Saturday, April 17, 2010

Malaria ... another World Malaria Day!

Dear Colleagues

On April 25th, there will be another World Malaria Day.

I have not seen much data in the run-up to World Malaria Day this year concerning the progress being made. There is still a considerable amount of hype about the amount of money being spent, and the number of bednets being used ... but there is an eerie silence about the reduction in the prevalence of malaria and progress towards making a reduced level of malaria sustainable.

The impression I get is that while a very large amount of money has been spent, the data is not showing this money has been well used and that there has been a good reduction in the prevalence of malaria. Worse ... it does not appear that there is much progress, if any, in getting to a sustainable situation that is going to be affordable without huge international intervention.

I was hoping that the Millennium Villages Project headed up by Jeffrey Sachs might be able to show some interesting data ... but while they acknowledge they have a huge amount of data, they do not seem to be able to show anything that confirms malaria interventions have been cost effective. From my perspective, this program is high on PR, but way less in terms of data and transparency.

I was also hoping that PATH/MACEPA working in Zambia might be able to show data that demonstrated the cost effectiveness of specific interventions in specific locations ... and be able to confirm that bednets really did work as well as they are portrayed in PR hype. Though MACEPA puts out PR pamphlets, there is no data easily accessible that shows cost efficiency or cost effectiveness ... and there is some feedback that some big conclusions are based on very small sample surveys that are statistically inadequate.

The data that has been made accessible to me has been very limited. On the other hand I have been able to read a lot of PR material and academic papers that draw conclusions without presenting the underlying data. From this it becomes fairly clear that there is almost no integration of spatial thinking into any of the internationally funded interventions, and this suggests that costs are likely to be double or more than they need to be. The programs seem to be driven by plans that do not reflect very much local specific information ... the prevalence of malaria is not uniform across an area, but varies depending on the physical geography. Many other issues emerge, including some concern that one should have about possibility of resistance associated with the massive use of pyrethrum based insecticides.

Maybe I will be surprised .. but the current indications have me concerned that the international funding for malaria program, especially in Africa, will run out of money a long time before a sustainable low level of malaria has been achieved.

Peter Burgess

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