News Release

World Malaria Day: Ethiopia and Rwanda are leading lights

Peer-Reviewed Publication

The Lancet_DELETED

With the advent of World Malaria Day on April 25, malaria endemic countries and donors should be inspired by the achievements of Ethiopia and Rwanda in reducing malaria-related mortality. The issues are discussed in both a Comment and a Special Report in this week’s edition of The Lancet.

Rajat Gupta, Global Fund to Fight AIDS, Tuberculosis and Malaria, New York, USA, Raymond Chambers, United Nations, USA, and Tedros Adhanom Ghebreyesus, Federal Democratic Republic of Ethiopia and Roll Back Malaria Partnership, Addis Ababa, Ethiopia, say that the international community, led by UN Secretary General Ban Ki-moon, will throw its weight behind an ambitious campaign to expand access to wide-ranging package of malaria control interventions in sub-Saharan Africa, with the aim of ending malaria deaths on the continent in the near future. The package will target everyone at risk of malaria - not just pregnant women and young children – and while the initiative will lead with bed nets, the authors say: “Near-zero mortality can only be achieved with a comprehensive approach that includes targeted spraying of insecticides, provision of effective medicines, and expanded delivery through community health workers and other means. We must make these efforts simultaneously.”

While acknowledging that ambitious plans for tackling malaria have failed before, the authors highlight the successes of Rwanda and Ethiopia between 2005 and 2007. Rwanda managed to reduce malaria cases by 64% and deaths by 66% in children under five years — during this period; in Ethiopia, the corresponding figures are 51% and 60%. This remarkable success was achieved through expanded access to malaria control, primarily long-lasting insecticide-treated bed nets, and artemisinin-based combination therapies.

The authors say: “Although multiple factors have contributed to success in Ethiopia, there are arguably four main contributing components: a catalytic moment, demand for universal coverage, pragmatic donor response, and innovative problem-solving.” Spurred on by its worst malaria epidemic on record in 2003, the Ethiopian government early in 2005 boldly proposed that it would achieve universal coverage with long-lasting insecticide-treated bed nets by distributing 20 million in three years in the hope of reducing malaria related deaths by 50%. Rather than making do with the money available, Ethiopia made a compelling case for the money required – US$160 million – almost three times the previous national malaria control budget. And donors responded – with a consortium of partners (including World Bank, Global Fund) providing additional resources totalling over $200 million. And Ethiopia took advantage of the flexibility built into both the Global Fund and World Bank processes to take out the money straight away; and rather than disbursing its grants over five years, the country drew down on the pledged funds to finance the ambitious net-distribution programme in 1-2 years. Net provision was outsourced to UNICEF, and the government and partners prepared well for the scale-up phase of the programme.

The authors conclude that now is the moment to aim for results like those in Ethiopia and Rwanda throughout Africa. With Global Fund and World Bank resources, plus prospect of increased funds from G8 countries, malaria-endemic countries should no longer limit their aspirations to small-scale, incremental progress. Donors must be willing to accept greater risk and be flexible, and both governments and donors must plan early for the maintenance and eventual elimination phase, so that support does not flag as malaria deaths are reduced. They say: “The pieces are increasingly in place to achieve the UN Secretary General’s vision for universal coverage and make rapid gains toward ending malaria deaths in Africa. With one child dying every 30 seconds from malaria in Africa, we have not a moment to lose.”

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See also Special Report

Rajat Gupta, Global Fund to Fight AIDS, Tuberculosis and Malaria, New York, USA T) +1 917 459 9261 E) rajat_gupta@mckinsey.com

http://multimedia.thelancet.com/pdf/press/malaria.pdf


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