The Asia Pacific Malaria Elimination Network (APMEN): Supporting the common goal of a malaria-free Asia Pacific
The contribution of malaria control to maternal and newborn health
Defeating Malaria in Asia, the Pacific, Americas, Middle East, and Europe
Eliminating Malaria: Learning from the Past, Looking Ahead
A Decade of Partnership and Results
Business Investing in Malaria Control: Economic Returns and a Healthy Workforce for Africa
Mathematical Modeling to Support Malaria Control and Elimination
Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals
World Malaria Day 2010: Africa Update
Country Funding and Resource Utilization
The Asia Pacific Malaria Elimination Network (APMEN): Supporting the common goal of a malaria-free Asia Pacific
The APMEN was established in 2009 with growing political support from within the region and substantial financial assistance, namely from the Australian Government. Since then, it has not only emphasized and shared the successes of malaria control across a highly diverse region, but it has also worked with regional country programmes towards advancing the fight against the disease a few steps further on the continuum to elimination. Today it brings 16 countries and a wide range of international malaria control institutions together, with a formal commitment to support each other’s efforts and to achieve the long term goal of eliminating malaria regionally. It provides complementary support to the WHO and RBM Partnership efforts and contributions that have assisted, and continue to assist, the countries of the region progress their malaria agendas.
APMEN has been a significant contributor in accelerating the elimination agenda in the Asia Pacific through its core functions and, in that regard, it has undoubtedly become a model for other regions to consider. As high-level political will for malaria elimination is continuing to strengthen in that part of the world, two priorities have been identified for APMEN to support: mobilization of sustained commensurate funding levels to reach and maintain elimination; and fine-tuning of elimination implementation approaches involving private-public partnerships, community engagement, crosssectoral work and cross-border activities.
An achieving network
APMEN has achieved several successes in its core areas of advocacy and leadership, knowledge exchange, capacity building and building the evidence base for elimination. It has developed a country-led network with a strong sense of country ownership, progressing the elimination agenda in the region by providing advocacy and leadership for elimination and bringing attention to challenges and successes. Through annual meetings, working groups, study tours and workshops, APMEN partners are able to share experiences, identify priorities and develop strategies. APMEN builds capacity via training activities, including its fellowships programme, while the working groups and the country partner technical development programme have built the evidence base on matters of critical importance to the region. Central to APMEN’s success has been its well-developed governance processes, its collegial and collaborative platform and the diverse composition of the network that supports a collaborative approach to elimination within the network and with other critical malaria partners, such as WHO and the RBM Partnership.
Sharing and learning from others’ experiences
APMEN, recognizing that sharing and learning from others’ experiences is central to achieving elimination, has developed a range of knowledgesharing activities that help identify priority areas for action and the need for capacity building among malaria programme staff. Face-to-face meetings are essential to developing a shared agenda, as are practical opportunities to observe elimination programmes, such as the study tours. While APMEN enables countries to agree on priority areas for action, the thematic focus of APMEN discussions changes in response to the changing malaria landscape. Adaptability and flexibility allow for knowledge exchange to remain relevant to the evolving needs of countries as they move towards elimination.
APMEN brings together 16 countries, 33 partner institutions and other organizations that contribute in various capacities. It also continues to build partnerships between NMCPs, research institutions, WHO SEARO and WPRO, the Roll Back Malaria Partnership, other malaria networks and donors from both the public and private sectors. APMEN has established formal partnerships beyond the network with initiatives, such as the Malaria Atlas Project (MAP), the Malaria Elimination Group (MEG), the WorldWide Antimalarial Resistance Network (WWARN), Malaria No More, Malaria Consortium and Jhpiego.
APMEN has generated informal partnerships within the network, these collegial ties and mentoring relationships valued by partners as a means to better understand the priorities of others across the sector and develop efficiencies in their own work. Since many partners participate in APMEN in a pro-bono capacity, this presents good value for money. However, these informal partnerships, while common and valued, tend to operate on an interpersonal rather than on an institutional level. Countries continue to pursue elimination independently but with increased knowledge sharing and a greater awareness of cross-regional issues and the strategies employed by others, knowing they have peers from whom they can seek support and advice.
Lessons of collaborative, regional approaches to elimination
APMEN can offer many lessons to other regions wishing to establish collaborative approaches to malaria elimination. Some apply to all types of regional initiatives, while some are unique to networks. Challenges APMEN has faced include maintaining focus in a diverse and rapidly changing malaria landscape, developing mechanisms for engaging with others in the global health architecture and identifying benchmarks for measuring success. APMEN shows that a successful elimination network is an adaptive, learning organization; establishes clear and relevant aims that reflect country needs; attracts a strong base of expertise; has a defined role in regional health architecture; develops clear governance and an effective secretariat; and advocates for sustainable funding and ongoing political support to reach and sustain elimination.
APMEN is growing and adapting, and working to support countries in the region to reach and sustain elimination. Following the formation of APLMA, in February 2014 the Australian Government renewed its commitment to malaria elimination as part of the US$ 17 million grant to the newly formed Regional Malaria and Other Communicable Diseases Trust Fund within the Asian Development Bank.60 As momentum gathers around elimination efforts, APMEN will continue to adapt to changes in the malaria landscape. In March 2014, APMEN country partners signed a Declaration of Commitment, supporting the Malaria 2012 Declaration target that half of the countries in the region will have achieved their elimination targets by 2025, and reconfirming a commitment to working together to pursue the long term goal of regional malaria elimination.61 APMEN’s fluidity, its reputation as a successful and collegiate platform, and its unique combination of expertise and country ownership will ensure that APMEN continues to play a vital role in pursuing malaria elimination in the Asia Pacific.
The contribution of malaria control to maternal and newborn health
Prevention of malaria in pregnancy is a key component of malaria control and an important contributor to maternal and child health. National policies and effective delivery of available preventive measures in the antenatal setting will directly contribute to achieving the Millennium Development Goals (MDGs).
Interventions that substantially reduce adverse outcomes of malaria in pregnancy have been available for more than two decades yet the coverage of such interventions is generally poor.
Malaria in pregnancy must be a priority component of antenatal care.
Malaria in pregnancy interventions save the lives of pregnant women and their newborns (1–28 days of age),b and should be an integral component of all reproductive, maternal, newborn and child health programmes. Malaria in pregnancy is a significant contributor to maternal and neonatal mortality. It is a major cause of anaemia in pregnant women, which contributes to maternal death at delivery due to haemorrhage, and causes stillbirths, preterm birth, and low birth weight increasing the risk of neonatal death. In Africa, 10 000 women and between 75 000 and 200 000 infants (children under the age of 12 months) are estimated to die annually as a result of malaria infection during pregnancy, and approximately 11% (100 000) of neonatal deaths are due to low birth weight resulting from Plasmodium falciparum infections in pregnancy. These outcomes are entirely preventable, and optimizing the delivery of malaria in pregnancy interventions will lead to direct improvements in maternal, newborn and infant health.
