The partnership needs to continuously respond to the changing malaira landscape and redefine its added value
Dr Fatoumata Nafo-Traore - RBM Executive Director
drawing

At the start of any community malaria research, it’s important to understand and visualize how plans will work (or not) in the field. Above, community health workers map out the areas for a sweeping ‘test and treat’ campaign, a huge research effort in Southern Zambia. In the past couple of years, thanks to a Ministry of Health and PATH-MACEPA partnership, more than 250,000 people in Southern Province have been tested for malaria at the household level.

FOREWORD

The partnership needs to continuously respond to the changing malaira landscape and redefine its added value
Dr Fatoumata Nafo-Traore - RBM Executive Director

Malaria has led to the tragic loss of lives and robbed many households and communities of their livelihoods, locking them in a vicious cycle of illness and poverty. However, the last decade has witnessed significant changes and improvements in the global malaria situation. In my new capacity as Executive Director of the Roll Back Malaria Partnership, I want to congratulate all Partners for the advances made to save lives and drive and safeguard development gains. Concerted efforts in strategy development advocacy, coordination, financing and service delivery have reaped considerable results. I feel privileged to be part of this highly respected initiative which has acquired a worldwide reputation as an effective and results-oriented global health partnership.

The progress made to date is extremely encouraging but we must now, more than ever, work collaboratively and effectively to sustain the gains and intensify our contribution to reach the ambitious goals set out in the Global Malaria Action Plan. Achieving the Partnership vision of near-zero malaria deaths by 2015 will require the participation of a wider range of partners and more carefully orchestrated action to avoid the risk of fragmentation.

Only three years remain to demonstrate that reducing the burden of malaria is a key factor in achieving several of the Millennium Development Goals including the reduction of child mortality, the improvement of maternal health, achieving universal primary education, and eradicating poverty .

In order to keep up the momentum, the Partnership needs to continuously respond to the changing malaria landscape, redefine its added value and ensure that its efforts translate into providing malaria services, preventing illnesses, saving lives, and ensuring that populations and communities in malaria-endemic areas can realize their economic potential.

I believe we must urgently act on the following:

  • Support the roll-out of our resource mobilization strategy and strive to ensure sufficient funding for malaria-endemic countries, so that they can continue their scale-up of malaria control
  • Strengthen implementation of plans to contain both drug and insecticide resistance
  • Improve targeting and focus more acutely on areas with the highest burden, as well as the hard-to-reach populations often comprising the poorest segments of society
  • Strengthen national malaria partnerships by broadening the range of country actors and implementing the ‘three ones principle’, namely: one national malaria strategic plan, one coordinating body, one monitoring and evaluation plan
  • Continue to maintain malaria as high as possible on the development agenda and articulate its inclusion in the post-2015 development agenda.

I look forward to working with you in the coming year to sustain the progress made to date, focus on identified priorities, and ensure that the architecture of this Partnership remains relevant as we push toward the realization of the 2015 targets contained in the Millennium Development Goals.

drawing

At the start of any community malaria research, it’s important to understand and visualize how plans will work (or not) in the field. Above, community health workers map out the areas for a sweeping ‘test and treat’ campaign, a huge research effort in Southern Zambia. In the past couple of years, thanks to a Ministry of Health and PATH-MACEPA partnership, more than 250,000 people in Southern Province have been tested for malaria at the household level.

Dr Victor Makwenge Kaput - RBM Board Chairtreatmentteachinghut

A MESSAGE FROM
THE BOARD CHAIR

FOLLOWING A YEAR OF OPTIMISM, PROGRESS AND RESULTS IN 2011, THIS PARTNERSHIP WAS CONFRONTED WITH A REALITY CHECK IN 2012.

Dr Victor Makwenge Kaput - RBM Board Chair

The impact of financial constraints faced by governments and institutions have drastically affected global funding for health, while the recent Global Fund reforms and restructuring have reduced the flow of funding for malaria control. According to calculations by the RBM Harmonization Working Group (HWG), 2012 has been the slowest delivery year for LLINs since 2007.1

The expansion of funding for malaria, which has characterized the past decade and which has led to an unprecedented record of results and impact, needs to be sustained in years to come. But in order to reach universal coverage, we need to look for ways to optimize synergies between programmes and maximize value for money.

Immediate concrete action is required to provide continued support to eight African countries (Central African Republic, Côte d’Ivoire, the Democratic Republic of Congo, Ethiopia, Mauritania, Niger, Nigeria and Sierra Leone) as they are currently facing acute funding gaps of an estimated US$1.8 billion over the next three years, with Nigeria alone accounting for US$1 billion of this sum. Rapid resource mobilization efforts are planned, including joint visits to countries and regional economic commissions to advocate for increased domestic contributions. The Partnership is generating specific financing plans for each country, which will be used to mobilize support.

HWG has been very effective in mobilizing malaria funding through grant applications, but the new Global Fund funding model will almost certainly require us to make adjustments to previous approaches. Stronger country-level RBM partnerships are now more essential than ever, as is maintaining a continuous dialogue with all health partners at country level, including malaria advocates, in order to have continuous and consistent representation on Country Coordinating Mechanisms (CCMs).

treatment

While it was decided that the historical Global Fund allocation of 52% HIV/AIDS, 32% Malaria and 16% TB will remain for the next 10 months until September 2013, RBM partners need to participate in consultations that will articulate a more rational basis for a new allocation based on the existing burden of disease. Additionally, we urgently need to determine a practical means of enhancing the value for money of each dollar spent on malaria control.

Securing diverse and sustainable support, including substantive funding from domestic sources, traditional bilateral and multilateral aid, as well as innovative sources of funding, is critical to meet the funding gaps over the coming years.

To pursue resource mobilization efforts outside of Africa, the 2013 Plan of Action emanating from the Sydney Consensus2 provides a platform for dialogue with the emerging economies in Asia. Public-private partnerships outside the health sector will be central in ensuring continued investments and keeping malaria transmission low to ensure that Asian countries move closer to pre-elimination status. This will also allow a continued inflow of private capital, the creation of job opportunities and economic growth.

Emerging economies need to be more robustly engaged in support of Africa’s needs, and the Tokyo Conference on African Development V (TICAD V) in 2013 will provide an ideal platform to advocate for greater involvement. Similar efforts are needed to reach outside the traditional OECD-DAC context, specifically toward the Arab Gulf countries and other emerging aid donors.

However, while looking at new donors, we should not forget the ongoing efforts of the United States to keep malaria high on the G8 agenda through the Accountability Report. In 2013, the United Kingdom will assume leadership of the G8 and will undoubtedly help to sustain and amplify political and funding commitments from the G8 group of donors to the GMAP in line with its previous strong commitment to malaria control and elimination.

teaching

Paramount to all our endeavours is keeping our focus on countries and communities needs by:

  • Ensuring bottom-up approaches for planning and budgeting so that country support is specific and tailored to operational challenges in malaria-endemic countries;
  • Strengthening support for country-level partnerships, through lead partners and/or the posting of Partnership officers, especially in large high-burden countries like Nigeria and DR Congo; and
  • Supporting the promotion of greater in-country communication for behavioural change and community empowerment.

The engagement of community health workers has been successfully implemented at the national level in some African countries, e.g. Ethiopia, Senegal and Rwanda, and could be used to support an integrated approach to case management (iCCM) as well as malaria prevention, particularly the continuous distribution of nets. WHO and other partners are currently undertaking operational research to inform the optimal design of community health worker extension programmes and how best they can integrate malaria control at the community level.

The RBM Partnership has the opportunity to build on the ‘One Million Community Health Workers’3 campaign and other related interventions which have the potential to help scale up malaria control and provide synergies with other programmes, including in data collection.

Finally, we must make sure that the Global Plan for Insecticide Resistance Management in Malaria Vectors (GPIRM) launched earlier this year is implemented comprehensively at country level. We have the collective responsibility to promote these critical strategies and ensure they are widely understood. In addition, WHO’s ‘T3: Test Treat Track’ campaign to promote malaria diagnosis is an essential message which must be conveyed at every opportunity.

1. The RBM Partnership estimates that 49 million LLINs were delivered to African countries in the first nine months of this year, compared to an estimated 75 million nets distributed over the same period in 2011, and 106 million in 2010. At the current rate of delivery, the 88 million nets distributed three years ago may not be replaced, and the scale-up necessary to achieve the 2015 targets will be compromised.
2. Consensus on Malaria Control and Elimination in the Asia-Pacific, agreed at the Malaria 2012 conference held in Sydney, Australia, in October-November 2012.
3. A Call for One Million Community Health Workers, Earth Institute, Columbia University, September 2011.
 
