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

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 E2 Trend of Malaria Deaths China N.America & Europe Africa Annual Deaths from Malaria (millions) (R.Carter,1999) Central & S.America Asia World

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 E3 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 E4 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

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 E5  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

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 E6 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 E7 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 E8 Access to Prompt and Effective Treatment Coverage Children under 5: medium 50% (3- 69%) –Based on 35 national surveys ( ) –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 E9 Insecticide-treated bednets (ITN) Children under 5 (coverage as found in 45 country surveys) Eritrea81% Togo63% 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 E10 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 E11 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 E12 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

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 E13 What should be done? 1.Strong WHO leadership 2.Right technical policy Treatmentdone IRScoming soon ITNcoming soon 3.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 E14 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 or create a new one? What should be done?

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 E15 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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