Recommendation II: Utilize Cross-Sectoral Approach and Resources to Combat Malaria Associated with Development Efforts
Potential Impact of Resource Development Projects on Malaria
Development projects have the capacity to influence the transmission of malaria. It can be expected that if not anticipated and corrected for in the initial plan, most development projects will result in an increase in malaria transmission because of one or more of the following factors:
For example, water resource development projects such as multi-purpose reservoirs, irrigation canal systems, and urban drainage projects have been shown in many cases to increase the incidence of vector-borne disease in Africa, especially malaria. These macro-scale projects are generally characterized by the following: their location in semi-arid lands (where irrigation projects are directed), the diversion and manipulation of large quantities of surface water, their requirement for significant donor funding, and a total implementation period that normally spans 10-15 years.
Furthermore, many water resource projects for irrigated semi-arid lands are implemented without any significant assessment of potential health impact. The fact that most semi-arid regions of Africa are presently low endemic areas for malaria means the potential is great to create high endemic and epidemic conditions in close proximity to the project.
Example: Irrigation Development and Malaria Incidence in Zanzibar
Irrigation development in Zanzibar was initiated with the objective of increasing rice production in the isles and consequently reducing the import bill for rice. Initially, no consideration was given to the potential for irrigation schemes to increase transmission of malaria and other vector-borne diseases. It was only later in the project phase when the Malaria Control Project of Zanzibar cautioned the project planners on the excessive use of insecticides, which were also suitable for mosquito control, that a concern for malaria was reported.
A fact-finding mission was subsequently organized to collect more information on the presence of vector mosquito larvae and snail intermediate hosts in the paddy fields. The preliminary survey indicated that the presence and, to some extent, the density of mosquito larvae of the genus Anopheles were directly related to the irrigation regime:
It was very unfortunate that during the planning phase for such endemic areas of malaria no attention was drawn to the need and the possibilities for systematic action and to indicate where research, collaboration and assistance could be most effective. (Khatibu)
In addition, the resources of development sectors other than health, frequently often the private authority responsible for the development project, must be tapped and coordinated to bring to bear the broadest approach and resource base for tackling malaria control.
Opportunities for Control of Malaria Associated with Development Efforts
Planning for and monitoring of malaria control associated with development efforts
It is recommended that all development projects take into account the potential for an adverse impact on malaria. Project plans must thus include provisions for reducing the potential for transmission. Development of such plans and mechanisms for monitoring impact can best be achieved by cross-sectoral teams.
Standard pre-project planning requires input from such teams with representation from various sectors. Controlling malaria associated with these development efforts would be strengthened by changing the requirements for project planning and implementation to mandate that these experts should operate as a team throughout the project life to monitor project impact, recommend revisions to the project as required, and evaluate actual compliance with and effectiveness of revised malaria control efforts.
Prevention of malaria associated with development can best be established at the pre-planning stage. Early prevention of malaria is generally simpler and cheaper than instituting corrective measures later.
Specified recommended components, to be carried out by the team members, must be included in the planning and implementation phases, respectively, to prevent an adverse impact on malaria. It is critical that the implementation phase must continue and reinforce the interventions initiated in the planning phase. These efforts should include:
In the planning phase:
In the implementation phase:
Establish a requirement for a strengthened Environmental Impact Assessment
Current environmental impact requirements are neither strong nor specific enough to prevent or reduce malaria associated with planned development efforts. For example, A.M.A. Imevbore points out that although "the National Health Policy established since 1986 explicitly requires intersectoral collaboration among ministries of health planning, agriculture and finance, several irrigation projects have nevertheless been built without implementing this policy for intersectoral collaboration at the planning stage" (paper by Imevbore, in Appendix of print version of this report). Also, in the USAID checklist for environmental impact, public health and disease vector questions receive less attention than do endangered species, pest plants and animals, or tourism and recreation. Given the importance of malaria as a public health problem, and the potential that development schemes have to influence the intensity of malaria transmission, a requirement for malaria-specific impact statements should be justifiable in Africa. The emphasis should be placed on reviewing current requirements for Environmental Impact Assessment in USAID-funded development projects, and incorporating safeguards for malaria control throughout a project cycle.
Therefore, it is also recommended that:
Establish a requirement for cross-sectoral assessment of selection, design, and construction of development sites
In addition to the recommendations provided above for general development efforts, special opportunities exist for targeting malaria control interventions to urban, industrial, and infrastructural development.