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

1. Roll Back Malaria:Why it has far failed?What should be done? Dr A Kochi Director, Global Malaria Programme WHO/Geneva

2. Africa Asia China Central & S.America World N.America & Europe 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 W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

3. Malaria cases by region in 2002 (estimates) W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

4. 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 W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

5. 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 W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

6. 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 W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

7. 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 W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

8. 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) W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

9. 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% W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

10. Indoor Residual Spraying (IRS) Implemented in 17 Southern and West African countries Coverage 2.7 million households (1999) 4 million households (2003) W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

11. Intermittent Preventive Therapy (IPT) in pregnancy • 29 countries adopted IPT policy • 22 countries are implementing IPT • 6 countries achieved more than 60% coverage W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

12. 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 W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

13. 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 W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

14. 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 operations1~5 TB model • Research to be expanded, more focused and innovative • Partnership: fix the current one orcreate a new one? W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

15. 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 W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E

16. W O R L D H E A L T H O R G A N I Z A T I O N / G L O B A L M A L A R I A P R O G R A M M E