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RBM PARTNERSHIP
VISION,
OBJECTIVES
AND TARGETS

THE RBM PARTNERSHIP WAS LAUNCHED IN 1998 BY WHO, UNICEF, UNDP AND THE WORLD BANK TO MOBILIZE COORDINATED ACTION AGAINST MALARIA WORLDWIDE.

Today, the Partnership brings together hundreds of partners from malaria-endemic countries, multilateral and donor organizations, the private sector, non-governmental organizations, foundations and the research and academic community.

The force of this public-private partnership lies in the diversity of its partners and in its ability to rally all sectors of society towards the common goal of reducing cases of malaria, saving lives and alleviating the poverty caused by malaria.

The RBM Partnership is guided by the goals and vision of the Global Malaria Action Plan (GMAP), behind which the global malaria community has united. Fully implemented, the plan could save 4.2 million lives by 2015.

VISION: ACHIEVE A MALARIA-FREE WORLD

GLOBAL MALARIA ACTION PLAN (GMAP)

In light of the progress made by 2010, the GMAP objectives and targets were updated in June 2011:

[OBJECTIVE 1] Reduce global malaria deaths to near zero by end-2015.

[OBJECTIVE 2] Reduce global malaria cases by 75% by end-2015 (from 2000 levels).

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[OBJECTIVE 3] Eliminate malaria by end 2015 in 10 new countries (since 2008) and in the WHO Europe Region.

Targets include:

  • Achieve and sustain universal access to and utilization of prevention measures
  • Achieve universal access to community case management (CCM) of malaria
  • Accelerate development of surveillance systems
  • Achieve universal access to case management in the public sector and to case management, or appropriate referral, in the private sector.

STATE OF THE GLOBAL
MALARIA RESPONSE

Malaria death rate per 100,000 population
4 women

THE IMPACT
OF MALARIA

The World Malaria Report of 2012 shows that in 2010, approximately 3.3 billion people were at risk of malaria around the world and 219 million cases are estimated to have occurred. The disease kills approximately 660,000 people annually, mostly children under five years of age in sub-Saharan Africa. Malaria transmission continued to affect 99 countries and territories around the world, inflicting a tremendous burden on countries in sub-Saharan Africa.

In addition, country-level malaria estimates available for 2010 show that 80% of estimated malaria deaths occurred in 14 of the 99 countries with ongoing transmission. Together, DR Congo and Nigeria accounted for over 40% of the estimated global total of malaria deaths. Tanzania, Uganda, Mozambique and Côte d’Ivoire were also highly affected by malaria. These six countries accounted for an estimated 47% (103 million) of global malaria cases. In South-East Asia, the second most affected part of the world, India has the highest malaria burden, followed by Indonesia and Myanmar.

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Overall Malaria mortality rates have fallen by more thank 25% since 2000

INTENSIFYING THE GLOBAL
RESPONSE TO MALARIA

A decade of intensified malaria control has clearly contributed significantly towards the rapidly accelerating trend of declining under five (U5) mortality rates in Africa4.

An in-depth study in Kenya by the World Bank5 argued that the observed infant and U5 mortality decline can be attributed to the ownership of LLINs (39% and 58%, respectively). The steeply declining U5 mortality rates will certainly enable a significant number of malaria-endemic countries to meet Goal 4 of the MDGs (which calls for halving of U5 mortality). However, despite a rapid reduction in U5 mortality the absolute death rates are still high. New determination embodied in the ‘Child Survival Call to Action’ launched this year by US Secretary of State Hillary Clinton, challenges the world to make specific plans to reduce child mortality to below 20 child deaths per 1,000 live births by 2035.

people

Malaria has also been placed at the forefront of the UN Secretary General’s (UNSG) five-year action agenda for 2012–2016, and features in the UNSG’s Every Woman Every Child initiative, which aims to save the lives of 16 million women and children between 2010 and 2015.

As a result of intensified efforts presented in the WHO World Malaria Report 2012:

  • Malaria mortality rates have fallen by more than 25% since 2000, with 43 countries recording decreases of more than 50% in the number of malaria cases
  • The number of ACT treatment courses delivered globally to the public and private sectors increased from 187 million in 2010 to 278 million in 2011
  • ACT stock-outs were averted in 17 countries as a result of increased inter-agency efforts
  • Coverage of at-risk populations through the increased delivery of bed nets in sub-Saharan Africa rose from 6 million in 2004 to 145 million in 2010
  • Scaling-up of indoor spraying has resulted in the protection of 153 million people. In Africa, the proportion of the at-risk population that was protected rose from less than 5% in 2005 to 11% in 2011, with 77 million people benefitting from the intervention
  • Eleven malaria-endemic countries and one area in sub-Saharan Africa are on track to meet the Abuja target of reducing the malaria burden by more than 50% by 2015
  • An estimated 28 million infants born each year stand to benefit from intermittent preventive treatment of infants (IPTi), a safe, simple, cost-effective treatment that has been well accepted by health workers and communities
  • Four new countries – Armenia, Morocco, Turkmenistan and the United Arab Emirates have been declared malaria-free. Overall, it is estimated that, between 2001 and 2010, 274 million more cases and 1.1 million more deaths were averted worldwide by the action taken by the international community to scale up the fight against malaria.6
4. The Economist (2012). African child mortality. The best story in development. Africa is experiencing some of the biggest falls in child mortality ever seen, anywhere. 19 May 2012.
5. Demombynes G., Trommlerova S.K. (2012). What Has Driven the Decline of Infant Mortality in Kenya? Policy Research Working Paper 6057, May 2012.
6. World Malaria Report 2012, WHO, Geneva, December 2012.
Figure 1: 2012 Country Road Map analyses of malaria control commodities. As as end 2012, 44 out of 47 (94%) Malaria-Endemic countries in Africa maintained a country road map
Ethiopia's health extension program

Ethiopia's health extension program
The Government of Ethiopia implemented the innovative Health Extension Program (HEP) to train a cadre of more than 3,000 health extension workers which provide basic curative and preventive health services to rural communities. This programme builds on the idea of equitable community-based access and aims at universal coverage. Such a context-sensitive approach transfers knowledge and skills to households and has succeeded in changing practices and attitudes towards disease prevention, family health, and hygiene and sanitation. Health extension workers test and treat malaria and provide the necessary data to track progress.

The WHO Global Plan for Insecticide Resistance Management in Malaria Vectors

Resistance Containment
The WHO Global Plan for Insecticide Resistance Management in Malaria Vectors (GPIRM) was launched in May 2012. GPIRM calls for the rapid identification of areas at risk of pyrethroid resistance. In order to measure this risk, technical resources need to be rapidly recruited at country level. Similarly, sentinel drug resistance monitoring sites need to be revitalized and expanded to cover areas outside the Greater Mekong region. This scale up of monitoring capacity requires additional resources and coordination, as well as extensive promotion and dissemination at country level.

A YEAR OF PARTNERSHIP
AND RESULTS.
KEY ACHIEVEMENTS IN 2012

Disease Control

SUB-REGIONAL FORA

The RBM Partnership supports countries to implement their national malaria control plan by establishing sub-regional networks (SRNs) in which malaria strategic planning, implementation review, bottleneck resolution and joint monitoring of progress can be undertaken to ensure the continued scale-up of malaria control interventions.

Ladies

10 High Burden Countries
Together, WHO, ALMA, IFRC, the RBM Secretariat and the office of the UN Special Envoy on Malaria have established a situation room to track challenges and bottlenecks and provide additional support to accelerate scale up in the following 10 hardest hit countries: Burkina Faso, Cameroon, Côte d'Ivoire, DR Congo, Ghana, Mozambique, Niger, Nigeria, Tanzania and Uganda

These fora provide a neutral platform for all interested stakeholders to align their inputs with GMAP to facilitate coordination of malaria control activities in the sub-region. They also create a supportive network among groups of countries to share experience in addressing operational challenges and enable the exchange of best practices between national malaria control programmes (NMCPs).

DEVELOPMENT AND TRACKING OF COUNTRY ROAD MAPS

Country road maps help countries to plan and record country progress in reaching milestones. The road maps contain key data on commodity needs and gaps, including the delivery of long-lasting insecticide-treated nets (LLINs), treatment and RDTs. As at end 2012, 44 out of 47 (94%) malaria-endemic countries in Africa maintained a country road map.

