I am greatly concerned with the current philosophy about malaria control, and would like to start a conversation to build upon this controversial subject.
Too often the message discussed takes the perspective from the writer, and we tend to be possessive. However realistically and in the long run the control operations are necessarily the domain of the local Ministry of Health. Certainly if the operations are to be sustained it will be their responsibility. They have to cut the suit according to the cloth, so realistically the strategies must be designed to suit local situations.
Then who is there to design such interventions? In most endemic countries there is a dearth of local scientists, hardly any epidemiologists are employed in the MoH and so a lack of personnel to become familiar with the extent and distribution of the disease. Most programmes are run by medical officers (and in deference) they see health issues differently from those in public health.
There needs to be a great deal of integration between the medical and biological approach in setting a strategic plan. In my own case, in Rhodesia when we ran a successful malaria control operation for nigh on 50 years!, the programme was locally designed, based on local expertise and dealt with issues like insecticide resistance in mosquitoes etc. The strategy was based on IRS done systematically and under strict supervision with effective distribution of chloroquine. The fatality rate and transmission of malaria during that period was microscopic and can be referenced in the annual reports of the Secretary for Health. These are located in the National Archives in Harare.
These days, much of the interventions are designed as projects, there are a variety of donors each will their own agenda and the MoH is not in the position to plan locally (without upsetting one or other donor). How does the International body deal with this?
Certainly in my experience, there are few places where there is a plan even to replace spent bed nets. In conversation with experts who shall be unnamed! I was told "We cannot replace them, what will we do with all the spent nets?" Is this a strategy?
In fact there is no short cut, there is a need for local expertise to plan for and design sustainable interventions, so my suggestion first, is to address this lack of trained local personnel. There should be a plan to set up courses in malaria epidemiology in the broad sense in local Universities so as to train entomologists and epidemiologists. These people as they become employed in dealing with the problem and interacting with the expatriate scientists working locally will them become the source of local expertise to which the MoH can address so as to plan the interventions.
While there are still funds being allocated to malaria, this training is what should be a major priority.
Perhaps this can be the starting point for a discussion, lets see!
Thanks, Clive Shiff.