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WASHINGTON, April 24, 2008 – The World Bank and partners in the global war against malaria are calling for an intense push to eliminate malaria as a major public health problem and end deaths from this ancient disease. This week, the Bank invited world music superstar Youssou N’Dour to perform before African ambassadors, Roll Back Malaria partners, Bank staff, and other distinguished guests. The occasion? World Malaria Day—an opportunity to focus attention on the challenge and opportunity malaria presents for those most directly affected and those able to help do something about it.

From his place at the top of the music charts, Youssou is doing his share, by reaching out to everyone from African youth who enjoy his music and have young siblings at risk, to world leaders who can apply vast resources to the problem. “The world has started a war against malaria, a war we can all win.  We have a grand alliance, called Roll Back Malaria. Allies like the World Bank, the Global Fund, the U.S. and the U.N. are doing more.  And on the first World Malaria Day, we have presidents and even basketball players involved. The high-level attention to malaria is just what we wanted when we started the Africa Live malaria concert in 2005, but it’s still not enough.  Mosquitoes don’t care about visas—we need cross-border efforts like the Zambezi region proposes. With efforts like that, we can eliminate malaria,” Youssou said.

Commitment from Africa and current partners is at an all-time high. Youssou, the World Bank, and partners across the globe are calling on others to join this winnable fight.

Malaria is preventable and treatable, but a million or more people – mostly African children – still die from it every year.

“The good news however, is that more African countries are showing that it is in fact possible to control malaria,” notes World Bank Vice President for Africa, Obiageli Ezekwesili. “Despite difficult conditions and initial pessimism, countries such as Benin, Ethiopia, Rwanda, and Zambia are successfully scaling up malaria control efforts through provision of bed nets and effective drugs. Certainly more countries can follow a similar path with enough resources and technical support.”

Critical to the success of these countries is the ability to ramp up malaria control efforts quickly and sustain the level of effort long enough to drastically reduce the number of people and mosquitoes harboring the parasite that causes malaria. Given the current immense global interest in malaria, now is the time to do it, and effective partnership is crucial to the equation.

“The malaria community is in a better place than ever before. The Roll Back Malaria Partnership is working to produce unprecedented collaboration. People on the ground and at the global level are excited about the prospect of ending deaths from malaria,” said Ray Chambers, United Nations Special Envoy for Malaria. “We know what to do; now we just need to get it done.” Additional financing is essential.

Since the 2005 launch of its Booster Program for Malaria Control in Africa, the World Bank has committed US $467 million to malaria prevention and treatment in Africa, making it one of the top three funders of malaria control. This funding has been requested by African countries to buy long lasting insecticidal nets (LLINs), effective drugs, and supplies for spraying the walls of homes with insecticide. It includes money to strengthen health care systems so that they can better manage the life-threatening malaria cases that can consume up to 40 percent of public health resources in heavily-affected countries.

This funding comes from the World Bank’s International Development Association, better known as IDA. IDA is a mechanism by which the poorest countries receive no-interest loans or grants from the world’s richer countries. Every three years, donor countries meet to decide what each of them will contribute. Pledges made by donor countries in December 2007 mean that IDA 15 (the 15^th time the fund has been replenished) will contain a record US $41 billion.

While that sounds like it would buy more than enough bed nets, drugs, and insecticides to stop malaria, IDA resources are used to support an entire spectrum of development issues – roads, education, agriculture, health, and many others. Even under the “simple” rubric of health, any number of diseases and issues come into play. And it is the countries borrowing the money who decide how to spend it. The Bank has been able to commit $467 million for malaria control only because 18 African countries decided malaria was important enough to allocate a significant portion of their IDA funds to it.

From this next round of funding, the Bank anticipates that countries will spend significantly more of their IDA funds on malaria to take advantage of the current momentum around eliminating malaria as a public health threat. This would go a long way toward removing malaria as a major barrier to Africa’s economic growth.

“Defeating malaria is essential to Africa’s development,” emphasized Professor Awa Marie Coll-Seck, Executive Director of the Roll Back Malaria Partnership. “In addition to making people physically miserable, malaria reduces productivity. When adults–or their children–are sick with malaria, they lose
time from their work, which means they cannot produce the food, money, or other things they and their countries need.” She added, “Unless malaria is tackled in Africa, few countries there will meet FIVE key Millennium Development Goals on child health, maternal health, infectious disease, universal primary education, and the eradication of poverty. Malaria must be stopped, and the world is now poised to achieve this goal.”

