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Africa: Roll Back Malaria
Africa: Roll Back Malaria
Date distributed (ymd): 981130
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+
Summary Contents:
This posting contains a fact sheet on Malaria from the World Health Organization,
preceded by brief excerpts from the announcement of the Roll Back Malaria
campaign by WHO Director-General Dr. Gro Harlem Brundtland. Extensive additional
information and links can be found on-line at the web site of Malaria Foundation
International (http://www.malaria.org).
Another posting today provides background on HIV/AIDS.
+++++++++++++++++end profile++++++++++++++++++++++++++++++
Dr. Gro Harlem Brundtland,
Director-General, World Health Organization
Launch of Roll Back Malaria
United Nations, New York, October 30, 1998
"Why have we taken this initiative?
First, because we share the concern of the rising human suffering from
malaria - on all continents - but above all in Africa where this re-emerging
disease represent more than 10% of the total disease burden.
3000 children die every day of malaria. Every year there are about 300-500
million clinical cases of malaria, 90% of them occuring in Africa. This
is above all the disease of the poor - killing the young and the weak mostly
living in rural areas in Sub Saharan Africa.
Second, because we share the concern of the severe impediment malaria
is putting on the economic and social development of so many countries.
Some studies indicate that malaria can hold back income by as much as 12%.
Where there is malaria, there is likely to be severe strains on foreign
investments.
Third, because we believe we can do something about it. We do not talk
of eradication - that was tried some decades ago - it succeeded in some
continents but failed severly on others. We are aiming at a concerted action
to significantly reduce mortality and morbidity from this disease. ...
We in the World Health Organization are calling Roll Back Malaria a
pathfinder - and we do so for three reasons:
- first - because Roll Back Malaria will help us pull in all parts of
WHO - the tropical disease expertise, the child health expertise, the environmental
health expertise and the pharmaceutical expertise.
- second because it will pave the way for this new partnership with other
parts of the UN familiy, with the private sector, the research community
and NGOs - illustrating that we can achieve more when we work together.
- third - and most importantly - because Roll Back Malaria will put a
particular emphasis on the strengthening of the national health systems.
This is key. This is not another "rapid in - rapid out" operation.
Our aim is to focus on the health sector's ability to cope with malaria
- at a national level and especially at a local level. When a child gets
the malaria fever, time is short - very short. Rapid access to drugs is
critical. That means that we have to focus on how the health sector can
provide these services - which are low-tech and not very expensive.
The same goes for prevention. Malaria can be better contained - much
better than today. The simple use of impregnated bednets can save scores
of sleeping children from the death-carrying mosquito. So we need to get
these simple tools out there where they can do so much good.
And finally - we need to push for the ultimate solution - a malaria
vaccine. That is not for tomorrow - but is getting within a new reach which
may offer hope. Industry is engaging in Roll Back Malaria and so is research.
We need to be there to take immediate advantage of scientific advances
as they see the day."
Fact Sheet No 203 October 1998
ROLL BACK MALARIA
Upon taking office in July 1998, the World Health Organization's (WHO)
new Director-General, Dr Gro Harlem Brundtland, decided that malaria was
to be one of WHO's top priorities. It was evident that malaria was both
a top political priority among African leaders and that it was still a
major health scourge in many parts of the world, in Africa above all.
There are an estimated 300-500 million cases of malaria per year. The
majority of these occur in Africa, while the vast majority of the estimated
1 million annual deaths from the disease occur among children, and mainly
among poor African children. Malaria is above all a disease of the poor,
impacting at least three times more greatly on the poor than any other
disease. Although malaria had been a priority of WHO since its inception
in 1948, malaria control efforts, Dr Brundtland found, had often suffered
from a lack of financial resources and uneven implementation. She thus
resolved, upon taking office, to find a means of focussing the world's
attention and support on renewed and redoubled efforts to beat this scourge
of the young and the poor: Roll Back Malaria.
RBM's objectives
Roll Back Malaria (RBM) is as an opportunity not only finally to beat
a devastating disease, but also to develop endemic countries' health systems
and build new means of tackling global health concerns. Thus, the goals
of RBM will include:
- Support to endemic countries in developing their national health systems
as a major strategy for controlling malaria;
- Efforts to develop the broader health sector (i.e., all providers of
health care to the community -- the public sector health system, civil
society and non-governmental organisations, private health providers [including
drug vendors and traditional healers] and others);
- Encouraging the needed human and financial investments, national and
international, for health system development.
