Africa fooled on Mosquito/Malaria Control? (8)
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Dear Colleagues
I cannot answer the question posed by Dr Stephen Toovey from an
entomological scientific perspective... but would like to give
an answer from the perspective of economic effectiveness.
As I understand the problem:
(1) there is a need to eliminate, or at least very much reduce
the number of mosquitoes (the specific species that act as a ma-
laria vector) in the area and in potential contact with human
beings;
(2) there is a need to very much reduce the pool of malaria
parasite in the human being and cycling between human and mos-
quito and human;
(3) there is a need to have a system for continuous monitoring
of progress, and a management regime that has the flexibility to
do what is scientifically best depending on the evolution of the
problem.
There are several ways to reduce the malaria population. The
most cost effective should be the one that is used... cost ef-
fective in both the short run and over the longer term. Aerial
spraying is very cost effective where the affected area is
large, and access is difficult. Ground fogging may be the most
cost effective in build up areas and interior residual spraying
(IRS) may be the most cost effective under some conditions. Ae-
rial spraying is likely to be far the most cost effective where
the areas to be covered are large... as is the case in most of
the affected areas in Africa. Getting rid of mosquito breeding
areas, especially around places where people live is also a
valuable intervention... and very expensive if it is done by a
"service" but not so when everyone in the community does its
part.
Because the parasite is very common in Africa... access to
treatment to kill this parasite needs to be done in parallel
with eliminating the vector. The issue of creation of a resis-
tance needs to be recognised, but this becomes less critical if
the vector is being reduced and the treatment is not one that is
to go on in perpetuity.
In this model, the value of insecticide treated bednets (ITN) is
as much to keep the mosquito from picking up the parasite from
an infected person as it is protect the person. Net net (no pun
intended) the long term cost of ITN is high simply because lit-
tle is really being done to get to the root cause of the African
malaria crisis.
Element (3) above should be strong, involving entomology ex-
perts, involving medical experts and as well involving a manage-
ment information/accounting and finance component so that the
programme goes ahead with the best results at the lowest cost.
The success of mosquito/malaria control will be determined at
the community level where people live... but funding beyond the
immediate capacity of the community is needed initially. This
must come from national and international sources. In the long
run each community should be able to afford to maintain a pro-
gram to keep the mosquito and malaria from returning. In the im-
mediate situation external funding is needed... and at some
level this is what the GFATM is there to do, as well as bilat-
eral programs. The funds available need to be mobilized and used
in the most effective way... and it would be very helpful if
there can be a lot of feedback about costs and results so that
there is good use of the relatively scarce resources available.
I hope there will be progress from discussion to action...
sooner rather than later.
Sincerely,
Peter Burgess
Tr-Ac-Net in New York
Tel. +1-212 772 6918
mailto:peterbnyc@gmail.com
The Transparency and Accountability Network
With Kris Dev in Chennai India
and others in South Asia, Africa and Latin America
http://tr-ac-net.blogspot.com
http://www.tr-ac-net.org