AFRO-NETS> Malaria initiative gains momentum

[Dieter Neuvians MD <neuvians@harare.iafrica.com>]

Malaria initiative gains momentum
---------------------------------

WHO's new Director-General, Gro Harlem Brundtiand, acted swiftly 
on her arrival in office to tackle one of sub-Saharan Africa's 
greatest health threats. She announced the start of a new initia-
tive called 'Roll Back Malaria' (RBM) - a campaign intended to 
curb a disease that kills a million people every year, most of 
them children in poor African countries.

Malaria causes up to 500 million cases of illness each year. The 
economic costs, including control efforts and working days lost 
through illness are estimated to be between 1 % and 5% of the 
gross domestic product of affected African countries. Poverty, 
disintegrating health services, war, rapid urbanisation and the 
mass movement of refugees have all fuelled the spread of the dis-
ease in recent years.

RBM is different from previous approaches to controlling the dis-
ease. As well as seeking to develop new tools, it is intended to 
strengthen the health systems catering for the populations most 
heavily affected by malaria so that they can deliver the existing 
tools for preventing and treating the disease more efficiently 
and equitably. This means, for example, making insect-impregnated 
bednets more widely available and improving access to treatments 
with the existing drugs, which can save many lives. 

RBM's approach will also seek to involve less formal healthcare 
providers in communities, including drug vendors and traditional 
healers. The project is jointly sponsored by UNICEF, UNDP, the 
World Bank, and WHO. Its budget over the first 18-month planning 
stage is just under US$ 20 million.

Tore Godal, RBM's acting project manager, said the first year's 
priorities included the formation of clear strategies in each af-
fected country. These strategies would need to take account of 
the realities of the health system, he said. Godal added that the 
provisional findings of assessments of each country's needs had 
revealed that, in many cases, the situation was worse than ex-
pected. "People are given substandard treatment and the use of 
health facilities seems to be minimal even where they exist," he 
said. "That just provides further justification for Roll Back Ma-
laria."

Within five years, he hopes, the project "will really make a dif-
ference in the field". He envisages more potent combinations of 
drugs that should help to slow the emergence of resistant malaria 
parasites; and, equally important, advances in the delivery of 
health services that would enable more people to benefit from the 
existing drugs and the best standards of existing care and pre-
vention. In addition, the project's goals include more accurate 
measurement of malaria's impact on child survival, using "senti-
nel" sites across the sub-Saharan African region.

From: Bulletin of the World Health Organization, 1999,77(1)


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