An article published in the online Malaria Journal argues that the World Health Organization is woefully behind in its 1998 Roll Back Malaria plan that sought to cut malaria deaths in half by 2010 and then in half again by 2015. According to Harvard researchers Vasant Narasimhan and Amir Attaran, the RBM project has attracted barely five percent of the funds it needs to succeed.
Based on surveys of donor countries and external estimates of their spending, Narasimhan and Attaran estimate that RBM receives roughly US$98 million annually. It would need about US$1.5-$2 billion annually to reach its goal of halving malaria deaths.
The odd thing is that this estimate is filled with a bizarre level of uncertainty. Switzerland, for example, told the researchers that not only did they not know how much their country was giving for malaria control, but they did not even know how to go about finding out since malaria control spending was subsumed into larger health spending budgets. Narasimhan and Attaran write that this will pose enormous problems for funding of malaria control efforts,
In short, the Swiss answer, which seems likely to apply to some other donors too, is that the extent of malaria control funding is not just unknown, but actually unknowable. Leaving aside the reasons why this is true (e.g. it is found in integrated health programmes and not easily disaggregated), this poses a huge strategic threat to RBM’s goals: What is the likelihood of increasing malaria control funding, when the donors lack the accounting procedures and ability to know how much they are spending? Without reliable financial surveillance, there is good reason to suspect that aid to malaria control will stagnate, as it has done for decades, without triggering public pressure to demand improvement.
The other interesting thing is that the $98 million spending estimate is significantly smaller than other estimates that put annual malaria control spending at US$130 to $160 million. Part of the reason for the difference is that some organizations, including the World Bank, appear to be exaggerating their malaria control spending (emphasis added),
Although the Bank publicly claims that “at present, World Bank direct financing for malaria control activities is over $200 million in more than 25 countries”, we find on the Bank’s own project list only 10 countries having “active” malaria control projects . In India, where in 1997 the Bank pledged its largest malaria control effort ($164.8 million), the project neared its close in 2003 after disbursing little over a quarter of this amount. In Africa, where 90% of malaria deaths occur, the Bank has only 4 active projects: in the Comoros, Eritrea, Madagascar, and Senegal. Yet not one of these countries suffers particularly intense or sustained malaria transmission Â– three are hardly malarious at all by African standards Â– meaning that the Bank’s efforts will contribute little to halving the burden of malaria.
Worst of all, the Bank has practically reneged on the dramatic pledge it made to two dozen African heads of state at Abuja in April 2000 to provide “up to $500 million more…for the fight against malaria in Africa” . Nearly three years after that pledge, Eritrea is the only country to receive a new loan expressly including malaria control (the loan package is $40 million, split among 4 diseases). Assuming that the each disease in the Eritrea loan package receives an equal share, then the Bank’s new lending for malaria control since Abuja amounts to only $10 million; and three years after Abuja, up to $490 million of the $500 million that the Bank promised remains uncommitted and unspent. Furthermore, at this writing (December 2002), the Bank’s own malaria project list shows not one new African malaria control project in the planning pipeline. There seems to be no activity underway at the Bank to keep the promise that was made.
The authors recommend that the World Bank appoint a malaria “czar” to oversee malaria control projects in much the same way it appointed an AIDS “czar” to oversee AIDS control projects.
They also criticize views in Western donor nations that malaria spending is wasted because developing nations do not have the health care infrastructure to meaningfully absorb the aid. Instead, they argue that this is a sort of chicken-or-egg problem — additional spending on malaria would drive the creation of additional health care infrastructure. I suspect donor nations are a bit more skeptical than are Narasimhan and Attaran. As the authors themselves concede, the United States, for example, spent billions on malaria control in the 1960s with very little to show for it.
Roll Back Malaria? The scarcity of international aid for malaria control. Vasant Narasimhan and Amir Attaran, Malaria Journal, April 15, 2003.
Malaria project in funding crisis. BioMed Central, Press Release, April 25, 2003.