Cost effective anti-malaria interventions

Dear Colleagues

Over the past five years there has been a major increase in the fund flows related to anti-malaria interventions. It is expected that in 2008, there will be more than $1 billion disbursed related to malaria work.

But it is interesting to note that the easy sound bite about child death ... "A child dies in Africa because of malaria every 30 seconds" ... or "some 3,000 children under 5 years of age die in Africa every day" remain the same now as they were two and three years ago. Is this lazyness on the part of the PR people ... or is this because the impact of the funding is insignificant.

With so much funding, it is reasonable to expect that there will be some cost accounting and performance analysis. President Bush made it clear that this was going to be a characteristic of the President's Malaria Initiative (PMI) and everyone talks about the importance of performance metrics. But in reality, the presently available performance metrics are simplistic and merely confirm that certain activities have been carried out ... which is a start ... but there is little about how effective these activities are in addressing the burden of malaria.

What is the goal? To reduce the burden of malaria in the society.

What is the burden of malaria? There are many elements of which the following are important. How much cost does this have?
1... High mortality among young children
2... High mortality among pregnant women
3... Mortality among all other groups in the population
4... Morbidity among all groups in the population ... which has a big economic impact when working age adults are incapacitated
5... Lost working time due to malaria
6... Cost of anti-malaria interventions
...1... Medical care
...2... Personal protection (coils, sprays, etc)
...3... Personal protection (bednets)
...4... Interior residual spraying (IRS)
...5... Source control ... larvaciding
...6... Adult mosquito control ... ULV adulticiding

What are the key metrics that show progress and relate progress to the costs of the associated anti-malaria activities?
1... Reduction in mortality among young children
2... Reduction in mortality among pregnant women
3... Reduction in mortality among all other groups in the population

4... Reduction in morbidity among all groups in the population
5... Reduction in lost working time due to malaria

6... Reduction in the cost of needed anti-malaria interventions
...1... Medical care
...2... Personal protection (coils, sprays, etc)
...3... Personal protection (bednets)
...4... Interior residual spraying (IRS)
...5... Source control ... larvaciding
...6... Adult mosquito control ... ULV adulticiding

7... Reduction in the prevalence of malaria parasite in the human host
8... Reduction in the prevalence of malaria parasite in the mosquito population
9... No emergence of resistance in any of the anti-malaria interventions
10.. No environmental damage
11.. No negative side effects for the human population

What is the cost? What is the optimum cost? How to get the least cost and the most benefit for anti-malaria interventions
...1... Medical care
...2... Personal protection (coils, sprays, etc)
...3... Personal protection (bednets)
...4... Interior residual spraying (IRS)
...5... Source control ... larvaciding
...6... Adult mosquito control ... ULV adulticiding
...7... Cost of data collection, data logistics, data analysis and administration

The metrics described here are a lot more substantive than anything that seems to be available at the present time in the malaria sub-sector ... though there will be around $1 billion disbursed in 2008 to address the malaria component of African health.

The international relief and development sector does not have a good track record on financial control, cost accounting and related matters. The good news is that there is some discussion of the need for performance metrics. The bad news is that what currently goes for performance metrics is very limited in quality and comprehensiveness.

With limited performance metrics ... performance is compromised. The cost is huge. Good management information is possible. Good management information is used in the corporate sector, but good management information is almost entirely absent in the public sector, and especially in the international relief and development sector. This is obscene, and serves only those that want to rip off the system or are engaged in activities that have little or no value.

Your comments are welcome.

Peter Burgess