USAID Poised To Make Progress Against Malaria

Main Category: Tropical Diseases
Article Date: 17 Dec 2006 - 8:00 PDT

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Africa Fighting Malaria (AFM) has published a report detailing USAID's malaria control policy reforms for FY2006 (Available as a PDF file here). In "Moving Mountains: The Evolution of USAID's Malaria Control Program", the health advocacy organization credits the Agency with supporting a broad range of malaria control interventions, measuring the impact of its activities on disease burden, and increasing transparency and accountability for results. Concerns remain over USAID's ability to build in-country capacity to control the disease in the future.

A combination of reforms instituted in the latter half of 2005 together represent a sea change in the US government's approach to malaria control. USAID went from dividing half of its FY2005 budget between 21 African country-level programs and 3 regional offices to spending over two-thirds of its budget in 17 African countries and one regional office. Approximately one-third of its FY2006 malaria funding, $35 million, was spent in the first three countries of the President's Malaria Initiative (PMI).

"The PMI's first year has been truly groundbreaking," said AFM Director Richard Tren, a co-author of the report. "The increased funding and commitment to an integrated approach to malaria control enabled USAID to run indoor residual spraying (IRS) campaigns in Angola, Tanzania and Uganda. IRS was minimized or blocked for years by donors because of its cost and unpopularity among environmentalists. We look forward to USAID's reporting of the results of its IRS campaigns in decreased malaria prevalence."

USAID has also substantially increased the proportion of its program funding dedicated to the purchase of malaria control commodities, such as anti-malarial drugs and insecticide-treated nets (ITNs). AFM criticized the Agency in the past for spending over 90% of its annual malaria control budget on overheads, conferences and consultants. It also criticized the Agency for measuring program success by inputs, such as the number of drugs or ITNs distributed, instead of the impact on disease burden. It noted that while the PMI has committed itself to measurable outcomes and a focus on disease burden, the same standard has not been set for non-PMI programs.

"The PMI is doing the right thing by measuring baseline rates of malaria prevalence," said Roger Bate, American Enterprise Institute Fellow and Co-Director of AFM. "It is troubling that either a lack of resources or a lack of political will has prevented non-PMI programs from doing the same. Good program management flows from good data. USAID should not neglect its other programs until they make it into the PMI spotlight."

While AFM acknowledged better collaboration on the ground in PMI countries, it also registered concern over the persistence of US-based contractors in USAID's malaria control efforts on the ground. Contractors are an integral part of USAID's operational model, but they are not conducive to building in-country capacity. AFM noted that this could be gleaned from the fact that USAID's spent such a substantial proportion of its budget on consultants in the past 8 years with little in-country malaria control capacity to show for it.

USAID's most noteworthy departure from business as usual has been increased transparency efforts. The Global Health Bureau, which is responsible for malaria control financing and the management of the PMI, is only the second USAID program to systematically post its contracts and grants online.

"Contracts are posted online along with detailed budgets and progress reports," said Tren. "This gives Congress, the malaria advocacy community, and anyone with internet access an unprecedented opportunity to hold USAID accountable for its policy decisions on malaria control. And we are doing just that."

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For further information please go to:
Africa Fighting Malaria

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