* * * * *

The World Bank Group is a vital source of financial and technical assistance to developing countries around the world. We use our financial resources, staff, and extensive experience to aid countries in reducing poverty, increasing economic growth, and improving the quality of life. The impact of malaria extends far beyond the realm of public health and exacts a heavy toll on development. This makes the disease central to the Bank’s development agenda. In 2005, the World Bank launched the Booster Program for Malaria Control in Africa. Booster is a ten-year program designed to help African nations meet critical targets for malaria control and reducing child and maternal mortality.

For more information on the World Bank’s Booster Program for Malaria Control in Africa, visit www.worldbank.org/afr/malaria.

For more information on the Roll Back Malaria Partnership, visit www.rbm.who.int

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World Bank Malaria Site

Related Links

• Feature Story: Combating Malaria in Benin: The Mosquito Net Distribution Campaign
• Feature Story: Combating Malaria in Cameroon: a Coalition to Benefit All
• Press Release: Youssou N’Dour Joins Top World Bank Officials in Calling for Immediate Action to Conquer Malaria
• Website: World Malaria Day 
• Issue Brief: Malaria 

• Control of disease is center to country’s health strategy.
• Progress includes declines in deaths, cases, and admissions.
• World Bank and partners working to close gaps in fighting disease.

April 24, 2008—Approximately 53 million Ethiopians (63 percent of the population) live in malaria-risk areas. Of these, 33 million – almost 40 percent of the total population – are in endemic areas, and nearly one quarter of Ethiopians reside in endemic-prone areas.

Malaria is a leading cause of death in children and adults. In 2000 alone it killed over 29,000 children, equivalent to almost 80 children per day. In a country where 81 percent of the population lives on less than two dollars a day, reversing the spread of malaria and its destructive impact on poor households and their livelihoods is a formidable challenge.

The Ministry of Health has taken on that challenge

In the past five years, the Government of Ethiopia has put malaria control at the heart of its health sector strategy, with a scaled-up approach adopted in 2005. In a country the size of France and Spain combined and with terrain that stretches across rocky mountains, arid desert, and rainforest, and which, at times, faces political uncertainty, this is no mean feat.

A recent WHO rapid impact assessment (November/December 2007) in four main regions in Ethiopia recorded the following findings for 2001-7 for children of all ages.

• There has been a 67 percent decrease in confirmed malaria outpatient cases,
• a 54 percent decline in malaria admissions, and
• a 55 percent decrease in malaria deaths.

The decrease in malaria cases can be compared with results of non-malaria incidences in this table:

Table 1. Weighted mean percentage of malaria cases in children 2001-2007, Ethiopia

Historically, since malaria has accounted for a large proportion of deaths among children below the age of 5, these recent achievements have meant that thousands more children are reaching their fifth birthday than in previous years.

This success may also mean that in the near future there may be a shift in Ethiopia’s malaria transmission status from moderate-low to very low. Moreover, achieving control over malaria epidemics will free up resources for improving healthcare service delivery elsewhere in Ethiopia, helping the country to meet its other health-related Millennium Development Goals.

Which activities did Ethiopia undertake to achieve this?

Ethiopia’s malaria control program took a three-pronged approach.

• Insecticide-Treated Nets (ITNs) Less than five years ago, Ethiopia was lagging behind many countries in Africa, with less than 5 percent of households owning even a single mosquito bed net. In 2004 the Government set itself an ambitious target: to ensure every household in a malaria-risk area owns two long-lasting, insecticide- treated nets (ITNs) – a total of 20 million nets. At an estimate of an average of five members per household, this intended to achieve almost 95 percent coverage by mid- 2008. By January 2008, Ethiopia had exceeded this target. As of March 2008, 20,492,318 ITNs have been distributed. This represents a three-fold increase in bed net distribution since 2005. Every one of the nine regions or city-states receiving nets met its goal and in five of the regions/city-states these were exceeded.
• Artemisinin Combination Therapy (ACT) In mid-2005, the Government embarked on administering six million doses of the anti-malaria drug Coartem. This will cover up to 2.2 million newly identified malaria cases. ACT has been made available to all health facilities and communities and no stock outs have been reported.
• Indoor Residual Spraying (IRS) Up to the end of 2005 this was the primary intervention for vector control with coverage of 30 percent of the population at risk. Today the impact of IRS is even greater because it is working in tandem with both ITNs and ACTs. However, implementing IRS is difficult, partly because of Ethiopia’s terrain. Spray technicians often use horseback or donkey in order to reach the most remote households.

