AFRO-NETS> Rolling back malaria

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

This is from the TDR Newsletter 58.

Jocelyne Bruyere, 
TDR Communications 
mailto:bruyerej@who.ch

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Rolling back malaria
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In the last issue of TDR news we mentioned the new WHO Roll Back Ma-
laria (RBM) project, which supports the Global Roll Back Malaria part-
nership. It aims to co-ordinate global action to fight malaria and help 
governments reach their own targets to combat the disease in their 
countries.

Many efforts in malaria control have been initiated in the last decade. 
For instance, readers will be aware of the political commitment shown 
by the adoption of the Malaria Control Strategy in 1992 by ministers of 
health in Amsterdam; the research commitment seen with the setting up 
of the Multilateral Initiative on Malaria in 1997; and the private sec-
tor commitment now apparent with the setting up of the Medicines for 
Malaria Venture.

So why do we need another effort?  Isn't there enough capability for 
research and control of malaria in endemic countries?  Aren't many ini-
tiatives in malaria control going on in most endemic countries these 
days?  The fact is that, despite affirmative answers to questions such 
as these, malaria is still a problem. In some places the disease is 
getting worse, and in many places we are holding the disease at bay, 
but in all places we are failing to roll it back. Reasons for this in-
clude lack of co-ordination of international assistance to countries 
for control, failure to deliver and implement malaria control tools due 
to weak health systems in malaria-endemic countries, lack of funding, 
and technical reasons such as drug resistance and insecticide resis-
tance. RBM is addressing all these issues. It will provide overarching 
co-ordination of all efforts at malaria control; it will promote the 
development and better utilisation of all tools for malaria control - 
old, new and future - as and where appropriate; and it will help 
strengthen the health sector. But it will be driven by the countries.

To provide help for countries and monitor all interventions, RBM will 
depend on Resource Networks, each concerned with a specific issue and 
linking experts in research and academic institutions with district 
health teams and disease control institutions in endemic countries. 
Tools for malaria control that will be implemented through networking 
include insecticide-treated bednets, rectal suppositories, the package 
of essential interventions for Care of the Sick Child, simple packaging 
of anti-malarials to help ensure people take the proper course of 
treatment, improved referral for severe malaria by mothers and tradi-
tional healers, and training of drug suppliers in provision and coun-
selling for safe use of anti-malarials. Networking will also help en-
sure that locally-produced antimalarials meet Good Manufacturing Prac-
tice standards and that favourable pricing structures for antimalarials 
are created for poor peoples, that epidemics are forecast better, and 
that drug and insecticide resistance are detected and their spread 
slowed. 

But will it work? One reason for a positive answer is that we know we 
can better control malaria with the tools at our disposal today. And 
this is without the new tools that are on the horizon - vaccines, re-
sistant mosquitos, new drugs. And we know that there is capability for 
malaria research and control in endemic countries.

Didn't WHO try a similar thing once before? Similar, perhaps, but not 
the same. In the 1950s and '60s the aim was eradication, whereas today 
it is more modest - to significantly reduce the number of childhood 
deaths from malaria and the incidence of malaria through better imple-
mentation of all control tools. Considered by many a failure, the 
eradication campaign of WHO did in fact have a major impact in most 
places - in some places even the goal of eradication was achieved and 
in most places, except highly endemic areas, the disease was at least 
brought under control. One lesson learned was that dedicated campaigns 
for control are not sustainable and that there is no one solution to 
fit all malaria situations - each situation is unique. That is why one 
of the first steps in RBM is for each country to carry out a situation 
analysis (of local malaria treatment and prevention practices, avail-
ability and quality of health care, etc.) and needs assessment and, on 
the basis of this, incorporate actions for roll back malaria within 
health sector development.

The RBM project has now been functioning for more than six months. The 
first priority was Africa. All heads of government in malaria-endemic 
countries of Africa have been contacted and many Resource Networks have 
been set up - as reported in the last issue of TDR news, four networks 
met for the first time in Geneva in October. Already some situation 
analysis methodologies have been developed for district level in Af-
rica. RBM is now expanding to other regions, and preparatory activities 
have begun in the WHO Regional Offices for South-East Asia and the 
Western Pacific. In December, all stakeholders in RBM met in Geneva to 
begin establishing the global RBM partnership.

At first led by Tore Godal, the Roll Back Malaria project now has its 
Manager in David Nabarro, ex Chief Health Advisor and Strategic Direc-
tor at the Department for International Development in the UK.

For further information on RBM, 
mailto:rbm@who.int



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