Malaria in pregnancy interventions can substantially improve maternal, newborn and infant health.
Under routine programme conditions, intermittent preventive treatment during pregnancy (IPTp) or insecticide-treated mosquito net (ITN)c use in first and second pregnancies in 25 African countries was significantly associated with an 18% decrease in the risk of neonatal mortality and 21% decrease in low birth weight. According to the Lives Saved Tool (LiST), about 94 000 deaths (uncertainty interval: 19 000–251 000) among newborns were averted between 2009 and 2012 thanks to the scale-up of prevention of malaria in pregnancy interventions. Had an 80% coverage of prevention of malaria in pregnancy interventions been achieved over these three years in these same countries, about 300 000 neonatal deaths could have been averted. Countries with high coverage and use of malaria control interventions saw child mortality rates fall by about 20%. Continued focus on scaling up coverage and access to these interventions will substantially increase the magnitude of these health benefits.
Cost-effective interventions to prevent and treat malaria in pregnancy are widely available.
Highly cost-effective interventions to prevent and treat malaria in pregnancy are available. Effective, prompt diagnosis and case management provide benefits to pregnant women infected with the malaria parasite and to their unborn children.
Intermittent preventive treatment during pregnancy and ITNs are highly effective: research has shown that IPTp reduced severe maternal anaemia by 38%, low birth weight by 43%, and perinatal mortality by 27% among women in the first or second pregnancies; and that ITNs reduced miscarriages/stillbirths by 33%.
Despite global gains in malaria control and the known effectiveness of malaria in pregnancy interventions, coverage in some sub-Saharan African countries remains extremely low. Even though most countries have high antenatal care (ANC) coverage for one and two ANC visits, there is not a commensurate level of delivery of life-saving malaria control interventions, i.e. IPTp and ITNs.
IPTp and ITNs are delivered to pregnant women through antenatal clinics, IPTp at every ANC visit in the second and third trimester, and ITNs at the first ANC visit, as early as possible. However, despite relatively high antenatal care coverage (>77% of pregnant women attending ANC at least once [ANC 1+]) in most countries, IPTp and ITN coverage rates are well below global and national targets. IPTp coverage and ITN use among pregnant women increased only modestly between 2004–2008 and 2009–2012, respectively from 14% to 22% and from 17% to 39%.
Many obstacles to increasing coverage with intermittent preventive treatment can be overcome relatively quickly but others will require more integral and complex health system strengthening.
Research has shown that many obstacles to delivering IPTp are relatively simple barriers that are specific to IPTp and could be resolved in the short term. Other obstacles are more entrenched within the overall health system context, and will require increased support for health system strengthening. Improvements in the quality of ANC services and creating demand at the community level will also lead to higher attendance and better maternal and newborn health outcomes.
Malaria control interventions must be harmonized with other reproductive health policies and antenatal care services.
Focused antenatal care (FANC) aims to provide a comprehensive package of evidence-based services for all pregnant women; however there is fragmentation across programmes using the ANC platform for service delivery. Improved policy and programme coordination between reproductive, maternal, newborn and child health programmes, and other health programmes is required, with special attention to integrated mechanisms for budgeting and funding as part of the FANC package, and effective and appropriate integration at the service-delivery level (e.g. integrated laboratory services, integrated procurement/supply chain management, and task-shifting for improving human resources bottlenecks).
The World Health Organization (WHO) updated its malaria in pregnancy policy in 2012 with the key recommendation of extending the provision of IPTp to four times during the course of gestation and also made key recommendations on timing of the intervention. Critical next steps are for countries to harmonize malaria and maternal health policies, national guidelines and training materials based on the new policy including simplified guidance on how to deliver IPTp in the antenatal care setting. Strategies to encourage women to attend ANC as early as possible in pregnancy are also needed.
Partners from the RBM Malaria in Pregnancy Working Group recently released a consensus statement to engender further commitment, momentum and partnership between reproductive, maternal, newborn and child health programmes and malaria control programmes. Specifically, the aim is to reprioritize malaria in pregnancy as a core component of focused antenatal care, advocate for harmonized policy-making and integrated programme implementation and reinforce key interventions to optimize the delivery of malaria in pregnancy programmes, and prevent adverse maternal and newborn outcomes.
Defeating Malaria in the Americas, Europe, the Middle East and the Pacific
1. Malaria remains a public health problem in 51 countries outside of Africa, particularly affecting poorer populations.
- Malaria remains a public health problem outside of Africa. It leads to an estimated 34 million cases and 46 000 deaths among a population at risk of 2.5 billion people. The level of malaria risk can vary enormously. It can be as high as in parts of sub-Saharan Africa, with cases and deaths concentrated in children under five years of age, or 1000-fold lower where cases and deaths occur according to the degree of exposure. Both Plasmodium falciparum and P. vivax parasites occur in great frequency. Diagnostic testing to determine the specific parasite and using the appropriate drug are critical. Malaria outside Africa is also characterized by greater mosquito vector diversity. Different vectors may have widely different breeding, feeding, and resting behaviours. Vector control interventions need to adapt to specific vector characteristics in a locality.
- Poorer populations are more likely to be affected. Poorer populations are more likely to live in rural areas in housing that offers little protection against mosquitoes. Furthermore, they are less likely to have access to mosquito nets or indoor residual spraying (IRS). They also tend to live further away from health facilities that can offer effective diagnostic testing and treatment and be less able to afford quality treatment.
- Malaria imposes costs on society which go beyond the costs to individuals and families affected by the disease. Productivity of businesses and government is reduced because of employee work time lost due to illness, and extra costs are incurred in preventing, diagnosing, and treating malaria. Malaria can discourage investment and trade-markets may be undeveloped owing to traders' unwillingness to travel to and invest in malaria-endemic areas. A country's tourist industry may remain undeveloped due to the travelers' reluctance to visiting malariaendemic areas.
2. Progress in defeating malaria has been substantial.
- Funding for malaria control has increased. Since 2003, international funding for malaria control has risen by more than eight-fold primarily because of the growth in funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria, which accounted for approximately 88% of the US$ 300 million of international funds disbursed for malaria control outside of Africa in 2010. A further 8% of international funding was from the World Bank and another 2% from the Australian government. The growth in international funding for malaria control has been matched, in some instances, by increases in domestic spending.
