In an interview with AllAfrica for World Malaria Day on April 25, Dr. Fatoumata Nafo-Traoré, executive director of the Roll Back Malaria Partnership, says while death rates have been cut radically, successes in the campaign to eradicate malaria have nevertheless been “partial and fragile.”
What is the current status of global malaria control efforts?
In recent years, we’ve made tremendous strides against malaria. Thanks to increased financing and access to interventions, estimated malaria mortality rates decreased between 2000 and 2013 by 47 percent worldwide and by 54 percent in Africa alone – where 90 percent of all malaria-related deaths still occur – contributing to an estimated 20 percent reduction in global child mortality and helping drive progress against the United Nations Millennium Development Goal (MDG) Four [to reduce child mortality].
As a result of our efforts, 64 countries are on track to meet MDG Six – to halt and begin reversing malaria incidence by 2015 – 55 of which are also on track to reduce malaria case incidence by 75 percent.
But still, our successes are partial and fragile. Almost half of the world’s population remains at risk from malaria. Despite unprecedented advances in prevention, diagnostics and treatment, the latest WHO (World Health Organization) report estimates that there were approximately 198 million cases of infection around the world in 2013, killing an estimated 584,000 people.
Globally, a child still dies from malaria every minute. Our successes need to be replicated across all regions affected by malaria, and they need to be sustained and expanded to prevent malaria from coming back in areas where we’ve eliminated it.
As former Minister of Health for Mali, WHO Country Representative in Ethiopia and now executive director of the Roll Back Malaria (RBM) Partnership, how have you seen the global health landscape change in recent years?
The global health landscape has seen tremendous improvements. In 2000, the world came together in agreement on the Millennium Development Goals, a set of targets aimed at reducing poverty, providing universal education, improving maternal and child health, and halting the spread of infectious diseases by 2015.
The global community rallied around these goals, helping to raise the will and the funds to improve the health and wellbeing of people in some of the most disadvantaged communities around the world as a foundation for human and economic development.
Since the adoption of the MDGs, new donors and development actors have emerged onto the scene. The Global Fund to fight AIDS, Tuberculosis and Malaria has become an important and critical player, and the U.S. President’s Malaria Initiative, the United Kingdom, Japan and numerous development banks and agencies are providing the resources necessary to scale-up innovative interventions and save lives.
Domestic resources – while low – are on the increase. More and more donors have come to see the value of investing in global health as a way to drive greater economic development, and partnerships like Roll Back Malaria have provided value for money and increased donor confidence by coordinating the actions of a wide group of actors.
And the landscape will – and must – continue to evolve. Despite the great efforts made through “Sector Wide Approaches”, the International Health Partnership, budget support, collaboration and intrasectoral coordination, the health arena is still fragmented.
Improving the global health architecture, streamlining financial procedures, improving accountability and striving for greater results are a must. The call for universal health coverage in the Sustainable Development Goals (SDGs), a health-in-all policy and improvements in socio-economic determinants of health are critical areas of investment moving forward.
The Ebola crisis has shown the importance of investing in health across the board and the role of strong health systems. We all stand to learn from this crisis – health professionals, decision makers, politicians, communities and donors.
What will it take to achieve the goals of the Roll Back Malaria Partnership?
At this critical stage, we must intensify our efforts to ensure adequate resources are in place so we can sustain the gains we’ve made under the MDGs and finish the unfinished business as we move into the post-2015 SDGs. No single organization or government can defeat malaria – success will require collaboration across all sectors to ensure we can stretch the value of our investments, increase efficiencies, maximize impact and, ultimately, leave no one behind.
There are many actors in the global fight against malaria, but we have a solid coordinating mechanism in the Roll Back Malaria Partnership and a clear roadmap in the Global Malaria Action Plan and its subsequent “Action and Investment to defeat Malaria (AIM) 2016-2030: for a Malaria-Free World”, which RBM will launch later this year. Together with the technical guidance of the World Health Organization, we have the tools need to build on our successes and eliminate malaria. But additional financing and strong political commitment will be crucial.
As we approach the deadline of the MDGs, what role will innovations play in helping us achieve our malaria goals?
Innovations are crucial for us to continue improving the health and well-being of populations around the world. With malaria specifically, we know that we need new prevention and treatment tools to help that ensure all are protected from the fatal disease and we can eventually eliminate it in high-burden areas. We must continue investing in research and development so we have alternatives in the face of emerging artemisinin and insecticide resistance.
We also need to find new ways to reach affected communities with effective malaria control commodities and to ensure they are used appropriately. This will require investments in well-trained community health workers and innovative behavior change and social mobilization efforts to ensure life-saving messages and tools reach those in all communities, no matter how remote.
Last but not least, we need to continue thinking outside the box to ensure that there is sufficient funding for the fight against malaria.
This will require us to work together – within and between sectors – to help increase efficiencies and maximize impact of our efforts.
Malaria has a nasty way of bouncing back as soon as our efforts to control it start to wane. Traditional development aid will not suffice, so a number of innovative financing solutions – like UNITAID’s tax on air tickets – have been created and others are being piloted, like the pay for performance tax bond just starting in Mozambique.
