August 19, 2013
Robust investments in malaria control over the past decade have yielded remarkable returns. Global malaria cases dropped from 233 million in 2000 to 219 million in 2010, and the number of malaria-related deaths declined from 985,000 to 655,000 over the same period. In 2010, half the world’s population (3.3 billion) remained at risk of malaria. Global policymakers stress the need to consolidate gains to avoid resurgence of malaria as a major public health threat in countries where it has been previously been controlled.
In sub-Saharan Africa, 1.1 million children have been saved from malaria infection over the last decade. Eleven countries in the region have reached the 2010 Global Malaria Action Plan targets, in addition to 32 endemic countries outside of Africa.
Across the world, in countries where access to malaria control interventions has improved most significantly, overall child mortality rates have fallen by approximately 20%. In Africa, mortality rates have fallen by 33%. Fifty countries are on track to reduce their malaria incidence rates by 75% by 2015; however, these countries account for only 3% of the total estimated cases.
Eighty percent of estimated malaria cases occur in 17 countries. Some countries, such as Morocco, Turkmenistan, the UAE and Armenia have achieved national malaria elimination over the past five years. Countries such as Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia and Zimbabwe have developed a regional strategy to eliminate malaria.
The global malaria burden remains unnecessarily high, however, and affects children disproportionately. An estimated 86% of deaths occur in children under five.
The disease takes a high toll on households and health care systems, and impedes economic development in endemic countries. It is estimated that malaria reduces GDP growth by approximately 1.3% per year in some African countries. Malaria also discourages foreign investment, increases people’s out-of-pocket spending on health care, and impairs children’s ability to learn, particularly those who survive severe illness.
The most cost-effective interventions against malaria include the use of long-lasting, insecticidal-treated mosquito nets, effective case management (rapid diagnosis and effective treatment), and indoor residual spraying. Rising drug resistance, such as along the Thai-Myanmar border, is causing serious public health concerns and points to the need to invest also in strengthening essential public health functions such as surveillance in endemic countries.
Dramatic reductions in malaria have occurred through stronger harmonization among partners in support of countries’ programs, global commitment and sustained government leadership.
The international community has set clear targets to reduce the world’s malaria burden -- under the Millennium Development Goals -- and has united under the Roll Back Malaria (RBM) Partnership to meet these goals. The World Bank is a founding member of the Roll Back Malaria Partnership, which serves as a global framework for implementing a coordinated response against malaria.
RBM partners, including the Bank, have endorsed the objectives and targets of the Global Malaria Action Plan (GMAP), launched in 2008. Achieving these targets will significantly reduce child mortality (MDG 4) and improve maternal health (MDG 5) – which are also priorities under the Bank’s strategy for health, nutrition and population.
The World Bank is the third largest financier of malaria control globally, after the U.S. President’s Malaria Initiative and the Global Fund. Overall, the World Bank has committed close to $1 billion to malaria control:
(a) In Africa from 2005 to 2011, the Bank committed $773.6 million to the fight against malaria in 20 countries -- more than a ten-fold increase since 2000-2005. From 2006 to 2012, through its support for country projects in sub-Saharan Africa, the World Bank financed the procurement and distribution of 62 million anti-malaria bed nets, as well as distribution of an additional 39.3 million bed nets procured by other RBM partners. This significantly increased household bed net coverage in the Democratic Republic of Congo, Zambia, Benin, Nigeria, and Ethiopia, among others. Additionally, the Bank has financed 97 million doses of malaria treatment drugs and 22.3 million rapid diagnostic tests. Almost 60% of Bank resources for malaria control in Africa goes to Nigeria and DRC Congo, which together account for 58% of malaria infection and deaths in Africa.
(b) In India, the Bank has allocated close to $190 million to malaria control efforts as part of a broader vector control project. The Bank financed 6.1 million insecticide-treated bed nets, as well as a substantial amount of rapid diagnostic tests and drugs.
The Bank uses a two-pronged approach to support malaria control efforts: First, scaling up effective interventions and second, strengthening systems issues such as supply chain, human resources, and monitoring and evaluation. Strengthening health systems and ensuring that countries perform essential public health functions such as surveillance, will be critical for countries to sustain gains and continue toward elimination of malaria. In the past, the Bank has successfully leveraged its IDA resources to bring non-traditional donors to the fight, including the Russian Federation, which has co-financed World Bank malaria control activities ($16 million) in Zambia and Mozambique.
The Bank’s malaria strategy also extends to sectors other than health. For example, a $42 million malaria program covering the Senegal River Basin (including Senegal, Mali, Mauritania and Guinea) was embedded in a larger Water Resource Development Project covering the same countries. Likewise, in D.R. Congo, the Bank financed $13 million for the purchase of mosquito nets as part of an Emergency Urban and Social Rehabilitation Project.
The Bank recognizes the importance of monitoring and evaluation (M&E) to adjust planning and ensure results, and has worked with countries to strengthen M&E capacity and conduct surveys to monitor progress and identify bottlenecks.
Impact evaluation helps deliver programs more effectively and equitably. The Bank has launched impact evaluation work on malaria such as in Kenya and Senegal (school-based programs); Nigeria (impact of community distributors and patent vendors training); and India (improving malaria control outcomes through evidence-based program design).
Country results of Bank support for malaria prevention and control programs include:
- Rwanda: Bank support has led to a 63% increase in the use of insecticide-treated mosquito nets; a 62% decrease in malaria incidence; and a 30% decrease in child mortality.
- Ethiopia: In 2010, 90% of children under 5 slept under insecticide-treated bed nets, compared to 5% in 2003.
- Zambia: Annual malaria deaths decreased by 50% from 2000 to 2008, contributing to a reduction in under-five deaths of 29% and in infant mortality of 26% (between 2000 and 2007).
- Sierra Leone: Households owning at least one treated mosquito net rose from 33% in 2010 to 87% in June 2011.
- India: The Bank has financed 6.1 million mosquito nets, 1.1 million malaria drug doses, and 3.6 million rapid diagnostic tests for malaria.