It is time to focus on the real drivers of malaria
24 Apr 2015 by Dudley Tarlton, Programme Specialist, Health and Development
Eliminating malaria seems like a straightforward issue. The parasitic infection is transmitted to people through bites from infected mosquitoes. So if we prevent the mosquito bites, we avoid the infection.
But decades of malaria control efforts show there is more to the story. Much of our vulnerability to malaria, it turns out, is determined by human actions. The conditions in which people are born, grow, work, live, and age define to a great extent who is vulnerable to malaria and who is not.
Malaria is both a result and a cause of a lack of development. We know that it is those countries with the lowest levels of human development that are most affected by malaria. And within populations, those living in the poorest circumstances also suffer disproportionately.
We have long understood the impact malaria has on development. We are now better understanding the impact development has on malaria.
The factors that determine malaria risk are shaped by the distribution of money, power and resources. The key interventions to prevent malaria (bed nets, insecticide spraying, and access to treatments) are well known, but eliminating the disease will require a broader range of actions. Efforts to improve housing and infrastructure development, sanitation, agricultural practices, mobility, and nutrition are essential. These underlying conditions have not been traditionally part of malaria control, but that may change soon.
This year will mark a turning point in the world’s response to malaria. The adoption this year of the new global framework Action and Investment to defeat Malaria (2016-2030) will further place the management of the disease as a development issue. Under this plan, countries will for the first time report their progress on incorporating non-health sector interventions into their malaria control efforts.
In addition, the likely adoption of a broad and comprehensive set of Sustainable Development Goals will put a premium on multi-sector action and linkages among health and non-health targets.
This will help the malaria community, and the development community overall, see the varied drivers of epidemics like malaria and respond with actions that move beyond the health sector and engage a wider range of partners.
UNDP has been working with the Roll Back Malaria Partnership and other UN agencies to re-orient the malaria community’s approach. In 2013 we convened a meeting of leading malaria experts and nine endemic countries to look at the evidence of what social determinants drive malaria. The findings resulted in an Action Framework for countries.
Iran, for instance, has moved towards a comprehensive approach to malaria. In the 5 endemic provinces, students begin learning about malaria from age 11; the energy department prioritizes electrification projects in malaria-endemic areas; and elected local Islamic councils work with health staff to mobilize communities and households for safe water storage. With its most recent malaria grant to Iran, the Global Fund to Fight AIDS, TB and Malaria has broadened the range of what malaria interventions they traditionally fund.
Parasites, mosquitoes, humans. The disease is no more complex today than it was decades ago. Yet programmes have continued to focus on either the parasite or the medicines. Eradicating the disease will require addressing the third element in this simple equation: the people.