Recommendation I: Broaden Attack on Malaria by Strengthening Cross-Sectoral Cooperation for Malaria Control
Humankind's long history with malaria has provided ample opportunity for the trial and failure of many approaches. Earlier this century, "malariologists" alone were expected to be able to control malaria. It is now increasingly recognized that a much broader, coordinated approach, range of skills, and resource base are required in Africa. In addition to epidemiologists and parasitologists, for example, entomologists are necessary to study the occurrence and habits of the vectors; anthropologists are needed to ascertain the local beliefs and practices regarding the perceived cause of malaria, and local methods of prevention and treatment; community development specialists must provide the link to working effectively with communities to conduct the above assessments and to plan appropriate programs that respond to the problems and priorities identified by the communities. Economists, as well as specialists from development sectors that may have an adverse impact on malaria, must also be consulted.
Nevertheless, the health sector in developing countries and in donor agencies, such as USAID, is well placed to take the lead in strengthening a cross-sectoral approach to malaria control. Such an approach will serve to:
Actions for National Governments
To enhance malaria prevention and control, the cross-sectoral integration of ministries involved in specific development efforts must be established or, in the case where such cooperation already does exist, strengthened. In particular, the Ministry of Health (MOH) must play a leading role in planning, implementing, and monitoring development efforts that may have an adverse impact on malaria.
The MOH should therefore take the initiative in developing a national group to coordinate anti-malaria activities, effectively involving other relevant ministries, NGOs, women's groups, schools, etc. This MOH-directed group would be responsible for:
Other priority functions of such a coordinating group include:
Two of several interesting African examples are the cross-sectoral bodies in Ghana and the Sudan. The Blue Nile Health Project (BNHP) in the Sudan has established a participatory management structure, which includes a National Coordination Committee, Management Board, Scientific Advisory Group, and Health Education and Community Participation component. The National Coordination Committee, with wide national membership, has become an important component of the management structure. As the objectives of the project are shared by many governmental and non-governmental departments and agencies, coordination among them and the project administration has become a significant feature of the management system. Notably, the BNHP and the Health Committee on Water Resources in Ghana (described in greater detail later in this report) are both led by the respective country's Minister of Health.
Actions for Donors
Cooperation is required among the sectoral departments of single donor organizations, and among independent donor agencies. Structuring donors in a cross-sectoral manner will assist donors in encouraging cross-sectoral implementation, and in creating a program mechanism for funding cross-sectoral initiatives.
Health sector specialists in donor agencies must therefore establish coordinating bodies within and among donor agencies. These entities would increase awareness of malaria as a problem in sectors other than health, and ensure cross-sectoral planning, implementing, and monitoring of development efforts that may have an adverse impact on malaria.
USAID can also take the lead in working with other international development agencies to establish a model and protocol for cooperation between sectors to establish safeguards against increased malaria transmission. They will also undertake joint evaluations of the program impact on malaria and other health priorities. Lessons may be learned from the World Bank's large-scale efforts to reorganize and reorient staff and to strengthen the Bank's commitment toward safeguarding the environment from development's adverse effects.
Support Existing Cross-Sectoral Cooperation in Sub-Saharan Africa
Existing examples of cross-sectoral cooperation require financial support as well as evaluation to determine how they can best be strengthened, and with regard for potential replication in other settings in Africa. It is also clear that to be sustainable and effective, cross-sectoral bodies must have their own funding and clear authority. A few examples of networks specific to environmental and development-related health issues follow:
These cooperative efforts can play a pivotal role in developing cross-sectoral approaches to malaria control and other diseases associated with development.