The graph in Figure 1 reflects the commodities that countries have programmed and that could be delivered within existing country capacities. At the beginning of 2012, considerable gaps were observed between planned and available or funded quantities existed for artemisinin-based combination therapy (ACTs), RDTs and indoor residual spraying (IRS), whereas for LLINs available quantities corresponded more closely with requirements.

MALARIA PROGRAMME REVIEWS

The malaria programme performance review (MPR) is a periodic joint programme management process for reviewing progress and performance of country programs within the national health and development agenda. Its aim is to improve performance and re define the strategic direction and focus of the malaria control programme. MPRs also provide a critical basis for coordination among partners and for application of the ‘Three Ones’ principle: one result oriented strategic and operational plan; one national coordinating mechanism for implementation support; one monitoring and evaluation system.

The in-depth review of the entire malaria programme, including the organization and strategies for the delivery of commodities, relies on the data and information collected from field visits and other sources and leads to a re-orientation of country plans to sustain malaria control or to steer towards elimination. In 2012, 60% (27) of all African malaria endemic countries conducted MPRs, including DR Congo, Ethiopia, Nigeria and Sudan, with support provided by RBM partners and sub-regional networks (SRN). Increasingly, this practice has been adopted by non-African countries including Nepal, Indonesia, Bhutan, India and Thailand.

Guidance for MPRs is provided by WHO’s Global Malaria Programme (GMP). In 2012, a strong consensus emerged on the need for the process to be made less time consuming and less resource-intensive for countries. A revised edition of the MPR guidance will be released in the first half of 2013.

Figure 1: 2012 Country Road Map analyses of malaria control commodities.

JOINT PARTNER MISSIONS TO IDENTIFY BOTTLENECKS

Joint partner missions to 23 African countries were organized by SRNs in 2012. The missions were undertaken to identify specific country support needs and to help strengthen the capacity of national partnerships to implement country plans and overcome operational bottlenecks related to procurement, supply chain and programme management.

CAMPAIGN MICRO-PLANNING TO SCALE UP THE PROVISION OF LONG LASTING NETS

The Alliance for Malaria Prevention (AMP), working closely with the Harmonization Working Group and SRNs, supported the planning of mass distribution campaigns of long-lasting insecticide-treated nets (LLINs) in Angola, Cameroon, Chad, Guatemala, Malawi, Nigeria, Swaziland, Togo and Uganda, leading to the delivery of some 33 million LLINs for an expected coverage of over 60 million people.

STANDARDIZING RAPID DIAGNOSTIC TESTS – IMPROVING ACCESS

The Procurement and Supply Chain Management (PSM) Working Group created a consortium to look at the standardization of rapid

As as end 2012, 44 out of 47 (94%) Malaria-Endemic countries in Africa maintained a country road map
diagnostic tests (RDTs), both to avoid the need to retrain health workers every time a new RDT is introduced and to reduce prices by improving market competition. A group led by the Antwerp Institute of Tropical medicine is reviewing all characteristics of RDTs to identify commonalities and explore, with implementers and manufacturers, whether a blueprint RDT can be developed.

COUNTRY-LEVEL COMMUNICATIONS – OVERCOMING BARRIERS TO COMMODITY USE

Few national malaria control programmes have evidence-based strategic communication plans with a set of indicators that can measure increased use of malaria commodities and improved health-seeking behaviour. In 2012, 14 endemic countries, together with USAID-PMI, IFRC, C-CHANGE, CDC, MNM, JHUCCP and UNICEF, finalized a Strategic Framework for Malaria communication which promotes investment in this area and describes best practices. English and French versions of the framework were promoted and disseminated in the Eastern and Southern Africa sub-regions in September and November, respectively.

BOOSTING ACCESS TO ACTS IN THE PRIVATE SECTOR

The Affordable Medicines Facility for Malaria (AMFm) was designed to improve access to artemisinin-based combination therapies (ACTs), the most effective anti-malaria treatment currently available. An independent evaluation conducted in 2011–12 showed that this approach increased availability and drove down the price of ACTs for the end user.

The Global Fund Board extended its mandate to host the AMFm until 31 December 2013 to ensure that access to quality-assured ACTs is not disrupted.

Ethiopia's health extension program

Ethiopia's health extension program
The Government of Ethiopia implemented the innovative Health Extension Program (HEP) to train a cadre of more than 3,000 health extension workers which provide basic curative and preventive health services to rural communities. This programme builds on the idea of equitable community-based access and aims at universal coverage. Such a context-sensitive approach transfers knowledge and skills to households and has succeeded in changing practices and attitudes towards disease prevention, family health, and hygiene and sanitation. Health extension workers test and treat malaria and provide the necessary data to track progress.

MONITORING AND EVALUATION

New WHO Surveillance Guidelines were launched by the Director General in Namibia in April 2012. In addition, the RBM Monitoring and Evaluation Reference Group (MERG) updated the Core Population-Based Indicators and Malaria Indicator Survey documentation. The substantial revisions made to these documents are designed to ensure a homogeneous approach to coverage and impact evaluation across countries, as well as surveys carried out at various time intervals. The revision also integrates the most recent sets of indicators that have been used for updated programme management. These changes will ensure a uniform approach to the evaluation of malaria control interventions and will be crucial in determining the impact of programme activities over a specified period of time.

MERG members also developed and adopted a common strategy which promotes the ONE monitoring plan – to be implemented in all malaria-endemic countries – which was shared with NMCP managers and M&E officers from various endemic countries; between now and 2015, more than 15 countries are expected to undertake formal malaria control impact evaluations.

NEW MALARIA CONTROL STRATEGIES

With the changing epidemiology of malaria, a progressive paradigm shift is taking shape from a ‘one size fits all’ approach to the formulation and targeting of malaria control strategies aimed at specific populations and/or locations for maximum effectiveness. Following research by a task force, WHO recommended the introduction of Seasonal Malaria Chemoprevention (SMC) across the Sahel sub-region, where most of the malaria mortality and morbidity occurs during the short rainy seasons.

WHO launced the T3 Initiative, TEST, TREAT, TRACK.

Providing malaria chemoprevention throughout these periods of greatest risk has been shown to be effective, cost-efficient, safe and feasible for the prevention of malaria among children aged under five.

On the occasion of World Malaria Day 2012, the WHO Director General Dr Margaret Chan launched the T3: Test, Treat, Track initiative in Namibia. T3 seeks to ensure that every suspected malaria case is tested, that every confirmed case is treated with a quality-assured antimalarial medicine, and that the disease is tracked through timely and accurate surveillance systems to guide policy and operational decisions. The initiative focuses the attention of policymakers in malaria-endemic country and donors on the importance of adopting the latest evidence-based WHO recommendations on diagnostic testing, treatment and surveillance, updating existing malaria control and elimination strategies and country-specific operational plans.

 

The WHO Global Plan for Insecticide Resistance Management in Malaria Vectors

Resistance Containment
The WHO Global Plan for Insecticide Resistance Management in Malaria Vectors (GPIRM) was launched in May 2012. GPIRM calls for the rapid identification of areas at risk of pyrethroid resistance. In order to measure this risk, technical resources need to be rapidly recruited at country level. Similarly, sentinel drug resistance monitoring sites need to be revitalized and expanded to cover areas outside the Greater Mekong region. This scale up of monitoring capacity requires additional resources and coordination, as well as extensive promotion and dissemination at country level.

 

 

 

 

Nigeria - A Special Case

Nigeria - A Special Case
In order to mobilize the required US$1 billion for the period 2012 – 2015 for Nigeria, discussions have been led by the UNSG Special Envoy, the Global Fund, the US President’s Malaria Initiative and the World Bank. In Nigeria, saving mothers and children and meeting Goals 4 and 5 of the MDGs is a Presidential initiative. A financing plan that incorporates domestic resources to address the funding gap for malaria and other diseases is being implemented by the highest authority in the country.

The Malaria Bond

The Malaria Bond
Developed by an RBM Task Force on Innovative Financing, the concept of a Malaria Bond will be tested as a pilot project under the leadership of the UN Foundation. This proposes to frontload funding for malaria prevention, by subscriptions for bonds against future donor funding, with repayments to be made on a pay-for-performance basis. Prevention measures today will decrease the financial costs of malaria treatment and control over the longer-term. Several private sector organizations, particularly from the mining industry, have expressed interest in the concept and are providing funding for the start-up.

