I have just written the following about the cost of malaria interventions.
The issue of malaria concerns me a lot. Efforts to reduce the impact of malaria has gained funding over the past few years impressively and now exceeds $2 billion a year. It is interesting and really quite disgusting that one high profile film star gets more attention than millions and millions of ordinary people!I wrote this in response to this posting written by Tove Rasmussen. The URL is:
My main issue is that the use of this malaria control money may have been an awful waste. There is hardly any verifiable data about the cost effectiveness of what is being done. I have been in contact with the US President's Malaria Initiative in Washington and they publish a lot about what they plan to do with the money, but rather little about what they actually have achieved with the money beyond very vague unverifiable generalities. This is, of course, a standard government approach to accountability ... but it is also a process that allows a lot of money to get disbursed without very much of value being obtained from the fund flows.
Organizations like Malaria No More have helped raise the profile of malaria as an international health issue, but they have also been a dangerous part of promoting single approach solutions that are not universally appropriate. It would most likely have been much more effective to start with control of transmission through better control of the mosquito rather than merely putting people under bednets and using Artimesan based drugs. Malaria has an important spatial dimension that is ignored in most of the initiatives that are currently getting big funding. What a waste!
http://www.justmeans.com/Ancient-Malaria-Killer-Gains-Spotlight/43710.html This is the text:
Ancient Malaria Killer Gains SpotlightSubsequently there was another comments as follows. The writer, Ano Lobb, comes at malaria control from a medical perspective:
Posted On: February 04
George Clooney's recent contraction of malaria together with the publicity talents of Malaria No More (MNM) have put the disease in the spotlight. It causes 1 to 3 million deaths per year, with ninety percent in Africa. Of these, most are young children. With some relatively simple solutions and development of a vaccine, the ancient disease can be eliminated.
George Clooney contracted Malaria following a trip to Sudan unfortunately.
This has raised the profile of the disease, prompting many to ask what Malaria is. The disease is spread by the bite of infected Anopheles mosquitoes. Its symptoms include headache, fever, and other flu-like symptoms. Untreated, it leads to comas, serious anemia and death.
MNM has played a key role in putting the focus on malaria, and wants to eradicate the health issue by 2015.
MNM co-founder Ray Chambers approached President and Mrs. Bush to host a first-of-its-kind world event on the single disease. As a result, in 2006 the White House Summit on Malaria brought together global government, health, NGO and faith leaders - and gave the health issue much-needed global attention.
The Economist treated the event as a new product launch: "This Thursday George and Laura Bush are due to host a most unusual product launch …. the eradication of malaria. The brains behind the summit, a group of business leaders and philanthropists operating under the auspices of a non-governmental organization called Malaria No More, are convinced that the time is right to launch what they hope will be the next big thing in the giving business." ("The Branding of Malaria," The Economist, December 12, 2006.)
As malaria has gained prominence so has funding to develop a vaccine, including the Bill and Melinda Gates Foundation $10 billion to develop vaccines for the world's poorest countries over the next ten years. Though malaria is one of the oldest diseases, a vaccine has still yet to be developed. Other available tools to eliminate the disease are basic: long-lasting insecticide treated bed nets (LLINs), education, insecticides, and early diagnosis and treatment.
MNM is also working to ensure each family in Africa has access to the malaria prevention toolkit. In early 2010, MNM provided close to 90,000 mosquito nets to Senegal.
One Tweet by Ashton Kutcher on World Malaria Day 2009 became the most re-tweeted message, resulting in the 90,000 nets for Senegal. With social media changing the face of funding, getting more bed nets is no longer the issue.
The bigger challenge now is distributing tens of thousands of bed nets over a few weeks, rather than thousands in one year. To solve this logistical challenge, MNM has teamed up with the Alliance for Malaria Prevention (AMP), made up of over 40 international organizations who train health workers on how to effectively distribute the bed nets effectively.
In Senegal, a number of organizations including the U.S. Peace Corps, World Vision, the National Malaria Control Program (PNLP), Sumitomo Chemical and local heath workers provided the nets to families, ensuring they were trained in their use. Following the project, nearly 100,000 nets hung in the communities of 265,000 people.
Photo Credit: dullhunk
Further compounding the struggle against malaria is its frightening, and fascinating, ability to evade control by vaccination, being cloaked in a constantly mutating jacket of protective protein: http://jm.ly/5wI9PQAnd then my follow up comment:
Innovation in how to develop more effective vaccines will hopefully foil the parasite's wiley guise and add inoculation to the anti-malarial arsenal: http://jm.ly/coh58C
The matter of vaccination against malaria is extremely complicated ... and I do not pretend to know the scientific details. From a resource management perspective however I would observe that there has been great success in controlling vector borne diseases like malaria by effective control of the vector ... the mosquito.I have done considerable research around the cost effectiveness of health interventions in developing countries, and it comes as no surprise that there are quite modest results from very substantial resources. The understanding of costs and efficiency is almost totally absent in the community of technical experts that are engaged with the problem, and it is therefore no surprise that the costs are out of control. This problem is aggravated by all sorts of "leakages' of resources out of the system as a result of corruption.
The origins of the US Center for Disease Control goes back to malaria in the USA ... and explains why the CDC is based in Atlanta and not DC. The history of SUCCESS with malaria control is all about effective investment in vector control ... and for that the best starting point is very good spatial understanding of the mosquito and its habitat, and humans and where they live and go about their business.
Pretty much all the money is being disbursed to research vaccines, distribute bednets and subsidize Artimesan based drugs with virtually nothing going into systems for sustainable vector control.
I am pretty unhappy about this situation, and especially the role of the high profile business and entertainment elite in making decisions that are high cost and not very effective. I am appalled at how little performance information is actually available ... probably in great part because the performance is low relative to what has been said in the PR.
Malaria is a disease that mostly kills poor people ... and the sophisticated solutions to address the problem that are being pursued with available funding are totally uneconomic and unsustainable for poor societies. Much of what needs to be done to improve vector control can be done with local interventions ... but is not really on the agenda at WHO, the NIH, the Gates Foundation, medical researchers and all the rest. Old fashioned low tech may well be the best way to go!
Peter Burgess
truevaluemetrics.org
At some point the people in charge of all of this have got to get serious ... hold people accountable for performance ... or be held accountable themselves!
Peter Burgess
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