RBM's implementation at country level will provide an indicator of the
effectiveness of these health systems, while the programme will also serve
as a model for WHO in developing both other global health and development
initiatives and new methods of controlling infectious diseases.
RBM: a new approach to malaria control
WHO will establish a functioning partnership with a range of organizations
at global, regional and country levels, which results in development of
a sustained capacity to address malaria (and other priority health problems).
WHO's partners in RBM will include malaria endemic countries, other UN
organisations (on 30 October 1998, the United Nations Development Programme,
UNICEF, the World Bank and the World Health Organization announced that
the four agencies were launching RBM jointly and that they would cooperate
in all aspects of its activities, see press release WHO/77), bilateral
development agencies, development banks, non-governmental organisations
and the private sector.
WHO's role in the global partnership will be to:
- Provide strategic direction and catalyse actions;
- Provide an RBM secretariat of approximately eight to 10 people at its
Geneva headquarters;
- Work to build and sustain country and global partnerships;
- Arrange the provision of technical endorsement, directly, or through
approved resource networks, for both a collective strategy and for individual
partners' actions;
- Ensure that all aspects of progress of RBM are monitored;
- Provide global accountability for RBM;
- Broker technical assistance and finance on behalf of those who need
it;
- Undertake responsible advocacy for the RBM approach to reducing malaria-related
suffering.
The role of UN partner agencies
UNICEF will:
- provide support to intensified malaria control efforts via its country
programmes.
- work with Government & NGO partners to: give special attention
to reducing the terrible toll of malaria on young children and pregnant
women; further strengthen support for community-based and local action
to improve health and nutrition; focus on making insecticide treated mosquito
nets available to all families that need them and on ensuring that every
child with malaria has access to early and effective treatment; mobilize
leaders (community, district and national) to make effective malaria control
a priority.
- at international level, raise additional funds for country activities,
and focus support on 10 of the most severely-affected countries in the
next two years.
- take lead responsibility for developing an impregnated bednet resource
network.
UNDP has committed to the following actions, as malaria has important
implications for health and poverty. Effective responses will require broad-based
support across sectors and the involvement of a range of development partners.
At country level, UNDP will:
- Create capacity for integration of malaria-related action into national
poverty eradication policies, strategies and programmes.
- Strengthen, through Sustainable Human Development activities, the balance
of action among state, private sector, civil society and communities themselves,
to ensure that people have access to basic social services and productive
assets.
- Work through the UN Resident Coordinator system to encourage collaborative
programming in support of intersectoral action and resource mobilization.
At regional/sub-regional levels, UNDP will:
- Support links between Sub-regional Resource Facilities (SURFs), providing
technical referral services to country offices and the Roll Back Malaria
resource support networks;
- Collaborate with WHO Regional Offices to strengthen capacity of relevant
regional inter-governmental organizations (ISO) in support of Roll Back
Malaria.
At global level, UNDP is:
- Providing continuing support for the UNDP/World Bank/WHO Special Programme
for Research & Training in Tropical Diseases (TDR), which has as a
major focus the development of drugs and tools for malaria control and
adapting research in local settings.
The World Bank Group strongly supports the Roll Back Malaria global
partnership. Malaria has a major impact on social and economic development.
Consequently, the Bank has committed to:
- Increasing World Bank investments in malaria control and research;
- Facilitating resource mobilization to support RBM;
- Enhancing a more effective involvement of Departments of Finance, Economics,
Infrastructure, Agriculture and others to become full partners in reducing
malaria as a break on economic growth;
- Exploring innovative finance mechanisms to deliver support;
- Supporting research on the economic aspects of malaria;
- Helping establish private-public partnerships with industry on new
malaria products.
Together with Roll Back Malaria partners, the Bank will actively pursue
these activities through its country programmes and research agendas. Malaria
must be reduced as a negative factor on macro-economic growth.
RBM's first focus: Africa
The Roll Back Malaria campaign will focus first on Africa. It is aimed
at:
- upgrading health delivery systems at both the local and national levels
in malarious countries;
- intensifying use of bednetting (nets coated with insecticide) to prevent
night-time biting by malaria-carrying mosquitoes;
- mapping of malaria regions and of medical facilities to better direct
health resources;
- developing new drugs for victims already infected with malaria;
- coordinating the development and testing of new malaria drugs and vaccines;
- developing methods to address malaria in emergencies, (eg., refugee
and post-war situations).
At country level, RBM will work towards development of sustained capacity
to address malaria (and other priority health problems) that is adapted
to local realities, and delivering measurable and properly validated results.