Lady Ministers committed to increase their domestic resources for health and adopted the Tunis Declaration specifically referencing Malaria, HIV/AIDS and TB

A YEAR OF PARTNERSHIP
AND RESULTS.
KEY ACHIEVEMENTS IN 2012

FINANCING
COUNTRY PLANS

GLOBAL FUNDING

In 2012, the two main bilateral donors for malaria, the United States and the United Kingdom continued to demonstrate sustained financial commitment to malaria control.

France also launched its 5% initiative to provide technical expertise in the implementation of Global Fund grants, from which National Malaria Control Programmes (NMCPs) have already benefitted. Australia pledged to invest more than AUS$100 million over the next four years in the fight against malaria in the Asia-Pacific region. In addition, UNITAID committed new funding of up to US$44.4 million to support the market for rapid diagnostic tests (RDTs) and standardize quality testing. The Global Fund still remains the largest source of external malaria control funding; a robust replenishment of the Global Fund, in keeping with the 2012 reaffirmations of financial support from Germany, Japan, Saudi Arabia and Spain, is essential to continued success in malaria control.

Refinements are being made to the new Global Fund funding model which will present unique challenges to the work of this Partnership and which will almost certainly require adaptations in the way the Partnership supports countries to access funds to implement national plans. Discussions are still ongoing to ensure available resources are used efficiently and that the largest possible number of lives are saved for every dollar spent.

RBM has continued to prioritize its support to malaria endemic countries to access development aid funding and to implement grant resources in timely and effective manner, particularly in a context of international financial constraints. This included a Malaria Advocacy Working Group (MAWG) workshop in London in January to clarify the modalities of the World Bank’s International Development Association (IDA) funding mechanism, with stakeholders urged to advocate integration of malaria-specific financing into country IDA applications.

Nigeria - A Special Case

Nigeria - A Special Case
In order to mobilize the required US$1 billion for the period 2012 – 2015 for Nigeria, discussions have been led by the UNSG Special Envoy, the Global Fund, the US President’s Malaria Initiative and the World Bank. In Nigeria, saving mothers and children and meeting Goals 4 and 5 of the MDGs is a Presidential initiative. A financing plan that incorporates domestic resources to address the funding gap for malaria and other diseases is being implemented by the highest authority in the country.

COUNTRY GAP ANALYSIS

The RBM Harmonization and Malaria Advocacy Working Groups and SRNs joined forces in June to undertake a comprehensive gap analysis to identify commodity needs in Africa. The meeting of these two working groups was held in Dakar, Senegal, and was attended by 37 African countries and one country from South-East Asia, Myanmar. An additional two-day workshop was held for Nigeria, with representatives from the Federal Government. Continuous support by the HWG and the SRNs has helped 32 countries undertake programmatic gap analyses, which are the foundation for developing country financing plans.

SUSTAINING CURRENT PROGRESS

With the cancellation of the Global Fund Round 11, countries that demonstrated an interruption of essential services were invited to apply for funding through its Transitional Funding Mechanism (TFM). Of the 14 countries that the HWG supported to develop Global Fund round 11 malaria proposals, only seven countries met the eligibility criteria for the TFM (Benin, Burkina Faso, Chad, Ethiopia, Indonesia, Niger and Zambia) and had their proposals approved. Worldwide, 14 countries submitted malaria proposals to the Global Fund TFM. Eleven of the 14 (79%) were successful, mobilizing US$200 million (out of a total pool of US$511 million, thus accounting for 39% of the total funding available) for a two-year period.

SUPPORT TO RELEASE GLOBAL FUND
PHASE 2 FUNDING

At the beginning of 2012 the Global Fund was holding US$3.4 billion, including all Phase 1 and 2 of undisbursed funds designated for existing malaria grants. One of the key priorities for the RBM Partnership was to unlock these funds by resolving implementation challenges and assisting countries to develop and submit the best possible case to retain Phase 2 funding.

The HWG, together with the Sub-Regional Networks, supported 13 African countries to develop technically sound Global Fund Phase 2 requests – all of which were successful. The support to Nigeria facilitated the Global Fund to make an additional US$50 million available above and beyond what was planned to fund the Round 8 Phase 2 grant. SRNs and their corresponding focal points are critically positioned to mobilize appropriate and timely expertise from a wide range of partners to respond to specific implementation challenges in their sub-region.

THE RESOURCE MOBILIZATION STRATEGY

The RBM Resource Mobilization Sub-Committee was established to develop a resource mobilization strategy for 2012–2015 and align the RBM Partnership on a forward trajectory by developing an implementation plan and a monitoring process.

The strategy addresses near-term global funding gaps, including a menu of fundraising options to cope with uncertainties, by diversifying risk and identifying additional sources of funding. The strategy includes specific recommendations to expand the funding base from traditional donors, mobilizing domestic financing, increasing aid from emerging economies, applying innovative financing solutions, and improving cost-effectiveness. In particular, the strategy focuses on Africa as a priority, as its funding gap is hindering progress towards the 2015 GMAP target of near-zero deaths. An additional US$3.8 billion is needed to ensure adequate quantities of delivered commodities (including some supporting interventions) over the next three and a half years to achieve and sustain universal malaria prevention and treatment coverage. Closing this gap is expected to help save 3 million lives in Africa by 2015. In the short term, an estimated US$2.1 billion over 2013–2014 (including carry-over of 2012 unfunded needs) is required to achieve and sustain universal coverage.

The Malaria Bond

The Malaria Bond
Developed by an RBM Task Force on Innovative Financing, the concept of a Malaria Bond will be tested as a pilot project under the leadership of the UN Foundation. This proposes to frontload funding for malaria prevention, by subscriptions for bonds against future donor funding, with repayments to be made on a pay-for-performance basis. Prevention measures today will decrease the financial costs of malaria treatment and control over the longer-term. Several private sector organizations, particularly from the mining industry, have expressed interest in the concept and are providing funding for the start-up.

TARGETING DONORS

Throughout 2012 Partners actively encouraged existing global donors both to maintain and increase their support, while also initiating consultations to attract new sources of funding, delivering strong messages on malaria as a sound economic investment.

The RBM Executive Director, Secretariat and members of the Malaria Advocacy Working Group, including UK partners Malaria No More, Malaria Consortium and Malaria Vaccine Initiative, worked with the UK All-Parliamentary Group on Malaria and Neglected Tropical Diseases to showcase their important work and highlight the role played by the UK’s Department for International Development in advancing global malaria control.

Encouraging the engagement of private sector and philanthropists continued during the World Economic Forum in Davos (January 2012) and the World Congress of Muslim Philanthropists (April 2012), both excellent platforms to present malaria control as an opportunity to drive development and improve global health.

RBM Special Representative Princess Astrid and RBM Goodwill Ambassador Yvonne Chaka Chaka advocated greater private sector involvement and promoted the forging of strategic partnerships for high-impact social investments. Princess Astrid highlighted malaria as a sound economic investment and encouraged commitments by the Gulf Cooperation Council (GCC) countries in Qatar and Saudi Arabia (September 2012).

In Europe, Partners sensitized the European Parliament and Commission on the possibility of establishing a special malaria facility under the European Financial Framework (MMF) – the EU funding mechanism for R&D – which was being deliberated for the period of 2014–2020.

Through ongoing relations with Permanent Missions to the UN and several trips to the Arab Gulf sub-region, national authorities were briefed on the situation faced by malaria-endemic countries, and face-to-face advocacy was conducted with potential new donors from GCC countries. As a result two additional new donors made commitments to the RBM Partnership Work Plan, the Kuwait Fund for Arab Economic Development and the State of Kuwait.

INCREASING DOMESTIC FUNDING

To ensure more sustainable and predictable malaria financing, two areas of intensified action were identified in the resource mobilization strategy. Firstly, resource mobilization processes at country level, including through the development of fully fledged country-level financing plans; and secondly, coordination with the World Bank and regional development banks to revamp their engagement in malaria control, as well as with governments from emerging aid donors.

During the Ministerial segment of the RBM Board Meeting held in May 2012, advocacy focused on the development of comprehensive malaria control and elimination financing plans. A high-level ministerial conference on health financing hosted by the African Development Bank and organized by the Harmonization for Health in Africa mechanism (HHA), in collaboration with the African Union and United Nations Economic Commission for Africa, was held in Tunis on 5 July 2012. In the course of this conference the RBM Board chair made a strong case for specified significant domestic financing for malaria control. Ministers committed to increase their domestic resources for health and adopted the ‘Tunis Declaration,’ specifically referencing malaria, HIV/AIDS and TB.

