Inter Press Service - November 22, 2004
Wilson Johwa

"We are expecting a normal to above-normal overall malaria season in Southern Africa, with a high risk potential for outbreaks in Zimbabwe, southern Angola and northern Namibia - and low risk potential in South Africa and Botswana," says Shiva Murugasampillay of the World Health Organisation's (WHO) Southern Africa Malaria Control Programme. The project's headquarters are in the Zimbabwean capital, Harare.

Southern Africa records 18 to 20 million malaria cases annually which, according to the WHO, result in about 200,000 deaths. The disease is the world's the biggest killer of children under five.

It's also a major cause of poverty. Control and treatment of malaria cost Africa 12 billion United States dollars every year in lost production. This, in turn, reduces economic growth by about 1.3 per cent annually.

Much is known about the transmission of malaria: people are infected with the disease through being bitten by anopheles mosquitoes which host the virus. In light of this, dealing with malaria would appear to be a relatively straightforward matter.

Indeed, the WHO says that large areas of South Africa, Botswana, Zimbabwe, Namibia and Swaziland have been freed from the scourge.

"We have done it and we can do it more and more," says Murugasampillay. He likens the anti-malaria initiative to a military campaign, as both require "long, consistent, field-based efforts over 30 to 50 years - or more."

More resources have become available to combat malaria through the Global Fund to fight AIDS, Tuberculosis (TB) and Malaria (launched in 2002) - and other mechanisms such as the Initiative for Heavily Indebted Poor Countries (HIPC). Started by the World Bank and International Monetary Fund in 1996, this programme aims to reduce the debt payments of poor states so that more money can be spent on social needs.

"The Global Fund has certainly increased the flow of resources for malaria beyond what has been available in previous years," says Mark Young of the United Nations Children's Fund. Every country in Southern Africa has been successful in obtaining money from the fund, while Zambia has twice received support for the fight against malaria.

Last week, officials who gathered in the northern Tanzanian town of Arusha for the ninth board meeting of the Global Fund agreed to launch a new round of grants - this despite fears that too little money had been raised to support additional donations.

Nonetheless, Murugasampillay says disbursement of money from the Global Fund can be slow.

Richard Tren, head of the Johannesburg-based advocacy group Africa Fighting Malaria, also has concerns about the success of programmes to curb malaria - seeing them as long on good intentions, short on funds.

The international Roll Back Malaria Campaign, for instance, was launched in 1998 with the aim of halving malaria deaths by 2010. Yet, says Tren, fatalities have risen by 12 percent.

Murugasampillay ascribes this apparent increase to better reporting of malaria cases.

"Malaria has been killing such large numbers of people over the years and suddenly people are asking why there's an increase," he says. "They should be asking why such a campaign took so long to establish."

But, Murugasampillay does agree that the campaign against malaria in Africa needs more financial support.

"The objectives for now till 2015 are to control malaria and bring down infection and deaths to manageable levels...Only then can we set our sights on elimination or eradication," he says.

According to Young, controlling malaria in Africa would cost about two billion U.S. dollars a year. However, this sum seems out of reach when one considers that 2.4 billion dollars worth of new funding has been budgeted by the Global Fund for treating AIDS, malaria and TB next year, (an additional 1.4 billion dollars is needed to renew existing grants).

Part of the answer lies in increased health funding from African governments themselves. In 2000, leaders from around the continent met in the Nigerian capital, Abuja, where they promised to bring malaria under control by 2005.

In particular, the heads of state and government undertook to ensure that at least 60 percent of Africans at risk from malaria, especially young children and pregnant women, benefited from the use of insecticide-treated mosquito nets and other measures to combat and control the disease.

In Southern Africa, the fight against malaria is focusing on a combination of interventions such as the use of insecticides sprays, and treated nets.

In addition, all states except Mozambique and Angola have introduced newer, more effective drugs to treat the disease, (resistance has built up to long-established medicines such as Chloroquine and Quinine).

However, all these countries "face one and the same problem which is that the newer drugs are 10 or 15 times more expensive," says Murugasampillay.

Regional and international efforts notwithstanding, the World Malaria Report of 2003 notes that the financial burden of malaria prevention and treatment is still borne by individual households. It seems, therefore, that malaria may only be eradicated when people become wealthier.

Spraying with insecticides might have helped Europe and the U.S. eradicate malaria shortly after the Second World War. But, says Tren, "the disease had been declining for decades before simply because people were getting wealthier" and could afford "better personal protection.as well as to be diagnosed and treated."

In Africa, it is likely to take some time for a similar situation to develop.

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