|Fact sheet No 203: Roll Back Malaria - October 1998 (WHO, 1998, 5 p.)|
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.
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
· 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.
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.
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