Winning the battle against malaria

Kent Campbell & Jonathon Simon | 07 Aug 2012
The Hill
In Zambia, like 14 other African countries, major progress has been made in the fight against malaria, thanks in large part to the efforts of the President's Malaria Initiative (PMI). The use of proven interventions like insecticide-treated bed nets, indoor residual spraying of insecticides (IRS), improved diagnostic tests, and highly effective antimalarial drugs has increased dramatically. The result: more than 28 million people were protected with IRS in 2011, and more than 31 million bed nets have been distributed since PMI began. Because of the program, more and more children are able to sleep under the protection of bed nets and benefit from IRS in their homes—contributing to more than one million lives being saved in the last decade alone.

It is not something you hear often when talking about a life-threatening disease, but according to Kabwe, a clinical care specialist in Zambia's Central Province, malaria is "a success story—it's very clear that with everything that has been put in place, that we are winning the battle."

PMI is a shining example of the profound impact the U.S. is making in global health. A recent external review of the first five years of its work shows substantial progress toward PMI's goal of cutting malaria deaths by half in 15 African countries. According to evaluators, PMI is well-positioned to expand the U.S. government's (USG) malaria control efforts moving forward. The report lays out PMI's key strengths:

· Effective leadership, strong management, and bipartisan support: Evaluators found the PMI team has done a remarkable job using the initial PEPFAR and the subsequent Lantos-Hyde Authorization Act make substantive and substantial contributions to the global response to malaria. They quickly re-oriented the once problematic USG malaria program, took it to a large scale quickly, efficiently and effectively complemented the larger global malaria program—ultimately contributing to a significant reduction in child deaths.

· An integral partner in the field: Recognizing that country leadership is the key to sustaining gains against malaria, PMI has operated under the direction of national programs. Reinforcing the importance of national ownership, PMI supports national entities so they can assume responsibility effectively, by helping to develop strong control systems, accountability measures, and logistical support into the national infrastructure when needed. National Malaria Control managers have called the PMI approach "flexible," "inclusive in designing its approaches," and "receptive." Global Fund personnel have praised PMI's ability to assist them in maintaining country program efforts.

The evaluation also offered recommendations as PMI plans for the future, and the simplest recommendation is also the most emblematic of the program's success: PMI should expand. According to the evaluators, PMI has been so successful that the natural next step is to expand its financial resources and geographic reach to sustain and build on this progress. The results it has achieved and the growing financial constraints other malaria partners will face in the years ahead, point to a clear need for a continued and expanded PMI.

PMI's strategy is also in line with the new roadmap released through the USAID Child Survival Call to Action, a country-led approach to ending preventable child deaths. Malaria is one of the five health conditions globally responsible for 50 percent of all mortality under age 5, and the Call to Action describes the need to save lives by scaling up known solutions in high-burden areas. To heed this call, PMI will require continued commitment and support.

There is much work to do, and there will be more challenges on the road to eliminating malaria. Mosquito behavior can change. The malaria parasite could become resistant to available drugs. PMI must have sustained political and financial support to adapt to these potential challenges and be ready to face them with new strategies and interventions.

Now more than ever, we must build on PMI's success and expand its reach so it can help high-burden countries carry their recent gains into the next decade. Economists and health experts agree that malaria control is one of the best investments that can be made in global health and development. We must employ multiple program approaches in the fight to eliminate malaria —and PMI is one of our best.