Malaria Landscape 2007

Executive Director's Report to the 13th Board Meeting

INTRODUCTION

• This Landscape Report will assess: – Where we are today; – Where we want to go moving forward;

and– What we need to do to get there.

OUTLINE• Antimalarial Commodities:

– ACTs & LLINs: Translating Distribution and Coverage into Usage

– IRS & IPT– Taxes & Tariffs

• Global Impact: – Expanding Partnership Base– Key Advocacy Events in 2007

• Country Success: – Measuring & Sustaining Impact– Country Examples– Integrated Mass Distribution

Campaigns

• Resource Mobilization: – Tapping Existing & Additional Source

• Next Steps & Challenges Ahead

Momentum has been

gained across each

area

But old as well as new challenges

remain

ANTIMALARIAL COMMODITIESACTs

POLICY SHIFT ACT Recommended First Line Treatment of uncomplicated

malariaIn 2003, only 10%10% of countries

recommended ACTsToday, 93%, or almost ALL do

ACT recommended

Other antimalarials recommended (CQ, SP)

Non-malaria endemic area

By 2006, that number had jumped to

79%

Antimalarial Commodities IIACTs

PROCUREMENTPROCUREMENT: : Significant growth since 2003 and over the past year in the procurement of ACTs

USAGEUSAGE:: is still low as a result of:

High pricesHealth System particularly

distribution challengesTraining, information and

education issuesLack of information about

availability and use

CHALLENGESCHALLENGES: : MonotherapiesCounterfeitsPenetration of ACTs in the

private sector

Growth in doses of artemisinin-based combination therapies procured worldwide

(millions)

0

20

40

60

80

100

120

2003 2004 2005 2006

Source: RBM Database, UNICEF, WHO

Source: UNICEF & RBM, Malaria & Children, 2007

Distribution of U5s Receiving ACT

1.00%2.00%

13.00%

3.00%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

Q1

MIN

MEDIAN

MAX

Q3

Antimalarial Commodities IIILLINs

• GROWTHGROWTH: : Procurement of insecticide treated nets has grown exponentially since 2003

• USAGEUSAGE: : However, distribution is not always indicative of usage

Coverage and usage have been growing since 2000, but the most recent data suggests large increases, particularly 2006-2007, taking into account, for example, Ethiopia

This is attributable to intense nationwide LLIN distribution campaigns

Appropriate emphasis must be placed on replacement policies and behavioural change communication to translate coverage into usage

Source: (2000-2006) UNICEF Africa Malaria Report 2003, UNICEF & RBM, Children & Malaria 2007, (2007 Projections)

Global Fund Round 7 Proposals

Percentage Increase in the Distribution of U5s Sleeping under ITNs 2000-2006 vis-à-vis 2007

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2000-2006 2007

Q1

MIN

MEDIAN

MAX

Q3

FGrowth in ITN imports into MECs of Africa (millions)

0

10

20

30

40

50

60

70

80

2003 2004-2005 2006-2007

Source: RBM Database, UNICEF, WHO

INDOOR RESIDUAL SPRAYING (IRS)• As recently as 2003, only 12 countries

(29%) in Africa implemented IRS, mainly to prevent and control epidemic malaria

• In 2007, 25 out of the 42 (60%) malaria endemic countries in WHO / AFRO have included IRS in their national strategy for malaria control

• In the 2006-2007 malaria season a total of 5 million units/structures were sprayed, protecting 21 million people

• Challenges remain: Shortage and inconsistent financing

Routine Spraying

No IRS

Pilot spraying or plans to pilot

Non-AFRO

Source: WHO/AFRO, Implementation of Indoor Residual Spraying of Insecticides for Malaria Control in the WHO African Region, 2006-2007. October 2007.

INTERMITTENT PREVENTIVE TREATMENT (IPT)POLICY SHIFT

From the WHO/UNICEF World Malaria

Report 20052005

From the RBM/UNICEF

Malaria & Children 20072007

IPT recommended

IPT NOT recommended

Non-malaria endemic area

No data

About 50%50% recommending IPT Now almost ALLALL do

..

.

