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Recommendations in Malaria Policy to the Obama Administration

By Arlan Fuller | 16 Nov, 2009 Last edited by Robert Szypko on 02 Aug 2011

In the U.S., a coalition of global health advocacy organizations has come together to consider how US development assistance for health should be structured in the future. The Francois-Xavier Bagnoud Center for Health and Human Rights, a partner of the Global Health Delivery Project, was a contributor in this effort. The group recently launched a report, “The Future of Global Health: Ingredients of a Bold and Effective U.S. Initiative,” as the first effort to define expectations for President Obama’s planned Global Health Initiative (GHI), now being developed through an interagency team led by Deputy Secretary of State Jacob Lew. Since the announcement of the initiative in May 2009, the GHI consists only of a limited number of known elements; fundamental aspects such as scope, targets, timelines, and specific costing data have yet to be finalized. The language of a broad and realistic vision of what the U.S. can accomplish, however, is encouraging. The new advocacy report tries to fill in some of these missing details and describe policy and funding needs for a U.S. government response that will help lead the world to universal access to comprehensive healthcare in developing countries.

On the subject of malaria, what should be asked of the United States? While the Roll Back Malaria Partnership’s Global Malaria Action Plan sets out very ambitious and concrete targets, the United States’ goals within this global effort are not as clear. To policy makers and implementers, alike, what should be expected of U.S. involvement in global malaria efforts? Are the targets and recommendations outlined below accurate?

The report recommends that the U.S. be a strong leader in the fulfillment of global targets and live up to its pledges to support, by 2015:
• Purchasing and distributing 730 million LLINs;
• Achieving a mortality rate near zero for all preventable deaths and a 75% reduction in malaria burden in the original 15 PMI countries;
• Expanding PMI malaria support to at least 10 more countries and malaria control program strengthening to the Democratic Republic of the Congo and Nigeria;
• Continuing universal coverage with effective interventions: ITNs, IRS, diagnosis, and provision of ACTs and IPTs;
• Ensuring global and national mortality is near zero for all preventable deaths and global incidence level is reduced by 75% from 2000 levels;
• Achieving the malaria related Millennium Development Goal of halting and beginning to reverse the incidence of malaria with a focus on all PMI focus countries and regions where USAID and PMI are supporting national and regional malaria control programs; and
• Eliminating malaria in eight to ten countries by 2015, continuing with all countries in the pre-elimination phase today and working with countries to receive certification of malaria elimination by the World Health Organization.

The report also recommends a key set of policy changes needed to ensure that U.S. global malaria programs and the Global Health Initiative can be most effective:

Strengthen Health Systems
• Continue to focus on strengthening health systems to deliver integrated services, particularly maternal and child health programs.

Comprehensive Evaluation
• Encourage the Global Malaria Coordinator and the Interagency Coordinating Task Force to comprehensively evaluate all programs to determine effective and ineffective programs and policies; use these findings to promote best practices with all malaria funding recipients.

Support the Global Fund
• Increase support to the Global Fund and encourage other nations to fulfill their funding commitments.

Resource Support
• Increase resources to support normative work and technical assistance provided by the World Health Organization and Roll Back Malaria Partnership, supporting countries in regional strategy development and achieving universal coverage targets through PMI, USAID, and CDC, as consistent with the Hyde-Lantos U.S. Global Leadership for HIV, TB and Malaria, P.L. 110-293.

Re-Emphasize Monitoring and Research
• Expand emphasis on drug and insecticide resistance monitoring and research.

Improve Country Coordination
• Enhance the sustainability of interventions by continuing to improve alignment with in-country national priorities and existing implementation strategies.

Continued Commitment to Research and Development
• Continue leadership in research – vaccine development, drug resistance research, new drug development.


Thank you in advance for any feedback or suggestions you can offer. For further information about the report, please visit www.theglobalhealthinitiative.org.

Replies

 

Kileken ole-MoiYoi Moderator Emeritus Replied at 4:36 PM, 17 Nov 2009

Thank you for sharing these malaria policy recommendations which were made to the Obama administration. Although significant progress has been made in some countries, access to ACTs remains unacceptably low in many malaria endemic regions, while resistance to artemisinin threatens to spread from the Cambodia-Thai border. Many of these challenges arise due to bottlenecks in the health system (workforce, supply chain, M&E, governance) and the health infrastructure (clinics, roads, hospitals, storage facilities). Are there specific recommendations on how programs such as PMI, or The Global Health Initiative at large, can address some of these systemic challenges?

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