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The contribution of health-care services to a sound and sustainable malaria-control policy

https://doi.org/10.1016/S1473-3099(03)00518-8Get rights and content

Summary

HIV and AIDS, tuberculosis, and malaria, besides presenting a large mortality and morbidity burden in developing countries, are also responsible for poor economic development. In the past international agencies devoted resources and efforts to control malaria and other diseases without taking into account health-system perfomance and sustainability. Even assuming that the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM)—a recent international initiative—would provide the necessary funds, a poorly performing health-care system will not be able to use these funds optimally. Moreover, even if all interventions are cost-effective, their impact on mortality and morbidity will only be marginal if access to proper care is not guaranteed. It is the responsibility of scientists and health managers to highlight to donor agencies the importance of an accessible and well functioning health-care system at all levels for the control of specific diseases.

Section snippets

Health services and malaria control

It is still unclear whether the GFATM will be able to collect and efficiently distribute the necessary financial resources for reducing the burden of AIDS, tuberculosis, and malaria. Nevertheless, considering the difficulties and limitations of organising disease-control activities in the context of existing health systems, only a long-term commitment will be able to achieve a substantial impact. Besides the performances of health services, drug-resistance monitoring, prevention through a

Malaria case management

In most countries, malaria case management is fully integrated into the existing health services. This trend has been strengthened by the introduction of Integrated Management of Childhood Illnesses (IMCI). Health services must be capable of managing most of the common diseases regardless of the local burden of malaria because this is just one of the several health problems affecting the local population. However, when considering that health services tend to be more and more decentralised, the

Prevention through insecticide-treated bednets

Insecticide-treated bednets (ITNs) can substantially reduce childhood mortality and morbidity in places where malaria is a major contributor to death. Intervention studies in four African countries32 estimated that six deaths per 1000 children can be prevented by ITN use. This intervention should be considered complementary to good case management and a primary form of prevention in much of sub-Saharan Africa. ITNs, by decreasing malaria morbidity, can reduce the workload of the health services

Malaria epidemics

In areas of unstable malaria the rapid detection of epidemics is greatly important for a rapid response. Adequate detection needs a reliable health-information system and well-trained and dedicated personnel. When these are missing, the consequences can be serious as illustrated by a malaria epidemic that occurred 20 years ago in South Africa. The epidemic was triggered by heavy rainfalls and was recognised too late because trained personnel were lacking.37 Indeed, the poorly developed

Conclusions

It is estimated that every year between one and two million people, mainly children, die of malaria, a large proportion at home without having been able to attend a health facility. Access to efficacious drugs is problematic, particularly now that resistance to commonly used drugs such as chloroquine and sulphadoxine-pyrimethamine is widespread. Moreover, adequate response to malaria epidemics is often delayed and has resulted in high mortality in countries such as Burundi, Ethiopia, Somalia,

Search strategy and selection criteria

Sources consulted in the writing of this paper were PubMed, a report of the colloqium Health Care for All, held in Antwerp, Belgium, Oct 25–26, 2001 (ITM press 2002), and internal discussions with the malaria working group. Keywords used in searches were “malaria first-line health services”, “integration disease control”, “epidemic forecasting”, and “malaria-control strategy bednets”.

References (41)

  • BremanJG

    The intolerable burden of malaria: a new look at the numbers

    Am J Trop Med Hyg

    (2001)
  • GallupJL et al.

    The economic burden of malaria

    Am J Trop Med Hyg

    (2001)
  • World Bank

    World development report 1993: investing in health

    (1993)
  • Population, health and nutrition 1997 sector strategy paper

    (1997)
  • WHO

    World health report 2000. Health systems: improving performance

    (2000)
  • International conference Health Care for All. 25–26 October 2001; organised by the Belgian government and the Institute...
  • CasselsA

    A guide to sector-wide approaches for health development

    (1997)
  • LanjouwS et al.

    Rehabilitating health services in Cambodia: the challenge of co-ordination in chronic political emergencies

    Health Pol Plan

    (1999)
  • LakeS et al.

    Zambia: the role of aid management in sustaining visionary reform

    Health Pol Plan

    (1999)
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