Malaria No More

VOICES

Foundation for Innovative New Diagnostics

Global Business Council

UNITAIDIslamic Development Bank

Global Impact Expanding Partnership Base

Alignment & Harmonization of all partners is key to the success of all of our work – other global health partnerships are trying to achieve the same thing

Innovative Vector Control Consortium

UK Coalition Against Malaria

International Health Partnership

KEY ADVOCACY EFFORTS & EVENTS IN 2007

G8 SummitG8 Summit Africa Malaria DayAfrica Malaria DayGF ReplenishmentGF Replenishment

Targeted AdvocacyTargeted AdvocacyTargeted AdvocacyTargeted Advocacy

Reports Released in 2007Reports Released in 2007

MalariaMalaria

ChampionsChampions

Leadership SummitLeadership Summit

US CongressUS Congress

Malaria Coalitions

Country Success• Evidence for impact is growing in, for example,

Eritrea, Namibia, Swaziland, Zambia, and Zanzibar

• Success is often a result of a combination of factors:

– Strong commitment from national government; – Multiple interventions (LLIN, IRS, IPT, et al.)

implemented simultaneously; – Free nationwide LLIN distribution campaigns;– Partnership– Additional resources from donors; – Timely data collection to document impact.

Country Success Eritrea

Source: East and Southern Africa Annual Malaria Review and Planning Conference, Conference Report, 14-18 August 2006.

Country Success Namibia & Zambia

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

2000 2001 2002 2003 2004 2005 2006

Year

Num

ber Deaths_U5

Deaths_Total

Namibia Out-Patient Department Malaria Cases

(2000-2005)

Zambia: Trends in Malaria Deaths (2000-2006)

Source: East and Southern Africa Annual Malaria Review and Planning Conference, Conference Report, 14-18 August 2006.

Source: HMIS, found in Dr E Chizema Kawesha &Dr F Masaninga, Business Plan Process and Achievements -Zambia Experience, National Malaria Control Programme.

Country Success - Zanzibar

Proportion (%) of OPD Monthly Cases a ttributed to Malaria Zanzibar

-

10

20

30

40

50

60

70

Ja

n-9

9J

ul-9

9J

an

-00

Ju

l-00

Ja

n-0

1J

ul-0

1J

an

-02

Ju

l-02

Ja

n-0

3J

ul-0

3J

an

-04

Ju

l-04

Ja

n-0

5J

ul-0

5J

an

-06

Ju

l-06

Ja

n-0

7J

ul-0

7J

an

-08

Ju

l-08

Ja

n-0

9J

ul-0

9J

an

-10

Ju

l-10

malaria %target MTSPtarget 2010Trend

Source: Ministry of Health and Social Welfare, Zanzibar Malaria Control Programme, Overview of Malaria Situation in Zanzibar, presentation, 19 July 2006.

Country Success - Swaziland

Source: East and Southern Africa Annual Malaria Review and Planning Conference, Conference Report, 14-18 August 2006.

Resource Mobilization: Existing• Almost USD 1 billionUSD 1 billion was

available for Endemic Countries in Africa in 2007

• Significant increase but Some sources estimate at least USD USD 2-3 billion2-3 billion is required annually for malaria control

• More recent estimates place the figure closer to USD 7 billion USD 7 billion per annum

• Of the 1 billion available in 2007, not enough is going to not enough is going to SUFISUFI

• About one-third of countriesone-third of countries applying to the GF Round 7 were planning for SUFI

Source: Global Fund Disbursement Reports, Round 6 & 7 Global Fund Proposals

Funds Available (2007)USD 929,367,065

1. Global Fund, 284,247,775,

30%

2. National Government, 183,752,784,

20%

3. PMI/USAID, 154,306,523,

17%

4. World Bank, 99,079,739, 11%

Other, 191,853,866,

20%

UNITAID, 16,126,378, 2%

1. Global Fund 2. National Government 3. PMI/USAID

4. World Bank Other UNITAID

Resource Mobilization: Additional

Round 7 AchievementsRound 7 Achievements::

Successful malaria proposals gained:>USD 450 million for

Phase I>USD 1 billion for the

entire 5 years

Support from the

Harmonization Working Harmonization Working GroupGroup greatly improved a country's chances of succeeding

FIGURE 5. Growth in Successful RBM Supported Proposals to the Global

Fund

0

100

200

300

400

500

600

700

800

900

1,000

Round 6 Round 7

Mill

ion

s

Total LifetimeBudgets

Phase I

Source: Global Fund

Type of support TRP + TRP- % positive

HWG intensive support package*

16 5 76

Limited or no support

3 5 38

Total for Africa19 10 61

Next Steps & Challenges Ahead:

• Secure more resources from more sources, including national funding

• Expand SUFI planning and operations to all 45 Malaria Endemic Countries in Africa

• The Challenge of Large Countries

• Move towards or maintain outstanding performance scorecards

• Build upon and bring the success of Round 7 to Round 8

• Coordinated support and action: One Global Malaria Business Plan

• Verified data sources: Malaria Indicator Surveys