Roll Back Malaria is a program launched back in 1998 by the World Health Organization, UNICEF, UNDP and the World Bank to coordinate interventions and funds aimed to reduce and eventually eliminate the burden of malaria. Malaria actually threatens nearly half percent of the entire population worldwide, and is responsible for the death of around 3,000 people every day, one million yearly, most of them children from African countries.
Malaria deaths are considered preventable and curable since the entire chain of transmission is well known, and treatment is also available. P. Falciparum parasite is transmitted to humans through the bite of infected mosquitoes, which reproduce in stagnant water. The Roll Back Malaria program has three main components: distribution of bed nets, combined treatment based on artemisinin, and use of insecticides inside the houses. Despite the resources and continuous efforts for more than 10 years, the incidence and mortality rates of malaria remain steady.
Some researchers like Jeffrey Sachs states that the resources put to work under this program are not enough, that there’s need for more money committed from the wealthiest countries and international agencies to fight this pandemic. This program has become unsustainable in economic terms, because when the funding stopped in some communities, the incidence and deaths caused by malaria rose up.
There’s also evidence that the implementation of the Roll Back Malaria program has been somewhat ineffective because it didn’t took in count cultural practices or beliefs or was introduced without empowering people of the communities. For example, in Brazil a community refused to have their houses sprayed with DDT because it stained the walls and people thought to be ineffective, but accepted another insecticide (lambdacyhalothin) because it didn’t tinted the walls and also killed cockroaches. Likewise, in Papua New Guinea people didn’t accept insecticide in their houses because it killed a wasp which controlled a caterpillar which ate roofs, in consequence roofs had to be replaced more often.
Regarding the use of bed nets, it’s estimated that only one in seven children in Africa sleep under a net, and only 2% of children use an insecticide-treated net. The reasons are many, ranging from lack of access, distribution of resources in the family, lack of knowledge of the benefits or past learnt behaviors.
Another critique to the program has been that it should include other elements besides bed nets, artemisinin and insecticides, like the control and drainage of stagnant water pools that are very common in the poorer, highly populated areas of Africa. Without removing this element from the cycle, the reproduction of mosquitoes P. Falciparium will continue to prevent any program centered on Malaria eradication to succeed.
The program should also incorporate the local internal and external environments to its strategy. The internal environment includes the strategies, staff, skills, style and culture, while the external environment takes in count the economic, social, institutional and political situation existing in the country.
For malaria control to be effective in the long term an integrated approach is required as well. There’s need to coordinate not only the efforts of the international agencies with the national governments, but also among different sectors in the country, such as the ministries of health, education and agriculture, local governments, NGOs and community based organizations, to promote the empowerment of all the agents in the fight against malaria.
