global strategic plan ROLL BACK MALARIA Foreword The development

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					global
strategic
plan ROLL BACK
            MALARIA
 2005-2015
Foreword
The development of an all-inclusive Global Strategic Plan could not have come at a more auspicious time than now when all is set
for the mid-term evaluation of the Abuja targets agreed upon during the African Summit on Roll Back Malaria.

The intent of the plan is to put forward a framework that will guide effective and harmonized involvement of the Roll Back Malaria
Partnership in implementation as a vital step in covering identified gaps.

It is noteworthy that this Global Strategic Plan 2005 – 2015 acknowledges the fact and indeed indicates that if effective malaria
control effort is initiated and sustained in all malaria endemic countries, this will contribute to the attainment of six out of the
eight Millennium Development Goals.

In order to generate the desired level of ownership several drafts of this document were shared with all constituencies of the RBM
Partnership Board for review before finalization.

On behalf of the Roll Back Malaria Partnership and its Board, I am pleased to present the Global Strategic Plan, developed as an
invaluable tool for scaling-up and harmonizing implementation of malaria control efforts.

I hereby invite all RBM Constituencies and all stakeholders to buy into the plan and support its implementation.

Let us Unite Against Malaria in support of the global moves to significantly reduce poverty and accelerate development.




Prof Eyitayo Lambo
Minister of Health, Federal Rebublic of Nigeria
Chairman RBM Partnership Board
global
strategic
plan ROLL BACK
            MALARIA
 2005-2015
The Roll Back Malaria Partnership is currently (2005) governed
by 20 voting representatives from the following constituencies:


Malaria-endemic countries
Benin
Democratic Rebublic of Congo
Nigeria
India
Sudan
United Republic of Tanzania
Venezuela
Western Pacific (pending nomination)


OECD donor countries
Italy
United Kingdom
United States of America


Multilateral development partners
UNICEF
UNDP
WHO
The World Bank


Research and Academia
Multilateral Initiative on Malaria (MIM)
                                                                  The text of this document may be freely reviewed, abstracted,                    This document, in its entirety, is attributed to the Roll Back Malaria (RBM)
                                                                  reproduced and translated, in part or in whole, but not for sale nor for         Partnership.
Nongovernmental organisations                                     use in conjunction with commercial purposes. Photographs are subject
CORE (alternate AMREF)                                            to licensing fees and may not be reproduced freely.                              RBM Partnership Secretariat, 20 Avenue Appia, 1211 Geneva,
                                                                                                                                                   Switzerland
Private sector                                                    The designations employed and the presentation of the material in this           Tel: +41 22791 3920        Fax: +41 22791 1587
Bayer (alternate Novartis)                                        publication do not imply the expression of any opinion whatsoever on             e-mail: inforbm@who.int    www.rollbackmalaria.org
ExxonMobil (alternate GSK)                                        the part of the Roll Back Malaria Partnership Secretariat concerning the
                                                                  legal status of any country, territory, city or area or of its authorities, or   Photos/illustrations - special thanks go to the following for their
                                                                  concerning the delimitation of its frontiers or boundaries.                      contributions in this brochure : Vestergaard Frandsen, Magnum/John
Foundations                                                                                                                                        Vink, Magnum/Ian Berry, WHO/TDR/Crump, Marlies Craig, WHO/TDR/
UN Foundation                                                     The Roll Back Malaria Partnership Secretariat does not warrant that the          Haaland, Novartis, Magnum/Thomas Dvorzak, Magnum/Susan Meiselas,
                                                                  information contained in this publication is complete and correct and            and Hilda Perez.
                                                                  shall not be liable for any damages incurred as a result of its use.
Ex-officio members
Executive Director, The Global Fund                               The editors alone are responsible for the views expressed in this
Executive Secretary, Roll Back Malaria Partnership                publication.
Acknowledgement
At long last those of us working in the world of malaria, especially from developing countries, will give a sigh of relief for
this very important Global Strategic Plan to support our efforts at rolling back malaria. The havoc caused by malaria is no
more in doubt as we see many children and pregnant women succumb to the disease year in and year out in many parts
of the world.

The document provides guidance to all stakeholders as to the type of interventions available for the prevention and
management of malaria, and more importantly, on how to scale-up these interventions nationally. This is quite refreshing
as some of us have been worried that the international community has spent too much time piloting projects in a few
communities, or at best in a few districts. We have come a long way and this is the time for all partners to mobilize our
collective resources to move these proven interventions to scale throughout our nations in order to make the required
impact.

The document also brings to the fore the reality that there is strength in partnership and collective responsibility. It
emphasizes the fact that the problem of malaria is too complex for any single agency or organization to address alone, but
we can make an impact when all partners come together to fight the common enemy based on our individual strengths
and comparative advantage.

I wish, on behalf of the RBM Partnership Board, to thank all our partners who are toiling daily to bring hope and relief to
millions afflicted by the disease. I thank all who contributed in no small way to making the development of this document
a reality.

It is my fervent hope that we shall not allow the document to collect dust on our shelves but mobilize the needed resources
to implement the Plan throughout the world. Then, and only then, can we sit back and relax with joyful satisfaction knowing
that we have played our part in rolling back malaria and rolling in development.


Dr. Kwadwo George Amofah
Former Chairman, RBM Partnership
"Six out of eight Millennium Development
Goals can only be reached with
effective malaria control in place."
global strategic plan
2005 - 2015




                        Contents
                            Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1       4.5 Strengthen delivery systems . . . . . . . . . . . . . . . . . . . . .              23
                        1   Vision, mission, targets and strategic approach . . . . . . . . . . 2                                 Increase national levels of capacity to deliver . . . . . . . . .                 23
                        2   Rationale for the Global Strategic Plan approach. . . . . . . . . . 4                                 Revitalize procurement and supply-chain
                        3   The RBM Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7                   management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      23
                            3.1 Structure and roles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7             4.6 Create awareness, demand and appropriate use . . . . . .                           24
                            3.2 The value of partnerships. . . . . . . . . . . . . . . . . . . . . . . . . 8                      Global/regional advocacy . . . . . . . . . . . . . . . . . . . . . . . .          25
                        4   Achieving results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11                Country-level advocacy and communication. . . . . . . . . .                       26
                            4.1 Ensure effective malaria prevention for at-risk                                                   Promoting appropriate use of interventions . . . . . . . . . .                    26
                                 populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11          4.7 Incorporate malaria interventions in all sectors. . . . . . . .                    26
                                 Malaria vector control and personal protection . . . . . . . . 11                                Health sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   26
                                 Intermittent preventive treatment . . . . . . . . . . . . . . . . . . 15                         Other sectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   29
                            4.2 Ensure effective, timely treatment . . . . . . . . . . . . . . . . . 15                      4.8 Gender approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        29
                            4.3 Reduce impact of emergencies and epidemics. . . . . . . . 16                             5   Putting the strategy in action . . . . . . . . . . . . . . . . . . . . . . . .         30
                                 Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16        6   Monitoring the Global Strategic Plan . . . . . . . . . . . . . . . . . .               37
                                 Epidemics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19      7   Risk management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        41
                            4.4 Results-oriented investments . . . . . . . . . . . . . . . . . . . . . 19
                                 Coordination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19      Annex 1 Abuja declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
                                 Financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19    Annex 2 Malaria-related Millennium Development Goals . . . . . . . . 42
    "We aim that by 2015, malaria control will be an integral
    part of all development activity."
8
global strategic plan
2005 - 2015



                        Introduction
                        Malaria continues to place an unacceptable burden on health and economic development in over 100
                        countries across the world. Effective tools are now readily available, and many countries are successfully
                        implementing comprehensive treatment and prevention strategies with significant impact and effect.

                        The international community is making funds available for malaria control      This document sets out the key elements of the RBM Partnership Global
                        in the most affected countries on a scale never seen before, and politicians   Strategic Plan for 2005 to 2015. It builds on the report entitled: Scaling-up
                        in both developing and industrialized countries are converging on the need     for sustained impact: Roll Back Malaria strategic orientations 2004-2008,
                        to act now. This is an opportunity to roll back malaria through a massive      January 2004 issued by the RBM Partnership, and also builds on
                        concerted scale-up of interventions over the next five years and by             consensus statements on scaling-up strategies. It does not aim to provide
                        consolidating these gains from 2010 onwards. This opportunity must not         a comprehensive description of each element of the strategy, as these have
                        be missed.                                                                     already been described in documents. The content of this publication is the
                                                                                                       result of other extensive consultations by partners.
                        The Roll Back Malaria (RBM) Abuja Targets (see Annex 1) are ambitious but
                        achievable. Although, realistically, they have not been achieved everywhere    The purpose of this document is a call to action and a practical guide
                        by 2005, the momentum must be maintained so that the targets do not            to those involved or interested in becoming involved in implementing,
                        slip and delay the next stage. Special efforts will be required in addition    supporting or monitoring progress. It outlines how partners can contribute
                        to broader health system development for a few years, with a parallel          to achieving global and national goals for malaria control. In addition, this
                        emphasis on integrating malaria interventions in all aspects of health and     document illustrates the benefits of working in partnership and shows
                        development. The aim is that by 2015, malaria control will be an integral      how this approach can help to bring about the ambitious goals of the RBM
                        part of every appropriate development activity and the achievements of this    movement.
                        decade will be maintained.




                                                                                                                                                                                  1
                                                                                                                                                          global strategic plan
                                                                                                                                                    2005 - 2015


        Vision, mission, targets and


    1
        strategic approach
        Our vision: by 2015 the malaria-related Millennium Development Goals (MDGs) are achieved. Malaria is
        no longer a major cause of mortality and no longer a barrier to social and economic development and
        growth anywhere in the world.
        Mission                                                                                          • in areas where transmission is stable, 80% of pregnant women receive
        To work together to enable sustained delivery and use of the most effective                        intermittent preventive treatment (IPT);
        prevention and treatment for those affected most by malaria by promoting                         • malaria burden is reduced by 50% compared with 2000.
        increased investment in health systems and incorporation of malaria control
        into all relevant multisector activities.                                                        By 2015:
                                                                                                         • malaria morbidity and mortality are reduced by 75% in comparison
        Targets1                                                                                           with 20052, not only by national aggregate but particularly among the
        By 2005, a significant increase in the number of vulnerable groups receiving                        poorest groups across all affected countries;
        recommended treatment and prevention measures, in accordance with the                            • malaria-related MDGs are achieved, not only by national aggregate but
        Abuja targets.                                                                                     also among the poorest groups, across all affected countries;
                                                                                                         • universal and equitable coverage with effective interventions.
        By 2010, particularly in the lowest two economic quintiles:
        • 80% of people at risk from malaria are protected, thanks to locally                            Strategic Approach
          appropriate vector control methods such as insecticide-treated nets                            The approach seeks to intensify the implementation of treatment and
          (ITNs), and, where appropriate, indoor residual spraying (IRS) and, in                         prevention interventions proven to have an impact on mortality and morbidity
          some settings, other environmental and biological measures;                                    in order to improve access by the poorest population groups and to scale-
        • 80% of malaria patients are diagnosed and treated with effective                               up the coverage of effective interventions to national scale for impact. The
          antimalarial medicines, e.g. artemisinin-based combination therapy                             guiding principles of the approach are to achieve equitable, affordable
          (ACT) within one day of the onset of illness;                                                  and sustainable access to cure and prevention through a results-oriented,


        1 These targets are in line with the targets proposed by the Millennium Development Project. www.unmillenniumproject.org/documents/malaria-complete-lowres.pdf

2       2 The baseline for this target is 2005, to ensure harmonization with other targets related to the Millennium Development Goals.
global strategic plan
2005 - 2015
multisectoral approach. The strategy promotes both rapid short-term
scaling-up of interventions and long-term delivery strategies to reach the
poorest people and to sustain high coverage. It advocates greatly increased
investment in malaria control as part of an increased broader investment
in health3. The strategy requires a partnership between the public sector,
the private sector and civil society, bringing together their complementary
strengths in order to effectively tackle malaria.