Advances were also made to re-engage the Islamic Development Bank (IDB) which has described malaria as a severe and debilitating threat to health in the Muslim world and remains a major challenge in more than half of the Member States of the Organization of Islamic Cooperation (OIC). Partners in the MAWG and HWG identified six OIC member countries (Chad, Niger, Nigeria, Mali, Mozambique and Yemen) that could benefit from IDB support, to assist them in developing sustained financing plans and proposals to donors, including to the Global Fund.

 
Malaria Medicines

Malaria Medicines
MMV-partnered R&D continued to address the challenges raised by artemisinin resistance and the needs of vulnerable populations. The first deliveries of the alternative Euratesim reached Cambodia in July 2012, while Pyramax received EMA approval for use in low-transmission resistance areas. Targeted medicines are under development for protection of pregnant women and for seasonal chemoprevention campaigns for children. Work on Tafenoquim as a simpler but radical cure for P. vivax entered Phase 2, with results expected in 2013.

A YEAR OF PARTNERSHIP
AND RESULTS.
KEY ACHIEVEMENTS IN 2012

Informing the
R&D Agenda

The malaria control community has made enormous progress in identifying research agendas and attempted to coordinate the global response to research and capacity challenges in the areas of elimination and eradication research (malERA, MESA), as well as around upstream product development (MMV, MVI, FIND, IVCC and DNDi). The RBM Case Management, Vector Control and Malaria In Pregnancy working groups convene many of the active research consortia (e.g. the ACT consortium) engaged in research on malaria control interventions, continuous net replacements and durability and on scaling-up malaria control through antenatal care services.

However, coordination has proved to be more difficult in the areas of applied and operational research. Although stock-outs have been tracked over an extended period in a recent study by SMS for Life, lack of appropriate drug procurement and supply chain responses demonstrates that health system readiness is not sufficient. In summary, current research results highlight the future need for a system-wide thinking of the malaria control community, be it to sustain community level prevention and treatment or to engage national priority setting and budgeting processes.

Malaria Medicines

Malaria Medicines
MMV-partnered R&D continued to address the challenges raised by artemisinin resistance and the needs of vulnerable populations. The first deliveries of the alternative Euratesim reached Cambodia in July 2012, while Pyramax received EMA approval for use in low-transmission resistance areas. Targeted medicines are under development for protection of pregnant women and for seasonal chemoprevention campaigns for children. Work on Tafenoquim as a simpler but radical cure for P. vivax entered Phase 2, with results expected in 2013.

MALARIA ERADICATION SCIENTIFIC ALLIANCE

Launched in May 2012, the Malaria Eradication Scientific Alliance (MESA) is dedicated to advancing the science of malaria eradication. Other disease eradication efforts, past and present, have taught us the critical role of research and development. MESA will build upon and carry forward the Malaria Eradication Research Agenda (malERA), published in January 2011, that identified key knowledge gaps in strategies and tools to eradicate the malaria parasite from the human population.

MESA’s objectives and activities are aligned with RBM’s Global Malaria Action Plan strategy to research new tools and approaches to support global control and elimination efforts. Within the R&D community, MESA monitors progress and takes the next steps to advance the science of malaria eradication. MESA by reviewing existing evidence and supporting projects on critical research questions.

Hosted at the Barcelona Institute for Global Health (ISGlobal), the MESA Secretariat benefits from guidance by a Strategic Advisory Council and funding by the Bill and Melinda Gates Foundation. In 2012, MESA convened working groups on two priority areas – ‘Measurement of transmission in elimination settings’ and ‘Health systems readiness for malaria elimination efforts’, following which a call for research project proposals resulted in three projects in each theme being selected for financial support by MESA and one proposal endorsed for support through other funding streams. Research activities in the six projects span Africa, Asia, Latin America and Australasia and are relevant to both P. falciparum and P. vivax malaria.

MALARIA VACCINE DEVELOPMENT

Research towards the development of malaria vaccines, as a potentially valuable addition to the available tools for malaria control, has been pursued in this technically complex field since the 1970s.

The RTS,S vaccine being developed in a partnership between GlaxoSmithKline and the PATH Malaria Vaccine Initiative, with a focus on P. falciparum in African infants and young children, has reached Phase 3 clinical trials. Preliminary results confirm the need for completion of the trials, as well as safety and efficacy data from groups of children and site-specific efficacy data, before a WHO policy recommendation on its application can be formulated, possibly in 2015. The vaccine will be evaluated as a possible addition to, and not a replacement for, existing preventive, diagnostic and treatment measures.

The new antisporozoite vaccine candidate, PfSPZ, involves for the first time participation of malaria-endemic countries in Africa and Asia to finance local trial costs at multiple sites. This ensures ownership and positively influences the required target product profiles for vaccine development.

DRC

Democratic Republic of Congo launches national RBM Partnership
At the Francophonie summit, France’s First Lady Ms Valérie Trierweiler, accompanied by Mr. Pascal Canfin, French Minister of Development, Dr. Félix Kabange Numbi, Minister of Health of the Democratic Republic of Congo and Dr. Fatoumata Nafo-Traoré, RBM Executive Director, visited a pediatric hospital. The occasion was marked by the launch of the national RBM Partnership and an initiative to reduce mother-to-child transmission of HIV by Ms Marie Olive Kabila, DR Congo First Lady.

Mauritania commits to accelerate malaria control

Following the visit of RBM Executive Director, Mauritania announced the establishment of a Parliamentary Group on Malaria. Earlier in the year it also allocated US$20 million in domestic resources to support MDG-related activities, including US$2 million to support the scale-up of malaria control.
handshake

President Jakaya Kikwete of the Republic of Tanzania hands over the Chair of the African Leaders Malaria Alliance (ALMA) to President Ellen Johnson Sirleaf in January 2012 during an African Union Meeting in Addis.

A YEAR OF PARTNERSHIP
AND RESULTS.
KEY ACHIEVEMENTS IN 2012

MALARIA ON
DEVELOPMENT
AGENDA

RBM ADVOCACY FRAMEWORK

A new advocacy framework was presented to the 22nd RBM Board in 2012 guiding all Partnership constituencies to unify their advocacy efforts toward the achievement of the 2015 GMAP Objectives and Targets. Drafted by the Secretariat and the MAWG, the framework serves to align messaging and harmonizes closely with the Resource Mobilization Strategy, aiming to create an enabling environment and provide a context in which increased resources can be mobilized to maintain and increase malaria control efforts.

WORLD MALARIA DAY 2012 – ‘SUSTAIN GAINS, SAVE LIVES: INVEST IN MALARIA’

The World Malaria Day (WMD) theme carried a strong message on investing in malaria control and was used to raise malaria awareness around the globe. The exhibition hosted by the Mairie de Paris, ‘Paludisme: du sang, de la sueur et des larmes’ (Malaria, Blood Sweat and Tears) drew media attention and newly elected government officials to the Hotel de Ville in the center of the French capital.

Paludisme

In New York, the commodity funding gap for Africa was the subject of a panel discussion and UN press briefing with Jeffrey Sachs, Princess Astrid, and Ray Chambers; additionally WMD was commemorated in New York with a NET-working reception co-hosted by Variety Magazine and the UN Foundation, at which the RBM Special Representative Princess Astrid was honoured with an award from the UN Secretary General for her work with RBM.

A special Global Fund briefing was also held in New York on 25 April to help maintain the confidence of countries and donors amid ongoing organizational reforms. Permanent Missions were invited to UN Headquarters to meet with Gabriel Jaramillo, General Manager of the Global Fund.

The appointment of Dr. Fatoumata Nafo-Traoré as the new RBM Executive Director in July 2012 provided renewed opportunities to meet with partners and donors, and support countries and regions in face-to-face advocacy. In whistle-stop visits to the United States, United Kingdom, France and Belgium commitments were reconfirmed and the EXD shared her vision for the Partnership going forward. Specially requested visits to DR Congo with France’s First Lady and to Mauritania at the request of the Minister of Health produced concrete outcomes with H.E. Mohamed Ould Abdel Aziz, President of Mauritania, outlining his country’s newly established plan to achieve the MDGs ahead of the 2015 timeline.

Three country reports in the RBM Progress & Impact series were published in 2012: Tanzania and Nigeria (April) and Swaziland (November). These reports help countries demonstrate the value of external investments in their own malaria control programme, and their respective launches showcased the achievements and impact of national malaria control programmes in endemic countries.

