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AFRO-NETS> Rolling back malaria
- Subject: AFRO-NETS> Rolling back malaria
- From: Dieter Neuvians MD <email@example.com>
- Date: Tue, 2 Mar 1999 17:07:31 -0500 (EST)
This is from the TDR Newsletter 58.
Rolling back malaria
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
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
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
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,
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