Priorities:
1) to ensure that costs are not a barrier for the poor and vulnerable, the
   RBM Partnership supports free or highly subsidized access to curative
   and preventive interventions for these groups;
2) to support countries to implement effective malaria control interventions
   nationwide;
3) to make significant investment in monitoring activities, especially to
   enable tracking of equitable coverage and access;
4) to actively seek out and engage private sector and civil society groups,
   including them in all phases of scaled-up malaria control efforts;
5) to greatly expand investment in research to obtain the strong evidence
   base needed to put into place the most effective and appropriate national
   policies and practices; and
6) to give greater emphasis to community-based advocacy and social
   mobilization as a vital process in increasing demand for, and use of,
   interventions.




                                                                                               "Malaria is a
                                                                                               global health problem."
3 An increase of at least US$ 34 per capita annually for a basic essential health package is

 recommended (Commission on Macroeconomics and Health, 2001).                                                            3
                                                                                                                                                                         global strategic plan
                                                                                                                                                                      2005 - 2015


        Rationale for the Global


    2
        Strategic Plan approach
        Malaria continues to place an unacceptable burden on health and economic development in over 100
        countries across the world4. A child dies from malaria every 30 seconds, and 350-500 million cases
        are estimated annually.
        In addition to children, pregnant women and people living with HIV/AIDS                                losses and reducing household expenditures on malaria treatment. There
        (PLWHA) are especially at risk from malaria5. Malaria is also a major cause                            are indications that malaria costs African countries US$ 12 billion each year
        of low birth weight, which increases the risk of death in the first month of                            and may considerably slow economic development. In some countries, an
        life. Estimates suggest that malaria accounts for up to 40% of all public                              African family may spend up to 25% of their income on malaria prevention
        expenditures on health and 20-50% of hospital admissions in many                                       and control7.
        countries (WHO and UNICEF, 2003). The largest proportion (89%) of the
        global malaria mortality burden is concentrated in Africa. Asian countries                             Effective malaria control at national level is essential for progress towards
        account for approximately 10% and the Americas for less than 1% of the                                 the MDGs. Malaria disproportionately affects poor countries: 58% of cases
        global malaria mortality burden6.                                                                      occur in the poorest 20% of the world’s population8. The Copenhagen
                                                                                                               Consensus Conference ranked development options across all sectors by
        In many countries, malaria is a major barrier to economic development and                              their cost effectiveness, and investments into controlling malaria ranked
        improving the health of populations. Successfully controlling malaria would                            among the top four development priorities9.
        yield multiple benefits in terms of preventing illness, reducing productivity


        4 Malaria is a potentially deadly disease caused through infection by the Plasmodium (falciparum, malariae, vivax, ovale) parasite. Plasmodium is transmitted to humans through the bite of an

         Anopheles mosquito infected with the parasite. One of the most effective malaria vector, A. gambiae, is widespread in Africa and very difficult to control.
        5 Malaria and HIV/AIDS interactions and implications: conclusions of a technical consultation convened by WHO, 23-25 June, 2004. Geneva, World Health Organisation, 2004 (WHO/HIV/2004.8
        6 World Malaria Report 2005, WHO/HTM/MAL/2005.1102
        7 Breman J, Alilio M and Mills A. Conquering the intolerable burden of malaria: what’s new, what’s needed: a summary. American Journal of Tropical Medicine and Hygiene, 2004, 71(Suppl. 2):1-15.
        8 Barat LM et al. Do malaria control interventions reach the poor? A view through the equity lens. American Journal of Tropical Medicine and Hygiene, 2004, 71(Suppl. 2):174-178.
        9 The Copenhagen Consensus Conference sought to assess and prioritize some critical global challenges, through a gathering of globally recognized economists. An expert panel ranked

         various economic estimates and created a prioritized list of solutions to the world`s great challenges. The list targets global and local decision makers, seeking to spark a debate on
4        prioritizing resources (http://www.copenhagenconsensus.com).
global strategic plan
                                                                                                                                 Monitoring the Global
2005 - 2015                                                                                   "In many countries, malaria is a          Strategic Plan

                                                                                                         major barrier to economic
                                                                                                                 development."
The Global Strategic Plan focuses on results. These are achieved through
different delivery systems, which are dependent on the local context.
Many different sectors will contribute to and benefit from the successful
execution of this plan. These sectors include environment, agriculture,
health, education and infrastructure. However, there is a critical need
to bridge the gap between what is known to work, even in resource-
constrained environments, and the level of current implementation of
control programs10. In order to accelerate implementation, all opportunities
for the delivery of interventions at national scale need to be systematically
used.

Therefore, the strategic approach aims to:
• support countries to rapidly expand access to effective treatment and
  prevention against malaria nationwide;
• improve management and healthcare systems to ensure that short-term
  gains can be sustained in the medium- to long-term;
• maintain malaria high on the development agenda using a results-
  oriented evaluation framework;
• provide a comprehensive research agenda, ranging from product
  development to implementation strategies.




10 Hanson K et al. The economics of malaria control interventions. Geneva, Global Forum for

  Health Research, 2004.                                                                                                                             5
"A child dies from Malaria
every 30 seconds."
global strategic plan
2005 - 2015


                            The RBM Partnership


                        3
                            The RBM Partnership11 was launched in 1998 on the initiative of World Health Organisation’s (WHO)
                            Director General, jointly with the United Nations Children’s Fund (UNICEF), the World Bank and the
                            United Nations Development Program (UNDP).


                            3.1 Structure and roles                                                                      The partnership has grown to include a wide range of constituencies who
                            All entities that subscribe to the RBM Global Strategic Plan, and objectives                 bring a formidable assembly of expertise, infrastructure and funds to the
                            and contribute to its implementation are considered Partners. RBM Partners                   fight against the disease. The partnership is made up of the following
                            adopt the following principles:                                                              entities (see also inside front cover):
                            • they share and adopt the common vision and strategy, outlined in the                       • malaria-endemic countries;
                               Global Strategic Plan;                                                                    • multilateral development partners;
                            • they consider the comparative advantage of each partner and identify                       • Organisation for Economic Co-operation and Development (OECD) donor
                               their own area of expertise or comparative advantage when supporting                         countries;
                               the Global Strategic Plan;                                                                • private sector;
                            • they promote a coordinated approach and support and employ the                             • non-governmental and community-based organizations;
                               operating mechanisms of the RBM Partnership.                                              • a global movement of women and youth against malaria;
                                                                                                                         • foundations;
                            The launch of the RBM Partnership was in response to the calls by health                     • research and academic institutions;
                            ministers (Amsterdam 1992), heads of state (Harare 1997) and building                        • the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).
                            on the African Initiative on Malaria. The RBM Partnership has significantly
                            increased the global commitment to fighting malaria and has achieved                          At global level, the RBM Partnership mechanisms are:
                            this by bringing together those already engaged in malaria control and
                            by mobilizing new partners in order to achieve the required scale of                         The RBM Partners’ Forum
                            response.                                                                                    The RBM Partners’ Forum is an assembly of all constituencies of RBM
                                                                                                                         Partners and is the ultimate coordinating body of the Partnership.



                            11 Roll Back Malaria operating framework, September 2004 (http://www.rollbackmalaria.org; Partnership Board channel)                                                7
                                                                                                                                                                                                                                       global strategic plan
The RBM Partnership                                                                                                                                                                                                               2005 - 2015
The RBM Partnership Board                                                                         Working groups                                                                        Operations of SRNs are facilitated by RBM Partnership Secretariat focal
The RBM Partnership Board is made up of 20 voting representatives from                            Working groups12 collate and disseminate information and seek agreement               points hosted by a partner.
the various RBM constituencies. The role of the Board is to:                                      on complex strategic issues concerning scaled-up implementation of policy,
                                                                                                  and advise the RBM Partnership Board on best practices for going to scale             At country level, RBM Partnership mechanisms are designed
• provide strategic guidance to the RBM Partnership;                                              with evidence-based interventions.                                                    to support countries in addressing any barriers they face in
• ensure increased support at country level through the coordinated                                                                                                                     implementing malaria control:
  engagement of the wider partnership; and                                                        Working groups may be medium-term or short-term, depending on the                     The RBM Partnership supports ministries of health and those engaged
• lobby for resources to meet needs.                                                              nature of the topic, and are task-oriented with specific goals. Working groups         in controlling malaria at country level to improve their coordination and
                                                                                                  operate as a virtual network between meetings, and their membership is                enhance their competency by working closely together as an RBM country
The Board approves the RBM Partnership Secretariat’s workplan and                                 drawn from all levels of the wider partnership.                                       partnership. Country partnerships are encouraged to appoint country
delegates the implementation of the plan to its Executive Secretary.                                                                                                                    partnership advisers (CPAs) who offer facilitation of coordination for the
                                                                                                  Working groups identify and address any gaps in the partnership’s capacity            prompt response to implementation barriers, such as:
The RBM Partnership Secretariat                                                                   to respond, and once consensus has been achieved on how partners can
The RBM Partnership Secretariat, led by the Executive Secretary, has the                          best fill these gaps, draw up a practical workplan or set of guidelines.               •   facilitating consensus on policy and strategy for malaria-specific issues;
following roles:                                                                                  Workplans identify prioritized short-, medium- and long-term goals that               •   identifying ways of creating favourable fiscal environments;
                                                                                                  need to be met by the wider partnership in its endeavour to reach its                 •   enhancing procurement capacity for malaria control commodities;
• to facilitate the coordination of contributions from individual RBM                             objectives.                                                                           •   identifying additional delivery opportunities;
  Partners, ensuring that they are in accordance with the RBM Partnership                                                                                                               •   assisting with the modification of existing malaria control programs.
  Global Strategic Plan;                                                                          Working Groups are chaired and hosted by RBM Partners.
• to foster consensus on best practices in scaling up interventions                                                                                                                     CPA hosting arrangements are negotiated by the RBM country partnership.
  recommended by the WHO to the scale required for impact and to ensure                           At subregional level, the RBM Partnership mechanism are
  their rapid dissemination;                                                                      subregional networks:                                                                 3.2 The value of partnerships
• to lead global advocacy efforts for malaria control;                                            The main purpose of the subregional RBM networks (SRNs) is to coordinate              The key reasons for working in partnership are:
• to mobilize additional resources for the fight against malaria and facilitate                    timely support to countries regarding technical, operational and systemic             • by adopting a shared strategic approach, efforts made by individuals are
  access to essential malaria control commodities;                                                issues and support acceleration in the scaling-up of effective malaria                  less fragmented;
• to strengthen communication and information between partners; and                               intervention packages. RBM Partners engaged in SRNs have a regional                   • actively expanding the number of partners implementing the program
• to ensure that the partnership is as broad and inclusive as possible.                           or subregional institutional mandate for country support. They develop a                will speed up the time it takes to reach the objectives;
                                                                                                  joint workplan responding to identified country capacity gaps and they                 • integrating malaria control efforts into existing health-care delivery
The global Secretariat team is hosted by WHO at its headquarters in                               ensure dissemination and promotion of RBM working group consensus                       systems will be made easier and enhance the effectiveness of curative
Geneva, Switzerland.                                                                              statements.                                                                             and preventive interventions.



