The Malaria Donor Score Card

Given that malaria continues to be a major public health concern throughout the world, with over 300 million cases annually and a death every 30 seconds, the attention is much needed. However, the danger with days such as Africa Malaria Day though is that they descend into a mere public relations effort. The millions of people at risk from this disease deserve more than PR, which is why my colleagues and I worked on a scorecard that examines donor agency efforts to control the disease. With one or two exceptions, the OECD donors fare badly; we hope they will respond constructively to our scorecard and improve their performance.

Most malaria deaths occur among children and pregnant women in sub-Saharan Africa. The dangerous combination of severe poverty, poor health infrastructure, highly effective malaria carrying mosquitoes and the presence of the most deadly form of the parasite secure the iron grip the disease has on the region. Yet many advocacy groups around the world have successfully managed to raise the profile of the disease. There is now increased political attention and essential funding for malaria control, which is a good thing. But the act of giving, although necessary to drive an on-going comprehensive malaria control programme, is not sufficient in itself to control or even eradicate the disease.

Indeed, increased funding for malaria control programmes without an effort to ensure that donors support the full range of malaria control interventions may lead to a waste of resources. Perhaps most crucially, without an effort to measure the effective uses of interventions, in terms of malaria cases averted and lives saved, donor agencies will not be able to assess whether their policies are working and will be unable to adapt such policies.

In order to assess and establish a benchmark on donor openness, transparency and accountability, Africa Fighting Malaria (AFM) director Richard Tren and myself compiled: The Malaria Donor Score Card, which analyses the malaria control programmes of the Organisation for Economic Co-operation and Development (OECD) donor agencies. After careful analysis we concluded that the United States Agency for International Development (USAID) through its lead program, the President’s Malaria Initiative (PMI), has the most comprehensive malaria control policy. Thanks to US Congressional scrutiny and interest it is more open and transparent and measures the outcomes of its malaria spending. This provided us with a good benchmark in order to assess the other large OECD donor agencies.

Relative to USAID many of the other donor agencies fared dismally. The majority of large multilateral donor agencies were simply not aware, or were unwilling to reveal, how much support they provided for malaria control programmes. Few seem interested in measuring the impact of their spending on the burden of malaria. The lack of effort in capturing and measuring the impact of their funding means that the scientific and advocacy community will be unable to assist, contribute and critique their malaria control programmes.

The unacceptably high levels of human suffering and misery the disease causes, coupled with the severe restrictions it places on the continents ability to grow and develop, necessitates a more comprehensive programme by the large multilateral donor agencies. Simply pouring more funding into the problem without transparency as to how taxpayers’ money will be spent and without any real commitment to improving monitoring and evaluation could potentially undermine long-term malaria control. Furthermore, a lack of sufficient monitoring and evaluation will make it extremely difficult, if not impossible, to assess whether interventions are working in terms of reducing the burden of malaria and to adjust policies accordingly. Evidence-based decision making cannot occur without evidence.

Politicians the world over are fond of making promises to do this, that and the other. In 2000, political leaders from around the world promised to achieve the Millennium Development Goals (MDGs) by 2015. One of these goals is to reduce the burden of malaria, which of course is commendable. However, that promise remains empty and meaningless without a serious effort to measure the baseline levels of malaria and to measure progress along the way in an open and transparent way. United States legislators and USAID should be applauded for the steps that they have taken to improve the performance of their malaria programme. We hope that the taxpayers and legislators in the other OECD donor nations will be similarly motivated and become more curious about how their agencies are spending public funds in the fight against the disease. Simply writing a big cheque will not do and is in fact insulting to the millions of vulnerable people that live with malaria.