“Malaria control is really improving, especially compared with the last three years,” according to Dr. Daddi Jima, head of the Government’s National Malaria Control Program. “The overall declining trend in the epidemic situation is showing a very significant decline.”

How has Ethiopia achieved such success?

•  Leadership. Meeting ambitious targets demands commitment and effective management. The success of the malaria initiatives can be attributed to the exceptional leadership of the Government. In the face of political, logistical, and financial difficulties, enormous strides in progress are still possible.
• Partnership. The Government’s malaria initiative has been fully supported by donors and it is this joint approach with a ”can do, will do” attitude that has contributed to the success. Multilateral and bilateral donors are working together to align with the Government’s system, provide technical support, particularly in logistics and planning and to fill resource gaps wherever necessary. This was only possible because of guidance from the Ministry of Health and it remains very much a Government-led process.
• Pragmatism. The Government has undertaken a realistic assessment of the country’s capacity for health service delivery. To fulfill its pledge to combat malaria, the MOH has temporarily outsourced some delivery of malaria-prevention services to those with an increased ability to handle it, while national capacity for service-delivery is built.

Dr. Daddi notes that the decline in malaria prevalence “directly correlates with the scale of [anti-malaria] interventions, of Coartem [an ACT], and ITN distribution.”

This scale-up corresponds with the introduction of the multi-million-dollar, multi-donor Protection of Basic Services (PBS) project. In 2006, several donors (AfDB, CIDA, DFID, EC, Irish Aid, KfW, Netherlands, and the World Bank) committed around eight hundred million dollars for the PBS project, while Government also scaled up its financing for services. The majority of this money is channeled to local districts, to support the provision of basic education, agriculture, water and sanitation, and, of course, health services. In the PBS donor-partners have agreed to harmonize their reporting and financial management requirements around country systems. Around US$80 million of World Bank and other donor resources have been assigned via the PBS to support the federal government in fulfilling its responsibilities in health service delivery. This delivery is primarily for the purchase of commodities, including ITNs, ACTs, indoor spraying services, medical equipment, vaccines, and contraceptives, as well as capacity building. Donors have provided over $22 million for malaria control alone, and this has enabled the IRS program to be revitalized, the free distribution of Coartem, as well as free distribution of over 3 million bed nets so far.

The World Bank’s contribution to reducing malaria in Ethiopia

The World Bank is committed to supporting the Government to meet its malaria control goals. The World Bank has provided over US$11 million via the PBS for anti-malaria commodities. In addition, in late 2007, a sudden gap in financing for malaria commodities came about, when expected resources were not forthcoming. The Bank was able to step in to bridge this gap by providing a further US$12 million for malaria via the PBS.  This demonstrates the Bank’s responsiveness and the joint approach of the international community, which works to cover gaps in financing in order to ensure the Government is fully supported. As the PBS project reaches its second phase in the latter half of 2008, the World Bank and other partners will continue to work in a unified way under Government leadership to help Ethiopia meet its targets to combat malaria.

Where do gaps still exist?

• Impact evaluation and monitoring of the healthcare system
• Epidemic surveillance and response system: this needs to be restructured, but should improve when the new Health Monitoring Information System is functional.
• Improving access to treatment
• Scaling up Indoor Residual Spraying (IRS) to cover all regions
• Ensuring the quality of IRS and improved targeting of spray areas, and the use of Insecticide-Treated Nets
• Linkages within the health system. Targeting malaria demands attention to other aspects of health and poverty reduction.
• Ensure provision of primary health care services, particularly by expanding the number of health extension workers (HEWs). The target is to deploy 30,000 HEWs by the end of 2009. The Government is on track. Over 24,000 HEWs were in place by February 2008.

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