- Malaria control programmes have been expanded. The increased funding has enabled worldwide implementation of malaria control interventions, including long-lasting insecticidal mosquito nets (LLINs) and IRS for the prevention of malaria, and rapid diagnostic tests (RDTs) and ACTs for the diagnosis and treatment of malaria. The largescale implementation of interventions against malaria has led to widespread reductions in malaria cases and deaths and a shrinking of areas affected by malaria.
- The number of malaria cases and deaths has decreased. A total of 34 countries outside of Africa have reduced cases by more than 50% since 2000. Malaria death rates have decreased by 30% outside of Africa and four countries have been certified as free of malaria since 2007 (Armenia, Morocco, Turkmenistan, and the United Arab Emirates). The World Health Organization (WHO) European Region is aiming for elimination of malaria across the entire region by 2015 and P. falciparum transmission has already been eliminated from the region. Another 17 countries are in the pre-elimination or elimination phases of malaria control and on the brink of eliminating malaria from within their boundaries.
3. Further progress is possible but major challenges lie ahead.
- Mechanisms for the delivery of malaria interventions have been developed. In most countries outside of Africa, delivery mechanisms have been established for mass distribution of LLINs and ensuring access to diagnostic testing and treatment in remote communities. Partnerships among different organizations involved in malaria control have, under the Roll back Malaria (RBM) umbrella, been established, to gain economies of scale and ensure that WHO policies for prevention, diagnosis, and treatment of malaria are disseminated to implementing partners and activities are coordinated to ensure a more rational allocation of resources.
- Progress has been substantial in countries with fewer malaria cases and deaths but slower in countries where the bulk of the disease burden lies. The 34 countries that halved their malaria case numbers between 2000 and 2010 accounted for only 14% of all non-African cases in 2000 (8.3 million cases out of 59 million estimated). Greater attention is needed to reducing the burden of malaria in countries where the problem is greatest.
- As malaria decreases it is increasingly concentrated in marginalized populations. Ethnic, religious, and political minorities are particularly affected as are migrant workers and populations living in less developed border regions. It is more challenging, and more costly, to offer services to these populations because of geographical accessibility, security, or political concerns.
- As malaria decreases, P. vivax malaria - which is more difficult to control - becomes more prominent. As malaria control is intensified, the number of cases due to P. falciparum falls more quickly than those of P. vivax so the proportion of cases due to P. vivax increases. Although P. vivax infections are less likely to lead to severe malaria and death it is more difficult to control because it has a dormant liver stage which cannot be detected with existing diagnostic tests and can only be eliminated by administering primaquine which must be taken daily over 14 days. Primaquine can produce serious side-effects (hemolytic anaemia) in patients who have more severe forms of glucose-6-phosphate dehydrogenase (G6PD) deficiency. The development of a low-cost and accurateRDT for G6PD deficiency would be an important advance for the control of vivax malaria.
- As disease incidence decreases populations are more prone to epidemics. As the incidence of malaria is reduced, naturally acquired immunity to the disease (which is at best partial) decreases. Although new infections are less likely to occur they can rapidly lead to illness, which can be severe, and they can more easily spread from one person to another. A high level of commitment is needed to maintain control programmes even once success has been achieved.
- Unique diversity in behaviour of the mosquito vectors presents additional challenges. These mosquitoes are diverse in their biting and resting habits and their living and breeding habitats. For example, some efficient vectors live and breed in forested regions and bite and rest outdoors and are therefore not easily controlled by insecticide-treated mosquito nets or IRS.
- Resistance to the latest antimalarial medicines has emerged in South-East Asia. P. falciparumresistance to artemisinins has been detected in Cambodia, Myanmar, Thailand, and Viet Nam. Although the large majority of patients with delayed response to artemisinins are currently still being cured when treated with an ACT, resistance needs to be contained in existing hotspots before it is spread around the world and the ability to treat P. falciparum malaria is lost worldwide. No other antimalarial medicines are available at present with the same level of efficacy and tolerability as ACTs, and the earliest that replacement medicines could be available is 2016.
- Resistance to the insecticides used to control mosquitoes is widespread. Existing vector control tools are currently effective in the vast majority of settings. However, insecticide resistance has now been reported in 24 out of 51 countries with malaria transmission outside of Africa. Resistance to a class of chemicals known as pyrethroids, which are the most commonly used chemicals for IRS and the only class used on LLINs, seems most widespread. Resistance to these chemicals could severely impact the ability to maintain gains already achieved in reducing malaria as well as the ability to aim for further success.
- Future funding for malaria control in Asia, the Pacific, Americas, Middle East, and Europe is threatened. Many endemic countries are particularly reliant on the Global Fund, which accounts for the vast majority of international disbursements for malaria control. The Global Fund has recently experienced lower levels of replenishment than expected and Round 11 of the Global Fund's application process was cancelled to be replaced with a transitional funding mechanism which aims to sustain existing investments. Along with other donors, the Global Fund is increasingly focusing its funding on the poorest countries in Africa with the highest malaria burden. International funding for countries outside of Africa may therefore decrease.
4. What needs to be done?
To achieve the ambitious global goals of reducing the needless loss of life due to malaria, and to further reduce the malaria burden outside of Africa, governments, development partners, and other stakeholders should focus their attention on six priority areas.
- Bridge the funding gap. While more money is available for malaria control outside of Africa than ever before, these resources still fall short of the amount required for effective disease control. An unprecedented global fundraising effort is needed-mobilizing both existing and emerging donors-to ensure that all endemic countries move closer to elimination, marginalized populations are reached, and the efforts to contain drug and insecticide resistance are scaled up. It will also be critical that malaria-endemic countries benefiting from economic growth allocate more domestic resources to fight malaria, or the progress made in reducing malaria to date will be put at risk.
- Increase technical assistance and knowledge transfers. To defeat malaria, many endemic countries will also need significantly more technical assistance to strengthen their malaria response. When requested, technical partners should scale up assistance to ministries of health to support them in their efforts to design, evaluate, and update national malaria control strategies and work plans. Development partners should continue to help ministries of health provide health worker training and strengthen human resources for health. Particular attention should be paid to the design of interventions that help vulnerable groups be reached.
- Provide universal access to preventive interventions. Greater efforts are needed to provide protection to all those at risk of malaria, particularly in the most populous countries with the greatest numbers of cases and deaths. Attainment of this goal will be particularly challenging for those communities that are mobile or live in remote border areas. In some situations, novel vector control methods may be needed, such as insecticidetreated hammocks to protect those who work and sleep in forests overnight, or insecticidal mosquito coils to protect against outdoor biting mosquitoes. As prevalence rates fall and remain very low in many areas, new approaches need to be developed to tackle the last remaining cases.