These are both examples of the impact that is achievable when leaders think innovatively about finance and actively commit to the people of this world. The combination of national leadership, international and in country solidarities as well as partnership will be essential if we are to succeed in the fight against malaria and improve the livelihood and quality of life for countless people in developing communities around the world.
How important is political leadership to helping RBM achieve its goals?
Political leadership is crucial to our efforts against malaria. Malaria is not only a health issue, it is also an economic and security issue; and it will require a high level of political leadership and regional diplomacy to ensure effective coordination and cross-border collaboration.
The Africa Leaders Malaria Alliance, which serves to unite political leadership in Africa, has helped exemplify the power of political leadership and bolster increased commitment to overcoming challenges across borders. Other groups like the African Union and the “Elimination 8” countries – who I will join in Zambia for World Malaria Day celebrations – have also played important roles in keeping malaria high on regional development and political agendas to ensure a coordinated, cross-border effort.
How is malaria interlinked with other development issues like poverty?
Malaria has tremendous economic impact on already struggling communities around the world, costing governments and societies billions of dollars in healthcare costs and lost productivity. In Africa alone, where 80 percent of malaria cases occur, malaria costs an estimated minimum of U.S. $12 billion in lost productivity each year, and in some high-burden countries it can account for as much as 40 percent of public health expenditure.
Malaria cases and deaths are not simply numbers; they are lives lost and promise not realized. Malaria keeps parents out of work, teachers out of the classroom and children out of school. When we invest in malaria, we not only invest in health, we invest in entire communities and future generations of leaders.
Since 2001, collective efforts have helped avert more than four million malaria-related deaths globally – the large majority of which are estimated to have been children under five – and today, fewer people than ever before in Africa are becoming infected with malaria.
More and more young children are living to see their fifth birthday and grow into productive members of their communities. Hospital beds once occupied by malaria-stricken patients are free, and as a result schools are full and markets are thriving. Our results are tangible across the board, not just in the health arena.
The RBM Partnership recently put out a call to action for malaria prevention in pregnancy?
Despite the tremendous gains we’ve made over the past 15 years, we continue to leave some of our most vulnerable behind – namely pregnant women and young children. Sadly, malaria infection during pregnancy is thought to be responsible for as many as 10,000 maternal and up to 200,000 infant deaths each year in Africa alone. In 2013, nearly half of the 35 million pregnant women in sub-Saharan Africa did not receive any preventive treatment during their pregnancy – meaning there were roughly 28 million live births on the continent that were not protected from malaria.
We can – and must – do better to protect these women from malaria. We know it is possible, and there are systems in place to reach these women. More than 60 percent of pregnant women have at least one antenatal visit during their pregnancy – we must do a better job integrating with these services to reach these mothers and ensure no woman is left behind.
Malaria in pregnancy represents a huge gap, and to overcome it we must sustain financing and work together to ensure comprehensive and equitable access to care. If we can do this, we can offer healthier pregnancies and a safer start to life.
What will increased financial commitments mean to the fight against malaria?
Investments in malaria prevention and control have been among the best investments in global health, resulting in a dramatic decrease in malaria deaths and illness and accelerating progress against broader development targets. Just recently, in fact, the UN Secretary-General noted that “Malaria control has proven to be one of the smartest investments in health we can make.”
We’ve seen global investments in malaria peak as international and domestic financing for malaria has increased in recent years, most recently climbing to $2.6 billion in 2013, helping us make great progress. But this number still falls short of the $5.1 billion RBM estimates is required annually through 2020 to achieve universal access of malaria control interventions.
Domestic financing for malaria must be increased to ensure national ownership and sustainable impact. Between 2005 and 2013, domestic financing for malaria in Africa increased, but only at a rate of four percent per year, compared to a 22 percent annual increase of international aid disbursements for the region.
Increased financing – including from domestic budgets – will play a central role in our story as we move forward toward ambitious elimination targets. Investment in malaria will only foster greater economic development for us all.
In fact, experts estimate that just more than $100 billion is needed to completely eliminate malaria by 2030. But this investment could reap a huge benefit: a potential 12 million lives saved, nearly three billion cases averted worldwide and a global gain of $270 billion if the disease is eliminated in sub-Saharan Africa alone.
What is the Roll Back Malaria Partnership?
It is the global framework for coordinated action against malaria.
Founded in 1998 by UNICEF (the United Nations Children’s Fund), WHO, UNDP (the UN Development Programme) and the World Bank and strengthened by the expertise, resources and commitment of more than 500 partner organizations, RBM is a public-private partnership that facilitates the incubation of new ideas, lends support to innovative approaches, promotes high-level political commitment and keeps malaria high on the global agenda by enabling, harmonizing and amplifying partner-driven advocacy initiatives.
RBM secures policy guidance and financial and technical support for control efforts in countries and monitors progress towards universal goals.
Dr. Nafo-Traoré is also currently a board member of the Global Fund to fight HIV, TB and Malaria.