12 There are currently six working groups: Communications Working Group (CWG), Case Management Working Group (CMWG), Finance Working Group (FWG), Monitoring and Evaluation Reference

    Group (MERG), Malaria in Pregnancy Working Group (MIPWG) and Working Group on Insecticide-treated Nets (WIN).


8
global strategic plan
2005 - 2015                                                                                                                                                                                                The RBM Partnership


At global level, the RBM Partnership has developed:                               the RBM Partnership Board or through joint activities; and                    advocate globally for malaria control;
• strategic frameworks for scaling-up the provision of ITNs to vulnerable       • fostered the creation of the Medicines for Malaria Venture (MMV). This      • promoted political empowerment through the board of the RBM
  groups;                                                                         public-private partnership unites public and private sector entities          Partnership. This allows individuals, institutions and constituencies to
• consensus statements that help with scaling-up the rapid deployment             to fund and provide managerial and logistic support for research and          engage on behalf of the Partnership, beyond their mandates. This adds
  of i) combination therapy (in particular ACTs), ii) ITNs and IRS, iii) ITNs     development of new medicines to treat and prevent malaria.                    credibility and trust through neutrality of engagement within the context
  in antenatal services. These have led to improvements in national                                                                                             of a Global Strategic Plan;
  programs;                                                                     At country level, the RBM Partnership has successfully                        • improved institutional effectiveness by rapidly deploying best practices
• a roadmap to accelerate access to combination therapy, in particular          promoted:                                                                       for the scaling-up of national control strategies; and
  ACTs;                                                                         • strategic national plans for affected countries that identify the need to   • accelerated program implementation through a coordinated country
• a roadmap to accelerate the development and deployment of long-                 control malaria. For instance, in Benin and Malawi, RBM Partners have         support plan, a common procurement mechanism and a shared
  lasting insecticidal net (LLIN) technology.                                     deployed national ITN strategies, which use the most effective mix of         monitoring and evaluation framework.
                                                                                  delivery mechanisms in order to reach economically and biologically
The Partnership has also:                                                         vulnerable groups;
• organized a review of antenatal care (ANC) packages that use IPT through      • a nationwide approach on how to manage malaria at home (e.g.
  a subregional approach by the Malaria In Pregnancy Coalition for Eastern        Uganda);
  & Southern Africa (MIPESA); a similar network exists for West Africa          • the nationwide deployment of interventions for prevention and cure, and
  (Réseau d’Afrique de l’Ouest Contre le Paludisme Pendant la Grossesse           the documentation of highly significant impact on the malaria-related
  (RAOPAG));                                                                      burden of disease (e.g. Eritrea, Viet Nam);
• developed cost-effective malaria control packages;                            • the use of existing national delivery mechanisms such as ANC (e.g.
• developed costing tools that make it easier to compile estimates for            Malawi), Expanded Programs on Immunization (EPI) (e.g. Benin, Ghana,
  resource requirements;                                                          Mali, Senegal), measles vaccination campaigns (e.g. Ghana, Togo,
• successfully mobilized additional financial resources by advocating for          Uganda, Zambia) allowing rapid expansion in access to ITNs; and
  malaria funding opportunities through the GFATM;                              • private sector voucher distribution mechanisms for ITNs that target
• advocated for a reduction of taxes and tariffs on malaria commodities, for      economically and biologically vulnerable populations (e.g. United
  example through a regional fiscal mechanism in West Africa implemented           Republic of Tanzania).
  by the Union Economique et Monétaire Ouest Africaine (UEMOA);
• set up a malaria commodity procurement support system, Malaria                The Partnership has also:
  Medicines and Supplies Service (MMSS), which seeks to remove any              • identified operational barriers through gap analysis in 14 countries in
  barriers preventing required volumes of needed malaria commodities              Africa undertaken by SRNs;
  from reaching countries;                                                      • developed a coordinated workplan to address gaps identified by SRNs of
• supported the production and updating of an atlas of malaria distribution       RBM Partners in East, West and Southern Africa;
  in Africa;                                                                    • supported the transfer of LLIN technologies to Africa;
• engaged additional partners through their constituency representation in      • engaged artists to raise awareness, effect behavioral change and



                                                                                                                                                                                                                                       9
                                                          global strategic plan
The RBM Partnership                                      2005 - 2015
                      "Malaria costs African countries
                      US$ 12 billion each year."




10
global strategic plan
2005 - 2015




                        4
                            Achieving Results
                            The experience of the last 5-10 years has shown that concentrated efforts over a short period are not
                            enough to achieve high-level coverage nor set the stage for sustainability. Therefore, this plan offers two
                            complementary approaches:
                            1. In the short term, a rapid increase in coverage of essential interventions       control is integrated in all sectors.
                               that make optimal use of local capacity, increased technical support and
                               greater financing of malaria control programs;                                4.1 Ensure effective malaria prevention for all at-risk
                                                                                                            populations, in particular in the lowest two economic
                            2. An intensified development of local capacity and health systems to            quintiles
                               ensure that short-term gains are sustained.
                                                                                                            Malaria vector control and personal protection
                            In order to carry out this two-pronged approach, seven different                The malaria vector control and personal protection component of the
                            strategic components have been identified and are described below:               strategy that deals with malaria prevention puts forward six areas that
                                                                                                            require action:
                            • The first three components describe how WHO-recommended prevention
                              and treatment will be taken to scale and consolidated, and how epidemic       •   select proven technologies appropriate to the local setting;
                              and emergency management strategies will be deployed; and                     •   reach high coverage quickly;
                                                                                                            •   sustain high coverage;
                            • The next four components describe how the Partnership will ensure that        •   target the most vulnerable (biological and socioeconomic) groups;
                              the required human and financial resources continue to be available,           •   ensure coverage is with high-quality products and services; and
                              that commodities reach those in need, that there is a strong commitment       •   continuously develop and optimize prevention technologies and delivery
                              to fighting malaria at both a national and global level and that malaria           mechanisms.




                                                                                                                                                                                   11
                                                                                                                                                                                                                                                       global strategic plan
Achieving results                                                                                                                                                                                                                                    2005 - 2015
Select proven technologies appropriate to the local setting                                        Reach high (>80%) coverage quickly                                                                 • re-treatment campaigns are needed to ensure maximum and equitable
Decisions on which vector control intervention to select should be made                            From a generally low baseline coverage, focused efforts are required in order                        coverage of high quality treated nets.
on the basis of an integrated vector management approach13. In almost all                          to achieve the necessary widespread coverage of selected interventions so
malaria-endemic areas, ITNs, in particular LLINs, are the priority intervention                    that the benefits of their potential can be reaped. Issues to be addressed                          IRS is relatively demanding in terms of the logistics, infrastructure and skills,
for RBM in the short- to medium-term. ITNs offer proven efficacy and                                are:                                                                                               planning systems and coverage levels that are needed for a successful and
can reach all target groups, even where infrastructure is minimal. Where                           • how to increase and sustain investment;                                                          effective operation. Nevertheless, such systems have been successfully
epidemiologically and logistically appropriate, other vector control methods,                      • how to ensure efficient supply and procurement;                                                   and effectively maintained for many years in some countries, especially
alone or in combination - in particular IRS with recommended insecticides,                         • how to strengthen delivery systems, using all suitable outlets (private                          those that contain large populations exposed to unstable malaria.
for example DDT - are promoted14,15 (used by Mozambique, South Africa                                 sector, public sector, joint service delivery and campaigns with relevant
and Swaziland in the Lubombo Spatial Development Initiative).                                         programs)16 and sectors;                                                                        However, in most African countries south of the Sahara, the majority of the
                                                                                                   • how to ensure well-planned re-treatment of nets to maintain and                                  rural population is exposed to stable and intense transmission, and the
This approach is being used in Africa, Asia, Western Pacific and Latin                                 increase ITN coverage;                                                                          systems needed for large-scale IRS do not exist. Here, the critical question
America. Preventive strategies will require geographical targeting according                       • how to improve communication about social and behavioral change;                                 is not whether one intervention is slightly more powerful than the other, but
to risk areas.                                                                                     • how to accurately monitor progress;                                                              which offers better prospects of achieving high coverage and long-term
                                                                                                   • developing and implementing strategies that make best use of subsidies;                          sustainability.
The choice between ITNs and IRS depends not only on short-term                                        and
epidemiological impact but also on considerations of feasibility and                               • disseminating updated best-practice consensus statements with                                    In these circumstances, ITNs have important advantages. As well as
sustainability in the long term regarding the availability of appropriate                             information on prevention options, supporting sharing of new strategies,                        being somewhat less demanding than IRS in terms of infrastructure and
infrastructure to deliver. For instance, in some countries in Southern Africa                         informing patients of best available options.                                                   organization, ITNs allow vector control resources to be targeted towards
and in the Horn of Africa, large sections of the population are at little or no                                                                                                                       those subgroups who are most at risk in stable endemic settings,
risk of malaria, while others are exposed to unstable or epidemic malaria. In                      Sustain high coverage (>80%)                                                                       i.e. pregnant women, young children and PLWHA.
these circumstances, IRS has some important advantages: it has rapid and                           Once coverage for selected interventions has reached target levels, the
reliable short-term impact, and it can be targeted to the communities at                           approach will need to be adapted in order for the results to be maintained.                        Moreover, ITNs can give protection of longer duration than IRS, since a
highest risk on an annual basis and in response to changing transmission                           To this end:                                                                                       net in good condition gives reduced but still significant protection to the
patterns.                                                                                                                                                                                             user even after the insecticide has worn off. This advantage will be further
                                                                                                   • the development of the commercial sector is an important element in                              strengthened by the emerging deployment of LLIN technology that greatly
                                                                                                     sustaining coverage and quality of ITNs, and needs to be incorporated                            extends the effective life of the insecticide.
                                                                                                     into immediate and future plans; and



13 Global strategic framework for integrated vector management WHO/CDS/CPE/PVC/2004.10. WHO. Geneva.2004
14 RBM Partnership Consensus Statement on insecticide treated netting. Personal protection and vector control options for prevention of malaria, March 2004 (http://www.rollbackmalaria.org/partnership/wg/wg_itn/docs/RBMWINStatementVector.pdf).
15 WHO position on DDT use in disease vector control under the Stockholm Convention on Persistent Organic Pollutants, 2004 (WHO/HTM/RBM/2004.53; http://mosquito.who.int/docs/WHOpositiononDDT.pdf).
16 WHO/UNICEF Joint Statement. Malaria control and immunization: a sound partnership with great potential, 2004 (WHO/HTM/RBM/2005.52; http://www.rollbackmalaria.org/docs/RBM-EPI-EN.pdf).