DRC

Democratic Republic of Congo launches national RBM Partnership
At the Francophonie summit, France’s First Lady Ms Valérie Trierweiler, accompanied by Mr. Pascal Canfin, French Minister of Development, Dr. Félix Kabange Numbi, Minister of Health of the Democratic Republic of Congo and Dr. Fatoumata Nafo-Traoré, RBM Executive Director, visited a pediatric hospital. The occasion was marked by the launch of the national RBM Partnership and an initiative to reduce mother-to-child transmission of HIV by Ms Marie Olive Kabila, DR Congo First Lady.

Mauritania commits to accelerate malaria control

Following the visit of RBM Executive Director, Mauritania announced the establishment of a Parliamentary Group on Malaria. Earlier in the year it also allocated US$20 million in domestic resources to support MDG-related activities, including US$2 million to support the scale-up of malaria control.

ENSURING MALARIA REMAINS HIGH ON THE UN AGENDA

A key component of RBM’s advocacy strategy has been to anchor the global malaria response on the United Nations development agenda by presenting it as a high-yield investment opportunity to governments.

Strengthening UN relations, including by providing support to the UNSG Office, has helped to maintain malaria’s prominence and encouraged ongoing commitment at the highest level. Ending malaria deaths and building on the global momentum of progress in malaria control and the decade of results and partnership figured among the priorities announced by the Secretary General as he began his second term in office at the beginning of 2012.

On 10 September 2012, the UN General Assembly adopted a resolution (A/RES/66/289) to urge accelerated progress against universally agreed malaria targets, including the health-related Millennium Development Goals (MDGs). The resolution took note, among others, of the declarations and decisions on health issues, in particular those related to malaria, adopted by the Organization of African Unity and the African Union, including the Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, containing the pledge to allocate at least 15% of national budgets to the health sector, and recognized that malaria-related ill health and deaths throughout the world could be substantially reduced with political commitment and commensurate resources.

United Against Malaria (UAM) – an initiative linking malaria to football in a winning combination – attracts substantial African private sector support. Many effective malaria prevention and treatment messaging campaigns have been launched with country leadership endorsement, which have maximized awareness of malaria control around football, most notably during the 2010 World Cup in South Africa and ahead of the 2013 Africa Cup of Nations scheduled to be held in Equatorial Guinea and Gabon. In addition, partners such as Voices (JHUCCP) and Malaria No More (USA) used music, drama and other popular media to raise public awareness in countries.

handshake

President Jakaya Kikwete of the Republic of Tanzania hands over the Chair of the African Leaders Malaria Alliance (ALMA) to President Ellen Johnson Sirleaf in January 2012 during an African Union Meeting in Addis.

Feature: Malaria in the Asia-Pacific region

IN 2012, THE PARTNERSHIP INTENSIFIED DIALOGUE WITH COUNTRIES, COALITIONS AND REGIONAL ECONOMIC MECHANISMS IN THE ASIA-PACIFIC REGION, THE SECOND MOST MALARIA-AFFECTED REGION IN THE WORLD.

In comparison to other parts of the world, the Asia-Pacific region faces some unique challenges in the fight against malaria. There is a different pattern to the spread of malaria, more types of mosquitoes, with different behaviour patterns, and more of the difficult-to-treat Plasmodium vivax strain of malaria. Significant progress has been made to reduce the number of malaria cases and mortality rates by around 25% since 2000; however, malaria remains a major threat in the region, with around 30 million cases and 42,000 deaths each year.7

Malaria epidemiology in the six countries of the Greater Mekong Sub-region (GMS) – Cambodia, China’s Yunnan Province, Lao Peoples Democratic Republic, Myanmar, Thailand and Viet Nam – is complex and characterized by immense geographical heterogeneity in disease distribution with many areas of high endemicity, differential prevalence of the two most predominant parasites Plasmodium falciparum and P. vivax, which require different drug treatments, and diverse vector systems with different vectorial capacities for these parasites.8 The Mekong Sub-region has topographical environments ranging from coastal plains to river estuaries and rugged mountainous terrains. Such divergent ecological systems offer diverse breeding habitats for multiple mosquito vector species with distinctive preferences for forest edges, foothills, or agricultural fields. The Mekong River runs through all six countries, and its watershed plays an important role in the transmission of vector-borne diseases.

Since the initiation of the WHO’s Mekong Malaria Program in 1999, malaria cases and deaths in the GMS have fallen. However, epidemiological challenges persist, notably in Myanmar and Cambodia, which exhibit enormous geographical heterogeneity with other high-burden countries. Within each of these two countries, malaria distribution is also patchy, exemplified by ‘border malaria’ and ‘forest malaria’ with high transmission occurring along international borders and in forests or forest fringes, respectively. ‘Border malaria’ is extremely difficult to monitor, and frequent malaria introductions by migratory human populations constitute a major threat to neighboring, malaria-eliminating countries.9

Under the umbrella of the RBM partnership, global malaria partners convened a high level meeting in 2012 to conduct comprehensive programmatic gap analysis and identify the most urgent programmatic challenges in 40 countries. Myanmar was one of the first countries in the Asia-Pacific region to participate.

ARTEMISININ RESISTANCE

Although regional political and economic instability is partially blamed for the resurgence of malaria, human population expansion and mobility into forested regions, and environmental changes such as urbanization and deforestation have all contributed to the changing picture of malaria epidemiology. Perhaps, the single most important culprit responsible for the regional and global malaria resurgence is the emergence and spread of Artemisinin Resistance.

The emergence of Artemisinin Resistance is now an urgent concern since Artemisinin is the core ingredient in the most effective malaria treatment – artemisinin-based combination therapy (ACT). Artemisinin Resistance puts at risk the gains that have been made to date to combat malaria, and may seriously jeopardise further progress in malaria control and elimination in the Asia-Pacific region.

The rise of drug resistance emerging from the Greater Mekong sub-region also demands concerted actions, including strengthening surveillance systems and establishing functional cross-border collaborations, as recommended by the Global Plan for Artemisinin Resistance Containment (GPARC).

Malaria remains a major treat in the region with around 30 million cases and 42,000 deaths each year
mosquito nets
grafetti
Building Malaria Awareness in the Asia-Pacific
Mr Ray Chambers
Mr. Bob Carr


UN Special Envoy for Malaria, Mr Ray Chambers and Mr. Bob Carr, Australia’s Foreign Minister, commit to creating a Asia Pacific Leaders’ Malaria Alliance at the Sydney MALARIA 2012 Summit.


Building Malaria Awareness in the Asia-Pacific

HRH Princess Astrid meets Dr Surin Pitsuwan, Secretary General of the Association of Southeast Asian Nations (ASE AN)

BUILDING MALARIA AWARENESS IN THE ASIA-PACIFIC

RBM UNDERTOOK HIGH-LEVEL CONSULTATIONS DURING THE ASEAN HEALTH MINISTERS MEETING IN THAILAND IN JULY TO GARNER GREATER POLITICAL SUPPORT FOR ONGOING MALARIA EFFORTS.

The Government of Australia hosted a high-level conference Malaria 2012: Saving lives in the Asia-Pacific in Sydney from 31 October to 2 November 2012, co-chaired by the UN Special Envoy for Malaria, and supported by WHO, RBM and other global partners. Working closely with AusAID, a wide range of RBM partners used this occasion to engage key political leaders and stakeholders in the Asia-Pacific region.

The RBM Partnership contributed to shaping the outcome document on ‘Malaria Control and Elimination in the Asia-Pacific’. Known as the Sydney Consensus, and agreed at a Ministerial Session hosted by the UN Secretary General’s Special Envoy for Malaria and the Australian Minister for Foreign Affairs, the document calls for a strategic plan to address the financial gaps in malaria control and elimination in Asia and the Pacific, including options for a regional financing mechanism based on voluntary contributions. It also called for an Asia-Pacific Leaders Malaria Alliance (APLMA) to galvanize political commitment at the highest level.

On the margins of the conference, the Government of Thailand hosted a bilateral meeting with officials from Myanmar’s Ministry of Health, WHO and the RBM Secretariat to examine best practices and identify opportunities for cross-border collaboration in control activities along the Thai-Myanmar border. Partners and journalists visited the area to report on the emerging artemisinin resistance and the containment efforts being undertaken by the Thai Ministry.