- Scale up diagnostic testing, treatment, and surveillance. With the 2012 launch of WHO's T3: Test. Treat. Track initiative, malaria-endemic countries and donors are urged 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. Scaling up these three interconnected pillars will provide the much-needed bridge between efforts to achieve universal coverage with prevention tools and the goal of eliminating malaria. It will also lead to a better overall understanding of the distribution of the disease, and enable national malaria control programmes to most efficiently direct available resources to where they are needed. T3 scale-up will enable affected countries to deliver a better return on investment on malaria funding received from international donors.
- Step up the fight against drug and insecticide resistance. The double threat of drug and insecticide resistance imperils recent gains in malaria prevention and control. Increased political commitment and new sources of funding will be needed to tackle these challenges. WHO has made global strategies available to address both drug and insecticide resistance. The Global Plan for Artemisinin Resistance Containment was released in January 2011, while the Global Plan for Insecticide Resistance Management in malaria vectors was issued in May 2012. These plans should be fully implemented by governments and stakeholders in the global malaria community to preserve the current tools of malaria control until new and more effective tools become available. Contributions from the research community and industry partners will be fundamental to tackling these emerging threats.
- Strengthen regional cooperation. Malaria can be defeated only if governments scale up regional cooperation efforts to strengthen the regulatory environment for pharmaceuticals and work together on removing oral artemisinin-based monotherapies and counterfeit medicines from markets. Countries also need to collaborate on managing the supply chain for malaria commodities and share information about drug and insecticide resistance patterns. In a world where malaria is increasingly confined to border areas-and where cross-border migration represents a major source of new malaria infection-regional cooperation is also critical for the development of cross-border strategies that are inclusive of marginalized populations.
Governments have already made a number of commitments in the UN General Assembly and the World Health Assembly, through the governing bodies of WHO regional structures, and through a range of regional cooperation platforms, such as the Union of South American Nations (UNASUR) and the Association of Southeast Asian Nations (ASEAN). However, stronger political commitment will be needed to provide universal access to all key malaria interventions and to move closer to malaria elimination. With malaria designated as one of the key priorities of the UN Secretary General's five-year action agenda (2012–2017), there is an unprecedented opportunity to end the unnecessary suffering caused by this disease.
5. What can be gained?
- The burden of a senseless, preventable tragedy can be lifted. Scaling up malaria control efforts has been proven to reduce illness and death, especially among the poorest populations outside of Africa. This relieves some of the most vulnerable populations of a significant illness that causes disruption to schooling, work, and, at the worst, death.
- Considerable long-term impact and financial savings can be achieved both in endemic countries and globally. Protecting the tools we have by working to contain emerging drug and insecticide resistance will have cost implications in the near term for which many malaria-endemic countries will need support. However, investment now will result in significant savings in the long run, improving the sustainability and public health impact of malaria interventions, not only in countries affected but globally.
- Health systems can be strengthened. Improving the malaria response-at both the national level and in larger regions-will boost the capacities of health systems to improve the treatment of other febrile illnesses and will help to direct financial resources where the funds are most needed. Strengthening health infrastructure and improving health information systems for malaria will strengthen countries' overall capacities to respond to future public health threats, while also helping bridge existing health inequalities.
- Large areas of the world can be free of malaria in the foreseeable future. Four countries outside of Africa have been certified free of malaria since 2007. Another 17 are in the pre-elimination or elimination stage of malaria control and poised to eliminate malaria soon-removing the threat of disease from 74 million people currently at risk. If elimination is attained in these countries it would represent a historic achievement to be remembered for decades to come and set the course for eventual eradication of this ancient disease.
Find out how your country is doing from the infographic, which shows the estimated number of malaria cases each year, the "probable and confirmed" cases, as well as the current phase of the malaria response in each contry.
View RBM interactive infographic [Interactive PDF]
Eliminating Malaria: Learning from the Past, Looking Ahead
Eliminating Malaria: Learning from the Past, Looking Ahead, the eighth report in the Roll Back Malaria Progress & Impact Series, details previous malaria elimination and eradication efforts to date, and summarizes ongoing progress in all malaria-endemic areas of the world. Country and regional goals of malaria elimination will become a reality when we truly achieve universal access to and utilization of today's tools — while investing in the people and systems required to implement them as well as in the research required to develop tomorrow's transformative tools. Following are the key messages from the report:
- Eliminating malaria by the end of 2015 in at least eight to ten new countries, including the entire WHO European Region, is one of the RBM Partnership's three objectives.
The malaria community is back on track helping countries progress to elimination. Since 2007, three countries have been certified by WHO as malaria-free. Sixteen countries and territories were certified by WHO as malaria-free during the 17 years of the Global Malaria Eradication Programme (1955 to 1972), and seven countries and one territory were certified in the period 1973–1987. After this, certification was abandoned for a period of twenty years.
- Further progress in malaria elimination is occurring in most regions in the world.
Seven countries are in the phase of preventing reintroduction and some may soon be ready for certification. Ten countries currently are in the elimination phase and nine countries are in thepreelimination phase.
- Successful malaria elimination programmes are built on strong national leadership, commitment to high-quality staffing and programme delivery, national stability (political and socioeconomic), sound technical approaches that address local malaria biology and evolve with changing epidemiology, and effective surveillance systems that can rapidly detect and contain transmission.
- Malaria elimination can be fragile and, once achieved, needs to be sustained through continued effort. Concomitant investments to improve socioeconomic conditions and housing in the at-risk areas, as well as raising awareness regarding key malaria elimination activities among community and business leaders, health workers and the wider public, will be critical to achieving and sustaining success.
- Many countries in the control phase have substantially reduced malaria morbidity and mortality and some have established or expanded malaria-free areas — progress that will require ongoing support for eventual transition to nationwide pre-elimination and elimination.
- Countries with intense malaria transmission will require new tools and strategies to speed their advance to elimination; maintaining investment for research and development and strengthening public-private partnerships' capacity to pursue long-term elimination objectives are essential. However, extraordinary progress is possible with existing tools and we must act now, while planning for the availability of new tools.
- In addition to national commitment, sustained and predictable technical and financial support will be required from regional and global partners for malaria elimination efforts in many settings. Investments in malaria control need to increase substantially over existing levels.
- Tremendous public health successes can be achieved on the way to malaria elimination, through its focus on the systematic building of local and community empowerment for health, quality health service-delivery mechanisms that reach the most peripheral areas, surveillance systems for timely detection and containment of disease transmission, and a new generation of results-oriented public health leadership.
A Decade of Partnership and Results
Roll Back Malaria Partnership vision, objectives and targets, as updated in 2011
Vision: Achieve a malaria-free world.
