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Date: Fri, 13 Dec 2002 09:01:34 -0500
From: Africa Action <[log in to unmask]>
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Subject: Africa: Broken Promises on Malaria
Africa: Broken Promises on Malaria
Date distributed (ymd): 021213
Document reposted by Africa Action
Africa Policy Electronic Distribution List: an information
service provided by AFRICA ACTION (incorporating the Africa
Policy Information Center, The Africa Fund, and the American
Committee on Africa). Find more information for action for
Africa at http://www.africaaction.org
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+ +health+
SUMMARY CONTENTS:
Failure to provide adequate funding for the Global Fund to Fight
AIDS, Tuberculosis & Malaria is not only crippling the battle
against the HIV/AIDS pandemic, but also weakening commitment to
fight the chronic killer malaria. The failures of both African
governments and rich countries to meet their commitments to
priortize health cost lives and undermine the prospects for
economic development.
This posting contains two recent documents on malaria, one a report
card on progress in the Fight against Malaria since the African
summmit on malaria in Abuja in April 2000, and the other a
background briefing on malaria in Africa, from the Roll Back
Malaria program of the World Health Organization and other
international agencies.
Note: The report of the UN Secretary-General mentioned in the first
document is not yet available on the UN web site. For earlier
documents on malaria, see:
http://www.africaaction.org/docs02/mal0202.htm
http://www.africaaction.org/docs00/mal0005.htm and
http://www.africaaction.org/docs98/mal9811.htm
+++++++++++++++++end profile++++++++++++++++++++++++++++++
THE FIGHT AGAINST MALARIA
Promises Made Two Years Ago Are Not Being Kept
October 2002
http://www.massiveeffort.org
Over two years ago at a major summit on malaria in Africa, world
leaders acknowledged that malaria was causing nearly one million
deaths every year in Africa even though the disease is preventable.
They also acknowledged that malaria is costing Africa more than
US$12 billion annually, even though it could be controlled for a
small fraction of that amount.
This recognition took place at the African Summit on Roll Back
Malaria, held in Abuja, Nigeria on April 25, 2000. The Summit was
attended by 17 Heads of State of the 49 malaria-affected countries
and territories in Africa. Another 26 African countries were
represented by high ranking officials. Also participating were UN
organizations and donor agencies, such as the World Bank, DfID,
USAID, CIDA, the Ministry of Foreign Affairs of Japan, and the
French Co-operation. At the conclusion of this meeting, African
leaders promised to do much more by signing The Abuja Declaration
on Roll Back Malaria in Africa. Donor agencies also promised to
provide much greater financial support for controlling malaria.
Now, over two years later, many heads of State and donor agencies
have not kept their promises. When these promises are kept, the
lives of millions of children can be spared.
PROMISE ONE
Mosquito net taxes will be dropped by all African countries
"Reduce or waive taxes and tariffs for mosquito nets and materials,
insecticides, anti-malarial drugs and other recommended goods and
services that are needed for malaria control strategies." (The
Abuja Declaration, April 2000)1
CURRENT STATUS
"Over the past three years, seventeen countries in Africa south of
the Sahara have either reduced or eliminated taxes and tariffs on
the importation of mosquito nets, netting material and
insecticides." (Draft report of the Secretary General, Nov. 2002)2
Unfortunately, 26 countries are still charging taxes on treated
mosquito nets. They are Angola, Botswana, Burkina Faso, Burundi,
Central African Republic, Congo, Republique Democratique du Congo,
Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia,
Guinea, Guinea-Bissau, Madagascar, Malawi, Mauritania, Niger,
Rwanda, Sao Tome & Principe, Sierra Leone, Somalia, South Africa,
Swaziland, and Togo.
Heads of State should keep their promises. They have it in their
power to do more to fight malaria. If the simple and obvious step
of ending taxation of live-saving health products isn't taken,
there is unlikely to be sufficient political will to scale up the
provision of mosquito nets and anti-malarias in their country.
