GMAP

[Full Table of Contents]
[Executive Summary]

Executive Summary

Introduction

Sustained country leadership and commitment are essential in overcoming malaria. The Roll Back Malaria (RBM) Partnership has developed the Global Malaria Action Plan (GMAP) first and foremost to support countries. The GMAP provides a global framework for action around which partners can coordinate their efforts. Developed through an intensive consultative process, it consolidates the collective input of 30 endemic countries and regions, 65 international institutions and 250 experts from a wide range of fields. The GMAP presents (i) a comprehensive overview of the global malaria landscape, (ii) an evidence-based approach to deliver effective prevention and treatment to all people at risk and (iii) an estimate of the annual funding needs to achieve the goals of the RBM Partnership for 2010, 2015 and beyond. The GMAP is a living document: as approaches and tools evolve to fight malaria, so will the plan.

The GMAP outlines the RBM Partnership's vision for a substantial and sustained reduction in the burden of malaria in the near and mid-term, and the eventual global eradication of malaria in the long term, when new tools make eradication possible. To reach this vision, the targets of the GMAP are to:

To achieve these targets, the GMAP outlines a three-part global strategy:

  1. control malaria to reduce the current burden and sustain control as long as necessary,
  2. eliminate malaria over time country by country and
  3. research new tools and approaches to support global control and elimination efforts.
    See Figure 1.

Figure I: Three components of the global strategy

This executive summary highlights the key messages from the GMAP. More detailed information can be found within the full plan.

Part I: Malaria Today

  1. Malaria is a complex and deadly disease that puts approximately 3.3 billion people at risk in 109 countries and territories around the world. In 2000, there were between 350 and 500 million cases of malaria and at least one million deaths world-wide, most of them in African children.[1]The World Health Organization released its most recent WHO World Malaria Report 2008 (WMR) in September 2008. The WMR 2008 contains information on burden, policies, coverage and funding for 109 malaria endemic countries and territories. In the report, WHO uses a revised and updated methodology to estimate the incidence of malaria outside the African Region. This results in fewer malaria cases than previously estimated in the Americas, Eastern Mediterranean, Europe, Southeast Asia and Western Pacific regions. RBM Partners, including WHO, are continuing to improve and align estimates of malaria burden worldwide.

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    In addition to its health toll, malaria places a heavy economic burden on many endemic countries, contributing to the cycle of poverty and limiting economic development. For example, Africa alone is estimated to lose at least US$ 12 billion per year in direct losses (e.g. illness, treatment, premature death), and many times more than that in lost economic growth.
  2. Today, malaria can be prevented, diagnosed and treated with a combination of available tools. The primary tools used for prevention are long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS) in which insecticides are sprayed on the walls of homes, and intermittent preventive treatment for pregnant women (IPTp) to prevent malaria infection in high transmission settings. Other vector control measures (e.g. larviciding and environmental management) are used when appropriate based on scientific evidence. Medicines and diagnostics are used for malaria case management. Malaria can be confirmed by parasitological diagnosis with either microscopy or a rapid diagnostic test (RDT). Artemisinin-based combination therapies (ACTs) are the recommended treatment against P. falciparum malaria. Chloroquine (CQ) and primaquine (PQ) are the treatment of choice against chloroquine-sensitive P. vivax malaria.
  3. Following an aborted Global Malaria Eradication campaign in the 1950s – 1970s, malaria received little attention until recently. Over the past decade, there has been substantial progress in raising awareness about malaria. Several countries have demonstrated that it is possible to substantially reduce malaria-related morbidity and mortality. For example, following expanded coverage with LLINs and ACTs, malaria cases and deaths in health facilities in Rwanda declined by more than 50%. Similar results were achieved in Eritrea, Sao Tome and Principe, and Zanzibar (United Republic of Tanzania).
  4. There is still much to do to achieve the RBM targets and bring the benefits of universal coverage to a wider range of countries. Country level capacity building and health systems strengthening will be critical to ensure countries can deliver the needed interventions to populations at risk. Data from the World Health Organization (WHO) World Malaria Report 2008 shows that many countries are far from meeting the universal coverage targets for key interventions. For example, across 18 African countries in 2006-2007, 34% of households owned an insecticide-treated net (ITN) and 23% of children under five slept under an ITN. In addition, UNICEF data on the number of ITNs produced shows an increase from 30 million ITNs in 2004 to 95 million ITNs in 2007, with further increases expected in 2008. Further, a number of partners and countries have been actively involved in boosting the utilization of indoor residual spraying in recent years.
  5. The trend in funding for malaria is positive. Unprecedented amounts of money have gone to malaria control since 2004, reaching an estimated US$ 1.5 billion from all sources combined in 2007. Disbursements from international donors alone increased almost threefold from US$ 250 million in 2004 to US$ 700 million in 2007 and are expected to increase to US$ 1.1 billion in 2008. However, to reach the RBM targets, funding will need to be increased to about four times the total current funding levels.

Part II: The Global Strategy

Control: Overcoming malaria

The RBM Partnership’s control strategy aims to reduce malaria morbidity and mortality by reaching universal coverage and strengthening health systems. The Global Malaria Action Plan defines two stages of malaria control:

  1. scaling-up for impact (SUFI) of preventive and therapeutic interventions, and
  2. sustaining control over time.

Elimination and Eradication: Achieving Zero Transmission

The Malaria Research Agenda

Costs of Investment in Malaria Control, Elimination and Research

Table 1: Summary of annual global costs


Cost (US$ millions) 2009 2010 2015 2020 2025
Prevention cost 3,728 3,982 3,724 3,864 2,576
Case management cost 968 1,359 550 226 87
Program cost 638 839 764 787 714
Global control and elimination costs 5,335 6,180 5,037 4,877 3,378
Research & Development cost 759 759 800 681 460
Total cost 6,094 6,939 5,837 5,559 3,838

Note: Detailed cost estimates are included in Part II - Chapter 5: Costs and Benefits of Investing in Malaria Control, Elimination and Research, Appendix 4 and Appendix 5
Source: GMAP costing model


Part III: Regional Strategies

Part IV: The Role of the RBM Partnership

The Roll Back Malaria Partnership, through its various mechanisms (e.g. Working Groups, Sub Regional Networks, Secretariat) and in collaboration with specific Partners, provides assistance at all levels, concentrating on areas with the greatest need and on tasks that benefit the most from collaboration and cooperation. These tasks, which complement and complete the plan, involve:

RBM Partnership Working Groups already cover many of these topics. The Partnership intends to further expand its activities in the coming years to be ever more responsive to the needs of endemic countries and to reach its targets. In the near term, areas to be expanded include greater support for resource mobilization, assistance with communication and behavior change methodologies, and support for countries facing humanitarian crises (e.g. conflicts, natural disasters). In all areas, the Partnership will strengthen its links with regions outside of Africa. Ties will also be strengthened with research institutions to develop new tools, to inform policies and to improve implementation. These steps will enable the RBM Partnership to more effectively coordinate efforts to implement this plan.

The Bottom Line

The costs of fighting malaria are significant, but the benefits are far greater and the risks of inaction are too large to ignore (e.g. lives lost, economic development stymied, resistance emerging).