Malaria

Malaria is now at the forefront of the health and development agenda as one of three major diseases of poverty (alongside AIDS and tuberculosis). However, years of neglect mean that it is a far bigger problem than it was 40 years ago, with rampant drug resistance and rapidly increasing insecticide resistance, compounded by weakening health systems across low income countries. The precise burden of malaria in terms of deaths and illness is not currently known, but the Commission on Macroeconomics and Health has provided much of the evidence base needed to promote worldwide recognition of the extent of the malaria problem. This and other advocacy efforts, such as Roll Back Malaria, have led to unprecedented commitment from donors and governments in malaria endemic countries.

At the same time, there have been major advances in development of antimalarial drugs and insecticides, substantial progress in vaccine development, and most recently, elucidation of the parasite and vector genomes, fundamental for developing a new generation of malaria control tools. However, coverage of key interventions remains low in almost all malaria endemic countries.

Deployment of malaria interventions in the last 15 years has coincided with widespread health sector reforms. Despite initial confusion, several countries have demonstrated that malaria control and reforms can be mutually beneficial. The key now is to scale up best practices from these countries in ways that can be sustained in the long term. Governments of endemic countries now have increasingly large amounts of funding available through the Global Fund for HIV/AIDS, TB and Malaria and other sources such as debt relief. Human resource development will be central to scaling up, as will working across sectors and in partnership with communities.