R3

Malawi PMI R2

Mozambique PMI R2

Niger

Nigeria USAID

Senegal PMI R2

Sudan USAID

Tanzania PMI R1

Zambia PMI R3

† The U.S. President’s Malaria Initiative (PMI) began in 2006 in R1 countries, in 2007 in R2 countries, and will begin in 2008 in R3 countries.

• In every country, no single donor contributes enough financial resources to bring malaria under control

• At country-level, the Booster Program works with all malaria control donors to support the efforts of National Malaria Control Programs

• Of the 15 Booster countries with Board-approved or pipeline projects, 12 are receiving support from the three largest malaria control donors

• Synergizing efforts permits more effective translation of available funding into concrete results


Examples of Partnerships at work at the country level

• Mozambique: Joint planning, GAP analysis

• Zambia: Systems strengthening, GAP analysis, Reprogramming

• Senegal River Basin: cross sector and cross border collaboration

• Tanzania: Rapid response to fill gaps.


Forging New Collaborations: Leveraging Additional Funds Leveraging Additional Funds for Controlling Malaria and Strengthening Systemsfor Controlling Malaria and Strengthening Systems

• Innovative collaborations, with traditional and non-traditional development partners, are key AAP deliverables

• Booster Program progress to mobilize additional support: ExxonMobil

• Support for M&E Russian Federation

• Co-financing of IDA • Support for human resource development

The Bill & Melinda Gates Foundation• Support for addressing critical bottlenecks in real time and district

level health planning


• While project design is flexible, WB’s commitment to achieving concrete results is the same across all of the Booster Projects it supports.

• The Booster Program works with MERG and countries to strengthen M&E and can provide support for tracking:

– Program indicators (household-based surveys)– Service provision in health facilities (facility assessments)– Spatial distribution of ITNs/ACTs

• “Malaria Scorecard”- Joint work in progress within the RBM MERG. Tracks:

– Financial commitments from Donors and Governments– Program, morbidity/mortality & economic indicators

Tracking Expenditures and Results


Malaria Scorecard:Tracking Commitments, Expenditures and ResultsTracking Commitments, Expenditures and Results

RESULTS

NOTES/SOURCES

FINANCIAL INFORMATION


Catalytic partnership for measuring Catalytic partnership for measuring results:results:

“If we cannot measure it, we cannot manage it”.

• The need to strengthen M&E at the global and country levels in the fight against malaria has been recognized by all partners

“How will we know when we get there?”

• In Dakar, countries called for partners to develop a coordinated tracking system and to agree on a common approach to M&E capacity building at country level to monitor progress and assist managers in solving real program problems.

World Bank / ExxonMobil Partnership for Malaria Control Results in Africa



Focus on: Focus on:

1. Building Monitoring and Evaluation capacity in countries:

– Facilitate Management of country-level activities

– Support local development of M&E systems and the timely and effective use of information by local managers and implementing partners for decision making

– Improve information dissemination to beneficiaries



Focus on:Focus on:2. Supporting Global Partnership Efforts on M&E:

• Work in progress: Malaria “Scorecard” sent to Partners for comments

• Overall, constructive feed back• Beta Testing of a Scorecard website and data warehouse

(Voices Project at Johns Hopkins)• “Broad agreement in February (RBM/MERG meeting) on

the principles”(Source, MERG Meeting summary on malaria data bases, New York, Feb 22-23, 2007)


Implementation Principles:Implementation Principles:1. This partnership will be firmly embedded within the

RBM/MERG and is expected to be of added value to partners within the MERG and other agencies.

2. This partnership will foster joint ownership by partners and countries of:

• Database content

• Management of database

• Tracking tools



• Constrained IDA allocations for malaria– Tradeoffs and Ceilings IDA replenishment

• Ensuring and maintaining quality across the portfolio

• Procurement delays– Weak country capacity– Inadequate staffing both within WB and in countries– Waivers to use UN agencies

Key Challenges of the Booster Program


Going Forward• While we are pleased that 12 projects have been

approved by the Board, we will need to translate these finances into concrete outcomes.

• Between now and the end of the Intensive Phase, we will be focusing on addressing major bottlenecks, including:– Addressing Supply Chain Management, including

Procurement– Strengthening the quality of the Booster portfolio– Expanding the partnership base, including internally

with other sectors– Mobilizing additional IDA resources since


“…since 2005 when the World Bank launched its Malaria Booster Program, it agreed to provide millions of dollars to help countries scale-up malaria control….…Today, we would like this initiative to be recognized and we applaud the renewed commitment of the World Bank. The Bank took a bold step by admitting its past shortcomings and went further to commit significant additional resources,

both human and financial, to develop a substantive country support program which adds value, is

transparent, and for which it can be held accountable.”

Extracted from correspondence of Eyitayo Lambo, the Honorable Minister of Health, Nigeria, and Board Chair of the Roll Back Malaria

Partnership, as published in the Lancet (Vol 368, July 15, 2006)


The Booster Website

The website has been revamped, please

visit and send us your comments for

improving it:

www.worldbank.org/afr/malaria

THANK YOU!THANK YOU!

http://www.worldbank.org/afr/malaria

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