[afro-nets] World Bank accused of deception over malaria funding

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

World Bank accused of deception over malaria funding
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* Campaign leader is unfit for task, say doctors
* Death toll prevention claims 'unfounded'

Sarah Boseley, health editor
Tuesday April 25, 2006
The Guardian

The World Bank, a leader in the global effort to control ma-
laria, has been accused of deception and medical malpractice by
a group of public health doctors for failing to carry out its
funding promises and wrongly claiming its programmes have been
successful at cutting the death toll from the disease.

The serious charges are levelled by Amir Attaran, a professor at
the Institute of Population Health and faculty of law of Ottawa
University, and colleagues from around the world. Writing in an
online publication for the Lancet medical journal, they say the
World Bank is unfit to lead global efforts to control the dis-
ease, which kills around 1 million people a year - most of them
small children.

Article continues They argue that the World Bank has not deliv-
ered the $300m-$500m (£168m-£280m) funding it promised to Af-
rica when it launched the ambitious global Roll Back Malaria
campaign in 1998, which was intended to halve malaria deaths
this decade. They add that it has not been open about the
amounts it is spending on malaria and that it has wasted money
and endangered lives by allowing countries to buy malarial drugs
that no longer work.

In a response, also published online, the Bank acknowledges that
it should have done more in the past but says its current pro-
grammes are well-funded, well-staffed and delivering results.

Professor Attaran and colleagues say the new plan "is inadequate
to reverse the Bank's troubling history of neglect for malaria".
The Bank at first refused to disclose how much it had spent on
malaria in each country, say the authors, but eventually pub-
lished accounts in April 2005 showing that in the previous five
years it had committed $100m-$150m to malaria programmes. It had
also spent non-earmarked funds on malaria it says are "difficult
to quantify", says the article.

"The most disturbing fact, however, is that the Bank actually
does not know, and at best guesses, how much money it spends or
loans for malaria," say the authors. "No commercial high-street
bank could keep such imprecise accounts for its clients without
running a serious risk of civil or criminal illegality."

In 1998 the Bank had seven staff dedicated to malaria. By 2002
it had none. "Without even a single worker, the malaria pro-
gramme could do little ... we cannot know what lay behind the
downsizing of the Bank's malaria team and whether the reduction
in staff is explained by careless management or an intention to
renege on the funds pledged to Africa. Regardless, funds stalled
just as Africa's malaria cases rose sharply, destroying several
million children's lives and deepening the poverty the Bank had
promised to ameliorate," they write.

The Bank says malaria cases in Brazil dropped by 60% between
1989 and 1996 as a result of its programmes there. Prof Attaran
and colleagues say the figure was 23%. The Bank claimed malaria
deaths in three Indian states, Gujarat, Maharashtra and Rajast-
han, dropped by 58%, 98% and 79% between 2002 and 2003. The au-
thors obtained statistics from India's directorate of national
vector-borne diseases control programme. In that year, "far from
malaria cases declining in the three states the Bank names, ac-
tually the numbers rose sharply in all of them", they write.

The Bank, they conclude, "remains unfit for any operational role
whatsoever in malaria control". They call for its role to be
passed to other agencies, principally the Global Fund to fight
Aids, Tuberculosis and Malaria.

Jean-Louis Sarbib and colleagues, for the World Bank, say it is
difficult to be specific about the sums spent on malaria, some
of which will have gone to improve healthcare systems, the
training of staff and the provision of drugs for a variety of
diseases, not just one. They reject accusations the Bank has
funded chloroquine for areas of India where it no longer works
because of resistance that has built up in the parasite which
causes the disease.

Mr Sarbib and colleagues say the World Bank is dedicated to
fighting malaria. "Paul Wolfowitz has put the full weight of his
leadership behind the Bank's renewed commitment to malaria,"
they say.

But the Lancet points out that "malaria was absent from
Wolfowitz's policy speech on April 11 ... instead, he emphasised
reducing corruption in recipient governments by increasing the
Bank's department of integrity staff from 53 to 65". If the Bank
is serious about results, the journal says, it needs to focus on
the Abuja 2000 target of halving mortality by 2010.

Parasite facts

* Malaria is caused by a parasite passed by an infected female
Anopheles mosquito. There are four species of parasite, of which
the two most common are Plasmodium falciparum and Plasmodium
vivax.

* Symptoms include extreme exhaustion with high fever, sweating,
shaking chills and anaemia.

* Patients need treatment within 24 hours to avoid risk of se-
vere disease, which has a high fatality rate.

* Resistance to commonly used drugs has grown rapidly. The new
hope is the artmisinin compounds, derived from a Chinese herb.