12
"Select proven technologies
appropriate to the
local settings."




                              13
                                                               global strategic plan
                                                        2005 - 2015
     Target the most vulnerable (biological and socioeconomic) groups
     Cost must not be a barrier to achieving high access to prevention17. RBM
     country partnerships identify the appropriate mix of public-private delivery
     and subsidy systems to ensure high coverage among economically and
     biologically vulnerable target populations. Strategies will include free
     distribution, highly subsidized products and voucher-based schemes, with
     the explicit objective of reaching high coverage with proven interventions in
     the poorest households. Special emphasis will be placed on identifying and
     targeting those affected most, for example, people in crisis situations, PLWHA
     and those living in the poorest areas of each country. Sharing successful
     country experiences will allow country programs to be implemented more
     quickly and speed up funding for those programs.

     Ensure coverage is with high-quality products and services
     Countries must be supported in their malaria control programs so they
     can improve and advance quality control and quality assurance for vector
     control commodities (ITNs, LLINs, insecticides) and services. Maintaining
     effective interventions also depends on research, and research helps to
     ensure that potential new prevention measures are fully developed and that
     obsolete tools are replaced (see the next component).

     Continuously develop and optimize prevention technologies and delivery
     mechanisms
     The priorities regarding ITNs include:
     • further development of long-lasting treatment technology and its transfer
       to a wide range of manufacturers;
     • collecting better data on coverage; and
     • assessing delivery systems for ensuring coverage of vulnerable groups.

     Development of alternative technologies, such as long-lasting treatment,
     alternative treated materials, new insecticides and smarter formulations,




     17 UNICEF / WHO joint statement: protecting vulnerable groups in malaria-endemic areas in Africa
14      through accelerated deployment of ITNs. WHO/HTM/RBM/2005.57
global strategic plan
2005 - 2015                                                                                                                                                                                                                                                     Achieving results


will be encouraged. Strategies to ensure the future availability of effective,                       4.2 Ensure effective, timely treatment                                                                   such as microscopy or rapid diagnostic tests will require an increase in
safe and affordable insecticides for IRS and ITNs are essential.                                     The gap between adequate access to effective treatment and the current                                   the availability of quality assured products, and the strengthening of
                                                                                                     situation is such that it demands an urgent large-scale and sustained                                    health service capacity at every level nationwide. Rapid diagnostic tests
To ensure prevention in the long-term, vaccine development needs to be                               response by all RBM Partners. The support needs to reflect local experience                               are promising, especially for peripheral health services and community-
intensified and sustained.                                                                            and demands as well as global consensus20. Priorities for the treatment                                  based services, but deployment of these tests will need quality assurance
                                                                                                     component of the strategic plan follow the same pattern as for prevention:                               schemes22 that function efficiently. There is an urgent need for a broad
Intermittent preventive treatment (IPT)                                                                                                                                                                       operational research effort to identify the requirements for optimal
The control of malaria in pregnancy is based on a three-pronged strategy                             •   select proven technologies appropriate to the local setting;                                         deployment.
recommended by WHO that includes case management, ITNs and IPT.                                      •   reach high coverage quickly;
Action is needed to ensure the following:                                                            •   sustain high coverage;                                                                               Reach high coverage (>80%) quickly
                                                                                                     •   target the most vulnerable (biological and socioeconomic) groups;                                    Several measures are urgently needed to accelerate access to combination
• pregnant women in Africa receive IPT with an appropriate antimalarial                              •   ensure coverage is with high-quality products and services; and                                      therapy, in particular ACTs:
  drug (currently sulfadoxine-pyrimethamine, or SP) in stable transmission                           •   continuously develop and optimize treatment technologies and delivery                                • ensure supply meets demand by accurately estimating country needs,
  areas18. Furthermore, ITNs should be promoted among pregnant women                                     mechanisms.                                                                                             translating them into forecasts and working with manufacturers (Malaria
  in all areas where malaria is endemic19;                                                                                                                                                                       Medicines and Supply Services (MMSS), see section 4.5.2);
                                                                                                     Select proven technologies                                                                               • develop pooled procurement mechanisms that meet country
• high IPT coverage through existing and strengthened ANC services;                                  The choice of best medicines for first-line and second-line treatment,                                       requirements;
                                                                                                     management of severe malaria and treatment of special groups (in                                         • develop operational strategies for implementing a global subsidy for
• alternative modalities developed in order to reach women who are not                               particular pregnant women), is both crucial and challenging given ever-                                     combination therapies, in particular ACTs23;
  accessing ANC;                                                                                     increasing resistance to drugs. The RBM Partnership endorses the WHO                                     • develop and implement strategies for making best use of subsidies;
                                                                                                     recommendation that countries, in revising treatment policies for falciparum                             • develop strategies to introduce and regulate use of ACTs in the private
• operational research in the field of IPT on alternatives to SP to be carried                        malaria, should opt for a combination treatment, preferably an ACT21.                                       sector and for malaria home management;
  out (to tackle drug resistance), and the best treatment strategies for HIV-                                                                                                                                 • share updated best-practice consensus statements with information on
  positive women need to be found; and                                                               For treatment of children who show signs of developing severe disease,                                      treatment options, support dissemination of new strategies and inform
                                                                                                     strategies for ensuring access to emergency treatment with artesunate                                       patients of best available options; and
• if the effectiveness and safety of intermittent preventive treatment in                            suppositories are recommended.                                                                           • disseminate information on country successes with home management
  infants is demonstrated, then the momentum should be continued with                                                                                                                                            of malaria.
  a view to rapid introduction.                                                                      As more costly treatments are introduced, diagnostic policies to increase
                                                                                                     rational medicine use are urgently needed. Implementing diagnostic policies

18 A strategic framework for malaria prevention and control during pregnancy in the African Region. Brazzaville, World Health Organization Regional Office for Africa, 2004 (AFR/MAL/04/01; http://mosquito.

  who.int/rbm/Attachment/20041004/malaria_pregnancy_str_framework.pdf).
19 RBM Partnership Consensus Statement. Use of insecticide-treated nets (ITNs) in pregnancy, March 2004 (http://www.rollbackmalaria.org/partnership/wg/wg_itn/docs/RBMWINStatementMPWG.pdf).
20 RBM Partnership Consensus Statement on insecticide treated netting. Personal protection and vector control options for prevention of malaria, March 2004 (http://www.rollbackmalaria.org/partnership/wg/wg_itn/docs/RBMWINStatementVector.pdf).
21 RBM Partnership Consensus statement. Assuring access to effective malaria case management, March 2004. www.rollbackmalaria.org
22 WHO technical consultation on the role of parasitological diagnosis in malaria case management in areas of high transmission, 25-26 October 2004 (in preparation).
23 Institute of Medicine. Saving lives, buying time: economics of malaria drugs in an age of resistance. Washington, DC, The National Academies Press, 2004. K.J.Arrow, C.B.Panosian and H.Gelband                                                                                   15
                                                                                                                                                                                                                            global strategic plan
Achieving results                                                                                                                                                                                                      2005 - 2015
Sustain high coverage (>80%) with high-quality products and                                       • improve capacity of health system to manage severe malaria (drug           4.3 Reduce impact of emergencies and epidemics
services                                                                                            supplies, safe blood).                                                     The goals of RBM will not be met unless special efforts are made to control
The existence of effective medicines will reduce the burden of disease only                                                                                                    malaria more effectively in areas that suffer from complex emergencies
if they are used properly.                                                                        Prioritize access for the most vulnerable (biological and                    (e.g. war and famine) or which are prone to malaria outbreaks. In malaria-
                                                                                                  socioeconomic) groups                                                        endemic countries considered complex emergency countries, the population
Priorities are to:                                                                                Cost must not be a barrier to achieving high access to treatment that is     is highly vulnerable to malaria as a result of limited access to effective
• deploy strategies that improve the ability of households and caregivers                         equitable across all household income quintiles. In order to ensure access   cure and prevention. In epidemic-prone districts, epidemic detection and
   to recognize and properly manage malaria while articulating demand for                         for those who need it most, strategies should be established that address    response mechanisms are missing or weak.
   high-quality care;                                                                             subsidies, access close to home (for instance through home management)
• ensure predictable financing for medicine procurements through global                            and address improvements in private sector provision.                        Emergencies
   subsidy;                                                                                                                                                                    Given the excessive burden of malaria in many countries with complex
• improve quality of care by strengthening health-care systems (including                         Continuously develop and optimize case management tools                      emergency, particularly those in chronic conflict, more attention needs to
   support, capacity and supervision);                                                            and delivery mechanisms                                                      be focused on reaching the following goals:
• include provision of combination therapy, in particular ACTs, in health                         Priorities are to:
   facilities and in community Integrated Management of Childhood                                 • improve monitoring and evaluation (resistance, pharmacovigilance,          • ensure leadership for a coordinated partners’ response in country;
   Illnesses (IMCI), and provide it in essential health packages and medicine                        safety);                                                                  • establish an emergency fund enabling partners to rapidly respond
   kits;                                                                                          • undertake research into strategies and products (e.g. packaging and          through strategically located buffer stocks of recommended malaria
• broaden the use of confirmatory diagnosis to increase rational medicine                             diagnostic tests) for managing malaria at home and in the community;        control tools24;
   use; and                                                                                       • accelerate development of fixed-dose combination therapy, in particular     • identify best practices relating to definition and deployment of tools in
• improve quality of care in private sector (quality assurance and regulation                        ACTs;                                                                       complex emergencies;
   of private providers including medicine sellers) by strengthening their                        • ensure incentives for new pharmaceutical developments, such as those       • ensure links between short-term humanitarian programs and post-
   involvement;                                                                                      provided through the Medicines for Malaria Venture (MMV);                   conflict development programs;
• strengthen national medicine procurement, supply and management                                 • increase investment in research into medicines for special groups,         • develop and maintain response capacity of non-governmental
   systems;                                                                                          particularly pregnant women and infants;                                    organizations and international organizations to deploy appropriate
• improve quality control of medicines, including preventing counterfeits                         • introduce quality-assured rapid diagnostic tests, and research into          control measures;
   reaching the market by supporting more efficient registration processes,                           improving sensitivity and specificity of low-cost diagnostic tests and     • develop simple methodologies to evaluate results and impact; and
   supporting national regulatory authorities and more innovative                                    research into use of rapid diagnostic tests; and                          • undertake research into new tools for prevention and cure suitable in
   approaches;                                                                                    • support a research agenda to introduce new child health technologies         complex emergency situations.
• increase involvement of civil society, especially in combating counterfeit                         into IMCI.
   medicine distribution through public information and activism; and




24 Malaria Emergency Fund for the Containment of Malaria Epidemics in Africa (www.rollbackmalaria.org, Partnership Board channel; see Fourth RBM Partnership Board meeting)



16
global strategic plan
2005 - 2015




                        "The current situation demands
                        an urgent large scale response by all RBM partners."




