[afro-nets] Malaria - Conference in Ethiopia - Some Observations

["Peter Burgess" <peterbnyc@gmail.com>]

Dear Colleagues

In a recent message about a Malaria Conference in Ethiopia the following was said:
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"Malaria poses one of the greatest threats to human life in the developing world. Of the estimated 1 million malaria deaths worldwide, 90% occur in Africa, killing mostly young children at a rate of 3,000 every day.

"Malaria costs Africa US$12 billion every year in lost productivity.

"Currently, in countries with a very heavy malaria burden, the disease can account for as much as 40% of public health expenditure, 50% of inpatient admissions and up to 60% of outpatient visits.

"Antimalarial medicines are a critical component in the fight against malaria, alongside other preventative interventions such as insecticide treated mosquito nets and indoor spraying with insecticide."

and Ray Chambers, Co-Chairman of Malaria No More was reported to have said:
"We have the knowledge, the tools, and the will to succeed ... We will work hand in hand with all the Roll Back Malaria partners to end this scourge. No more children should die from malaria; entire countries should no longer suffer."
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These remarks raise questions that do not seem to get answered in any of the presentations being made to the public.

(1) ... The number of 3,000 children dying every day has been used for several years now ... and during this time period a very large amount of money has been disbursed for anti-malaria activities. Either we don't have a serious set of impact metrics or we are using the anti-malaria money in a very ineffective way. Perhaps it is both. In any event this is a red flag for an accountant, which is part of my training and passion.

(2) ... If "Malaria costs Africa US$12 billion every year in lost productivity" doesn't it make sense to address this matter as a high priority? But how would you actually address this? My answer would be to consider anti-malaria interventions that reduce the burden of malaria on society ... specifically the morbidity of adults caused by malaria. In the current anti-malaria intervention paradigm, this is totally discounted with effort and funds going into interventions to reduce mortality of young children and pregnant women, both of which are emotionally correct, but have little or no impact on the lost productivity cost. The singular focus on young children and pregnant women using bednets and to a less extent IRS, is showing good results in this limited population but at a very high cost with probably no impact on the larger morbidity issue. A fully integrated comprehensive program would be much more effective AND in large part Africa could pay for it in due course with the productivity gains.

(3) ... The above numbers about the proportion of health sector expenditures going towards malaria is an interesting number, but not much more. Journalism at its best. I really don't know what it means since the financial information about health sector activities is mostly totally incoherent in part because of the international funding components and in part because of the tiny role of government money and the much bigger role of individuals' money and in part because accounting is such a very low priority in the international relief and development sector.

(4) ... I keep reminding myself about the eradication of malaria in other parts of the world and a long time ago. Gorgas during the Panama Canal construction and all sorts of other successes through the 1960s. While "antimalarial medicines are a critical component in the fight against malaria, alongside other preventative interventions such as insecticide treated mosquito nets and indoor spraying with insecticide" the important question is whether or not this is going to be enough to break the transmission cycle and stop perpetual re-infection ... together with more and more difficult resistance. Getting to grips with the mosquito dynamic as well as the malaria parasite is absolutely critical unless the world is willing to have this fight and this funding go on for ever.

(5) ... Mr. Ray Chambers of Malaria No More leaves out one absolutely vital element ... while he refers to "tools" to succeed, the critical management tool of metrics about cost effectiveness is missing. While there is a lot of activity in the anti-malaria sub-sector, metrics about cost effectiveness are almost totally missing. Surely a key metric is the prevalence of malaria parasite in the mosquito population and in the human host and how much this is reduced and at what cost. Is this the best that can be done? As far as I can see, the key leaders in the sub-sector have every intention of leaving this situation the way it is. This does, of course, facilitate low quality operational performance and outright corruption ... and in the final analysis ensures that more people will die and more people will be ill than should be the case.

I wish I was wrong ... but please keep this e-mail and have a look at it again in five years time.

Sincerely

Peter Burgess

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Peter Burgess
The Transparency and Accountability Network: Tr-Ac-Net in New York
http://www.tr-ac-net.org
IMMC - The Integrated Malaria Management Consortium Inc.
http://www.IMMConsortium.org
+1 917 432 1191 or +1 212 772 6918  
mailto:peterbnyc@gmail.com