AAAS > International > Africa > Malaria and Development in Africa
  

Foreword

Executive Summary

Introduction

Background

Recommendations:

I. Broaden Attack on Malaria by Strengthening Cross-Sectoral Cooperation for Malaria Control

II. Utilize Cross-Sectoral Approach and Resources to Combat Malaria Associated with Development Efforts

III. Strengthen Local Capacity, Including Developing Cross-Sectoral Approaches

IV. Sustainable Malaria Control Requires a Community-Based Approach

V. Raise Global Awareness of the Magnitude of the Malaria Problem in Sub-Saharan Africa

VI. Encourage Innovative Approaches to Malaria Prevention and Control

Conclusions: Lessons Learned

References

List of Background Papers

Panel of Experts and Other Contributors
 
 

Executive Summary

The findings and recommendations contained in this report reflect the deliberations of our panel of experts. These conclusions are further illuminated and substantiated by examples from case studies prepared by these specialists and found in the Appendix [note: case studies not currently available online].

In presenting recommendations, we have specified contributions best made by African governments, donors, and NGOs. A prescription is given for the health sector to take the lead wthin each of these groups and in their joint efforts. The role of community participation in control strategies is also discussed.

Problem Statement 1

Malaria is a complex problem for which there is no "magic bullet," no quick or easy solution, particularly in Africa, where approximately 80 to 85 percent of cases and 90 percent of deaths in the world due to malaria occur. Patterns of transmission and environmental and cultural factors all vary so greatly throughout the continent that differences in prevalence and incidence occur even between neighboring villages. The virulence of both parasite and vector has thwarted control efforts, and emerging "multi-drug resistant" parasite strains appear to be inducing an increasing human toll, with a resulting impact on already overburdened health services, and on productivity.

Approach

In response, the development of locally sustainable approaches is critical. these approaches must be tailored as specifically as possible to the myriad physical and social environments across the continent. To achieve this goal, the following strategies are recommended:

  • Perhaps the most important investment to be made for malaria control is in human capital: to build local capacity in Africa to develop solutions specific to the affected local environment and population. Several options are proposed for developing the expertise in Africa to enable the design of strategies appropriate to identified ecological and human environments: research, reference, and training centers; as well as networks of African scientists and their institutions; and, finally, enhanced and innovative training and exchanges, including mentorships and short courses offered by scientific societies.
  • Participation by communities throughout the project cycle is critical to program success and sustainability. It is important to recognize that "communities are already actively undertaking malaria control strategies of their own," (Mwabu) with members actively seeking treatment from health providers and carrying out preventive measures, such as clearing homesteads of mosquito breeding sites, or purchasing drugs, nets, and sprays. Malaria programs must be designed to be culturally sensitive: Program objectives must conform with the beneficiaries' needs and preferences in order to achieve success (Etkin).
  • Urban and peri-urban populations, as well as groups with high mobility (seasonal laborers, nomads), require special attention as do the traditionally recognized high-risk groups, pregnant women and children under age five.
    • The inhabitants of urban and peri-urban areas are often more accessible than dispersed rural dwellers. However, urban populations are growing rapidly, and are presently facing some of the most acute environmental problems. Many of these city dwellers are migrants and, as such, may lack immunity to the local parasites.
    • Furthermore, the deterioration of the urban environment is enhancing the proliferation of vectors in urban areas (Thitai).
    • Population changes related to employment, resettlement, and other events can significantly affect malaria transmission (Etkin). Migratory groups represent a large proportion of Africa's population, and require special strategies because their frequent movement exposes them to high risk of morbidity and mortality from malaria (Warsame).
  • Opportunities should be seized for initiating innovative approaches. For example, the increasing decentralization fo governmental decisionmaking in Africa offers a unique opportunity fo restablishing effective cross-sectoral initiatives and launching pilot projects for integrated approaches to malaria control.
    • In Kenya, for example, the District Development Committee "is the obvious meeting point of the representatives of all the relevant sectors to ensure environmentally sound planning and implementation of water [and other development] projects" (Thitai)
    • With African governments increasingly looking to cost recovery methods for health services, government incentives and penalties for practices that influence transmission of malaria should be established. "In practice, the pattern of financial incentives and disincentives in the area of health behavior is sometimes the exact opposite of what it should be. Products with positive externalities in fact are taxed, and products with negative externalities are subsidized. In these circumstances, useful anti-malaria work might be done by removing the distortion." (Barlow)

Problem Statement 2

Overall development can have an impact on transmission of malaria. Agricultural development, water resource management, industrial and infrastructural project sites, and household and community environments can create habitats favorable for mosquito breeding. (Gwadz) The potentially adverse impact of overall development on malaria can be reduced by:

  • Strengthening "cross-sectoral" approaches for planning and implementing development initiatives. Furthermore, this study reveals that cross-sectoral approaches do already exist in Africa. Support should be provided for: (1) strengthening these efforts based on an inventory of their needs and priorities; and (2) researching how and where best to replicate and improve upon these models.
  • Strengthening the health components of Environmental Impact Statements and/or establishing "Malaria Impact Statements." Currently, Environmental Impact Statements, where implemented, do not have the authority necessary to monitor and take corrective measures to prevent or reduce the impact on malaria of a development initiative.

To strengthen the implementation of these recommendations -- and of ongoing malaria control efforts -- the priority of malaria control must be raised (for governments, donors, NGOs, and affected communities), together with the recognition that malaria is not an intractable problem across the continent. The current increased interest in malaria must be taken advantage of, and national as well as global commitments strengthened. The Report to the President (March 1991), prepared by Dr. Louis Sullivan, US Secretary for Health and Human Services, and Dr. Ronald Roskens, Director, US Agency for International Development, placed highest priority on investing in malaria control The October 1991 WHO meeting on malaria control in Africa also signals increased attention toward malaria in general, and in Africa specifically. The present opportunity must not be lost: This is a pivotal moment for asserting as an urgent priority the long-term sustainable malaria control strategy embodied by adopting a cross-sectoral approach and by building the capacity of Africans themselves.

 

 
   
 
 
   
 
AAAS > International > Africa > Malaria and Development in Africa