                                                                               17
                                                                                                                                        Eritrea




          of
Risk resultsMalaria Epidemics                                                                                                                                       global strategic plan
Achieving                                                                                                                                                     2005 - 2015
in Highland Areas                                                                                       Sudan
                                                                                                                                                  Djibouti




                                                                                                                                                              Ethiopia
          0          150         300
                Kilometers



Risk of Epidemics
       Low                                                                                                                                                   Somalia

       Moderate
       High                                                 0          150          300
       Areas <1000m (excluded)                                                                                                           Kenya
                                                                   Kilometers
                                                                                                                    Uganda
       Lakes

                                                  Risk of Epidemics
                                                          Low
                                                          Moderate
                                                          High                                             Rwanda
                                                          Areas <1000m (excluded)
This map is a product of the MARA & HIMAL collaboration (http://www.mara.org.za). July 2002,
                                                              Lakes
Medical Research Council, PO Box 70380, Overport, 4067, Durban, South Africa
CORE FUNDERS of MARA & HIMAL: International Development Research Centre, Canada (IDRC); The               Burundi
Wellcome Trust UK; South African Medical Research Council (MRC);
Swiss Tropical Institute, Multilateral Initiative on Malaria (MIM) / Special Programme for Research &
Training in Tropical Diseases (TDR), Roll Back Malaria (RBM).
Malaria Risk of Epidemics Model: JS Cox, MH Craig, D Le Sueur and B L Sharp (1999).
Mapping malaria risk in the highlands of Africa. Durban, MARA/HIMAL Technical Report/CDROM                                   Tanzania
Topographical data: African Data Sampler, WRI, http://www.igc.org/wri/sdis/maps/ads/ads_idx.htm.




18
global strategic plan
2005 - 2015                                                                                                                                                                                                                               Achieving results


Epidemics                                                                                        undertaken at country level, as well as at regional and global levels, to         from all sources, combining sustained local commitment through national
The Abuja Declaration includes a target for 2005 indicating that 60% of                          convince partners to make a real commitment to supporting joint national          budgets with predictable external financing. The main sources of external
malaria epidemics should be detected within two weeks of onset and                               malaria control strategies, and ensuring that their support is complementary      financing will include:
60% responded to within two weeks of detection. Achieving this objective                         to that of other partners.
requires a sustained commitment from the RBM Partnership in order to:                            Country leadership is paramount in the fight against malaria. A key                • GFATM;
                                                                                                 responsibility for Ministries of Health (MoH) is to set up an environment         • multilateral development banks (the World Bank, African Development
• establish and maintain early warning systems and to ensure support for                         conducive to facilitating the multisectoral approach needed to tackle               Bank, Asian Development Bank, Inter-American Development Bank);
  local authorities to develop an operational preparedness plan whereby                          malaria and to allow each partner to contribute to the delivery of proven         • bilateral agencies;
  all operational partners have clear functions and responsibilities;                            and cost-effective technologies to the population — particularly those most       • specialized United Nations agencies;
• engage additional sectors such as meteorological services as well                              in need. The availability of national policy, a strategic plan shared with all    • international NGOs;
  as engaging agricultural and environmental surveillance systems for                            stakeholders and an agreed monitoring and evaluation plan will contribute         • foundations; and
  drought monitoring and food security, and research institutions, to                            to better coordination.                                                           • large multinational corporations and high net-worth individuals.
  evaluate the effectiveness of early warning systems;
• respond rapidly by establishing and operating an emergency fund and                            Country leadership will be assessed through the availability of these             Domestic financing through national budgets
  strategically placing buffer stocks of recommended malaria control                             coordinating tools along with the political and financial commitment. An           Countries affected with malaria will take the lead for financing malaria
  tools; and                                                                                     appropriate level of domestic funding for malaria control is necessary to         control. As the revenue base is very low in many countries, these countries
• rapidly share experiences regarding the performance of early detection                         sustain efforts to roll back malaria. It is important to use malaria control as   will be able to commit modest sums in the foreseeable future. However,
  and rapid response systems.                                                                    an indicator of socioeconomic development and part of the macroeconomic           it is critical that even the poorest countries demonstrate commitment by
                                                                                                 dialogue in countries with a high malaria burden.                                 allocating regular annual budgets to malaria control.
4.4 Results-oriented investments
Improved resource allocation from both domestic and external financing                            Financing                                                                         In order to ensure high visibility for malaria control and allocation of adequate
is essential to achieve the results of this strategic plan. In addition to                       Both the Commission on Macroeconomics and Health and the Copenhagen               resources proportional to the malaria burden, malaria control needs to be
prioritizing the use of existing resources, the need for substantial additional                  Consensus Conference indicate that the annual cost of a package of                promoted by countries in their poverty reduction strategy papers (PRSPs),
resources still needs to be emphasized. This would entail both internal re-                      interventions necessary to achieve the MDGs requires approximately                sector-wide approaches (SWAps) and essential health packages. The PRSP
allocation of funds to malaria control as well as mobilizing significantly                        US$ 34 per capita. In addition, the Global Fund currently estimates the           process will need to include analysis of the link between malaria and
greater external investments.                                                                    annual resource needs for malaria control to be US$ 2.9 billion25. The RBM        economic development, the key elements of the countries’ malaria control
                                                                                                 Partnership uses the comparative strengths of each partner to help bridge         strategy, their medium-term goals and short-term actions and indicators.
Coordination                                                                                     the funding gaps related to malaria control.
Partner coordination has been the keystone of the RBM movement from its                                                                                                            This will serve as the basis for incremental resource allocation in the
inception in 1998, and is bringing good results at country and subregional                       The RBM Partnership will work to mobilize adequate financing of malaria            national budget, to be negotiated through the medium-term expenditure
level. Effective partner coordination is crucial in order to scale-up priority                   control, with a view to achieving rapid increases in treatment and                framework (MTEF). Health outcomes need to be emphasized in SWAps and
interventions to country level, thus ensuring complementary investments                          prevention coverage in the short term, and sustaining those gains in the          MTEFs. The RBM Partners currently work with countries to develop and
and making the best use of available resources. Extra efforts need to be                         medium- to long-term. Sustainable financing requires guaranteed funds              apply planning and budgeting tools to support local decision-making and


25 Addressing HIV/AIDS, Malaria and Tuberculosis : The resource needs of the Global Fund 2005 – 2007. GFATM. Geneva. 2005. www.theglobalfund.org                                                                                                                 19
                                                                                                                                                                                                                    global strategic plan
Achieving results                                                                                                                                                                                             2005 - 2015
malaria control modules within national health accounts (e.g. developing          development to ensure that health system requirements are addressed.             supplier’s country of origin.
tools such as marginal budgeting for bottlenecks).                                Countries should ensure priority is given to funding appropriate strategies
                                                                                  when submitting their GFATM grant applications; the RBM Partnership              Specialized United Nations agencies
There needs to be an overall increase in investment in the health system          will provide guidance on this. The review of GFATM proposals needs to be         The multilateral system includes specialized United Nations agencies,
in general, in accordance with political commitments to increase the              consistent with the RBM Global Strategy.                                         which are not donors. United Nations agencies resources can be used in a
percentage of public sector spending allocated to the health sector. A credible                                                                                    strategic manner to leverage additional funding to support appropriate and
macroeconomic framework to ensure increased internal investments in               Multilateral development banks                                                   effective implementation of malaria prevention and control programs. They
malaria control needs to be developed. The RBM Partnership will review            In addition to financing, institutions such as the World Bank, African            also play a central role in convening partners and providing the leadership
the macroeconomic environment facing various national malaria control             Development Bank, Asian Development Bank and Inter-American                      and consensus building required for mobilizing an adequate international
(NMC) programs, to form a basis for building a dialogue between MoH and           Development Bank also have the capacity to provide technical support for         and domestic response. In addition, and together with NGOs and other
Ministries of Finance (MOF) on how to increase internal mobilization of           health system development, institutional reforms, analysis and intersectoral     international organizations, they provide essential health services to affected
resources for malaria control efforts.                                            perspectives for malaria control. They are particularly well positioned to       populations in countries emerging from complex emergency situations. At
The RBM Partnership will also promote an internal review by MoH on the            assist countries in preparing malaria-responsive PRSPs, medium-term              global and regional levels, they also provide technical leadership.
institutional structure of NMC programs. Based on these findings, the MoH          expenditure frameworks and debt relief or cancellation agreements. It is
can determine if the position of NMC programs need to be strengthened             essential that the development banks work actively as RBM Partners to            International NGOs
within the MoH in order to effectively advocate with government and               ensure the technical quality of the PRSPs and the programs to be financed.        International NGOs provide health and other services in challenging
partners to raise the profile of malaria control, for example by developing        The RBM Partnership expects these institutions to provide substantial            contexts and emergencies, as well as providing assistance to various
comprehensive and complete documentation.                                         increases in their financial commitments to malaria control and to intensify      research organizations, academic and charitable institutions engaged in
                                                                                  their non-financial support for malaria control. In low-income countries,         malaria control. International NGOs are frequently in partnership with civil
External financing                                                                 external financing of malaria control should be in the form of grants, where      society groups who can help promote transparency and maintain advocacy
The Global Fund                                                                   feasible. Where loans are provided, countries and multilateral banks could       on a pro-poor agenda. NGOs also contribute to community efforts through
The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)                   form partnerships with co-financiers in performance-based buy-downs that          social mobilization.
is a financing mechanism providing a large boost for malaria control;              convert the credits into grants.
between its inception in 2002 and the end of 2004, it has allocated US$ 1.8                                                                                        Foundations and large multinational corporations
billion to malaria control since its inception. The RBM Partnership calls for     Bilateral agencies                                                               Foundations support the RBM Partnership by providing direct investments and
a continuation of the GFATM’s work as a sustainable financing mechanism.           Bilateral agencies have the capacity to continue providing financial              by leveraging additional investments for the partnership as a whole. Through
The RBM Partnership considers it crucial for countries and the GFATM to           assistance and technical support for malaria control. The RBM Partnership        their ability to second staff, foundations can support the RBM Partnership’s
ensure that funds from GFATM be additional to other sources of funding for        will work with countries and bilateral agencies to expand this support in        operating mechanisms. Foundations also have the potential to strengthen
malaria control and not a substitute for those other sources.                     accordance with plans that are agreed upon at country level and led by the       any activities carried out by related foundations that are able to incorporate
                                                                                  government. The Partnership will encourage bilateral agencies to release         malaria control interventions. In addition, foundations provide administrative
The Partnership also considers it necessary for the GFATM to continue             their assistance, thus allowing recipient countries to use bilateral resources   flexibility, whereas individuals and corporations can make financial donations
and improve collaboration with partner agencies that provide technical            for the most suitable goods and high-quality services, regardless of the         in support of activities carried out by the RBM Partnership. Finally, foundations
expertise, implementation support and cross-sector skills in institutional


