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The world could wipe out malaria. A new report shows why that isn't happening

By Sungano Mharakurwa Moderator | 20 Dec, 2016

Please see excerpt below and http://www.latimes.com/world/global-development/la-fg-global-malaria-snap-201.... One really hopes that we will not lose the battle to malaria again.

EXCERPT
Despite progress toward preventing the spread of malaria, the world is moving too slowly toward elimination of the disease, which still claims hundreds of thousands of lives each year, the World Health Organization said Tuesday.
On the positive side, children and pregnant women in sub-Saharan Africa have greater access to tools that stop the transmission of malaria, according to the annual World Malaria Report. Diagnostic testing for children and preventive treatment for pregnant women has risen steeply across the region over the last five years, and the use of nets treated with insecticide has expanded rapidly.
But overall progress toward eliminating the spread of the disease is threatened by “substantial gaps” in the number of people with access to those measures, and the fragile health systems that exist in many countries, the international health agency said.
In addition, “For the last five years, global funding for malaria has flat-lined,” Pedro Alonso, director of WHO’s global malaria program, told reporters in a telephone briefing. “If this flat line remains, we shall not be able to achieve the ambitious goals and targets that the world has agreed upon.”

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Replies

 

Maimunat Alex-Adeomi Moderator Replied at 2:52 PM, 20 Dec 2016

Thank you for this article Sungano. In line with the thoughts above, believe health systems strengthening is key to achieving the goal of malaria elimination.

Peter Burgess Replied at 3:59 PM, 20 Dec 2016

Dear Colleagues

I am bothered by the complete absence of useful management information
related to the prevention of malaria in particular and the improvement in
health in general. There are lots of good ideas mixed in with ideas that
are driven simply by a profit motive, and little or no information to
enable better decisions to be made based on easy, timely, relevant data.
There is a reason that management metrics are notably absent ... it is that
performance is actually not very good, and there are a lot of people making
a lot of money from this rather low performing system. Good management
metrics would make this abuse of the system much more difficult ... but is
there anyone in leadership that really wants this sort of radical
accountability.

Peter Burgess
who has been working on management information for more than 50 years!

_____________________________
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Sungano Mharakurwa Moderator Replied at 2:47 PM, 21 Dec 2016

Thank you Maimunat. Health system strengthening would have considerable impact indeed. Presumably, it would be important to roll out system access to grass-root level where malaria primarily predominates. Also quite instructive is a the case study series compiled by WHO (http://www.who.int/malaria/areas/elimination/casestudies/en/).

Sungano Mharakurwa Moderator Replied at 2:58 PM, 21 Dec 2016

Many thanks Peter for that thought-provoking perspective. Management capacity appears a largely neglected component, yet clearly management is the pivotal determinant of ultimate success for any endeavor.

Pierre Bush, PhD Moderator Replied at 9:12 PM, 21 Dec 2016

Thank you Sungano for this discussion; the economics of malaria control and elimination coupled with the local political will are the cornerstone of eliminating malaria.

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Peter Burgess Replied at 3:18 PM, 22 Dec 2016

Pierre Bush ... thank you for the link to the economics of malaria study.

In some ways this is a good study ... but for someone like myself that is
looking for management information it merely confirms that we have been
collecting a lot of data, doing a lot of analysis, and still have very
little information that can be used to manage the work needed to get to the
goal of eliminating malaria, or at least reducing its impact to a
negligible level at a reasonable cost.

The amount of money that has been spent to manufacture and distribute
bednets has been huge, but we don't seem to know how this cost compares to
other interventions like interior residual spraying, or larviciding, or
environmental clean-up or a variety of combinations of all of the possible
interventions. We don't seem to know where are the most efficient least
cost interventions ... the specific PLACE where this has been accomplished.
My understanding of the science is that country level data about costs are
quite useless for management because of the massive difference between
locations ...

I can go on ... but an international assistance intervention on the scale
of the various malaria programs without excellence in management
information is more suited to the 19th century than to the 21st century ...
and I have to admit I think it is appalling.

Peter Burgess

_____________________________
Peter Burgess ... Founder and CEO
TrueValueMetrics ... Meaningful Metrics for a Smart Society
True Value Accounting ... Multi Dimension Impact Accounting
http://www.truevaluemetrics.org
<http://www.truevaluemetrics.org/DBadmin/DBtxt001.php?vv1=txt20080001>
LinkedIn: www.linkedin.com/in/peterburgess1/
Slideshare: http://www.slideshare.net/PeterBurgess2/
Twitter: @truevaluemetric @peterbnyc
Telephone: 570 202 1739 <570%20431%204385>
Email:
Skype: peterbinbushkill

Pierre Bush, PhD Moderator Replied at 10:39 PM, 22 Dec 2016

Hello Peter,
You are absolutely right. A lot of money has been spent on Long Lasting Impregnated mosquitoes Nets (LLINS) and it appears that some countries got cheated by manufacturers by selling LLINS with no medicines in them. In other places, there were instances in which people used the nets for fishing, and drying crops. As you stated a lot of money was misused.

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William Jobin Replied at 8:47 AM, 24 Dec 2016

Hi Peter,

I share your frustration with the amateur level of operations by WHO Geneva, and can only hope that election of  a new Director General this spring will improve things.  Of course the fact that member nations of WHO/UN no longer support the organization is the basic problem.

Bill, having worked with WHO for about 50 years, starting long ago when it was a competent organization.
William Jobin25558 Road N.6Cortez, Colorado 81321 cell fone- 1 970 317 3881email-

William Jobin Replied at 8:49 AM, 24 Dec 2016

William Jobin25558 Road N.6Cortez, Colorado 81321 cell fone- 1 970 317 3881email-

Manuel Lluberas Replied at 7:56 AM, 27 Dec 2016

LLINs have been portrayed as the panacea when dealing with malaria and many vector-borne diseases, but as the vector continues to develop resistance to the insecticides in them, we will continue to see an increase in malaria numbers. Tragically, those promoting the use of LLINs seem to fail to understand that it is very difficult to change the insecticide in them and continue to promote their use in larger numbers. Unfortunately, though vector control operations need to be deployed around the world, many of those "managing" them have little to no experience on the subject. And many of them think insecticides should be banned altogether! Dr. Chan described the spread of Zika during the 2016 World Health Assembly as "the price being paid for a massive policy failure on mosquito control. Experts dropped the ball in the 1970s with regards to getting a handle on disease-carrying insects.”

Unfortunately, the ball is still on the ground.

Sungano Mharakurwa Moderator Replied at 2:56 AM, 30 Dec 2016

True indeed. We have learnt the hard way that one size fits all does not work for malaria control, let alone elimination. As the attached articles show, pyrethroid resistance has really escalated in many places, posing a major setback for vector control. In such locations at least IRS can allow use of alternative chemicals., though cost is another consideration. A time-bound elimination campaign seems the way to go if the political will, professional will and dedication can be drummed up.

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