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).
Objective 3: Eliminate malaria by 2015 in 10 new countries and in the WHO European Region.
Targets include: Achieve universal access to and utilization of prevention measures; sustain universal access to and utilization of prevention measures; accelerate development of surveillance systems; achieve universal access to case management in the public sector; achieve universal access to case management and referral in the private sector; achieve universal access to community case management of malaria.
A Decade of Partnership and Results demonstrates the dramatic successes achieved by the malaria community over the past 10 years. As a result of greater commitment and increased resources being made available to national malaria control programmes, interventions have reached vulnerable populations and thousands of lives have been saved. The report details the evolution and effectiveness of the Roll Back Malaria (RBM) Partnership over the years, demonstrating how a strong, well-organized community can help deliver broad health benefits while relieving overburdened health systems.
Leading the way to success
Since its inception, the RBM Partnership has evolved into a robust platform for discussions and harmonization of partners' goals and actions in malaria programming, resourcing and advocacy, bringing together a broad network of national, regional and global partners. This strong, united partnership has supported country leadership and national health systems leveraging data to inform decision-making, integrating malaria control activities into existing health systems and ensuring malaria remains a priority on the global health agenda to help secure long-term funding and political commitment. Through collaborative advocacy efforts, partners have helped increase funding for malaria 10-fold during the past 10 years, reaching US$ 1.5 billion in 2010. This dramatic rise in funding helped transform the malaria landscape, making universal coverage with proven interventions an achievable goal for many countries.
Impacting human lives
Many countries have rapidly scaled up their malaria control efforts and have demonstrated significant impact. Survey results, routine health information and monitoring studies have shown consistently fewer malaria cases and less anemia, severe disease and deaths. Reductions in disease burden have occurred in every malaria-endemic region in the world, including Africa, Europe, the Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific. Approximately half of the malariaendemic countries in these regions have been able to reduce malaria cases and deaths by 50% or more. Three countries—Morocco, Turkmenistan and the United Arab Emirates—have been certified by the WHO as having eliminated malaria. And in Africa, where the vast majority of malaria cases and deaths occur, the results have been even more dramatic: between the year 2000 and the launch of this report, an estimated 1.1 million African children's lives were saved from the disease.
Improving health systems
Since 2000, major changes have taken place in every aspect of malaria control. Policies to fight malaria now provide for universal coverage of proven prevention tools and embrace the strategy laid out in the Global Malaria Action Plan. Insecticide-treated bednets are now long-lasting, use of indoor residual spraying has been expanded beyond urban areas, prevention in pregnancy is reaching more women through antenatal clinics, rapid diagnostic tests have been approved for widescale use and effective treatment with artemisinin-based combination therapies is now widely available. Systems for monitoring programme action and progress have been strengthened and the timeliness and quality of information being collected has greatly improved.
Looking to the future
Efforts to fight malaria control are more successful than ever, but the gains that have been made in the past decade are still fragile. Continued success requires building on what works, rapidly anticipating the need for and developing new strategies and tools, addressing threats head on and ensuring that successful investments are not lost due to competing global priorities. The malaria parasite is a strong opponent and without continued funding and political commitment, the world runs the risk of losing the progress made to date. Next steps will require careful examination of existing and new strategies and tools to further reduce malaria transmission and put countries on the path to eliminating the disease.
Business Investing in Malaria Control: Economic Returns and a Healthy Workforce for AfricaPhoto © David Jacobs
Business Investing in Malaria Control: Economic Returns and a Healthy Workforce for Africa, the sixth report in the Roll Back Malaria Progress & Impact Series, examines how private sector investment in malaria control has improved cost effectiveness at companies operating in malariaendemic regions in Africa. Companies in Equatorial Guinea, Ghana, Mozambique, and Zambia have worked to prevent malaria among their workers and workers' dependents and have seen an excellent return on investment, with significant reductions in malaria-related illnesses and deaths, worker absenteeism, and malariarelated spending.
A summary of key messages
- Malaria is bad for business: the disease is responsible for decreased productivity, employee absenteeism, increased health care spending, and can negatively impact a company's reputation. A 2006 report found that nearly three-quarters of companies in the Africa region reported that malaria was negatively affecting their business.
- Malaria infection in company employees can impact the local economy because the overall labor force is weakened by sickness and absenteeism, savings are lost, commerce is slowed, investments and tax revenues are reduced and public health budgets are diminished.
- Companies have been able to scale up malaria control quickly and have seen a rapid return on investment. Malaria-related spending at three company clinics in Zambia decreased by more than 75%, and a very conservative estimate showed that the companies gained an annualized rate of return of 28%.1
- Strong models exist for businesses to take leadership roles in controlling malaria, protecting their workers and their families, strengthening their businesses, and extending programmes into communities.
- The private sector is a critical partner and can collaborate with and complement national programmes to resource and implement effective malaria control. The benefits reaped by malaria control efforts in the business context are fragile and can be temporary unless durable investments are made to ensure continued success.
Malaria hurts business
A report published in 2006 found that nearly three-quarters of companies in sub-Saharan Africa reported that malaria was negatively impacting their business, with 39% perceiving the impact to be serious. Varying reports estimate that during a typical malaria episode, a worker misses between one and ten days of work and often return to the workplace exhausted and less productive. Many companies provide healthcare for their employees and bear the cost of medical expenses when employees or their family members are ill. In addition to affecting individual workers, malaria can also damage the economic environment in which businesses operate, impacting the availability of local resources and public health budgets, and slowing economic growth.
The companies profiled in this report have demonstrated that the private sector is a powerful partner, capable of implementing effective malaria prevention programmes to quickly reduce malaria-related health-care expenditures, worker absenteeism, and illnesses and deaths.
Investing in malaria control pays off
Involvement in the fight against malaria helped build these companies' reputations for social responsibility and good corporate citizenship. It also had a significant leveragig effect. These companies used their diverse competencies and infrastructure to attract partners and resources, securing funding from external donors and jumpstarting scale-up interventions that otherwise would not have taken place.
Strong models now exist for the involvement of the private sector in malaria control:
- Three companies in Zambia 3 Mopani Copper Mines, Konkola Copper Mines, and Zambia Sugar—have made dramatic progress in a ten-year period. The number of malaria cases in company clinics dropped 94%, from 27 925 per year to 1631 and the number of malaria-related lost work days also dropped 94%, from 19 392 per year to 1133 (see Figure 1).