Strategic media outreach in advance of the AusAID conference resulted in significant international attention. The RBM Secretariat and WHO used the unique platform to launch the latest issue of the Progress & Impact (P&I) series: Defeating Malaria in Asia, the Pacific, Americas, the Middle East and Europe, authored by the WHO Global Malaria Programme (GMP). Conference participants attending the launch of the publication, included Ministers of Health representatives from multilateral organizations, NGOs, academic/research institutes.

The RBM Special Representative, Princess Astrid travelled to the region for World Malaria Day in April, meeting with private sector, philanthropists and scientists in Singapore and Indonesia; she was also present to launch Indonesia’s national RBM Partnership along with H.E. Dr. Boediono, Vice President of Indonesia, and WHO and UNICEF representatives. Strategic Review, an Indonesian journal specializing in leadership, policy and world affairs, featured an interview with Princess Astrid and other contributions where she highlight the need for increased political leadership and regional coordination to overcome pressing challenges in the Asia-Pacific region.

A little girls face

THE ASIA-PACIFIC MALARIA ELIMINATION NETWORK (APMEN)

APMEN WAS ESTABLISHED IN 2009 TO CATALYSE THE WORK ON MALARIA ELIMINATION IN THE REGION THROUGH LEADERSHIP, ADVOCACY, CAPACITY BUILDING, KNOWLEDGE EXCHANGE, AND BUILDING THE EVIDENCE BASE.

APMEN is currently composed of 14 Asia-Pacific countries (Bhutan, Cambodia, China, Democratic People’s Republic of Korea, Indonesia, Malaysia, Nepal, Philippines, Republic of Korea, the Solomon Islands, Sri Lanka, Thailand, Vanuatu and Viet Nam), as well as leaders and experts from key multilateral and academic agencies.

The 4th annual APMEN Business and Technical Meeting (APMEN IV) was held on 7–10 May 2012 in Seoul, Republic of Korea, with the participation of more than 85 representatives. The meeting theme of ‘Efficiency in Elimination’ reflected the urgent global need to maintain and expand malaria programs, in spite of substantial funding shortages related to the global financial crisis. The Network reaffirmed its commitment to share experiences on malaria elimination and continue the collaborative research projects, capacity building activities and advocacy efforts. APMEN’s priorities for the next two years include a) reducing the spread of artemisinin-resistant P. falciparum by aiming for a P. falciparum-free Mekong Delta; b) increasing the effectiveness of surveillance and response systems for malaria case detection and treatment; c) meeting the challenges of diagnosing and treating P. vivax; and d) sustaining gains made in malaria control and ensuring financial and political support for malaria elimination in the region.

7. WHO World Malaria Report 2011
8. Liwang Cui, Guiyun Yan, Jetsumon Sattabongkot, Yaming Cao et al (2012). Malaria in the Greater Mekong Subregion: Heterogeneity and Complexity. Acta Trop. March; 121(3): 227–239.
9. ibid (2012).
Child with Doctor

TIMELINE

timeline timeline

Publications 2012

Tanzania (P & I Series)

Tanzania (P & I Series)

Swaziland (P & I Series)

Swaziland (P & I Series)

Asia, the Pacific, Americas Middle East and Europe (P & I Series)

Asia, the Pacific, Americas
Middle East and Europe
(P & I Series)

Nigeria (P & I Series)

Nigeria (P & I Series)

Annual Report 2011

Annual Report 2011

Malaria in the Asia-Pacific (INFOGRAPHIC)

Malaria in the Asia-Pacific
(INFOGRAPHIC)

Independent Supplement

Independent Supplement

Poster

Poster

Financial Times Supplement

Financial Times Supplement


Hands
Mothers and Daughters
Roll back Malaria Partnership secretariat revenue by donor for all year ending 31 December 2012 (US$18.44 million)

Partnership in action

THE RBM PARTNERSHIP PLAYS A UNIQUE ROLE IN CONVENING, COORDINATING AND FACILITATING COMMUNICATIONS AND JOINT INITIATIVES TO ENSURE THAT THE SUFFERING AND POVERTY CAUSED BY MALARIA IS ALLEVIATED AND THAT COUNTRIES CAN EFFECTIVELY SCALE UP AND SUSTAIN MALARIA CONTROL, ELIMINATE AND ULTIMATELY ERADICATE MALARIA.

The RBM Partnership focuses its support on enhancing advocacy, resource mobilization, policy and regulatory affairs, planning, financing, procurement and supply management, communication and behaviour change, monitoring and evaluation, and appropriate research to inform existing interventions and to seek new tools.

Mothers and Daughters

Currently the Partnership convenes two types of working groups. Some working groups enable partners to reach consensus and agree on best practice while others focus on implementation of best practice10 in the different areas of RBM’s work.11 In addition, through its sub-regional networks in Africa (SRNs), the Partnership engages country partners in planning and implementation of malaria control activities, resolution of bottlenecks and tracking progress at country level.

Many RBM partners, national governments, foundations and individual donors, support multi-country coordination initiatives in the Mekong River region and in the Amazon region of South America. Partner organisations contribute to the work of regional groups, such as the Asia-Pacific Malaria Elimination Network (APMEN), the Asia-Pacific P. vivax Network, the Southern Africa Elimination 8 Initiative (E8), and the Meso-America Malaria Elimination Initiative (SM 2015), which focus on sustaining control and moving towards malaria elimination.

FINANCIALS

RBM PARTNERSHIP WORK PLAN AND BUDGET

RBM’s role of convening, coordinating and facilitating communication of actors in the global malaria control community is supported by the Partnership Work Plan (PWP). The PWP provides catalytic funding to Board endorsed mechanisms that will stimulate and enhance coordination. Based on Board-endorsed strategic analysis, the PWP is made up of priority activities that focus the efforts of the Partnership where they are most needed.

At its 21st session at Wuxi, P.R. China, in November 2011, the RBM Board approved a 2012 Partnership Work Plan expenditure budget of US$15,351,727 based on projected income, as well as a supplementary activity framework of US$6.39 million to be implemented according to mobilization of additional resources.

The expenditure budget was allocated across all RBM mechanisms, including the Secretariat, Working Groups and Sub-Regional Networks, under the eight operational areas of the Global Malaria Action Plan (GMAP) where specific RBM constituencies have a responsibility for driving progress:

  1. FUNDING
  2. DISEASE CONTROL
  3. PROGRAMME COORDINATION
  4. ADVOCACY
  5. COMMODITY SUPPLY AND DISTRIBUTION
  6. RESEARCH AND DEVELOPMENT
  7. TECHNICAL STANDARDS AND GUIDELINES
  8. CONVENE, COORDINATE & FACILITATE

22 outputs were identified for the eight GMAP areas and progress measured against them throughout the year.

Revenue for 2012 generally matched expectations, with donor contributions amounting to US$18.4 million being added to a carryover of US$2.9 million from 2011, for a total of US$21.3 million available resources. About US$5 million of the revenue received nevertheless related to contributions earmarked for PWP implementation in 2013.

Expenditure was in line with revenue available for use in 2012 and amounted to US$ 14,420,344 for the year.

FUNDING THE RBM PARTNERSHIP WORK PLAN AND BUDGET

Funding of the Partnership Work Plan continued to rely on five key donors: the Abu Dhabi Health Authority (HAAD), the United States Agency for International Development (USAID) – through which the support of both the President’s Malaria Initiative (PMI) and the Office of the Global AIDS Coordinator (OGAC) is channelled, the UK Department for International Development (DFID), the Bill & Melinda Gates Foundation (BMGF), and the World Bank (IBRD).

RBM Board approved a 2012 partnership work plan expenditure budget of US$15,351,727

The year was marked by commitments by the State of Kuwait for a contribution of US$3 million over two years 2013–2014 and by the Kuwait Fund for Arab Economic Development for a contribution of US$1,050,000 over three years 2012–2014, towards the work of the Roll Back Malaria Partnership.

The continuing global financial recession hampered resource mobilization and the funding of the supplementary activities. However, several Partner organizations were able to commit their own resources towards direct funding or implementation of PWP activities, which enhanced the reach of the RBM programme of work. Examples of such ‘parallel funding’ included support from Swiss TPH for the operation of the VCWG Secretariat; USAID/PMI support to ICF Macro to host the MERG Secretariat; IFRC’s hosting of the Alliance for Malaria Prevention HWG workstream; JHUCCP support to the United Against Malaria campaign, and NGO and private sector engagement in World Malaria Day commemorations.

