Malaria
Malaria is both preventable and treatable with proven and available interventions. However, every year it causes between 300 and 500 million illnesses and kills more than one million people. More than 90% of these illnesses and deaths occur in sub-Saharan Africa, and approximately 85% of all deaths occur in children under five years of age.
Strategy: USAID is leading an interagency and multi-donor response to fighting malaria, particularly in sub-Saharan Africa. Both the funding and the effectiveness of USAID's malaria programs will increase markedly in the next five years, providing comprehensive anti-malaria programs in much of Africa. The Presidential Malaria Initiative (PMI), announced on June 30, 2005, provides the leadership and means to cut malaria-related mortality in half in 15 African countries, and will dramatically transform USAID's programs and increase their impact.
Presidential Malaria Initiative (PMI): The PMI is a $1.2 billion five-year initiative focusing expanded efforts on 15 high-burden countries in Africa. PMI aims to achieve 85% coverage of vulnerable populations with key interventions, and a 50% reduction in malaria-related mortality after three years of full implementation. These targets are fully complementary with the commitments by other donors and the United States' support for multilateral efforts, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the Roll Back Malaria (RBM) Partnership. At the country level, the PMI strategies are designed in conjunction with National Malaria Control Programs and national strategies
The PMI will scale up rapidly four highly-effective, proven interventions:
- Prompt access to effective treatment, especially artemisinin-based combination therapy (ACT).
- Increased use of indoor residual spraying (IRS) with approved insecticides to prevent malaria.
- Expanded use of insecticide-treated nets (ITNs) to prevent malaria, including long-lasting insecticide-treated nets (LLINs), especially among children under five years and pregnant women.
- Increased coverage of pregnant women with intermittent preventive treatment (IPT) with an effective anti-malarial drug during routine antenatal visits to significantly reduce low birth weights and infant mortality.
Results: Less than six months following the June 30 Presidential announcement of PMI, lifesaving prevention and treatment activities are underway in all three first-year target countries, and a series of high-impact activities will be launched throughout this fiscal year. Within two months of the announcement, USAID, in collaboration with HHS/CDC, performed rapid assessment and planning visits in the three PMI countries and developed one-year malaria plans and five-year strategies for these countries. The interagency group also developed a comprehensive, state-of-the-art monitoring and evaluation plan.
By January, 2006, with PMI funding, Angola began implementation of a large-scale indoor residual spraying (IRS) program that covers 120,000 households and approximately 500,000 people. In Zanzibar, every mother and child under five years of age will receive a long-lasting insecticide-treated bednet. In war-ravaged northern Uganda, 270,000 long-lasting insecticide-treated bednets are now being distributed to internally displaced families. By the summer of 2006, IRS will have commenced in both Zanzibar and the Kabale district of Uganda. Also this summer, PMI will support a campaign to distribute over 950,000 nets to pregnant women and children under five years of age in Angola, as an integral part of the nationwide measles vaccination campaign.
Alignment of USAID's existing malaria control program with the PMI: In December 2005, the USAID Administrator issued new programming guidance to effectively combine all USAID malaria activities (PMI and "non-PMI") into a single, strategic, global malaria program. These changes concentrate funding in fewer countries in order to implement programs on a scale that can achieve demonstrable results, and will significantly increase the proportion of malaria funding that supports indoor residual spraying (IRS) and the purchase of life-saving commodities. Additionally, to provide for appropriate internal authorities for a malaria coordinator, USAID's management structure will change to ensure that responsibility for performance corresponds directly with decision-making authority over those same programs. Finally, to ensure improved reporting and transparency, GH has developed a comprehensive database for USAID's malaria programs, which is available to the public.
Malaria programs outside sub-Saharan Africa: In South and South East Asia and South America, the rapid spread and intensification of anti-malarial drug resistance represents the single greatest threat to malaria control efforts. In Central Asia, on the other hand, malaria is re-emerging as a serious public health problem due to dwindling support to national malaria control program infrastructure and activities. To address drug resistance in these regions, USAID will procure ACTs and provide technical support to improve drug management practices.
Research and Development: USAID supports the development of new malaria vaccine candidates and evaluates them in the clinic and the field. USAID also supports research into the community-based distribution of ACTs, malaria in pregnancy, and the development of new anti-malarial drugs. Finally, USAID funds operation research into the cost-effectiveness and efficiency of indoor residual spraying and other complementary vector-control interventions.
Performance of USAID malaria programs: In the 1990s, USAID was the leading donor for the research that led to insecticide-treated bednets, artemisinin-based combination therapies, and intermittent preventive therapy for pregnant women. In the past five years, USAID has helped over 20 countries to adopt ACTs as the first line treatment for uncomplicated falciparum malaria; 20 countries to eliminate or reduce taxes and tariffs on ITN; and 20 countries to adopt intermittent preventive treatment. In addition, to deal with serious shortfalls, USAID invested in efforts to stimulate African and international private sector participation to increase the production, and thus lower the prices, of ITNs. These investments led to the production and sale of 7.5 million insecticide-treated bednets and developed private sector capacity to produce millions more.
Strategic Allocation of Resources: In accordance with USAID's Policy Framework for Bilateral Foreign Aid, USAID allocates malaria funds according to several strategic considerations. Countries are selected into the PMI based on criteria including a high burden of malaria disease and mortality, a technically-sound national malaria control strategy, demonstrated national commitment to address malaria comprehensively, and opportunities for donor collaboration, particularly with the Global Fund.
Country resource allocations are focused on population, intensity of transmission, presence of other donor and government resources for malaria control, gaps in existing program support, and strategic investment opportunities which will lead to greater results in subsequent years.
|
PMI aggregate coverage targets | 2004-5 | 2006 | 2007 | 2008 | 2009 | 2010 |
| # of countries in PMI | 0 | 3 (1) | 7 | 15 | 15 | 15 |
| IPT (2 doses) | 35% | 49% | | | | 85% |
| ITNs for pregnant | 16% | 31% | | | | 85% |
| ITNs for <5s | 19% | 37% | | | | 85% |
| % of targeted houses sprayed | 1% | 70% | | | | 85% |
| Use of ACTs by <5s | 14% | 41% | | | | 85% |
| Cumulative number of ITNs distributed | TBD | TBD | | TBD | | TBD |
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Notes:
(1) While PMI countries in 2006 are 3, Zanzibar maintains separate health statistics, so the denominator for 2004-6 is 4 rather than 3.
(2)Data points are based on household surveys (DHS, MICS or MIS). When current year data point is not available the data from the previous year will be carried forward and used.
(3) Indicators include inputs from all donors and projects
Funding: Robust monitoring and evaluation will permit the tracking of budget allocations, inputs, outcomes, and results in malaria programs. Funding levels in FY 2006 - 2010 and the number of countries covered by the PMI are shown below:
|
Fiscal Year | Total Number of
PMI Countries | PMI Funding | Other Malaria Funding
(estimated) | Total Malaria Funding |
| FY 2006 | 3 | $30 million | $70 million | $100 million |
| FY 2007 | 7 | $135 million | $88 million | $223 million |
| FY 2008 | 15 | $300 million | $90 million | $390 million |
| FY 2009 | 15 | $300 million | $90 million | $390 million |
| FY 2010 | 15 | $500 million | $90 million | $590 million |
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Except for FY 2006, all PMI funding will be additive to a base USAID malaria budget of approximately $90 million. In FY 2006, USAID will allocate $100 million (before rescission), of which $30 million will be for the PMI, $10 million for malaria research, and $60 million for ongoing malaria prevention and treatment programs.
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