- In 2004, in the Ghanaian community of Obuasi, gold producer AngloGold Ashanti was seeing as many as 6800 malaria patients per month at the company's hospital, out of a total workforce of 8000 people. AngloGold partnered with Ghana's National Malaria Control Programme, among others, to implement indoor residual spraying, distribution of bednets, and rapid diagnosis and treatment. By 2009, only 1100 patients were visiting the hospital each month and monthly malaria medication costs at the company had fallen from US$ 550 000 to US$ 9800.
- In Bioko Island, Equatorial Guinea, Marathon Oil partnered with business partners and the Guinean Government to develop a five-year US$ 15.8 million initiative that increased the percentage of young children protected by bednets or indoor spraying of insecticides from 4% to 95% and reduced malaria parasite prevalence in children by 57% in just four years. The project, which won several high-profile awards for social responsibility and good citizenship, was extended through 2013 to develop local capacity and enable the programme to reach the mainland.
- During the first two years aluminum smelter BHP Billiton was operating in Mozambique, the company reported 6000 malaria cases, 300 medical evacuations, 13 fatalities, and incurred US$ 2.7 million in malaria costs while it was being built. The company partnered with the Lubombo Spatial Development Initiative to help reduce malaria infections from 625 cases per 1000 population to fewer than 200 cases per 1000 in the Maputo Province of Mozambique. In addition to savings from absenteeism and health care costs averted, the initiative's success helped secure two grants totalling US$ 47 million from the Global Fund for regional control of malaria.
Malaria control is a cost-effective business investment that offers a rapid rate of return. Both small and large businesses have proven to be critical contributors in the fight against the malaria, whether they work independently or partner with national governments. Supporting malaria control is a contribution that the private sector can and should make; strengthening their businesses while savings lives.
Sources: Company data from Zambia Sugar, Mopani Copper Mines (MCM)
and Konkola Copper Mines (KCM).
Yearly malaria cases reported in company health clinics for Zambia Sugar, Mopani Copper Mines and Konkola Copper Mines, Zambia, 2001–2009
The number of malaria cases dropped dramatically in each of the company health clinics between 2001 and 2009. This figure includes malaria cases of employees and dependents. Where possible, other non-employee and family cases are excluded.
Mathematical Modelling to Support Malaria Control and EliminationPhoto © Bonnie Gillespie/Johns Hopkins University
Mathematical Modelling to Support Malaria Control and Elimination, the fifth report of the Roll Back Malaria Progress & Impact Series, provides an overview of mathematical modelling, explains its history in relation to epidemiology and malaria, and details its implications and uses for global and national malaria control and elimination planning. The report aims to expand the dialogue within the global malaria community - and among public health decisionmakers in particular - on when and how mathematical modelling can help inform malaria control programmes and policies.
A summary of key messages
- Mathematical modelling has long been applied to malaria control and is particularly relevant today in light of rapid country progress in reaching high intervention coverage targets and given the intensifying global efforts to achieve the malaria-related Millennium Development Goals.
- Modelling is especially well-suited to helping inform decision-making around malaria control because of the disease's complex biological systems, the considerable infrastructural and cost requirements of prevention and elimination, and the rapid pace of change in global planning and national programming to halt malaria.
- Findings from modelling can provide valuable data to help inform a range of decision-making on issues such as identifying potential effective combinations of interventions; setting feasible coverage targets; devising target product profiles for new interventions; anticipating the implications of introducing new interventions; understanding the potential for malaria resurgence; and establishing how malaria surveillance can best enhance global or country progress.
- While models have limitations, their findings can be useful to the full range of constituents of the global malaria control community, including global and regional malaria control policy-makers, program planners at the country and local levels, academic researchers, those involved in product research and development, and donors.
Using modelling to inform decision-making
Mathematical modelling uses computer-based models to describe, explain, or predict behaviour or phenomena in the real world. It is particularly useful in investigating questions or testing ideas within complex systems. For this reason, modelling can be especially helpful in informing decision-making in global malaria control and eradication efforts because they involve extensive changes to a complex web of interconnected biological systems. Establishing optimal policies and programmes to support these efforts is complicated by the potential for parasites and vectors to evolve, the waxing and waning of human immunity, behavioural changes in human and vector populations, and interactions among large numbers of heterogeneous sub-populations of the organisms involved.
As countries scale up malaria control efforts and reach high intervention coverage targets, they are faced with the question of what to do next. The strategy for maintaining and enhancing the achieved reductions in transmission is not obvious. It is often not clear whether maintaining current coverage levels would continue to reduce transmission, stabilize transmission at a new level, or slowly give way to an increase in transmission. Mathematical modelling can build on available data, test multiple scenarios and combinations of intervention strategies, and make verifiable predictions on what can be expected from these strategies.
Box 1 offers a practical example of how mathematical modelling can be applied in a country context.
An example of the role modelling can play in malaria control: Understanding the potential implications of combining ITNs and IRS
Several African countries have achieved high coverage of insecticide-treated nets (ITNs) and are now considering the potential benefit (in terms of reducing disease burden or interrupting transmission) of adding indoor residual spraying (IRS) as an additional means of vector control. Different mathematical models are required in order to produce outputs that would reasonably inform understanding about this issue. The overall models need to:
- accurately describe the malaria transmission cycle including malaria infections in humans and mosquitoes;
- account for the effects of malaria infection in humans on clinical disease, morbidity, and mortality;
- include the effects of the health systems on malaria transmission and disease;
- account for the effects of ITNs and IRS on the malaria transmission cycle;
- use available data in model inputs (such as pre-intervention transmission level, predominant vector species, population age structure, first line treatment drug for malaria) and outputs (such as incidence of infection, age-prevalence of parasitaemia, age-incidence of mortality) to estimate parameter values for the model;
- use additional data for model outputs to ensure that it can reproduce data that it has not been fit to;
- include a set coverage level of ITNs to see the corresponding disease burden;
- add various coverage levels of IRS to see the effects on reduction in disease burden and transmission;
- compare different insecticides to see what is most appropriate to the situation, especially when insecticide resistance is taken into account;
- use cost data to determine the cost-effectiveness of adding IRS.
Adding a model for the evolution of resistance would allow for testing resistance management strategies with the combination of ITNs and IRS.
To produce relevant, robust findings, mathematical modelling should at the outset involve partnership and good communication between technical experts in mathematical modelling, experts in malaria field and laboratory science, and health policy decision-makers. Models produce the most useful data when they are formulated with important biological, economic, and practical realities in mind and when their results are interpreted with care, making them another useful tool in the fight against malaria.
Saving Lives with Malaria Control: Counting Down to the Millennium Development GoalsPhoto © Christelle Thomas / RBM Secretariat
A summary of key findings
- Malaria is the leading cause of child mortality in Africa and malaria control is critical to achieving several of the MDGs related to child survival.
