Malaria - SADC gets it right while the UN gets it wrong

As you are reading this, somewhere in a forgotten clinic or on the floor of a dark hut, a young child is dying of malaria. According to the World Health Organisation (WHO) the disease robs a child of his or her life every thirty seconds; akin to crashing 7 Jumbo 747s into the ground every day. Those that survive often face a blighted future as the malaria parasites damage the cognitive development of young children. This week is SADC Malaria Week and although the disease still claims far too many lives, many SADC governments have a lot to be pleased about in their fight against the disease. Many donor agencies and UN organisations, on the other hand, have much to be ashamed about.

One of the most effective ways of controlling malaria is to spray tiny amounts of DDT insecticide on the inside walls of houses where the Anopheles mosquitoes rest. It is one of the best insecticides for malaria control and also happens to be the one the chemical environmentalists love to hate. This form of control, known as Indoor Residual Spraying (IRS), eradicated malaria from Europe, the US and many other areas. It also dramatically reduced malaria in India and Sri Lanka, and in South Africa, pushed malaria back to the lowveld areas of KwaZulu, Mpumalanga and Limpopo. The US National Academy of Sciences estimates that DDT has saved around 500 million lives through its use in public health.

The problem with DDT though is that it was used very widely in agriculture. It is estimated that by 1972, around 2 billion kilograms of DDT had been released into the environment. The consequent environmentalist backlash against DDT led the US Environmental Protection Agency (EPA) to ban it for agricultural use in 1972. Ever since, public health officials have faced an uphill battle to try to retain and in some cases expand the use of DDT in malaria control.

Right now, the departments of health in South Africa, Swaziland, Mozambique, Zambia, Namibia, Botswana and even Zimbabwe are sending out teams to control mosquitoes and therefore save lives from malaria. Yet while these malaria teams have support from their national governments and the private sector, they are often marginalised by the donor community and UN bodies such as UNICEF. The problem for donors and the UN is that the most appropriate way to control malaria in the region is through IRS, frequently using DDT.

South Africa managed to reduce the incidence of malaria in northern KwaZulu Natal by around 80% through DDT spraying. On the Zambian Copperbelt, a private initiative run by Konkola Copper Mines, based on an excellent IRS programme using DDT, cut malaria cases by 50% in the first year of operation and by a further 50% in the second. In addition, the programme, which protects around 350 000 people, has achieved zero malaria mortality in the mine clinics. Based on this success, Zambia has now started its own IRS programme using DDT in five cities. In southern Mozambique, an IRS programme which has been running for the past few years and is co-ordinated by Dr Brian Sharp of South Africa’s Medical Research Council has managed to reduce malaria cases dramatically. For the first time in decades, Mozambicans have an effective malaria control programme; something that most South Africans have taken for granted.

Yet despite these successes, the donor agencies and UN bodies will not support IRS and shy away from DDT. On one level the donors disapprove of DDT because they are concerned about the potential environmental impacts of using the insecticide, even though there is little or no basis to this argument. While some donors suggest that they support IRS and even DDT in word, they do not do so in deed. The malaria control issue highlights the enduring problem with donor agencies; more often than not they pursue and promote policies that suit them and not the countries they are supposed to be assisting.

In 1998 the WHO, UNICEF, the World Bank and donor agencies such as USAID set up a new partnership, Roll Back Malaria, which was supposed to halve malaria cases by 2010. We are now halfway through the programme and according to the WHO malaria cases and deaths have increased by 12%. The major problem is that they promote a one size fits all policy of malaria prevention, Insecticide Treated Nets, and ignore other measures that are actually delivering results, such as IRS.

If donors wanted to help Africans and control malaria, they would buy insecticides and fund the malaria control teams that go out every day and save lives. Instead, an agency such as USAID does not spend a single cent buying any insecticide or any drug out of its US$60m budget for malaria control. USAID prefers to direct its funding towards its own preferred consultants, mostly based in the US, who get involved in nebulous projects with no measurable outcomes, such as “technical assistance” and “capacity building.”

The common factor among the successful malaria control programmes in the SADC region is that they are either funded entirely by the national fiscus, by the private sector, or by the newly formed Global Fund for AIDS, TB and Malaria. The Global Fund differs from other donors in that it asks countries to propose their own health programmes and then, as long as they are feasible, it funds them.

Both the South African Minister of Health and the Swazi Ministry of Health deserve special credit for promoting IRS and the use of DDT in Africa. Their leadership has saved countless lives while the unaccountable and intransigent donors and various UN bodies continue to promote and fund interventions that are at best ineffectual. Malaria in Africa is a colossal human tragedy and yet it is both preventable and entirely curable. Unless the donors and UN change their ways they will remain almost passive spectators while unnecessary deaths continue to haunt Africa.

Author: Richard Tren is a director of the health advocacy group Africa Fighting Malaria. 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/ 09 November 2004 - Policy Bulletin / 27 October 2009

Help FMF promote the rule of law, personal liberty, and economic freedom become an individual member / donor HERE ... become a corporate member / donor HERE