Human Development 42940 287 February 2008 Findings reports on ongoing operational, economic, and sector work carried out by the World Bank and its member governments in the Africa Region. It is published periodically by the Operations Results and Learning Unit on behalf of the Region. The views expressed in Findings are those of the author/s and should not be attributed to the World Bank Group. MalariaBoosterProgramforAfrica Gaining Ground against a Major Challenge to Health and Development Malaria control is a trea- meet the expectations and table and preventable earlier promises made at the disease -- yet it remains a Roll Back Malaria summit in major challenge to achieving Abuja in 2000. the Millennium Development Goals in Africa. It is not only Following this release, the a serious health problem, but Booster Program for Malaria an issue that cripples Control in Africa was launched development. in September 2005, Every year, malaria infects translating the global more than 500 million people strategy into a results- around the world and is one focused effort through which of the leading causes of child the Bank made a long-term deaths on in Africa, with commitment and pledged to 3,000 children dying from it leverage its unique every day. It is estimated comparative advantages to that malaria costs Africa $12 bring the disease under billion a year in direct costs control on the continent. and lost productivity. The disease strikes down The key features of the farmers just after the rains, Booster Program are the limiting their ability to reap following: the rewards of their harvest. And it overwhelms health systems, accounting for as (i) Support for country-led much as 40 percent of all operations to reduce outpatient attendance and 30 illnesses and avoidable percent of all hospital deaths from malaria while admissions in hard-hit improving the capacity for service delivery. Countries Findings countries. that choose to participate in The World Bank response the Booster Program reallocate part of their In April 2005, the World Bank resources from their IDA released its malaria-control envelopes toward malaria framework -- the Global control. With countries Strategy and Booster taking the lead role and Program -- in an effort to prioritizing their own resources, increased has a comprehensive This financing represents a accountability and a greater monitoring and evaluation nine-fold increase in Bank likelihood of sustainability component tailored to the support for malaria control in are encouraged. national context. At global Africa over the past 24 level, the World Bank has months compared to the (ii) Emphasis on both developed a Malaria preceding five-year period. effective scale-up of critical Scorecard for tracking dollar The Booster Program is disease control investments and coverage currently developing a interventions and the progress for key second phase of support to strengthening of health interventions, such as the sub-Saharan Africa countries systems. This dual strategy use of insecticide-treated (July 1, 2008-June 30, 2015). helps to distribute urgently bed nets, access to anti- This phase is being designed needed medicines and malarial treatment for child- in the context of the recent bednets, implement indoor ren, intermittent preventive call made for malaria elimi- residual spraying where treatment for pregnant nation as a major public appropriate and simultaneou- women, and indoor residual health threat in sub-Saharan sly builds health system spraying. Africa and will capitalize on capacity for long-term the Bank's comparative sustainability. (v) Knowledge generation advantages in cross-sectoral and innovations to finance projects and regional support. (iii) Partnerships to broker global public goods for mala- More resources will most global agreements and sup- ria control. In this context, likely be committed under port country-led programs. the Bank provides flexible, Phase II in response to strong Partnerships are at the core cross-border and multisector country demand and in light of the Booster Program and funding. These funding of major financing are critical to the successful mechanisms allow for a rapid requirements needed ($US control of malaria in Africa. scale-up of proven 10 billion over the next 5 The Booster Program is firmly interventions, as well as the years). embedded within the RBM ability to react to unforeseen The timing of this Partnership, to which the circumstances. coordinated global effort to World Bank remains fully The Booster Program has a address malaria could not be committed. In addition, the ten-year horizon with an better, given the success of Bank is working hard to established target of US$500 the IDA replenishment leverage IDA resources by million in IDA resources for discussions. The Booster bringing other partners to the Phase I of the Booster Pro- Program is a clear demon- fight against malaria in gram (July 2005­June 2008) stration of IDA at its best ¯ Africa (Russian Federation). to support the rapid scale-up catalytic, flexible, and of proven malaria collaborative. Through close (iv) Monitoring results interventions in work with RBM partners, we against monies spent. The approximately 20 countries provide coordinated funding program is working with through tailored designs around specific goals that partners to strengthen aimed at supporting national can yield results, with part- monitoring and evaluation malaria control programs. ners complementing each (M&E) efforts at global, regio- As of January 2008, over other. nal and country levels. US$460 million has been Baseline data has been committed (IDA and multi- Results collected in Booster Program donor trust funds), with 16 Due in part to the efforts of countries and areas where Board-approved projects and the Booster Program, projects have begun two multi-donor trust funds. countries and regions are implementation. In addition, Two additional projects are closing gaps in their health every Booster Program project under preparation. systems and employing effective malaria-control delivery was Benin's largest springboard for the ultimate interventions and treatment net distribution in history. goal of eradicating malaria. strategies. Countries are Over five years, this effort is benefiting from increased In total, more than 21 expected