PROMISE TWO
Mosquito nets will protect 60% of those at risk of malaria
"Ensure that by the year 2005...at least 60% of those at risk of
malaria, particularly pregnant women and children under five years
of age, benefit from the most suitable combination of personal and
community protective measures such as insecticide treated mosquito
nets (ITNs) and other interventions which are accessible and
affordable to prevent infection and suffering." (The Abuja
Declaration, April 2000)
CURRENT STATUS
"In 24 countries, use of ITNs for children under age 5 was at or
below 5%." (Draft report of the Secretary General, Nov. 2002)
PROMISE THREE
Effective drugs will be available to 60% of malaria patients
"Ensure that by the year 2005...at least 60% of those suffering
from malaria have prompt access to and are able to use correct,
affordable and appropriate treatment within 24 hours of the onset
of symptoms... and that at least 60% of all pregnant women who are
at risk of malaria, especially those in their first pregnancies,
have access to chemoprophylaxis or presumptive intermittent
treatment." (The Abuja Declaration, April 2000)
CURRENT STATUS
"A first assessment on national level coverage of two of the RBM
strategies, prompt access to effective treatment and ITN use in
malaria endemic African countries was recently conducted. The
assessment drew on data from 22 population-based Multiple Indicator
Cluster Surveys (MICS, UNICEF) and 7 Demographic and Health Surveys
(DHS, ORC Macro) conducted between 1998 and 2001. Of children <5
years with fever, a clinical indicator of malaria, in the previous
2 weeks, 56% were reported to have been treated with an
antimalarial. In fact, in 17 countries, analgesics, which are
ineffective against malaria, constituted the main form of fever
treatment. Moreover, a considerable proportion of antimalaria
treatments may not be life-saving because either the parasite is
resistant to the drug, the drug is of poor quality, the drug is
given too late in the course of illness, or a full course of the
drug is not provided (which can also promote drug resistance)."
(Draft report of the Secretary General, Nov. 2002)
PROMISE FOUR
The World Bank will provide an additional $500 million to fight
malaria
"Some 750 million US dollars has been pledged to African countries
to help fight malaria, following Tuesday's first regional summit on
the disease in Abuja. The World Bank... blazed the trail with a
pledge of 500 million dollars" (Pan African News Agency, April 26,
2000). "The World Bank has pledged $500 million toward the
eradication of the disease" (The Guardian, April 28, 2000). "By
the end of the 2-day conference, donors including the World Bank,
USA, UK and others had promised $750 million" (Lancet, April 29,
2000).
CURRENT STATUS
The World Bank has come nowhere near meeting this pledge. Among
donor countries, only Ireland has paid in full its entire initial
pledge to the Global Fund to Fight AIDS, TB and malaria. Only $500
million of new resources have been pledged to the Global Fund in
all of 2002.
Action
1. Join the campaign against malaria and stop the heads of state of
African countries from charging taxes on treated mosquito nets.
Government treasuries should not make profits from parents who are
trying to protect their children. Learn more about the "Drop the
Malaria Tax" campaign and send a message to African heads of state
at: http://www.MassiveEffort.org
2. Advocate that the World Bank fulfills its promise to do more to
help African countries fight malaria. Write: James D. Wolfensohn,
President World Bank 1818 H Street, N.W. Washington, DC 20433
U.S.A.
1 The Abuja Declaration on Roll Back Malaria in Africa by African
Heads of State and Government, 25 April 2000, Abuja, Nigeria.
2 Draft report of the Secretary General, 2001-2010: Decade to Roll
Back Malaria in Developing Countries, Particularly in Africa, for
release in early November 2002.
*******************************************************
World Health Organization
http://mosquite.who.int
Roll Back Malaria is a global partnership initiated by WHO, UNDP,
UNICEF and the World Bank in 1998. It seeks to work with
governments, other development agencies, NGOs, and private sector
companies to reduce the human and socio-economic costs of malaria.
[For more information:
Roll Back Malaria, World Health Organization,
20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Tel: +41 22 791 2891 E-mail: [log in to unmask]
An external evaluation of the Roll Back Malaria program can
be found at: http://mosquito.who.int/cmc_upload/0/000/015/905/ee.pdf]
2001-2010 United Nations Decade to Roll Back Malaria
Malaria in Africa
THE VAST majority of malaria deaths occur in Africa, south of the
Sahara, where malaria also presents major obstacles to social and
economic development. Malaria has been estimated to cost Africa
more than US$12 billion every year in lost GDP, even though it
could be controlled for a fraction of that sum.
