Malaria control programs seek to reduce the number of cases of malaria through preventive and curative methods. Roll Back Malaria is a program that brings together various countries, the World Bank, organizations and foundations, WHO, UNICEF, UNDP, and partners in helping fight together malaria. The 10 year-World Bank program which seeks a coordinated global approach to fighting malaria, has a goal of reducing malaria deaths in Africa by 75% by 2015.
The program had by April 2007 spent the US $370 million in about 20 months across 14 countries. The program utilizes health system development combined with disease control, helps to design malaria control programs in various countries to complement World Bank and other partners’ efforts. The bank also offers the IDA credits to pay for the gaps in the malaria programs implemented by countries and practices like supervision and tracking.
There was a plan to develop a system for monitoring the progress of malaria-control efforts through partnerships following a strong focus on its result according to the World Bank Group (2007). For example, Nigeria intended to use the funds in 2007 for distributing medicine, bed nets, generally funding their health systems. The country had strategized to distribute 6 million Artemisinin-based doses of AST free to those under 5 years, provide about 3 million treated bed nets to the same category, and pregnant women category which would also benefit with 1.9 million drugs.
By June 2008, a total of 23 countries in Africa had policies favoring free ACT treatment in the public sector. Africa has a total of about 45 malaria-endemic countries. By the end of 2006, a total of 16 countries had adopted policies for ITN targeting all groups of age, and 37 of them adopted a policy of providing the service to children and pregnant mothers free of charge (WHO, 2008). Among the WHO regions, South-East Asia and Western Pacific regions avail distribution of insecticide nets whereas there is lesser usage of ITNs in the other three regions. Different programs that exist to deal with malaria as a global health program have been launched in Africa.
Adoption of ACT as a first-line treatment has experienced an increasing growth worldwide but there has been a time lag until the deployment of the drugs in the general health services according to the WHO report (2008). The effectiveness of these programs however has been influenced by a number of factors.
In 2006, the African WHO region required about 324 million of ITNs considering the WHO recommendation of usage of one net for two people, yet only about 66.2 million people were protected in the same year assuming effectiveness of three years for each LLIN and one year for any other ITN. According to the WHO report, there was an increase in the number of distributed LLINs from 2005 onwards and formed 70% of the nets distributed in Africa by the National Malaria Control Programs in 2006.
Likewise, the number of ITNs nets also rose in 2005 and 2006. The fact that there are factors influencing the effectiveness of the Malaria control programs in Africa can be deduced from the figures produced by the WHO in their report indicating that 50% of those protected by distributed ITNs were in 6 countries, and only 20% in 19 countries in 2006. In addition, only eight countries completed national wide distribution of LLINs between 2004 and 2007. Distribution of the nets for children under 5 years and the pregnant women was therefore achieved as follows; in Mali during 2007, Sierra Leone (2006), Kenya in 2006, Rwanda (2006), Niger (2005-2006), and Togo (2004).
The countries that achieved distribution by targeting all households were only two, namely Zambia (2006-2007) and Ethiopia (2005-2006). A survey conducted by National Malaria Control Programs, and those published (all except 2007 Rwanda, Democratic Republic of Congo, and Nigeria surveys) covered 43% of the African population at risk from the attack of malaria who happened to be in 18 countries. The surveys indicated that 34% of the weighted mean for the population at risk owned an ITN and only 23% of children slept under an ITN in the 18 countries falling way below the WHO target of 805 and more. WHO also reports that only 23% of pregnant women slept under an ITN as indicated from a survey conducted on a subset of 8 countries.
The access to ant malarial drugs in the African region also was low in rural than urban areas. Usage of Chloroquine was found to have deteriorated among the surveyed countries.
Conclusions and Recommendations
Malaria control programs in Africa have focused on preventive measures which include the distribution of ITN and LTIN nets to prone populations including children and pregnant women. Although WHO set a high target of 80% and above for the children sleeping under ITNs, this was not achieved in 2006 when only about 23% was achieved. Subsequently, a low percentage (27%) of the pregnant women slept under ITNs during the same period. A wide disparity was found for the distribution of the nets with 50% being in only 6 countries and 20% in 19 countries. Several factors may be blamed for the low coverage of distribution and irregularity in it.
First, low distribution may be used to mean low access to the preventive methods of control by masses. Laxity in the adoption of the policies favoring distribution of malaria drugs and nets in all the sectors of the African governments may be blamed for failing to completely reduce the cost of preventive measures for affordability-yet it was reported by WHO that there was an equal proportion of patient with fever suspected of malaria, who accessed the private and public sector as deduced from household surveys in African and Western Pacific regions (2008).
In addition, although there was increased funding for malaria control programs in Africa than in any other region according to National Malaria Control Program for 2006 as indicated in the WHO 2008 report, the US $ 668 million was an underestimate because 26 of the 45 countries submitted their reports. The Meeting of the target was probably influenced by the inadequate funds in the reporting countries (the US $ 4.6 million) according to the WHO report. Failure of some countries to report on funding may lead to deteriorated tracking of the impact of the programs or usage of funds. This report gives the following recommendations;
- That adequate measures be put in place to ensure reporting of the usage of funds channeled for malaria control programs in Africa
- That funding be increased for malaria control programs in Africa through increased awareness and reporting of malaria incidences and needs. The governments also need to be put under pressure to increase funding for these programs in their countries and lead reforms in the programs if they have to continue to receive funding.
- That there be improved campaigns towards equitable distribution of Malaria drugs and support malaria control programs to all African countries. In order to achieve this, several challenges need to be overcome in the distribution channels by engaging the local people and the governments
- Effective control through programs can be boosted by channeling funds to adequate research into innovative methods of distribution rather than traditional methods. In addition, research on various factors influencing the distribution and program effectiveness needs to be emphasized so as to improve the program effectiveness.
- The government should assess the need for reduction of cost of anti-malarial drugs in the private sector to increase affordability at accessibility of the control methods. In addition, there is need for further subsidy for malarial control treatments.
References
Flanagin Annette, & Margaret Winker. Global health-Targeting Problems and Achieving Solutions. 2003. JAMA. 290:10. Web.
Freidman, T., L. (2000). The Lexus and the Olive Tree: Understanding Globalization. New York, NY: Farrar Straus & Giroux.
WHO. (2008). World Malaria Report 2008: Interventions to control malaria. Web.
World Bank Group. 2007. Boosting the fight against malaria in Africa. Web.