MALARIA OVERVIEW
Context
Robust investments in malaria control over the past decade have yielded remarkable returns. Global malaria cases dropped from 233 million in 2000 to 198 million in 2013, and the number of malaria-related deaths declined from 985,000 to 584,000 over the same period.
Half the world’s population (3.2 billion) remains at risk of malaria, and transmission is ongoing in 97 countries. The burden is heaviest in sub-Saharan Africa, where an estimated 90% of all malaria deaths occur. Children aged under 5 years of age account for 78% of these deaths.
As of 2014, 55 countries were on track to reduce their malaria case incidence rates by 75%, in line with World Health Assembly and Roll Back Malaria targets for 2015. Sixty-four countries were on track to meet the Millennium Development Goal target of reversing the incidence of malaria (between 2000 and 2015).
Malaria 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.
Partnerships
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.
Strategy
Malaria control is an important part of the World Bank’s health portfolio. Between 1989 and 2011, there were 73 World Bank-financed health projects with malaria control activities; of which 42 projects were in Africa. Under the Malaria Booster Program (2005-2010), the Bank committed almost US$ 1 billion for malaria control in Africa and India.
The World Bank treats financing for malaria control as an integral part of financing for essential health services in the context of universal health coverage. The Bank works with countries to ensure that essential health interventions (including malaria) are adequately planned, costed and budgeted for in national health sector plans in a sustainable manner.
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 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.
Region- and country-specific activities have included:
- 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.
- 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.
Results
Country results from Bank-supported malaria prevention and control programs include:
Nigeria: From 2007 to 2015, the proportion of children under 5 sleeping under insecticide-treated mosquito nets rose from 4% to 74%.
Zambia: The malaria case fatality rate per 1,000 admissions in hospitals (all age groups) declined from 49 in 2005 to 34 by 2013 -- a reduction of 31%.
Rwanda: Bank support 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.
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.
Last Updated: Apr 24, 2015