[comment] Malaria and the Limits of Good Intentions

from Foreign Policy in Focus

by Joseph Kaifala

When it comes to saving Africa, there's no shortage of ideas in the West. Most committees organized in the West on African issues are often run by Africans who have been away from the continent for decades and have lost contact with reality on the ground. Ideas conceived in the West, such as the Millennium Development Goals and other HIV/AIDS initiatives, often encounter difficult challenges when implemented in Africa. This is because beneficiaries in individual African countries are sometimes not consulted about solutions to their problems and ideas are often implemented universally across the continent, ignoring the cultural, economic, and geographical diversity.

The President's Malaria Initiative (PMI), launched by President George W. Bush last year, is one of many good-intentioned initiatives geared towards saving Africa that offers very limited promise of improving health conditions for Africans in the long run. According to the PMI, at least one million infants and children under the age of five in sub-Saharan Africa die each year from malaria. In order words, one child dies almost every 30 seconds. The initiative pledged to tackle this problem by increasing U.S. malaria funding by more than $1.2 billion over a five-year period to reduce deaths due to malaria by 50% in 15 African countries.

At the end of July, Bush signed the "Tom Lantos and Henry J. Hyde Global Leadership on HIV/ AIDS, Tuberculosis and Malaria Reauthorization Act of 2008." The bill authorized $48 billion to be spent over five years, including $5 billion to fight malaria. The funding is intended to combat the disease by contributing to the strengthening of health systems and health policies of partner countries. The bill also authorized the president to appoint a malaria coordinator to operate internationally through nongovernmental organizations and other partners in order to carry out prevention, care, treatment, support, capacity development, and other activities to reduce the prevalence, mortality, and incidence of malaria.
Wrong Approach

Bush's pledge brings hope to sub-Saharan Africa, where the toll of illnesses and deaths from malaria is dragging down economic productivity. But his initiative and many other approaches towards saving Africa from malaria have very few prospects for preventing the disease. The President's Malaria Initiative is using a comprehensive four-dimensional approach to prevent and treat malaria — indoor spraying of homes with insecticides, insecticide-treated mosquito nets, lifesaving anti-malarial drugs, and treatment to prevent malaria in pregnant women. While insecticides, anti-malarial drugs, and mosquito nets are temporary measures to cure already infected people and protect those at risk, they can't eradicate malaria.

Malaria is transmitted from person to person through the bite of a female anopheles mosquito. This kind of mosquito breeds in pools of stagnant waters, shallow lakes, and moisture from waste depositories. The densely populated slum areas of most sub-Saharan African cities provide breeding environments for mosquitoes. People treated with anti-malarial drugs often return to these mosquito-infested slums. Mosquito nets provided free-of-charge by aid workers are often sold by beneficiaries to feed their families. Some families simply can't use the nets because they aren't large enough to cover a large group of family members sharing the floor of a corrugated zinc shelter.

According to the Roll Back Malaria (RBM) initiative, malaria parasites are developing an unacceptable level of resistance to many drugs; most insecticides are also no longer useful against mosquitoes transmitting the disease, and an effective vaccine is at best many years away. Hence, those interested in solving Africa's malaria problem should devote their resources not only to curing infected people, but also to alleviating the breeding spaces of female anopheles mosquitoes, which are responsible for the spread of the malaria parasite and the disease.

Those who have visited a major city in sub-Saharan Africa can remember seeing that pile of garbage on the side of the road, the waste depository just outside the city, or the dumping of waste into gutters when it rains. Most of the waste dumped in gutters flows and settles into many sections of a city, allowing mosquitoes to breed and enter homes. No anti-malarial drug can prevent mosquito bites unless the root transmitters of the parasite are contained. Female anopheles mosquitoes must be driven away from densely populated areas.

It's high time the international community became realistic about addressing Africa's problems. While it's very tempting and self-gratifying to treat the continent's major problems as an emergency, we must be aware of the fact that the problem of malaria can't be solved by relief intervention. Sometimes the practical solution to a widespread medical problem might not lay in cure, but in tackling poverty and other root causes.

Perhaps we can end the vicious cycle of malaria by concentrating aid on helping sub-Saharan African countries to establish efficient waste-disposal mechanisms and expediting the achievement of goal seven of the Millennium Development Goals, which calls for a significant improvement in the lives of at least 100 million slum-dwellers by 2020. As the Liberian saying goes, unless the rotten tooth is removed, the mouth must chew with caution — even when painkillers are abundant. The deplorable image of Africa's death toll can sometimes ignite the desire for emergency relief interventions, but most of the continent's problems, unlike natural disasters and some other seasonal outbreaks, require long-term efforts to eliminate the source of the problem and put the continent on a path to sustainable development.

Joseph Kaifala, a Foreign Policy In Focus contributor, is a Davis United World College Fellow from Sierra Leone at the James Martin Center for Nonproliferation Studies.