Malaria: Get to something that works

Millions spent on malaria but problems remain

We have to ask just how much profit from a program that isn't effective is going to Big PhRMA rather than to help people and solve this problem 

By MARIA CHENG, AP Medical Writer  – Apr 19, 2010

LONDON – Health groups have spent more than a billion dollars and bought millions of bednets to fight malaria, and 20 African countries have increased their bednet coverage at least fivefold, new research says.
In a report on the status of malaria in Africa issued on Monday by UNICEF and Roll Back Malaria, a U.N.-led partnership, the authors said $1.8 billion was spent last year, a 10-fold jump since 2004. More than 150 million insecticide-treated bednets to protect against the mosquito-borne disease have been produced and donors have purchased 160 million drug treatments.
If the bednets are indeed getting to people at risk, that number puts some countries on target to reach a U.N. goal of providing a bednet to all 350 million people at risk of malaria by the end of this year, officials said.
But other experts said the figures are an artificial symbol of success against the disease.
"These are meaningless input measures that tell us only (the UN) is effective at spending other people's money," said Philip Stevens, a health-policy expert at the London think tank International Policy Network.
Richard Tren, director of Africa Fighting Malaria, an Africa and US-based advocacy group, said measuring malaria spending and the numbers of drugs bought did not always mean more Africans had access to them.
Tren said he had once been in Uganda when the central warehouse had plenty of malaria drugs but clinics throughout the country had none. "They had no trucks to deliver anything," he said.
There are few data to prove people are actually sleeping under these bednets. According to UNICEF and partners, the percentage of children sleeping under bednets ranges from 4 percent in Cameroon, Swaziland and Guinea to 62 percent in Zambia. In some countries like Tanzania and Malawi, more bednets go to the rich than the poor, though the poor are most at risk from the potentially fatal disease.
There is also little evidence sick kids are getting the drugs. "The proportion of African children receiving (a malaria medicine) is still very low," the report said.
According to its most recent figures from 2008, the World Health Organization estimated there were about 250 million malaria cases including 850,000 deaths. Africa accounts for 90 percent of the world's cases. Before 2008, WHO guessed there were nearly 500 million malaria cases and 1 million deaths. The agency doesn't issue yearly figures but estimates based on household surveys and national statistics so there is little concrete proof to show what difference programs are making.
Tren said U.N. policies have skewed toward bednets and that it should focus on other proven tools like pesticides. But convincing donors to pay for pesticide spraying is a harder sell than bednets, especially with strong lobbying from environmentalists calling for reduced pesticide use.
The U.N. insisted its initiatives are saving lives and more money is needed. "We cannot afford to relax our efforts," said Coll Seck, executive director of the Roll Back Malaria Partnership, in a statement.
The U.N. said based on mathematical modeling, more than 10 million children were saved from malaria thanks to bednets.
Tren agreed some progress was being made in countries like Rwanda and Ethiopia, but said countries needed to take responsibility themselves and that the U.N. shouldn't shy away from criticizing countries when problems like corruption compromised aid efforts. In Uganda, for example, three top officials in charge of the malaria program were recently arrested for stealing drugs and embezzlement.
"(The U.N.) spends too much time telling the good news and not the bad news," Tren said. "If we aren't upfront about the problems we're having now, there will be much bigger problems down the line."

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