20
global strategic plan
2005 - 2015                                            Achieving results




         "Populations exposed to complex emergencies
         are highly vulnerable to malaria."
                                                                      21
     SHOPS

             "58 per cent of malaria cases occur
             in the poorest 20 per cent
             of the world’s population."
22
global strategic plan
2005 - 2015                                                                                                                                                                                                                          Achieving results


provide major financial support for research and development in the field of                     Management capacity will be further strengthened by developing systems         (TEHIP) and the marginal budgeting for bottlenecks approach being piloted
malaria control. Similar support is also made available to the RBM Partnership                 (institutional capacity strengthening) that make it easier to engage a broad   with promising results by UNICEF and the World Bank. The RBM Partnership
by large multinational corporations. In addition, foundations also directly                    range of entities and individuals. The RBM Partnership will support the        will invest further in the systematic application of such tools.
support national malaria control efforts by assisting with the implementation                  transition from strategic planning to “business or operational planning” in
of national strategic plans, on a practical level.                                             each country, with support focused on developing and deploying managerial      Special focus will also be placed on strengthening district level capacity to
                                                                                               tools such as performance contracts. Governments seek improvement              manage resources efficiently in accordance with the widespread shift of
4.5 Strengthen delivery systems                                                                by strengthening the capacity of district health management teams              MoH management to a decentralized approach. Another facet of ensuring
                                                                                               (DHMTs) to organize the sale and distribution of ITNs at health centers,       successful decentralization will be working with governments as they
Increase national capacity to deliver                                                          while simultaneously increasing the ability of village health committees       strive to build stronger regulatory capacity at a ministerial and district level.
Achieving a rapid and sustained increase in the scale of malaria control                       to organize ITN sales and distribution at community level. Other efforts at    This is necessary to ensure the quality of products being imported and
activities requires increased support in terms of resources and institutions                   the service delivery level include the increased use of Health Surveillance    manufactured in each country. This would include focused training and
in each country. The RBM Partnership will develop strategies to ensure                         Assistants (HSAs) to bolster community tracking of malaria incidence. For      improved supervisory mechanisms to help avoid commodities “leaking”
investments enable countries to mobilize, retain and motivate highly                           instance, evidence from Malawi shows that the scaling-up of operations         from the public to the private sector, especially given that unregulated sales
qualified individuals to manage malaria control.                                                can be accelerated and made more efficient by modifying staff working           in the open market could increase the rate of development of resistance to
                                                                                               arrangements.                                                                  some antimalarial drugs.
The Partnership pursues a results-oriented and sustainable approach
to capacity development and investment in the scaling-up of innovative                         By adopting new and progressive operational arrangements (such as              Revitalize procurement and supply-chain management
approaches to human resource development and management. Particular                            employing practical business management tools, or the use of performance
support goes to those initiatives that aim to increase access by patients                      contracts), each partner brings their full range of skills and expertise to    Global level procurement mechanisms including Malaria Medicines and
to professional and skilled workers in the public and private sectors to                       the operation. A further benefit is that this approach encourages all those     Supplies Services (MMSS)
overcome the shortfall of at least one million health workers26 that are                       involved to be accountable to each other.                                      Governments of malaria-endemic countries, United Nations agencies and
required in order to scale-up health interventions.                                                                                                                           international organizations are the main procuring bodies for medicines
                                                                                               Whereas for the short-term the Partnership will support a rapid increase       and supplies in the fight against malaria at global level. There is a clear
The Partnership will invest in training these types of workers as well as                      in resources earmarked for malaria control, it is clear that sustaining        need for the Roll Back Malaria Partnership to take an active role in the
defining what can be realistically undertaken to motivate staff, thus                           funding in the medium- to long-term will require that the capacity for         supply chain for antimalarial products. A critical component of this includes
ensuring optimal performance. The Partnership will also support systematic                     allocating resources to priority interventions within each country greatly     accurate country-level forecasting of malaria commodity needs, based
expansion of practices that are demonstrated to be effective in mobilizing                     improves. The RBM Partnership will promote processing and wide-scale           on reliable financing estimates, and communication of these needs to
non-health workers. Promising examples include the recent franchising of                       dissemination of capacity development tools that contribute to improved        manufacturers on a regular basis. To that purpose, the Partnership has
shopkeepers in Cambodia and Kenya. The Partnership will seek to work in                        resource management at a central and district level.                           established MMSS, a unit that works with RBM Partners that have global
coordination with other global, regional and national initiatives to develop                                                                                                  forecasting, procurement and supply mechanisms in place, and that are in
approaches to improving salaries and incentives for health workers.                            Good examples include the district health accounts piloted in the United       direct contact with manufacturers. The rapid developments and increased
                                                                                               Republic of Tanzania by Tanzania Essential Health Interventions Projects       world market demands for anti-malarial medicines, diagnostics, nets and




26 Abuja, high level meeting on Millennium Development Goal health indicators, December 2004                                                                                                                                                                23
                                                                                                                                                                                                           global strategic plan
Achieving results                                                                                                                                                                                     2005 - 2015
insecticides make it imperative to increase investments in pre-qualification   National procurement processes                                                  4.6 Create awareness, demand and appropriate use
and to increase support to countries in terms of quality assurance. For       National procurement systems have to evolve in line with national priorities.   Strong advocacy and enhanced communication strategies are essential at
medicines and insecticides, prequalification criteria are identified by WHO.    Improving access to essential malaria control commodities on a national         global, national and regional levels to ensure that:
At the same time, the RBM Partnership needs to support national regulatory    scale requires quantities that are very much larger than those previously       • RBM interventions are supported financially and programmatically and
agencies and procurement systems to give them higher degrees of self-         managed by national procurement mechanisms. Special mechanisms                     scaled-up in all endemic countries;
reliance. In order to facilitate the translation of demand for commodities    and greater support are needed to ensure procurement that is timely,            • awareness and dialogue are generated to promote health-seeking
into firm orders with manufacturers, a pooled procurement and financing         efficient and good value. MMSS will identify needs and sources of technical         behaviors and demand for services and products; and
mechanism could be considered.                                                assistance in supply chain management to help assist countries improve          • antimalarial commodities are available when and where they are needed,
                                                                              their systems.                                                                     and used appropriately and effectively.

                                                                                                                                                              Coordinated partnership advocacy efforts are therefore needed at all levels
                                                                                                                                                              and require comprehensive strategies that elaborate a continuous drive
                                                                                                                                                              towards these priority outcomes and employ consistent and appropriate
                                                                                                                                                              messages to reach different target groups and audiences. Messages and
                                                                                                                                                              strategies must be regularly updated and reinforced as new information on
                                                                                                                                                              progress is secured.

                                                                                                                                                              The communications component of the strategic plan addresses the
                                                                                                                                                              following components:

                                                                                                                                                              • global advocacy;
                                                                                                                                                              • national advocacy;
                                                                                                                                                              • communication and advocacy for demand creation for malaria control;
                                                                                                                                                                and
                                                                                                                                                              • communication for promoting appropriate use of interventions.




24
global strategic plan
                                                                                                                                                                                                           Monitoring the Global
2005 - 2015                                                                                                                                                                                                       Strategic Plan


Global/regional advocacy
The main objectives of the RBM Partnership’s global advocacy strategy are
to ensure that:
• awareness of the malaria burden is maintained, and progress towards
   reducing the burden is documented and broadly disseminated, thus
   keeping malaria high on the international agenda; and
• international decision-makers are aware that progress towards MDGs
   (see Annex 2) requires more investment towards malaria control through
   agreed strategies and to invest in research and development of new
   tools, e.g. improved nets, new drugs and vaccines.

The global strategic advocacy plan should include the following elements:
• advocacy to ensure GFATM funds are truly additional, not redirected,
  monies;
• advocacy to ensure continuous investment in malaria research;
• advocacy that highlights the need for technical agencies to receive
  adequate funding to support countries with essential technical
  assistance including malaria control implementation, treatment policy
  change, ensuring financial flows, communication, reprogramming of
  GFATM funds, proposal preparation, etc.;
• advocacy to mobilize support for countries to develop communication
  capacity and strategic communication plans; and                           • producing reports and audio-visual materials for widespread broadcast            for Economic Co-operation and Development donor governments and
• advocacy for adopting the principles of the RBM Partnership, thus           and distribution;                                                                endemic nations to honor existing commitments and increase their support
  engaging more partners and strengthening the unified voice and reach.      • arranging inclusion of malaria messages on consumer-goods packaging              for the fight against malaria.
                                                                              to achieve maximum reach; and
Specific activities include:                                                 • providing support for independent fundraising events.                            Partners’ advocacy efforts must be galvanized around every international
• developing powerful advocacy products, messages, strategies and                                                                                              opportunity that presents itself throughout the annual calendar. The
  campaigns;                                                                It is essential to include “inside/outside” approaches that engage the vast        dependence in many countries on the achievement of the RBM objectives
• engaging malaria champions, e .g. parliamentarians, celebrities, high-    range of conventional institutional partners, but also include concerned           in order to reach several of the MDGs provides a major opportunity for
  profile commentators, leaders of industry in high-profile media and         individuals and citizens’ groups to carry out necessary but distinctly different   global advocacy, as do major international fora on health and development,
  popular events/visits to promote good practice and disseminate success    tasks. Inside approaches maximize the use of conventional institutional            e.g. Africa Malaria Day, and the RBM Global Partners’ Forum.
  stories;                                                                  channels to increase resources and heighten awareness, while outside
                                                                            approaches can serve to leverage key partners and influence Organisation