There are at least 300 million acute cases of malaria each year
globally, resulting in more than a million deaths. Around 90% of
these deaths occur in Africa, mostly in young children. Malaria is
Africa's leading cause of under-five mortality (20%) and
constitutes 10% of the continent's overall disease burden. It
accounts for 40% of public health expenditure, 30-50% of inpatient
admissions, and up to 50% of outpatient visits in areas with high
malaria transmission.
There are several reasons why Africa bears an overwhelming
proportion of the malaria burden. Most malaria infections in Africa
south of the Sahara are caused by Plasmodium falciparum, the most
severe and life-threatening form of the disease. This region is
also home to the most efficient, and therefore deadly, species of
the mosquitoes which transmit the disease. Moreover, many countries
in Africa lacked the infrastructures and resources necessary to
mount sustainable campaigns against malaria and as a result few
benefited from historical efforts to eradicate malaria.
In Africa today, malaria is understood to be both a disease of
poverty and a cause of poverty. Annual economic growth in countries
with high malaria transmission has historically been lower than in
countries without malaria. Economists believe that malaria is
responsible for a `growth penalty' of up to 1.3% per year in some
African countries. When compounded over the years, this penalty
leads to substantial differences in GDP between countries with and
without malaria and severely restrains the economic growth of the
entire region. Malaria also has a direct impact on Africa's human
resources. Not only does malaria result in lost life and lost
productivity due to illness and premature death, but malaria also
hampers children's schooling and social development through both
absenteeism and permanent neurological and other damage associated
with severe episodes of the disease.
One of the greatest challenges facing Africa in the fight against
malaria is drug resistance. Resistance to chloroquine, the cheapest
and most widely used antimalarial, is common throughout Africa
(particularly in southern and eastern parts of the continent).
Resistance to sulfadoxine-pyrimethamine (SP), often seen as the
first and least expensive alternative to chloroquine, is also
increasing in east and southern Africa. As a result of these
trends, many countries are having to change their treatment
policies and use drugs which are more expensive, including
combinations of drugs, which it is hoped will slow the development
of resistance.
Growing political commitment by African leaders for action on
malaria was given a boost by the founding of the Roll Back Malaria
global partnership in 1998. Less than two years later African Heads
of State and their representatives met in Abuja, Nigeria to
translate RBM's goal of halving the malaria burden by 2010 into
tangible political action. The Abuja Declaration, signed in April
2000 endorsed a concerted strategy to tackle the problem of malaria
across Africa. The Abuja Declaration endorsed RBM's goal and
established a series of interim targets-for the number of people
having access to treatment, protective measures or, in the case of
pregnant women, receiving intermittent preventive treatment-to
ensure that progress would be made towards the goal and
malaria-endemic countries and other RBM partners held responsible.
Much progress has been made since Abuja. In compliance with the
Abuja Declaration more than a dozen countries have reduced or
eliminated taxes and tariffs on insecticide-treated mosquito nets
(ITNs) to make them more affordable. Close to a third of African
countries, representing almost half the population at risk have
established `Country Strategic Plans' (CSPs) to achieve the RBM
goal and the targets set in Abuja. CSPs are all based on the four
technical elements of Roll Back Malaria and the evidence-based
interventions associated with them-prompt access to effective
treatment, promotion of insecticide treated mosquito nets and
improved vector control, prevention and management of malaria in
pregnancy and improving the prevention of, and response to, malaria
epidemics and malaria in complex emergencies.
Countries are now working through local partnerships to develop the
capacity to fully implement their CSPs using on-going health sector
reforms and linkages to other initiatives, such as IMCI (Integrated
Management of Childhood Illness) and MPS (Making Pregnancy Safer),
to improve access to key interventions. CSPs have been successful
in attracting new resources for malaria control. However, given
projected resource needs to the year 2010, only 20% of necessary
funds will be available locally. African countries, working with
their partners and donors, must identify and mobilize resources for
the remainder. Countries are looking to a variety of sources to
ensure sustainable financing of their efforts to Roll Back
Malaria-this includes traditional sources of funding, from the
national treasury and donor community as well as the exploration of
new opportunities through debt relief schemes and the newly formed
Global Fund to Fight AIDS, TB and Malaria.
************************************************************
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Center, The Africa Fund, and the American Committee on Africa).
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information and analysis in order to promote U.S. and
international policies toward Africa that advance economic,
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Documents previously distributed, as well as a wide range of
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