- The LiST model is a key tool in estimating the effectiveness and impact of malaria control interventions in reducing rates of malaria-related infant and child mortality.
- An assessment of current malaria control efforts using the LiST model has shown that 736 700 children in 34 African countries are estimated to have been saved between 2001 and 2010.
- If universal coverage of effective malaria control interventions is reached by the end of 2010 and maintained until 2015, an additional 3 million African children could be saved.
- Decreases in funding for malaria control and intervention coverage rates could result in nearly half a million additional child deaths.
- Recent financing to scale-up malaria control has saved many lives and represents an excellent return on investment. For every US$ 1000 that is spent, 380 children are protected from malaria.
Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals, the third report of the Roll Back Malaria Progress & Impact Series, analyses the impact of malaria control scale-up on child mortality over the last decade in 34 malariaendemic African countries. Using the Lives Saved Tool (LiST), the report demonstrates the dramatic progress made towards achieving the Millennium Development Goa l s (MDGs) relate to malaria and child survival - and the potential consequences of decreasing our commitment to fighting the disease.
Measuring progress, one life at a time
Measuring progress towards the MDGs is challenging in settings with limited resources where malaria and high rates of child mortality are common—particularly in Africa, where malaria causes 20% of all child deaths. Proven models, like the LiST model, can help estimate current and future progress, informing planning and strengthening responses to fight the disease.
First developed by the child health community, the LiST model generates data based on estimates and assumptions about each country's population and growth rate, mortality rate, cause-ofdeath patterns and estimates of coverage levels of child survival interventions. The LiST model allows users to set up and run multiple scenarios, providing a structured format to combine the best scientific information about effectiveness of interventions for maternal, neonatal, and child health with information about cause of death and current coverage of interventions. This enables program managers and Ministry of Health personnel to inform their work, helping to prioritize investments and evaluate existing programs. Over the last seven years, it has been refined to become a powerful tool in estimating the effectiveness of malaria control interventions on infant and child mortality.
As we approach the target set by African Heads of State in Abuja and UN Secretary-General Ban Ki-moon to reach universal coverage of essential malaria interventions by December 31, 2010, we find that many countries are making excellent progress towards this goal. Use of the LiST model has demonstrated that malaria control efforts have already saved many lives: between 2001 and 2010, nearly threequarters of a million children (736 700) are estimated to have been saved, almost entirely due to intervention coverage (see Figure 1). The vast majority of these children were saved in the last five years—a period in which there was a dramatic increase in funding and political commitment to fight the disease. Now, in 2010, an estimated 485 children are saved every day from malaria-related death.
Maintaining success for greater impact
Only five years remains before the world's deadline to reach the ambitious MDGs and application of the LiST model demonstrates that, through sustaining or increasing commitments to malaria control, the number of lives saved from malaria could grow dramatically in just a few years. If malaria endemic countries are able to reach universal coverage with proven malaria control interventions like insecticidetreated mosquito nets (ITNs), indoor residual spraying (IRS), and intermittent preventive treatment for pregnant women (IPTp) by the end of the year, nearly three million more children could be saved between 2011 and 2015. If current intervention coverage trends are maintained, but not increased, the lives of another 1.14 million African children could be saved.
Thus, this year marks a critical point in the fight for a world free from the burden of malaria.
Current progress is sustained through a fragile mix of funding political commitment and effective tools; should we lose momentum, nearly half of a million young children would die and our hardearned investments would be lost. Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals clearly shows that our highest priority should be focusing on quickly achieving and maintaining universal coverage - millions of children's lives depend on it.
Children's lives saved by malaria prevention scale-up from 2001–2010
The LiST model estimates that malaria prevention scale-up (IPTp, ITN, IRS) over the past decade, when compared with rates in the year 2000, has saved the lives of 736 700 children (uncertainty bound 483 600–1 021 800) in 34 African countries. There was minimal progress in the first five years of the decade when few resources were available. The biggest impact will be seen this year, with a projected 18% decrease in malaria child deaths from 2000 levels.
World Malaria Day 2010: Africa UpdatePhoto © Maggie Hallahan / Sumitomo Chemical
A summary of key findings
- Achieving and sustaining malaria control is central to achieving many of the MDGs, particularly those related to child mortality and maternal health.
- Though global funding for malaria control has increased 10-fold in the last six years-from US$ 0.3 billion to US$ 1.7 billion annually-existing levels still fall far short of the estimated US$ 6 billion needed in 2010 alone.
- Increases in funding and commitment to malaria control have led to significant country progress, helping to quickly scale-up intervention coverage and reduce bottlenecks, and providing support for countries to adopt more effective-but more expensive-treatment and diagnostic strategies.
- Most malaria-endemic African countries have developed national plans for achieving the universal coverage targets by the deadline of the end of 2010; RBM partners will help ensure that monthly ITN distribution plans are implemented and monitored effectively.
- These efforts are already demonstrating a clear impact on the lives of people at risk of malaria in many countries and areas. More evidence of positive impact will become available as additional countries scale up their programmes and document results.
World Malaria Day 2010: Africa Update, the second report in the 2010–2011 Roll Back Malaria (RBM) Progress & Impact Series, benchmarks the remarkable progress and momentum that are building toward halting malaria in Africa. Dramatic increases in malaria control funding and national capacity to fight the disease have brought about corresponding steep declines in malaria illness and deaths in many countries. Nearly a million lives have been saved since 2000, the vast majority since 2006, when Africa’s scale-up efforts began in force. However, as countries look to achieve global targets in 2010, there is much work that remains to be done.
Global malaria control targets are within reach World Malaria Day 2010 serves in part to highlight the ambitious RBM 2010 targets and Millennium Development Goals (MDGs) the worldwide malaria community aims to meet. The RBM 2010 targets call for:
- Achieving universal intervention coverage of all populations at risk of malaria by 2010.
- Reducing the 2000 malaria burden by three quarters and reducing the number of preventable deaths to near zero by 2015.
- Eliminating malaria by 2015 in at least eight countries currently in the pre-elimination phase.
- Eradicating the disease worldwide as a long-term goal.
Reaching these targets will contribute to the attainment of several of the MDGs, particularly those concerning child survival and maternal health, a key focus in the malaria elimination effort. Indeed, children under five years old in sub-Saharan Africa account for the majority of deaths from malaria, with an estimated 850 000 deaths occurring in 2008 alone.