                                                                                                                                                                                                                                      25
                                                                                                                                                                                                              global strategic plan
Achieving results                                                                                                                                                                                        2005 - 2015
Country-level advocacy and communication                                          enhancing the understanding and awareness by individuals and communities      a communication strategy can use mass media channels and commercial
Here, objectives are similar to those of global advocacy, but take into           of the benefits of malaria prevention and treatment, and addressing barriers   advertising concepts to create demand for public health commodities such
account the specific target audiences of national and subnational decision-        to community and individual action. Empowering communities to voice           as ITNs, while at the same time supporting service delivery and appropriate
makers and communities and individuals:                                           their needs will increase ownership of both the challenges and potential      use of these products.
                                                                                  solutions in the fight against malaria at the community level, and increase
• to ensure an environment that promotes the use of all prevention and            the demand for services and products.                                         Creating awareness, demand and appropriate use of malaria interventions
  treatment tools;                                                                                                                                              can often be carried out within the context of community IMCI and
• to provide communities and individuals with the opportunity to voice            Market priming is also an essential tool for increasing demand and supply     community capacity development activities, which aim to strengthen
  their needs and demands - especially the most vulnerable; and                   of a commodity in an environment where previously the commodity was           household care practices.
• to raise the profile of NMCP in-country and promote the partnership              not widely used and/or distribution channels are not widely developed.
  approach.                                                                       Market priming increases consumer interest in a product as well as the        4.7 Incorporate malaria interventions in all sectors
                                                                                  supply of that product. It also demonstrates to potential manufacturers and   In order to reach and maintain the levels of coverage envisaged and
Fully resourced country-level partnership communication strategies must           suppliers the size of the potential market and motivates traders to expand    to maintain them, effective malaria control interventions need to be
be integrated into national malaria control plans, or, if developed separately,   their distribution system and price the product competitively.                integrated into all health policies and mainstreamed into development
should reflect and directly support the national malaria control plan. These                                                                                     policies, strategies and programs by developing more integrated program
should specifically identify capacity needs and provision of resources for         Promoting appropriate use of interventions                                    approaches. Joint delivery systems that combine malaria interventions with
building advocacy and communication capacity.                                     The strategic plan supports the development of community-level                other health and/or development activities can increase coverage of both
                                                                                  communication activities to ensure that information about malaria             interventions and may result in savings in terms of human, material and
An important focus will be to engage political leaders at all levels, including   control interventions reaches the appropriate groups, and that families       financial resources. It is important that special arrangements are made to
local community leaders. Key areas should include continued advocacy              are empowered to make informed decisions concerning appropriate               ensure that the poor have access to malaria control interventions when
for countries to create enabling economic environments for malaria                care practices related to preventing and managing malaria. An effective       integrated into other health programs. This approach demands that new
commodities, for instance by reducing taxes and tariffs policies, as well         communication strategy builds capacity at community level and improves        partnerships be developed and that the effectiveness of the broader RBM
as advocacy for including malaria in all resource allocation exercises            care practices in the household (including adherence to appropriate           Partnership is improved.
and incorporating malaria control in the work of all sectors. Convincing          treatment), as well as creating demand for high-quality services and
arguments for investing in and prioritizing malaria control could include the     products.                                                                     Health sector
fact that an African family can spend up to 25% of their income on malaria                                                                                      Immunizations, IMCI, ANC and other health services can act as a vehicle
prevention and control, or the fact that malaria costs Africa an estimated        Developing community capacity requires effective communication for social     for delivering specific malaria interventions. Selected elements of malaria
US$ 12 billion per year in lost GDP.                                              change that responds to the needs of the community and that creates an        control, in particular ITNs or ITN voucher distribution, can be combined with
                                                                                  environment in which individuals - particularly women, caregivers and         immunization activities which generally have well-developed operational
Country-level communication strategies must incorporate activities that           heads of households - can improve their knowledge and the ability to          infrastructures27. In return, availability of malaria commodities may be
specifically target the vulnerable: pregnant women, children under five             assimilate and act on that knowledge, leading to appropriate behavioral       an additional incentive, for example for mothers and children to attend
years and PLWHA — and stress the importance of ensuring their access              change. Effective communication can be complemented by culturally             immunization or ANC sessions. Examples of joint delivery systems are the
to essential products and services. Particular attention should be paid to        appropriate information distributed via mass media and print. Specifically,    distribution of ITNs, ITN vouchers or re-treatment kits to pregnant women


26
global strategic plan
2005 - 2015                                                                                                                                                                                                                  Achieving results


and/or children during routine immunization activities and provision of IPT                  comprising all selected priority interventions.                              treatment kits. Social mobilization for these supplementary immunization
with SP at the same time as tetanus immunization of pregnant women.                                                                                                       activities (SIAs) can also be combined with those for malaria control.
In addition, supporting activities such as social mobilization, monitoring,                Recent evidence on important interactions between HIV/AIDS and malaria
training and supervision may also be shared across health services.                        has prompted the call for an integrated approach to the delivery of health     In most of Africa and many countries in Asia and the Americas, the
                                                                                           services relating to malaria and HIV. Collaboration should be promoted.        majority of first contact malaria treatment is given by private providers,
Many developing countries have ANC coverage, and the delivery of ITNs, ITN                 Campaigns that are related to health or other sectors may serve as a vehicle   with malaria medicines being procured by patients and caregivers at
vouchers and IPT to pregnant women can be integrated into this service,                    for delivering malaria interventions. Health days have proved very effective   local shops and pharmacies. Links with the formal private sector (private
e.g. as most women in Africa south of the Sahara attend ANC sessions at                    in achieving high coverage for measles, polio and vitamin A campaigns,         companies) and informal private sector (small retailers, kiosk owners, etc.)
least once and often twice during their pregnancy. ANC is the appropriate                  and should be used to deliver ITNs (possibly through vouchers) and/or re-      must be strengthened. There is a need for a better knowledge base on
platform for delivering and managing malaria during pregnancy, contributing
to better health outcomes for mother and child. Programs to scale-up these
malaria interventions will need to incorporate strengthened ANC services,
as necessary.

Similarly, where IMCI has been adopted, it is a useful vehicle for malaria
control, especially treatment interventions, and might also be considered
for provision of ITNs, re-treatment kits and prepackaged antimalarials to
the under-fives. Community child health and development efforts would
be a key vehicle for improving health-related behavior at community level.
Additionally, new funding for malaria control could help renew and expand
sources of funding for IMCI.
A number of countries have adopted a new “Accelerated Child Survival and
Development” approach, combining ANC, IMCI and Expanded Programs on
Immunization through a mix of service delivery strategies to deliver essential
interventions for the prevention and control of malaria. The service delivery
strategies employed include:

• community-based promotion and support of a package of family care
  practices;
• sustainable outreach and campaigns to deliver malaria interventions
  alongside EPI and ANC services; and
• facility-based delivery of an integrated minimum care package


27 WHO and UNICEF joint statement. Malaria Control and Immunisation: a sound partnership

  with great potential. WHO, Geneva. UNICEF, New York. 2004                                                                                                                                                                                        27
     "The result of adopting a common strategy
     is the reduction of fragmentation
     in partners’ work."
28
global strategic plan
2005 - 2015                                                                                                                                                     Achieving results


those interventions that are most effective in improving the role of private   • deploys malaria control interventions to protect industrial and agricultural
providers.                                                                       workforces. Such programs often involve larger communities where
                                                                                 malaria control interventions can be applied efficiently with employee
Other sectors                                                                    support, who are aware of the economic benefit of a healthy workforce.
Environment: agricultural development projects and environmental
hygiene programs, especially in urban areas, can play an important role by     In order to expand distribution systems for malaria commodities, the RBM
incorporating interventions.                                                   Partnership needs to actively engage the private sector.

Schools: play a particularly useful role by encouraging students to adopt      Faith-based organizations: work on a large scale at community level,
health-promoting behavior regarding malaria. This, in turn, benefits schools    in addition to faith-based health care delivery services. Community
as it contributes to a decrease in absenteeism and anaemia (important          and outreach services provide opportunities for malaria advocacy and
causes of suboptimal learning). Malaria control could be added to teachers’    information.
curricula. For example, school-based health initiatives (e.g. FRESH) can be
expanded to include malaria control.                                           4.8 Gender approach
                                                                               Malaria contributors agree on the necessity of taking into consideration the
Regulatory institutions: the RBM Partnership assists governments in            social inequality status between men and women in the management of
developing locally appropriate regulatory policies and statutes, commodity     malaria. Specifically:
management and procurement systems, pesticide registration mechanisms
and the expansion of exemptions of taxes and tariffs on antimalarial           • It is vital to address the socio-cultural and behavioural factors that
commodities.                                                                     influence women’s and men’s approach to malaria prevention and
                                                                                 treatment when planning malaria control interventions.
Agriculture: the RBM Partnership works with the agricultural sector to
increase the availability of Artemisia annua for the production of quality     • It is necessary to take into account women’s and men’s access to different
ACTs. National agricultural extension services should engage in providing         resources to pay for healthcare when elaborating and evaluating health
channels for malaria awareness raising and behavioral change. Extension           financing strategies; and assessing the impact of women’s ability to pay
services that currently boast high coverage also need to be involved as a         on individual and household livelihoods.
commodity delivery mechanism.
                                                                               • The gender approach should be addressed at all decision-making levels
Private sector: engages as an RBM Partner in the following ways:                 as well as during implementation of malaria control programmes.
• produces goods and services essential to roll back malaria;
• provides services in the formal and informal sectors. Plays an important
   role in regulation, quality control and identifying enabling environments
   for market development;


                                                                                                                                                                               29
                                                                                                                                    global strategic plan
                                                                                                                               2005 - 2015



         Putting the strategy


     5
         into action
         Tables 1a, 1b and 1c summarize RBM Partnership priorities for three main time periods covered by
         the global strategic framework. For each priority, agreed milestones are described together with the
         responsibilities of the different partnership constituencies and the roles of the partnership mechanisms
         in achieving these milestones.


         Constituencies are: governments of endemic countries, OECD donor countries, multilateral development partners (WHO, UNICEF, UNDP, World Bank), private
         sector, NGOs, foundations, and research and academia.

         Partnership mechanisms are: SRN = subregional RBM network; WG = working group: Communication (CWG), Case Management (CMWG), Finance (FWG),
         Monitoring and Evaluation Reference Group (MERG), Malaria in Pregnancy (MIPWG) and Insecticide-treated Nets (WIN).


         a
         Other abbreviations used                                                    MMSS = Malaria Medicines and Supplies Service
         ACT = Artemisinin-based Combination Therapy                                 MMV = Medicines for Malaria Venture
         ANC = Antenatal Care                                                        MVI = Malaria Vaccine Initiative
         GFATM = Global Fund to Fight AIDS, Tuberculosis and Malaria                 MTEF = Medium-Term Expenditure Framework
         IMCI = Integrated Management of Childhood Illnesses                         PRSPs = Poverty Reduction Strategy Papers
         IRS = Indoor Residual Spraying                                              RBM = Roll Back Malaria
         ITN = Insecticide-Treated Nets                                              RDT = Rapid Diagnostic Tests
         LLIN = Long-Lasting Insecticidal Net                                        SWAps = Sector-Wide Approaches
         MICS = Multiple Indicator Cluster Surveys                                   TDR = UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in
         MDG = Millennium Development Goal                                           Tropical Diseases



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global strategic plan
                                                                                                                                                                                                                        Putting the strategy
2005 - 2015                                                                                                                                                                                                                       into action




Table 1a: Action at country levela
2005
 Priorities                        Milestones                                                   RBM constituencies, with lead in bold                                                   Partnership mechanism, with lead in bold
 Make an all-out push to           60 million doses of ACT procured                             private sector, OECD donor countries, multilateral development partners, foundations,   Board, SRN, CMWG, MIPWG, MMSS
 achieve Abuja coverage                                                                         endemic country governments, NGOs
 targets in Africa, and increase
 coverage elsewhere                30 million ITNs and 60 million net treatments (targeting     private sector, OECD donor countries, multilateral development partners, foundations,   Board, SRN, WIN, MIPWG, MMSS
                                   pregnant women and <5s)                                      endemic country governments, NGOs
 System
 strengthening                     12 million LLINs (targeting pregnant women and <5s)

