Malaria: the Bigger Picture
By Dr Fatoumata Nafo-Traoré
20 April 2013
When in the year 2000 African leaders first decided to put a Malaria Day on the calendar of the world, the ravages of malaria were barely visible to global decision-makers in prosperous countries. A neglected disease of poverty, malaria shattered the lives of communities across the global South without much of a public outcry.
"Every day is malaria day here," a doctor told me once while I was visiting a health center in the Gao Region in the north of Mali. As the newly-appointed Health Minister of Mali, I was touring my country to take stock of the situation and meet the people who looked after the health of the nation. As I was talked to the staff, I saw a woman hunched over folded bright-coloured cloth, grief etched on her face. "She carried her twins in this," the doctor said. "She walked for two days to bring them here. They were in coma when she came - it was too late to treat their malaria."
"We see children die every day," a nurse added in a low voice. "And it rarely makes the news."
Malaria will make the news today. Major newspapers will talk about one of the best success stories we have recently had in public health. Cameras will be pointed at the frontlines of the malaria fight. On Twitter, Facebook and the entire worldwide web, organisations, champions from different walks of life will urge the world to focus funding and attention on the global effort to defeat malaria.
This groundswell of publicity - a success in its own right – speaks to the ground-breaking changes that have taken place in the malaria fight over the past 13 years.
African leaders' Abuja commitment to tackle malaria set in motion events that were to change the fate of millions. Their call to action was echoed in the millennium vision for improving the state of the world - the Millennium Development Goals, agreed by every UN member state. A global partnership to Roll Back Malaria deployed the power of its diverse partner organizations to bring the facts and faces of the untold malaria story to the public eye. It rallied all key stakeholders behind a single vision and a consensus strategy for coordinated action.
As confidence strengthened, international donors invested more than 10 billion in global malaria control efforts over the past decade, mainly through the Global Fund, the US President's Malaria Initiative (PMI), and the World Bank, but also through UK's DFID and the Gates Foundation. That funding bought four key antimalarial interventions – insecticide-treated nets, home-spraying, diagnosis and prompt treatment with effective medicines. With more commitment and cash behind global control efforts, the malaria community grew larger, more diverse and better equipped to support endemic countries in delivering commodities and services to people in need.
Today the malaria map is shrinking. Malaria deaths in Africa are down by one-third; worldwide - by a quarter, compared to year 2000. The last World Malaria Report 2012 shows thatof the 104 malaria-endemic countries, 50 are on track to reduce malaria incidence rates by 75% by 2015. 9 of these are in Africa. More than a million lives have been saved from malaria since year 2000, mainly among children under 5 years of age.
Malaria control has been hailed as one of the best buys in public health, a cost-effective strategy for making the world a better place. It has been shown to speed up progress towards many of the other MDGs related to child and maternal health, education and poverty reduction.
But the gains that have been made so far remain fragile. The push to roll back malaria cannot afford to stop here. The successes in countries need not only be widened to cover all populations at risk but also sustained for many years. Emerging resistance to currently available tools must be contained. Research for new tools, policies and techniques need to continue.
Despite its astounding progress, Africa faces defeat if the resources that have made its success possible are not maintained. And if Africa fails, the global effort would have failed too, and the cost of repairing the losses would far exceed the size of the investment needed today. Of the US$ 5 billion needed every year to achieve and maintain universal access to malaria interventions worldwide, less than a half – some US$ 2.3 billion - is currently available.
RBM partners have developed and are currently rolling out a strategy for mobilising the resources needed in Africa and worldwide to meet the 2015 malaria targets and keep malaria at bay thereafter. In today's global economic environment, committing domestic funds to health becomes all the more important; using available resources wisely – all the more critical and diversifying sources of funding – inevitable. These principles are key elements of the RBM strategy that partners are currently pursuing together with the UN Special Envoy for Special Envoy for Malaria and for the Financing of the Health-related Millennium Development Goals (MDGs).
Next month the RBM Partnership will launch a three-year campaign to show the bigger picture in malaria control and boost action towards reaching the malaria-related MDGs. The campaign will provide a window on political commitment and investments and show who is who in malaria control and how partner organizations contribute to progress. It will demonstrate that there can be no sustainable economic and social growth without a sustained investment in malaria control and elimination efforts.
In a few months – in September this year – the Global Fund, malaria's main financier, will be asking for donor contributions to continue its effort to reverse the three big killer diseases of our time – malaria, TB and HIV. While endemic countries are putting more of their own budgets into malaria control, many of them, especially among low-income countries, continue to rely on Global Fund grants to meet urgent malaria control needs. A fully replenished Global Fund will sustain countries' efforts to reach the health MDGs. Some countries will meet these ambitious goals, others won't. But every country would benefit from ramping up their efforts.
The momentum that has been built in the past years, if sustained, has the power to lift the burden of malaria and other major disease from Africa and the world. This is a rare opportunity. One that may not come again.
Now is the time to invest in the health of the world's poor. This will not be an act of charity. It will be an investment. An investment in healthier, more equitable and affluent societies. An investment in a safer world.