Malaria: Breaking the cycle

1. Malaria: Breaking the cycle A public consultation to help shape the UK Government’s policy and plans for tackling malaria in the developing world

2. The burden of malaria • 3.3 billion people at risk • 244 million cases a year • 863,000 deaths a year • 16% of all child deaths in Africa are due to malaria

3. Key issues: Effective tools are available . . . Reduction in malaria cases & deaths in Zambia In high-burden countries the rapid expansion of interventions can bring about dramatic reductions in malaria mortality. In Zambia the expansion of ITNs, IRS and ACTs has more than halved the numbers of malaria cases and deaths. ITNs = Insecticide-treated nets RS = Indoor Residual Spraying ACTs = Artemisinin-based Combination Therapies Source: World Malaria Report 2009

4. . . . but coverage is still too low Estimated household ITN ownership in high burden countries in Africa Less than one third of affected households in Africa* own an insecticide-treated net. Coverage rates for other key interventions are even lower. • *Modelled estimates from 35 high-burden African countries. • Source: World Malaria Report 2009 More than two thirds of households still don’t have an ITN

5. Adapted slide from Rob Newman WHO 2009 Strengthening health services and systems is crucial to expand and sustain coverage • Prevention • Insecticide- treated • bednets (ITNs) • Indoor Residual • Spraying (IRS) • IPT in pregnancy • IPT in infancy • Diagnosis and Treatment • Parasite-based diagnosis • Microscopy • Rapid diagnostic test • Artemisinin combination • therapy • Case management • Health facilities • Private sector • In the community • Surveillance, Monitoring • and Evaluation • Routine HMIS • Malaria surveillance and • response systems • Household surveys Strengthening Health Services and Systems IPT- intermittent preventative treatment

6. The emergence of resistance to Artemesinin The emergence of resistance to Artemisinin is spreading in South East Asia. This threatens to render the most important anti-malarial drugs ineffective.

7. Our increased focus and ambition to combat malaria • Tackling malaria is a key priority for the new UK Government. • The Department for International Development (DFID) is developing a business plan which will outline how the UK will contribute to global efforts to improve malaria control. • The views and opinions expressed during this consultation exercise will be used by DFID to give us a greater understanding of where we should target our aid interventions.

8. Our objectives • To reduce the burden of disease and deaths in high burden countries • To sustain the gains made in controlling malaria now and in the future The Malaria Business Plan will have two main objectives that frame the consultation : The following questions further identify issues and areas where we would particularly welcome your inputs.

9. We know what works to prevent and treat malaria, but far too few people have access to proven interventions. Weak health systems contribute to this failure. Addressing these failures and strengthening the delivery of interventions is essential to achieve sustained reductions in malaria morbidity and mortality, particularly amongst the most poor, women and children. Question 1: How can DFID best support health services and systems in high burden countries to improve and sustain coverage of effective malaria control interventions? Improving the quality and coverage of services

10. Innovative approaches have demonstrated that greater impact on malaria can be achieved through better integration with other health interventions and programmes, such as those delivering neglected tropical diseases, nutrition, maternal and child health. Links with other sectors (e.g. water and sanitation) and broader poverty reduction programmes can also strengthen impact. Question 2: What innovative approaches should DFID focus on to increase impact and yield additional health outcomes? What are the priorities for operational research to support effective delivery? Integrated approaches

11. Delivery of malaria control interventions takes place through a variety of public, private and community-based mechanisms. Multi-layered service delivery strategies, using different combinations of state and non-state provision, are often used, but mix varies by context and country. Question 3: What are the key areas for us to work with private and other non-state actors to deliver more successful malaria prevention and treatment outcomes? (please prioritise a maximum of four areas) Public and private delivery models

12. Reaching the poorest and most vulnerable with malaria control interventions is still largely an unmet challenge. We want to ensure that we have a demonstrable impact for these populations, including women and children. Question 4: What strategies and approaches should we focus on to ensure that we reach and have impact on the poorest and most vulnerable populations? Increasing access and building demand - impact in the poorest and most vulnerable populations

13. People living in conflict affected and fragile states are disproportionately affected by malaria. Mortality rates are 13 times greater in fragile states than other developing countries. In 2000, it was estimated that up to 30% of malaria deaths in Africa occur in the wake of a war, local violence or natural disaster. Question 5: What issues and approaches should we particularly focus on to control malaria in fragile and conflict affected states and in humanitarian situations? Working in fragile and conflict affected states

14. The emergence of resistance to artemisinin in South East Asia has the potential to render the most important anti-malarial drug ineffective. Experience suggests resistance can spread quickly to Africa, where the malaria burden is much higher. There is a narrow window of opportunity to dramatically reduce artemisinin mono-therapy and investigate the best ways to halt or slow spread of resistance, while longer term alternative drugs and new technologies are developed. Question 6A: What are the policy and programme priorities for DFID to help tackle drug and insecticide resistance in Asia and Africa? Who are the key partners we should work with? Question 6B: What should DFID’s research priorities for (i) development of new cost effective tools and (ii) operational research? Tackling drug and insecticide resistance

15. Thirty-five countries are responsible for 98% of the total malaria deaths world-wide. DFID has a presence in 16 high-burden countries and supports health programmes in twelve of these. DFID’s contributions to multilateral organisations - such as the Global Fund for AIDS, TB and Malaria - also reach a wider range of countries. Question 7: In which countries should we focus our efforts to reduce malaria related death and illness? Please list your five priority countries and explain the reasons for your choice Where should we focus our efforts?

16. Thank you for your contributions.

17. Leading the UK government’s fight against world poverty LONDON 1 Palace Street London SW1E 5HE GLASGOW Abercrombie House Eaglesham Road East Kilbride Glasgow G75 8EA Tel: +44 (0) 20 7023 0000 Fax: +44 (0) 20 7023 0016 Website: www.dfid.gov.uk E-mail: enquiry@dfid.gov.uk Public Enquiry Point: 0845 300 4100 If calling from abroad: +44 1355 84 3132