SADC ministers prepare to fight a killer

The annual South African Development Community (SADC) malaria week was recently held in Ondangwa, Namibia. The aim of the commemorations was to raise awareness of the risks of the disease before the start of the rainy season, which typically runs from November through to March. During this time the scourge of malaria is at its worst in the region. Across Africa over a million lives are lost needlessly to a disease that is entirely preventable and curable. The majority of deaths occur in children under the age of five and in pregnant women.

The theme of this years meeting was, “Scaling up Indoor Residual Spraying (IRS) with DDT”. Malaria has no reservoir in the wild; the parasite exists only in mosquito and man. So if the transmission can be blocked for a long enough period of time the parasite population collapses and the disease disappears. Combining drug therapy for humans, along with DDT for the inside walls of households, provides the one-two punch necessary to break the transmission and knock out the disease.

Malaria is generally limited to the far North Eastern corners of South Africa where the Limpopo, Mpumalanga and KwaZulu-Natal provinces border with neighbouring countries. In 1996 South Africa stopped using DDT due to international pressures and the desire to try an alternative control mechanism. Shortly after this, SA had a massive malaria outbreak. There was an eight-fold increase in malaria deaths from 1996 to 1999. The number of malaria cases increased at a similar rate from 5,000 per annum to more than 60,000. However, in 2000, SA reintroduced indoor residual spraying with DDT, amidst international pressures to ban the insecticide, and the number of cases dropped by a remarkable 80 per cent.

However, the flow of people, and therefore disease, across the South African borders has historically hampered the efforts to control malaria in SA. But the South African ministry of health along with other independent organisations have established cross border initiatives with neighbouring countries to control the malarial parasite in these countries. Indeed, the example set by the South African ministry of health has encouraged other sub-Saharan African countries to follow it in applying IRS using DDT and treating malarial cases with the new highly effective artemisinin based combination therapies (ACT’s).

An important feature of the SA control programme has been the domestic financing of malaria control initiatives, which means that scientists are free to make independent decisions regarding policies that work best here. Rather than pandering to international pressures from large multilateral agencies that specifically adopt a one-size-fits-all approach, SA has introduced polices based on what works on the ground.

In contrast, many large donor-led policies have failed due to their sluggish-style policies, which are generally mired in bureaucracy and slow to adapt. The United Nations Roll Back Malaria (RBM) initiative is a case in point. At its inception in 1998 it made the pledge that it would halve the burden of malaria by 2010. Eight years into the programme it is widely accepted that these targets will simply not be met.

In April 2001 African heads of state met in Abuja, Nigeria, and came up with Abuja declaration, which amongst other things pledged to devote at least 15 per cent of their total national budgets to improving healthcare. Yet currently, more than five years later, Liberia is the only country to have achieved this target, while only one or two others are close. But many African countries, if not all, continue to lobby for international assistance.

Past experience provides an important lesson for SADC member countries – the key to effective policies lies in their own hands. A domestic commitment to funding priorities, such as for combating malaria, prevents future disappointment when large donor agencies begin to phase out spending either due to shifts in priorities or poor performance. Given that there are effective preventative and curative measures for minimising and treating this disease – money spent on malaria control is money well spent.

Effective malaria control saves lives, prevents the trauma of unnecessary deaths in families, and has beneficial economic consequences for those who are spared from this debilitating disease. Malaria sufferers have great difficulty in carrying out sustained work, which exacerbates human misery and poverty in areas where the disease is prevalent.

Indeed, it is estimated that in malarial countries the disease reduces per capita economic growth by 1.3 per cent per year. This equates to approximately $12 billion in forgone income. Controlling malaria will consequently not only reduce human suffering but will also allow people to work and sustain themselves and their families. The SADC ministers therefore have an economic as well as a humanitarian reason for doing all they can to fight the tiny but deadly killer: the malaria-carrying anopheles mosquito.

Author: Jasson Urbach is a director of the health advocacy group Africa Fighting Malaria and a Fellow at the Free Market Foundation. This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author's and are not necessarily shared by the members of the Free Market Foundation.

FMF Feature Article/ 05 December 2006