A Review of Progress Towards Global Malaria Targets

Abstract

Rationale: Ambitious targets have been set to reduce the burden of disease caused by malaria, and funding to do so has increased. In spite of the large increase in funding, many countries are still far from meeting targets. The Roll Back Malaria global partnership was founded in 1998 with the ambitious goals to halve malaria-associated mortality by 2010 and again by 2015. Core targets of RBM include having at least 60% of all children and pregnant women sleeping under an insecticide treated net (ITN); ensuring that 60% of all children with malaria symptoms are treated with a nationally approved antimalarial within 24 hours of onset of symptoms; and providing at least 60% of all pregnant women with intermittent preventive treatment (IPT). Financial resources to support these goals increased significantly following the creation of the Global Fund for Aids, Tuberculosis and Malaria (GFATM) in 2001. The GFATM had committed almost $2 billion by early November 2006 to scale up targeted interventions to fight malaria in Africa and other malarious countries There is a growing interest in examining the extent to which GFATM resources are impacting on the variables of interest, which are health service coverage and population outcomes.

Objectives. This study seeks to achieve three specific objectives: assess the progress made towards meeting the global malaria targets contained in RBM and MDG goals; test the effect of GFATM on access to treatment and prevention in Africa; and identify factors for success

Methods. The study uses data from multiple household-based surveys principally demographic and health surveys (DHS), the multiple indicator cluster survey (MICS) and malaria indicator survey available for the period 1999-2006. We examine trends in coverage in the data. Further, several regression analyses are performed to test the effects of GFATM and country-level characteristics on coverage of ITN, prompt treatment and IPT. The dependent variable in these regression models was coverage of ITNs, ACT and IPT for pregnant women. Finally, a literature search was conducted to learn about some specific factors that may have been responsible for success or failure in a sample of national programs.

Results. Overall, the study reports that some progress towards meeting some of the RBM targets has been made in a few countries. However, only a few countries have reached the one of the Abuja targets of 60% coverage of ITNs. Progress by intervention has not been uniform as in many cases while ITN coverage has increased we note that coverage of access to treatment especially with ACTs has been sluggish. Clearly, more external funding is required to bring many countries closer to the targets. Country-level factors have also been found to affect progress. Finally, the study discusses the limitations and difficulties associated with current monitoring frameworks for tracking progress.