Intervention coverage progress
Controlling malaria is based on both preventing transmission and obtaining prompt and effective treatment when infection does occur. Many countries have already made important progress with regard to prevention, focusing on scaling up longlasting insecticide-treated bednets (ITNs), indoor residual spraying (IRS) of insecticides, and prevention of malaria during pregnancy. In the last decade, all 26 countries with trend data have significantly increased ITN coverage, with great impact. The report estimates that, between 2000 and 2010, ITNs saved over 908 000 lives-with three quarters of those deaths having been prevented since 2006 (Figure 1). If countries can reach 100% coverage of ITNs alone, an estimated 55% of projected annual malaria deaths will be prevented in 2010. In 2008, nearly 25 million people were protected by IRS as opposed only 2 million two years prior. However, while over 60% of pregnant women in Zambia and Sao Tome and Principe received the required doses of intermittent preventive treatment during their last pregnancy, coverage rates are variable, and still too low in most African countries.
While prompt and effective malaria treatment is reaching more children in Africa than ever, obstacles still remain. Artemisinin-based combination therapy (ACT) is the most effective form of antimalarial treatment but a very expensive one. So, as procurement of ACT has risen worldwide from half a million doses in 2001 to 160 million doses in 2009, very few children in Africa are actually receiving it. From 2005 to 2009, among children in African countries who received any antimalarial drug, the percentage that received ACT varied in range from zero to 50.
Financing is critical to sustaining progress
Increases in annual global financing for malaria control are encouraging. During the last six years contributions have grown approximately 10-fold. This financing has fuelled global production of key intervention commodities, country procurement, and distribution of these lifesaving interventions. But, as noted in the first report in the RBM Progress & Impact Series, Malaria Funding and Resource Utilization, current funding is only 25% of what is needed in order to achieve the RBM 2010 goals and the MDGs. Malaria control has proven to be a sound investment with life-saving results and committed countries-such as Nigeria, which plans to distribute around 60 million nets by the end of 2010-are taking decisive action to stop malaria.
Predicted number of malaria deaths averted in children under five years of age due to changes in ITN coverage during 2000–2010 based on modeled estimates, 35 African countries
An estimated 908 000 malaria deaths have been averted through ITN coverage between 2000–2010, with three quarters of the deaths averted since 2006.
Source: Data were abstracted from national surveys (Demographic and Health Surveys, Multiple Indicator Cluster Surveys, or Malaria Indicator Surveys).
Malaria Funding and Resource Utilization: The First Decade of Roll Back MalariaPhoto © Bonnie Gillepsie / Johns Hopkins University
A summary of key findings
- An assessment of malaria control financing and resource utilization in 12 African countries in which data were available found that reliable and sustained funding is central to saving many lives—from 2000 to 2009, approximately 384 000 child lives were saved.
- External financing for intervention scale-up is being used efficiently and appropriately by countries; funds are spent primarily on prevention, treatment, programme support, and health systems strengthening, respectively.
- Steep increases in global malaria financing have occurred since 2003. Seventy percent of 2003–2009 commitments are from the Global Fund, 15% from US-PMI, 8% from the World Bank, and 7% from countries and bilateral agencies.
- Current funding levels appear to have peaked at US$ 1.6 billion per year - approximately 25% of the estimated need to attain RBM targets and achieve the five malaria - related MDGs.
- Progress in reducing malaria burden positions the malaria control community strongly to attain RBM and MDG targets; 2010 is the year in which donors will help determine whether these targets are met.
Malaria Funding and Resource Utilization, the first report to be released as part of the 2010–2011 Roll Back Malaria (RBM) Progress & Impact series, confirms that investment in malaria control is rapidly saving lives and reaping far-reaching benefits for countries. But without sustained and predictable long-term funding, the significant contribution of malaria control toward achievement of the five Millennium Development Goals (MDGs) that are closely tied to malaria control, as well as progress toward achieving the 2010 Abuja target of universal intervention coverage, could be reversed.
A new era of malaria control funding
Two decades ago, malaria was highlighted as a disease of poverty, affecting the poorest people in endemic countries and there was little funding to fight the disease. Since that time, funding for malaria control has quadrupled, with US$ 4.5 billion of external assistance committed globally between 2003 and 2009. While many countries, organizations, and companies provide these resources, the majority of these funds are channeled through the Global Fund to Fight AIDS, Tuberculosis and Malaria, which began making commitments and disbursements in 2003, and the World Bank Malaria Booster Program for Malaria Control in Africa and the US President's Malaria Initiative (US-PMI), which were launched in 2006.
Ninety percent of the global malaria burden resides in sub-Saharan Africa, which is the recipient of 80% of external funding for malaria control. Countries are spending these funds appropriately, focusing primarily on prevention (42%) and treatment (31%), as well as health systems strengthening (14%) and programme support (13%). Once funding is received, countries are timely in procuring and distributing needed supplies - on average, more than 80% of funds were spent within the year they became available.
Increased support needed to continue saving lives
And it's working-increases in global funding for malaria control have saved lives and reduced illnesses, particularly for women and young children. In the 12 countries included in this report, an estimated 384 000 lives were saved from 2000 to 2009. Data suggests that if these same countries were able to achieve the RBM target of at least 80% intervention coverage by 2010, an additional 200 000 lives would be saved every year. Countries that have had even modest per-person spending have been able to make substantial progress in malaria control scale-up, which has helped shift the burden of the disease from low income families and national governments to a shared responsibility of the global community.
While current funding is effective, it is less than 25% of the total amount needed annually and there is some evidence that yearly commitments—currently estimated at US$ 1.6 billion per year—may have already peaked. Yet global financing needs for malaria control are estimated at US$ 5 to 6 billion annually for the next 10 years, as quantified in the RBM Partnership's 2008 Global Malaria Action Plan (see Figure 1). In addition, donor commitments and disbursements still have a high year-to-year variability, which can negatively affect programme planning, and they do not adequately respond to differences in need between countries.
Malaria Funding and Resource Utilization demonstrates that, while increased external assistance has had a dramatic impact on reducing malaria mortality and morbidity, external financing commitments must continue to increase in order to address outstanding needs and realize the full potential of malaria control in Africa. By bridging the current funding gap and helping countries implement their plans, partners can, together, make malaria a problem of the past.
Estimated annual global resource requirements for malaria control and current global malaria commitments from Global Fund, World Bank, and US-PMI.
The Global Malaria Action Plan estimated that between $5.0 and $6.2 billion is required per year between 2010 and 2015 to scale up and sustain control and progress toward malaria elimination globally. While there have been substantial increases in funding for malaria control, they continue to fall short of the amount needed to achieve the global goals.
Source: Global Malaria Action Plan (RBM, 2008), Global Fund, World Bank, and US-PMI.
Note: Current estimated commitments represent approved Global Fund grant requests (not all approved requests are committed funds) and estimates from the US-PMI and World Bank.