to: funding that is more flexible. million LLINs and 42 million ˇ Save 3.5 million lives Not only have the monies doses of ACT will be ˇ Prevent 672 million malaria been allocated, but they are distributed under projects in cases being spent on cost-effective the Booster Program's first and technically sound mala- ˇ Free up 427,000 hospital phase. About 240 million ria-control interventions. The beds in sub-Saharan Africa people -- including more World Health Organization's ˇ Increase annual GDP in than 42 million children (WHO) Global Malaria Pro- Africa by $30 billion. under age 5 and nearly 10 gram has certified that million pregnant women -- interventions and activities are in areas covered by A funding gap is likely pre- supported by the Booster Booster Program projects. venting full `scale-up for Program are in line with impact': The annual funding WHO policies and standards. needed to control malaria in Early results are Future challenges Africa has recently been encouraging: One of the underlying estimated at as much as principles fueling rapid dem- US$2.2 billion per year. The ˇ In Zambia, about 44 and for IDA resources under U.S. Government, the Global percent of households now the Booster Program has Fund to Fight Aids, have at least one insecticide- been a desire by client Tuberculosis and Malaria treated bednet -- from less countries to "front-load" (Global Fund) and the World than 5 percent just three malaria-control efforts. Bank are the three largest years ago. In addition, 62 Unlike many other public malaria-control donors to percent of pregnant women health problems, malaria Africa and collaborate closely now receive preventive cannot be controlled with as part of the RBM malaria treatment, tripling incremental approaches, Partnership. These three the coverage from three largely because its vectors donors have approximately years ago. are too efficient. US$2.5­2.8 billion in total Successful malaria control commitments between them ˇ In Ethiopia, over 90 percent requires bold, decisive steps to be spent over the next 4-5 of households now own at to obtain widespread years for malaria control in least one bednet ­ from less coverage of key proven mala- Africa, or about US$500 than 5 percent just four ria-control interventions million per year. years ago. Recent data quickly, followed by a phase This leaves a critical gap in suggest sharp declines in the where those gains are financing of approximately number of malaria cases. sustained through recurrent US$1.7 billion per year over public health services. The the next five years to bring ˇ In South Sudan, US$10.9 development community has malaria under control in million worth of long-lasting labeled this concept of a sub-Saharan Africa. While bednets, malaria treatments, heavy up-front effort, as more intensive efforts are water purification, and oral opposed to a more now underway in the RBM re-hydration therapy have incremental approach, Partnership to quantify the just arrived and are being "scaling-up for impact" or needs (financial and delivered. "SUFI." technical) of what is This rapid scale-up ap- required to control malaria, ˇ Finally, in Benin, about 1.4 proach will save millions of this number is a useful million nets were delivered lives, produce tens of billions reminder that substantially in October of 2007. This of dollars in economic more resources are returns, and provide the necessary to bring the disease under control in ˇ IDA envelope constraints The design of Phase II of Africa. as well as constraints in the Booster Program will other partner resources have take into account these Lessons learned led to the design of programs important lessons. The Bank The early successes in some with limited scope and size has carried out consultations countries suggest that in several countries, with key partners and client existing resources are resulting in a possible countries to ensure that beginning to yield concrete "sprinkling effect" at country Phase II will capitalize on the results. The Booster Program level. Despite significant bank's comparative advantage is working with partners, and resources already mobilized in the context of the elimina- encouraging emerging by partners, national tion agenda. donors, to ensure that coverage has yet to become a As the Honorable Minister resources are available to reality for many countries. of Health of Ethiopia, Dr. accelerate and sustain pro- This approach raises Tedros Adhanom gress. questions of how likely Ghebreyesus, recently said, countries are to achieve While strides have been "To truly bring malaria SUFI. The Bank has already made, much work remains to under control, we must begin began using its comparative be done: additional funding to treat Africa as an island. advantage in innovative sources must be identified, We've made remarkable financing, cross-sectoral and current donors must progress in some countries projects and regional support continue their commitments; over the past few years, but but has not exploited these supply-chain and distribution many are being left behind. tools to the fullest. issues must be overcome and Malaria does not respect long-term solutions to ˇ A major impetus is still borders, and it's time we find eliminate malaria as a needed on monitoring and a way to eliminate malaria as a disease of public health evaluation to achieve high- public health threat across importance from the level consensus around high- Africa, building on the good continent must be level results tracking at work that individual countries implemented and country level. One key are doing. We need to take the maintained. question remains: is the nets and drugs to a continental current progress being made As the Booster Program scale, and quickly, to break through incremental, coun- enters the final year of the back of transmission in try-by-country gains is Phase I, some important Africa and free up scarce satisfactory or should we lessons are beginning to resources in the health system capitalize on the unique emerge: to tackle other pressing opportunity and momentum concerns." that currently exists globally and consider a more continental approach? For more information on the Malaria Booster Program, please contact Jumana Qamruddin (jqamruddin@worldbank.org) or Nansia Constantinou (nconstantinou@worldbank.org).