One way to improve the fight against malaria is to bring additional resources into the fight by broadening our vision beyond conventional medical approaches. I suggest that we enlist the scientists and engineers who deal with water resources, because water is the medium for anopheline mosquitoes, and because human communities around water projects are often exposed to malaria transmission because of the mosquito breeding that occurs in the reservoirs of the new dams, and in the irrigation canals and drains which are part of those water projects.
Thus as water projects are developed, increasing food and energy availability, we can also expect health to improve, if we design and operate the water projects properly.......In addition we should all expand our vision of the fight against malaria, to include contributions from many scientific disciplines outside of the medical sector. There are at least three ways that Engineers and Hydrologists can contribute to the fight against malaria in Africa….
THE FIRST WAY is by bringing a completely different approach to the Fight against Malaria based on consideration of comparative health consequences for alternative designs of water projects, use of new scientific concepts for managing water, sophisticated mathematics and computer modeling, and cost/benefit analyses, as compared to the traditional medical approach used by WHO and the US PMI which focus only on patients and their personal needs. In addition, Engineers and Hydrologists are trained in manipulation of the aquatic environment, especially when it comes to water projects such as irrigation and drainage, and also in designing human communities and housing related to those projects. When Entomologists provide the Engineers with critical information on larval habitat requirements and mosquito biting behavior, the Engineers can then design mosquitoes out of the picture….
THE SECOND WAY that Hydrologists and Engineers can contribute is by increasing the financial resources available for anti-malarial works. This is due to the place that Engineers have in planning water resource development projects. The Engineer is hired by the Owner to design and to estimate costs for water projects. As part of that process, the Engineer prepares a cost-benefit analysis for alternative project designs, including various crop selections, canal configurations, and drainage and housing features for an irrigation project; or various dam, reservoir and community relocation configurations for a hydroelectric project. The reason the Engineers carefully prepare cost-benefit projections is that the Owner (perhaps a River Basin Authority) will request a construction loan from an international bank, such as the World Bank or the African Development Bank. These loans, when made to a developing country in Africa, are usually on very favorable terms with low interest rates, long grace periods, soft-currency provisions and long payback times. Here is where the Water Project becomes a Health Opportunity. If anti-malarial features are included in the Water Project and thus in the loan request, the loan becomes a source of funds for anti-malaria work beyond what the normal governmental agencies can provide through operational funds in their ministry budget. So if the irrigation project has extra-refined water control features in the irrigation canals to avoid spillage, and extra-large drainage canals and pumps to minimize standing water, and screened housing located away from mosquito habitats (included and justified economically because they prevent malaria and other mosquito-born diseases which decrease labor productivity) then the loan towards these features saves expenses in the operational budget of the Ministry of Health for treating infected persons, or for spraying biocides to control the additional mosquito populations created around the Water Projects…..
THE THIRD WAY that Engineers and Hydrologists can help in the fight against malaria is through Health and Environmental Impact Assessments, which most international banks now require for water projects in Africa. Through these assessments – patterned after the well-known Environmental Impact Assessments – alternative designs and locations of a water project can be assessed for their relative risks regarding malaria and other water-associated diseases. Health Impact Assessments usually include funding of careful and extensive epidemiological surveys of existing mosquito vectors and transmission patterns, providing valuable information for the national fight against malaria…….
SUMMARY: In these three ways, Engineers and Hydrologists can add to the fight against malaria in Africa while promoting efficient use of water resources, and thus economic development, and without adding additional burdens to the already stressed Ministries of Health. Thus it should not be necessary to point out that National Malaria Control Programs should include hydrologists as well as irrigation, drainage and hydropower engineers among the directors. Also, the leader of the NMCP should be sure to become part of the water resources planning groups in the Ministries of Irrigation and Agriculture and in the Ministry of Energy….. I recommend that Ministers of Health make these important additions to their NMCP boards and staffs, as soon as possible, in order to improve the fight against malaria.