AFRO-NETS> Malaria Strategy - 11 months later

[Jacques du Preez <amsharp@mweb.co.za>]

Malaria Strategy - 11 months later
----------------------------------

With reference to the USAID Infectious Diseases Strategy Conference 
last year I want to enquire on global progress. If my calculations are 
correct another one to two million people have died as a result of Ma-
laria.

How many new role players joined the global fight against Malaria?

How many individuals/entrepreneurs have been given incentives for their 
work participation?

I am asking these questions in view of the following two reasons:

1. Statements underlining the overwhelming support that should be given
   to preventative measures at the Strategy Conference 16-17 Dec. 1997.

2. Recently I introduced the world's first US$ 1.00 Mosquito Bednet for
   use by the poorest amongst humans - unfortunately this initiative is
   lacking support.

Maybe I did not speak to the right audience - if you can help remedy 
this situation and assist us to gain support for our campaign - based 
in South Africa - it will be a blessing to mankind. We endeavour to es-
tablish the first "Malaria Day" in the year 2000 to gain global support 
for the fight against Malaria.

Have we moved from a strategy to a definite plan?

The following statements were taken from the official proceedings Re-
port: Technical Consultation on USAID's infectious Diseases Strategy. 
16-17 December 1997, Washington, DC:

(From: -Preface: J Brian Antwood (USAID Administrator) On December 16-
17, 1997 the United States Agency for International Development (USAID) 
hosted a two-day conference with many of its key partners as part of a 
consultative process to help develop a new strategy for USAID in infec-
tious diseases. As a result of this conference and subsequent consulta-
tions, USAID has developed a comprehensive strategy for infectious dis-
eases. This strategy reflects the substantive and strategic input of 
USAID's partners, and will help guide our efforts to reduce the threat 
of infectious diseases in the developing world.

(From: Senator Patrick Leahy's Statement) "I share the view that there 
are diseases like TB and Malaria that deserve particular attention. We 
need an integrated, global network. We all recognise that governments 
cannot do this alone. The private sector plays a central role, and the 
strategy must reflect that. Private companies need incentives. We need 
to do what others and I did in the first years of the campaign against 
landmines: - shine a bright light on the problem. Once people under-
stand it, they will want to solve it. Perhaps more than anything, in-
fectious diseases illustrate that we are a global community, that we 
are linked to one another in increasingly complex ways, and that we are 
all in this fight together. It is a fight I welcome, because we are go-
ing to make life better for millions and millions of people."

(From: Summary of Dr Nils Daulaire's Presentation) "Fifty million dol-
lars in the first year of this initiative is a considerable sum and 
should enable USAID to make a significant contribution to addressing 
the problem of infectious diseases. The emphasis of the new initiative 
will be on targeted activities, which build on the foundation of ongo-
ing activities in primary prevention and improved health systems."

(From: WHO: Summary of Dr. David L. Heymann's Presentation:) These dis-
eases seek out the poorest and most vulnerable: woman and children.

(From: UNICEF: Summary of Dr. Vincent Orinda's Presentation) Potential 
NICEF Contribution: Malaria prevention and control through scaling up 
bednet programs and re-dipping of bednets.

(From: Summary of Technical Presentation by Dr. Tore Godal, WHO;) "An 
estimated 300-500 million cases of Malaria are reported each year 
throughout the world. Eighty percent of Malaria morbidity and 90% of 
mortality occurs in Africa. WHO's current control strategy focuses on 
prevention administering prophylaxis during pregnancy, promoting use of 
insecticide-treated bednets, and selective use of insecticides.

Both short- and long-term measures can be recommended. Short-term: 
Strengthen national control programs (e.g., improve case management, 
implement use of insecticide 96 impregnated bednets, survey drug resis-
tance). Ensuring optimal use of resources calls for increased collabo-
ration between Malaria-related and health-sector-related programs, be-
tween public and private sectors, and between bilateral and multina-
tional agencies".

(From: World Bank: Summary of Ms Malayah Harper's Presentation) The 
overall World Bank Strategy in health has been to link up with global 
initiatives. The Bank is interested in developing a program emphasising 
Malaria and other major diseases. At present, there are only six major 
diseases. At present, there are only six free-standing Malaria projects 
with total funding of $200 million. The vast majority are in India. 
There is only one free-standing programme in Africa, with total funding 
of $25 million. Given that record, the Bank has decided to put more re-
sources in Malaria control. The Bank's Malaria "work in progress" has 
three basic goals: to increase the number of projects in Africa, to 
conduct additional research (a two-year research project on the econom-
ics of Malaria is ongoing), and to launch an African-led and -based Ma-
laria program in the year 2000.

(From: NIH: Summary of Dr. George Curlin's Presentation:) "Addressing 
emerging infectious diseases is a national priority for the United 
States. Areas of concentration: Malaria NIH plays an active role in a 
multinational initiative in Malaria, with most work in the area of vac-
cines for control in concert with other interventions".

(From: Work Group No 1 Report on Malaria) "Prevention through bednets: 
Information on preventing Malaria is mostly based on trials with the 
use of insecticide-treated bednets in Africa. USAID sponsored a confer-
ence in October 1997 on bednets; participants discussed issues of de-
mand, access, affordability, and monitoring and evaluation of correct 
use of bednets. WHO has invested a lot of money in bednet research. Ef-
ficacy trials are nearly completed, but participants agreed that more 
research needs to be done and agreed that, in general, large-scale Ma-
laria control programmes have not provided very good monitoring and 
evaluation information. Ideally, every family would have bednets, but 
participants wondered if large-scale programs were sustainable. Trails 
of bednet use have shown that some question remain unanswered; in par-
ticular, no one really knows how to implement a large-scale programme."

(From: Summary. Synthesis, and Next Steps: Summary of Presentation by 
Dr. Nils Daulaire, USAID)

MALARIA
a. Programs should focus on management of cases in the home and in the
   community; 
b. Prevention efforts should emphasise insecticide-impregnated bednets,
   environmental management, and vaccine trials.

(From: Closing Presentation, Administrator J. Brain Atwood, USAID) 
"USAID Staff will begin tomorrow reviewing your recommendations, incor-
porating your advice, and working with you to enlarge the partnership 
you have helped establish. We all bring to this discussion the strength 
of our specific perspectives. Represented among you are a broad variety 
of personal and institutional missions, and each of us would probably 
describe our challenge somewhat differently. At USAID, our mission of 
course is, and will continue to be, sustainable development. We view 
all our programmes and funds through the lens of what they will do to 
strengthen societies' ability to address their own problems over the 
long term. Our job is to build America's partners of tomorrow, not to 
preserve dependency on our largesse, or our expertise. Triage can only 
be effective in the short term. This is at times a different vantage 
point from those of you whose mission is to deal with disease, often 
one particular disease, and whose first priority is to get the job done 
as quickly and efficiently as possible. I believe the discussion that 
has unfolded over the past two days has brought these two vantage 
points together, so that we are all much closer to being able to envi-
sion our battle as it really is: not just an issue of microbes, but one 
of human societies. Not just of cure, but of fundamental prevention. As 
we move over to the next months from a strategy to a definite plan.

And I have asked Dr. Daulaire to make sure that the process continues 
to be open and collegial, and to assure that the end product will both 
fight disease and promote sustainable development".

CONCLUSION:

In my opinion a definite plan should include incentives and 
practical means to promote participation by inventors / creative indi-
viduals / entrepreneurs / and small and medium business enterprises. 

Healthy Blessings,

Jacques du Preez
International Bednet Co-ordinator
mailto:amsharp@mweb.co.za

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