RBM will support the building of coalitions for action at regional and
country level, and assist with development of clear, evidence based action
plans at country and regional levels. RBM will develop a systematic approach
to monitor progress and results, and broker financial and technical inputs
into countries.
RBM will support Resource Networks which will facilitate the implementation
of RBM in endemic countries by providing support in specialised areas,
e.g.:
- Needs assessment and intervention at district level;
- Sector-wide approaches and financing;
- Quality and supply of anti-malarials at the local level;
- Implementation of bed net programmes, including supply of nets and
insecticides;
- Improving quality of care at the home;
- Geographic mapping of malaria and health care;
- Prevention and control of epidemics;
- Monitoring of drug and insecticide resistance;
- Malaria control in war-torn zones.
Most victims of malaria die simply because they do not have access to
health care close to their home, or their cases are not recognized as malaria
by health care professionals. In addition, life saving drugs are often
not available. In Africa, RBM will create a network of teams to go into
villages and analyze treatment and prevention practices at the household
and community level, the availability and quality of health care by the
public and private sector, and potential local partners. RBM will provide
technical and financial support for each analysis through this network
at the district level.
In African districts with stable, high transmission malaria, RBM will
simultaneously seek to significantly improve early diagnosis and appropriate
treatment of malaria-related fevers in children, early treatment/prevention
in pregnant women, and personal protection for children and pregnant mothers
through the use of insecticide impregnated bednets (IIBNs). In many districts,
this will require reinforcement of the local public and private health
sector, focusing on activities at the community level. RBM will also attempt
to upgrade the training of health care providers to ensure quality care
after the campaign ends.
RBM will set up a resource network throughout Africa to forecast malaria
epidemics and their prevention. The network will link surveillance information
from countries and regional surveillance systems and establish the means
of routine and rapid analysis of this information for forecasting and early
detection of epidemics. Regional, sub-regional or country strategies for
epidemic preparedness and emergency action will be formulated. The resource
network will also be used to track the quality and supply of drugs used
to treat malaria.
Geographic mapping of malaria and health care
For countries participating in RBM, national malaria information will
be integrated with regional information to produce a comprehensive national
malaria control map, as part of the international mapping of the disease.
The information will allow a better estimation of the burden of malaria
and the population at risk, and hence a better assessment for RBM. It will
also provide more reliable and area-specific information for national and
international advocacy for malaria control. Where RBM operations have started,
information on the availability and quality of health services and the
results of monitoring and evaluation will be added to the data base.
The road forward
RBM will be in a "roll-out" phase until the end of 1999. By
that date, RBM will have:
- Supported countries in Africa to develop implementation plans for high
transmission, stable malaria, that meet the overall objectives of RBM;
- Advanced plans for other malaria situations, i.e., epidemic malaria
and malaria in other regions of the world.
The general objective of RBM will be to significantly reduce the global
burden of malaria through interventions adapted to local needs and by reinforcement
of the health sector. Goals are to be set by countries based on situation
analyses and assessment of feasibility, and could include: malaria morbidity
and mortality goals; financial goals (e.g., significant increase in resources
available for community level activities in health care); accessibility
goals (e.g., Percentage of population with access to early and adequate
treatment); coverage goals (e.g., Proportion of the targeted population
with insecticide treated bed nets); health sector reform goals (e.g., New
partnerships with private sector health care providers); goals of policy
change (eg., Significant changes in policy favouring evidence-based strategy
development).
Performance indicators will also be used to assess the RBM Project:
WHO's link with external partners e.g., capacity of WHO to support the
global partnership. WHO's impact on country level operations. WHO's in-house
working arrangements.
RBM team
Roll Back Malaria will be run with a central team of eight to 10 people
headquartered in WHO in Geneva. The team will be led by Dr David Nabarro,
who until his appointment as RBM project manager was Chief Health Advisor
and Strategic Director of the United Kingdom Department for International
Development.
For further information, journalists can contact the Office of Public
Relations, WHO, Geneva. Telephone (41 22) 791 2584. Fax (41 22) 791 4858.
Email: info@who.ch.
All WHO Press Releases, Fact Sheets and Features as well as other information
on this subject can be obtained on Internet on the WHO home page http://www.who.ch/
This material is being reposted for wider distribution by the Africa
Policy Information Center (APIC). APIC's primary objective is to widen
the policy debate in the United States around African issues and the U.S.
role in Africa, by concentrating on providing accessible policy-relevant
information and analysis usable by a wide range of groups and individuals.
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