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: rbm@who.int 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. ************************************************************ This material is being reposted for wider distribution by Africa Action (incorporating the Africa Policy Information Center, The Africa Fund, and the American Committee on Africa). Africa Action's information services provide accessible information and analysis in order to promote U.S. and international policies toward Africa that advance economic, political and social justice and the full spectrum of human rights. 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