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Need for some effective coordination in malaria control interventions

May 19, 2014 - 17:31 -- Clive Shiff

Wherever malaria has been eliminated, success was likely to have been based on the interplay of a series of mechanisms. In the United States it may have coincided with the advent of residual insecticides, but there were a variety of factors associated with the success. These were seasonal changes, environmental factors, political decisions that affected where people could live, the advent of improved treatments and increase in wealth and improvement of living standards. The same can be said of Italy and much of Europe in the early part of the 20th Century. The International efforts to eradicate malaria following the advent of residual insecticides and the drug chloroquine after World War II were successful in parts of Europe and Asia, but failed in much of Africa, South America and Eastern Asia. Lessons learned were that tools were inadequate, both insecticides and drugs failed due to the evolution of resistant vectors and parasites, and the logistics and expenses were not sustainable. One thing that was learned was that it is unwise to squander the efficacy of a cheap and useful drug like chloroquine on uncontrolled and unmanaged use and there was insufficient research for the interventions. The platter of public health was empty. To a large extent the platter has been replenished, but the current strategy to control malaria has lost focus. Control is often seen mainly to reduce mortality by uncontrolled use of the one effective drug available, but evidence from history has shown this is will not eliminate the parasite population. Emphasis needs to be placed on an integrated approach that is targeted against the parasite. The use of insecticide either sprayed on walls or on bednets has been effective in reducing transmission but this too is not sustainable mainly due to use patterns, decline of insecticide activity or ineffective coverage. Success in the past was in fact based on improvements in the overall public health infrastructure, because no intervention can be operational without an effective and efficient public health system. Someone needs to carry out and monitor the intervention, and a resident infrastructure is a key component. You cannot control what you do not measure and the whole effort to control malaria, particularly in Africa needs scientific coordination. Is not this the role of a restructured and adequately funded WHO Global Malaria Programme?



Cliff Landesman's picture
Submitted by Cliff Landesman on

It is certainly true that better public health systems are essential to success in controlling malaria. At the same time, can outsiders do much to bolster these systems without also contributing to inefficiency and waste? To whom are these institutions accountable? Are they innovative, responsive, and effective?

Submitted by Clive Shiff (not verified) on

Thanks for the comment: You are correct in that outsiders could do better, but most that provide personnel in the form of advisors seldom add ( or require) resources that could attract local counterparts, so when the project ends, then a gaping hole exists in the infrastructure. Having worked in an African Ministry of Health that was scientifically orientated I saw the benefit of short term advisors, but most nations on the continent do not have adequate career opportunities for local personnel, so the whole arrangement is unsatisfactory because there is nothing sustained. My overall thought is that WHO needs to be strengthened so that they can facilitate the development of mutual arrangements that will build local capacity. Only an international scientific body has the "sapiential authority" to do this in a way that could integrate the services that the donor brings with the needs of the local government so that both benefit and the process is sustainable.