Burundi + 8 more

Health in Emergencies Issue 9, Mar 2001


Rejecting 'business as usual' for Malaria Control in Emergencies by David Alnwick, Project Manager, Roll Back Malaria
Roll Back Malaria (RBM) is a global initiative to reduce death and suffering from malaria by 50% by 2010. Nowhere is the need for action more acute than in complex emergencies.

The last decade has witnessed a significant increase in both the numbers of conflict-based emergencies and natural disasters across every continent of the world. The majority of these complex emergencies have occurred in malaria endemic areas and many have continued for years unresolved. More complex emergencies have occurred within Africa than any other continent during this period. Today over 180 million people in Africa are living in countries affected by conflict, where infrastructure breakdown, population displacement, poverty, poor access to basic health care and food supplies, are the norm. War-affected communities often live in appalling conditions for years and are amongst the most vulnerable in the world to disease and starvation.

Tragically, 86% of all annual global deaths from malaria occur in Africa where the deadly Plasmodium falciparum strain of malaria predominates. Of the 960,000 estimated annual deaths in Africa WHO estimates at least 30% occur in countries affected by conflict. Malaria is often the main cause of ill health and death in emergencies.

Some groups are particularly vulnerable, especially in the acute phase of a complex emergency, because they are given less priority in distribution of limited resources or have greater difficulty in accessing treatment and care.

Depending on the situation, these may include minority ethnic groups, older people, people with disabilities, and infants and children who are already weak or sick.

The Challenge

To halve malaria deaths and reduce suffering in these complex circumstances demand new and dynamic approaches - current approaches aren't doing the job. However, many of the necessary approaches to the problem are already in place:

  • a committed and focused partnership of national and international organisations, including the UN, governments, donors, NGOs and faith based organisations working together with the affected communities;
  • appropriate tools with which to work and good technical direction and backup. As the secretariat of the global partnership, the technical resources that WHO can bring to this initiative, both internally and through it's wide ranging network of partners, is potentially enormous;
  • cost-effective treatments already available for malaria. New artemisinine based combinations of anti-malaria drugs are available for less than $3 US per treatment, and some of the cheapest drugs, where still efficacious, cost as little as 10 cents per treatment. Family size impregnated bed nets can be purchased in bulk for as little as $2.50 each. There are at least two remaining challenges to achieving RBM's goals. The first is to ensure that the RBM partners with key roles assume their responsibilities and use the tools available to them to control malaria in complex emergencies. This is particularly important for WHO, because taking its leadership role in the partnership to Roll Back Malaria in complex emergencies will require the Organization to work in new and innovative ways. For RBM to succeed in emergency situations, WHO will need to proactively forge new dynamic and effective partnerships with NGOs, faith based organisations, affected communities as well as national authorities in each complex emergency. Well supported cross-sectoral country partnerships are the key to success.

The second main challenge is the development of new tools to use in efforts to control malaria in complex emergencies, and to make these widely available at the field level. RBM is currently supporting the development and evaluation of insecticide impregnated emergency shelter materials, new drug combinations particularly suited to emergencies, a field handbook, a data base on complex emergency countries and emergency training resources.

The challenges are enormous. It is imperative that we seize the new opportunity which the global support for RBM now provides. The rapidly growing partnerships in complex emergencies together with both existing and new tools under development provide a better opportunity than we have had for reducing death and suffering even in the most complex of situations.

Strategies to Tackle Emergencies

RBM is tackling both chronic emergencies - such as in DR Congo and Sierra Leone - and new emergencies in order to reduce the toll of malaria in these countries. In recognition that these different types of complex emergencies require different approaches, RBM has developed two different strategies for interventions.

RBM is taking a two-pronged strategic approach to rolling back malaria in chronic emergency countries. The first prong of this approach calls for assessing the situation and determining the capacity in-country to respond to the assessed needs. What is needed for scaling up response to meet demands is also ascertained. The second prong of the strategy is to provide full-time RBM partnership support officers in country. They will provide daily support to partner organisations by assisting their RBM assessment, advocacy, planning, implementation and monitoring activities and will receive specific, short-term support of the Technical Support Network (TSN) on complex emergencies as needed. This will be piloted in DR Congo with two RBM partnership support officers, one in Kinshasa and one in Goma. Three other priority countries will receive similar support in 2001.

New emergencies require a slightly different approach comprised of two parts. Short-term technical support will be rapidly mobilised to support countries through RBM's secretariat and it's TSN. This is a network of partners that can provide short-term technical assistance to countries on an ad hoc basis. In addition, a number of new tools are being developed to improve the efficacy of efforts to control malaria (see article on page 4 for more information on these new tools). The same strategy can be applied to countries outside of those targeted in chronic emergencies. For further information, please contact R. Allan at allanr@who.int


Roll Back Malaria (RBM) is a global partnership launched on behalf of WHO, UNICEF, World Bank, UNDP by the Director General of WHO, Dr Gro Harlem Brundtland, in October 1998. It was evident that malaria was both a top political priority among African leaders and that it was still a major health scourge in many parts of the world, in Africa above all.

The goal of the global partnership, which includes governments of endemic countries, the international donor community, NGOs, faith-based organisations, the private sector including commercial enterprises, academic institutions, UN organisations and affected communities, has set a goal of halving deaths from malaria by 2010.

For further information, please contact R. Allan at allanr@who.int

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