Roll back Malaria Partnership secretariat revenue by donor for all year ending 31 December 2012 (US$18.44 million)

RBM mechanisms also continued to address their own resource needs for the year, beyond those which could be covered from the PWP expenditure budget. This included Sanofi SA support for the printing of the SARN regional MPR report and TZMI business plan; GBCHealth funding for the SARN regional meeting on Malaria Elimination; WAHO support to the WARN annual meeting, and Gates Foundation, UNICEF, AfDB and World Bank funding of participants to the HWG ‘Gap Analysis’ workshop at Dakar in June.

Revenue for 2012 generally matched expectations, with donor contributions amounting to US$18.4 million

The Executive Director, Secretariat staff and Goodwill Ambassadors regularly engaged with potential donors on the value-added of investment in RBM mechanisms and programmes, including in the context of visits to the Arabian Gulf and South-East Asian regions; a roundtable consultation of global financiers and decision-makers at the UN Secretariat; promotional events such as the World Congress on Muslim Philanthropy, and high-level bilateral consultations during the UN General Assembly.

The year 2012 saw continued enhancements in the financial tracking and analytical capacity of the Secretariat, which has resulted in clear Finance and Performance Committee guidance. Through savings generated on positive exchange rate fluctuations, the FPC has endorsed a one off increase to the RBM risk mitigation instrument known as the Working Capital Reserve (WCR). The WCR amounted to US$ 897,000 at the end of 2012 and is a key tool to protect against delays in payment of contributions or negative financial shocks like unforeseen exchange rate movements.




ROLL BACK MALARIA FINANCIAL REPORT

STATEMENT OF FINANCIAL PERFORMANCE FOR THE PERIOD 1 JANUARY TO 31 DECEMBER 2012 (SHOWN IN UNITED STATES DOLLARS).

Opening Fund Balance 1 January 2012 2,913,567
Revenue 18,444,111
Contributions
Total Revenue 18,444,111
Total Expenses 14,420,344
DONOR DESIGNATED FOR USE IN 2013 4,023,767
Closing Fund Balance 31 December 2012 (WHO Statement) 6,937,334
10. e.g. Vector Control Management Working Group (VCWG).
11. Harmonisation Working Group (HWG), Malaria Advocacy Working Group (MAWG), Procurement and Supply Chain Management Group (PSM).

ANNEXES

The Partnership is composed of hundreds of partners organized into seven constituencies:

  • Malaria-endemic countries
  • Multilateral development partners
  • Donor governments
  • Private sector
  • Non-governmental and community-based organizations Foundations
  • Research and academic institutions
  • The RBM Partnership is comprised of the following main governing, advisory and administrative bodies:
  • Partnership Board
  • Executive Committee, Subcommittees and Task Forces
  • Secretariat
  • Working Groups
  • Sub-Regional Networks

ROLL BACK MALARIA PARTNERSHIP (RBM)

The Partnership is the global framework to implement coordinated action against malaria. It mobilizes for action and resources and forges consensus among partners.

RBM’s strength lies in its ability to form effective partnerships at global, regional and country levels, with a focus on areas where harmonization and combined effort will provide added value to the quality and impact of the interventions. Partners work together to scale up national malaria control efforts, coordinating their activities to avoid duplication and fragmentation, and to ensure optimal use of resources.

RBM is the driving force behind the Global Malaria Action Plan (GMAP), adopted in September 2008, which articulates the strategy and action required to achieve the Partnership’s goal of a malaria-free world.

The seven constituencies listed above, along with the ex officio members – Global Fund to fight AIDS, Tuberculosis and Malaria, UNITAID, UNSG Special Envoy for Malaria, African Leaders Malaria Alliance and the RBM Executive Director – determine representation on the RBM Board (28 members) and participate in all RBM Partnership mechanisms.

The RBM Secretariat is hosted at WHO headquarters, which provides a legal and accountability framework as well as administrative and fiduciary support and services. The offices of SRN Coordinators for EARN (Nairobi) and WARN (Dakar) are hosted by UNICEF, and for CARN (Yaoundé) and SARN (Gaborone) by IFRC. Hosting arrangements for SARN changed in the course of the year, from the SADC Secretariat to the IFRC Regional Office in Gaborone, Botswana. Consultations also took place in relation to WHO’s hosting of Partnerships, as part of the WHO reform process.

Governance and coordinating meetings are held at least annually for all RBM mechanisms. A list of the principal statutory meetings convened is set out in annex A.

annex A graph

ANNEX A

PRINCIPAL MEETINGS OF RBM MECHANISMS IN 2012

child
another child
  • Monitoring and Evaluation Reference Group (MERG), 18th Meeting, Dar es Salaam, United Republic of Tanzania, 24-26 January
  • Malaria Advocacy Working Group (MAWG), 8th Meeting, London, UK, 6-7 February
  • Vector Control Working Group (VCWG), 7th Meeting, Geneva, Switzerland, 6-8 February
  • Alliance for Malaria Prevention (AMP) Annual Partners Meeting, Geneva, 9-10 February
  • Procurement and Supply Chain Management Working Group (PSMWG), 8th Meeting, Geneva, Switzerland,27-29 February
  • Harmonization Working Group (HWG), 12th Meeting, Nairobi, Kenya, 5-6 March
  • Malaria in Pregnancy Working Group (MPWG), 14th Meeting, Kigali, Rwanda, 18-20 April
  • Roll Back Malaria Partnership Board, 22nd Meeting, Geneva, Switzerland,16-18 May
  • Monitoring and Evaluation Reference Group (MERG), 19th Meeting, London, UK, 6-8 June
  • Case Management Working Group (CMWG), 6th Meeting, Geneva, Switzerland,11-13 June
  • HWG Programmatic Gap Analysis and Filling the Funding Gaps Workshop, Dakar, Senegal, 19-22 June
  • Central Africa Regional Network (CARN) Annual Review and Planning Meeting, Yaoundé, Cameroon, 10-12 July
  • Southern Africa Regional Network (SARN) Annual Constituencies Consultative Meeting, Johannesburg, South Africa, 23-27 July
  • West Africa Regional Network (WARN) Annual Review and Planning Meeting, Praia, Cape Verde, 3-7 September
  • East Africa Regional Network (EARN), 13th Annual Review and Planning Meeting, Arusha, United Republic of Tanzania, 3-7 September
  • Southern Africa Regional Network: SADC Malaria Managers, SARN Steering Committee and Research Constituency Meetings, Johannesburg, South Africa, 3-8 October
  • RBM Communication Community of Practice (CoP) at Country Level, 1st Meeting, Maputo, Mozambique, 7 November: Launch of Strategic Framework for Malaria Communication at the Country Level 2012-2017 (SFCC)
  • Procurement and Supply Chain Management Working Group (PSMWG), 9th Meeting, Geneva, Switzerland, 19-21 November
  • Harmonization Working Group (HWG), 13th Meeting, Dakar, Senegal, 3-4 December
  • Roll Back Malaria Partnership Board, 23rd Meeting, Dakar, Senegal, 5-7 December
  • The RBM Board subcommittees - Executive Committee, Finance & Performance Committee, Resource Mobilization Subcommittee, Progress & Impact Series Oversight Committee, met regularly on a quarterly or monthly basis, usually by teleconference.

PHOTO CREDITS:
Cover: © Georgina Goodwin | Slide 1: Mapping Malaria © Jesmondine | Slide 2 top: © Tim Siegenbeek Van Heukelom | Slide 2 middle: © The Global Fund/John Rae | Slide 2 bottom: © The Global Fund/John Rae | Slide 3 top: © The Global Fund/John Rae | Slide 3 bottom: © Konstantin Ikonomidis | Slide 4 top: © Maggie Hallahan | Slide 4 middle: © The Global Fund/John Rae | Slide 4 bottom: © RBM Secretariat | Slide 5 top: © Sunmap | Slide 5 middle: © Lemu Golassa | Slide 5 bottom: © The Global Fund/John Rae | Slide 6 top: © Sunmap | Slide 6 middle: © PMI, Malawi/Gomezgani Jenda | Slide 6 bottom: © Maggie Hallahan | Slide 8 top: © RBM Secretariat | Slide 8 middle: © ALMA | Slide 8 cover: © Adam Nadel | Slide 9 feature image 1: © The Global Fund/John Rae | Slide 9 feature image 2: © The Global Fund/John Rae | Slide 9 feature image 3: © AusAID | Slide 9 feature image 4: © RBM Secretariat | Slide 9 feature image 5: © Rasmus Brunn | Slide 9 feature image 6: © Ben Moldenhauer | Slide 10 top: © United Against Malaria | Slide 10 bottom: © Maggie Hallahan.

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