The World Bank Becomes Interested in Malaria Control (5)
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Dear Colleagues
Dr. Williams has referred us back to the message from Dr. Paula
Tavrow regarding the failure of a USAID project in Zanzibar to
solve the mosquito malaria vector problem in the period 1981 to
1987.
I don't think those of us who are seriously advocating for the
use of large scale interventions to eliminate the mosquito as a
malaria vector are saying that it is easy. The science is com-
plex, and the mosquito aims to be a survivor. However, it is no-
table that the mosquito has remained in a winning position in
Africa, but not in Florida or California or Darwin Australia...
nor indeed in much of the Caribbean. From what I know about the
science, it is possible to eliminate the mosquito as a malaria
vector if it is done professionally, is organized in the right
way and there is adequate funding.
One of my reasons for advocating for elimination of the vector
rather than using the bed-net approach is that I am always con-
cerned about sustainability and durable benefits. The bed-net
helps save lives, which is VERY GOOD, but it is only sustainable
as long as the bed-net is funded (by the family or by donors).
The vector eradication strategy also saves lives which is also
VERY GOOD, but in addition it helps to upgrade the environment
so that life is less in danger all the time. I consider vector
eradication as a durable solution... while the bed-net is not.
That is not to say that bed-nets should be banned. They should
be encouraged, but the question is best use of limited resources
since, as Dr. Paula Tavrow points out budgets for health inter-
ventions in Africa are tiny.
When WHO and UNICEF were engaged in mosquito eradication pro-
grams in the 1950s and the 1960s, they experienced some of the
same failure described by Dr. Tavrow... and they also experi-
enced some successes. What were the differences? I do not have
all the data, but one thing that I have described over and over
again in development analysis is the idea that results need to
be analyzed and programs adjusted in a timely manner so that
good results are achieved. Years ago this was described in the
military as the Program Evaluation and Review Technique (PERT)
so that there was a continuum of correction. Mosquito eradica-
tion success requires this mindset.
One more last point. This is a long term program. While there
will be high costs in the first few years, there will be ongoing
costs for ever. But in relation to the value of increased pro-
ductivity and reduced morbidity and mortality, major interven-
tion to reduce the incidence of malaria is justified.
I would be interested in hearing from others who are interested
in making mosquito eradication a bigger part of the health
agenda in Africa, with international funding helping to get the
process started. I also want to know about the problems... since
nobody wants to spend money merely to learn what others already
know.
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