                                   Existing delivery systems (ANC, measles campaigns, EPI,      endemic country governments, private sector, OECD donor countries, multilateral         SRN, WIN, CMWG, MIPWG
                                   private providers, IMCI) are strengthened and used to        development partners, foundations, NGOs
                                   increase coverage of malaria interventions, e.g. through
                                   strategy development, social and resource mobilization

                                   Malaria interventions are integrated into health packages    endemic country governments, NGOs, private sector, multilateral development             SRN, WIN, CMWG, MIPWG
                                   of ANC, IMCI, essential health package                       partners, OECD donor countries, foundations

                                   Coordinated delivery systems for complex emergencies         endemic country governments, NGOs, private sector, multilateral development             SRN, WIN, CMWG, MIPWG
                                   achieving high coverage with appropriate interventions       partners, OECD donor countries, foundations

                                   Rapid epidemic response capacity in countries at risk        endemic country governments, NGOs, private sector, multilateral development             SRN, WIN, CMWG, MIPWG
                                                                                                partners, OECD donor countries, foundations

                                   Commodity reserves at global and national levels for rapid   multilateral development partners, endemic country governments, NGOs, private           SRN, WIN, CMWG, MIPWG,
                                   response                                                     sector, OECD donor countries, foundations                                               FWG, CWG, MMSS




                                                                                                                                                                                                                                          31
                                                                                                                                                                                                               global strategic plan
Putting the strategy
into action                                                                                                                                                                                               2005 - 2015
2006 - 2010
 Priorities                   Milestones                                                       RBM constituencies, with lead in bold                                           Partnership mechanism, with lead in bold
 Achieve, maintain and        Countries with lowest achievement towards Abuja targets in       endemic country governments, multilateral development partners, OECD donor      Board, SRN, WIN, CMWG, MIPWG, FWG, MERG, MMSS
 exceed agreed RBM targets    2005 catch up                                                    countries, foundations, NGOs, private sector
 (as indicated in Strategic
 Approach section)            Coverage of key interventions reaches 80%, including lowest      endemic country governments, multilateral development partners, OECD donor      SRN, WIN, CMWG, MIPWG, FWG, CWG, MERG, MMSS
                              household income quintiles                                       countries, foundations, NGOs, private sector

                              By 2010, one-third reduction of <5 mortality rate                endemic country governments, multilateral development partners, OECD donor      SRN, WIN, CMWG, MIPWG, FWG, MERG
                                                                                               countries, foundations, NGOs, private sector

                              High program capacity to absorb and manage GFATM funds           endemic country governments, multilateral development partners, OECD donor      SRN, WIN, CMWG, MIPWG, FWG, MMSS
                                                                                               countries, foundations, NGOs, private sector

                              Incorporation of malaria control in health strategies, SWAps,    endemic country governments, multilateral development partners, OECD donor      SRN, FWG
                              PRSPs, etc.                                                      countries

                              Adequate allocations in budgets to achieve outcomes (e.g.        endemic country governments, multilateral development partners, OECD donor      Board, SRN, FWG
                              within MTEFs)                                                    countries

                              Systematic scale-up of confirmatory diagnosis to improve          endemic country governments, multilateral development partners, OECD donor      SRN, CMWG, MIPWG, MERG, MMSS
                              quality of care and surveillance                                 countries, foundations, NGOs, private sector

                              Malaria control is integrated with other child health programs   endemic country governments, multilateral development partners, OECD donor      SRN, WIN, CMWG
                                                                                               countries, foundations, NGOs, private sector

                              Reproductive health services fully incorporate malaria           endemic country governments, multilateral development partners, OECD donor      SRN, MIPWG
                              interventions                                                    countries, foundations, NGOs, private sector

                              Early warning systems and rapid response capacity effective      endemic country governments, multilateral development partners, NGOs, OECD      SRN, CMWG, WIN, MMSS
                              in countries at risk                                             donor countries, foundations, private sector



2011 - 2015
 Priorities                   Milestones                                                       RBM constituencies, with lead in bold                                           Partnership mechanism, with lead in bold
 Achieve malaria-related      Two-thirds reduction in <5 mortality rate                        endemic country governments, multilateral development partners, NGOs, private   Board, SRN, WG
 Millennium Development                                                                        sector, OECD donor countries, foundations
 Goals
                              Malaria-related household expenditure is reduced from 2005       endemic country governments, multilateral development partners, NGOs, private   Board, SRN, WG
                              levels in lowest two quintiles, using “tracer” countries         sector, OECD donor countries, foundations

                              Malaria morbidity and mortality is reduced by 75% in             endemic country governments, multilateral development partners, NGOs, private   Board, SRN, WG
                              comparison with 2005                                             sector, OECD donor countries, foundations

                              Universal and equitable coverage with effective interventions    endemic country governments, multilateral development partners, NGOs, private   Board, SRN, WG, MMSS
                                                                                               sector, OECD donor countries, foundations

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global strategic plan
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2005 - 2015                                                                                                                                                                                                                into action




Table 1b: Global advocacy and finance
2005
 Priorities                       Milestones                                                 RBM constituencies, with lead in bold                                               Partnership mechanism, with lead in bold
 Achieve Abuja coverage           Global (upstream) subsidy in place for ACTs (see           OECD donor countries, foundations, multilateral development partners, operational   Board, CMWG, MIPWG, FWG, CWG, MMSS
 targets in Africa and increase   footnote 23)                                               research, endemic country governments, advocacy NGOs
 coverage elsewhere
                                  More ACT products pre-qualified (reduction in               private sector, WHO, OECD countries, endemic country governments, multilateral      Board, CMWG, MIPWG, CWG, MMSS
 System strengthening             monotherapies, increase in raw materials)                  development partners, foundations, NGOs

                                  LLIN manufactures develop viable business plans to         Private sector, endemic country governments, multilateral development partners      Board, FWG, MMSS
                                  attract venture capital

                                  Increase financial flows to country malaria control          OECD donor countries, multilateral development partners, endemic country            Board, CWG, FWG, SRN
                                  programs from all financing sources (including national     governments, foundations, private sector, NGOs
                                  budgets, global financing sources, e.g. GFATM, bilateral,
                                  multilateral, foundations, corporations)

                                  Enabling environment:                                      endemic country governments, OECD donor countries, multilateral development         Board, FWG, CWG, SRN
                                  reduction in taxes and tariffs                             partners, private sector

                                  Enabling environment: diversification of commodity          private sector, endemic country governments, OECD donor countries, multilateral     Board, CMWG, WIN, FWG, MMSS
                                  production (e.g. production of generics and LLINs in       development partners, foundations
                                  endemic countries)

                                  Emergency funding mechanism                                OECD donor countries, multilateral development partners, endemic country            Board, CWG, FWG
                                                                                             governments, foundations, private sector, NGOs




                                                                                                                                                                                                                                   33
                                                                                                                                                                                                                        global strategic plan
Putting the strategy
into action                                                                                                                                                                                                        2005 - 2015
2006 - 2010
 Priorities                       Milestones                                                    RBM constituencies, with lead in bold                                                   Partnership mechanism, with lead in bold
 Achieve, maintain and            Continue to increase and sustain adequate financial flows       OECD donor countries, multilateral development partners, endemic country                Board, CWG, FWG
 exceed agreed RBM targets        to global financing mechanisms for RBM (GFATM, bilateral,      governments, foundations, advocacy NGOs
 (as indicated in strategic       multilateral, foundations, corporations)
 approach)
                                  Increased investment in malaria research and                  OECD donor countries, multilateral development partners, foundations, private sector,   Board, CWG, FWG, WIN, CMWG, MIPWG, MMSS
                                  development, operational research (implementation)            research & academia, TDR, endemic country governments, advocacy NGOs

                                  Sustained annual global malaria spending of at least US$      OECD donor countries, multilateral development partners, endemic country                Board, CWG, FWG
                                  3 billion                                                     governments, foundations, advocacy NGOs

                                  Emergency funding mechanism                                   OECD donor countries, multilateral development partners, foundations, NGOs              Board, CWG, FWG




2011 - 2015
 Priorities                       Milestones                                                     RBM constituencies, with lead in bold                                                  Partnership mechanism, with lead in bold
 Achieve malaria-related          Medium- and long-term predictability of adequate funding       OECD donor countries, multilateral development partners, endemic country               Board, CWG, FWG
 Millennium Development           sources to allow stable five-year planning and budgeting to     governments, foundations, advocacy NGOs
 Goals                            occur




Table 1c: Research and development
2005
 Priorities                       Milestones                                                    RBM constituencies, with lead in bold                                                   Partnership mechanism, with lead in bold
 Achieve Abuja coverage           Global agenda for research, development and deployment        research & academia, multilateral development partners, endemic country                 Board, WG, MIM, TDR, MMV, MVI
 targets in Africa and increase   related to malaria                                            governments, private sector, OECD donor countries, foundations
 coverage elsewhere
                                  Shorten prequalification procedure for new LLIN technologies   private sector, WHO, OECD donor countries, endemic country governments                  Board, WIN, MMSS
 System strengthening
                                  Shorten prequalification procedure for new ACTs                private sector, WHO, OECD donor countries, endemic country governments                  Board, CMWG, MMSS

                                  Shorten prequalification procedure for new RDTs                private sector, WHO, OECD donor countries, endemic country governments                  Board, CMWG, MMSS




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global strategic plan
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2005 - 2015                                                                                                                                                                                                                into action




2006 - 2010
 Priorities                   Milestones                                                   RBM constituencies, with lead in bold                                            Partnership mechanism, with lead in bold
 Achieve, maintain and        Global agenda for research, development and deployment       research & academia, private sector, endemic country governments, multilateral   Board, SRN, WG, MIM, TDR, MMV, MVI
 exceed agreed RBM targets    related to malaria                                           development partners, OECD donor countries
 (as indicated in strategic
 approach)                    Alternative safe drugs for pregnancy                         research & academia, private sector, endemic country governments, multilateral   Board, SRN, CMWG, MIPWG, MMSS
                                                                                           development partners, OECD donor countries

                              Replacement products for ACTs                                research & academia, private sector, endemic country governments, multilateral   Board, SRN, CMWG, MIPWG, MMSS
                                                                                           development partners, OECD donor countries

                              Reliable RDTs                                                research & academia, private sector, endemic country governments, multilateral   Board, SRN, CMWG, MIPWG, MMSS
                                                                                           development partners, OECD donor countries

                              Novel Long-Lasting insecticide products                      research & academia, private sector, endemic country governments, multilateral   Board, SRN, WIN, MMSS
                                                                                           development partners, OECD donor countries

                              Novel insecticides for deployment through IRS                research & academia, private sector, endemic country governments, multilateral   Board, SRN, WIN, MMSS
                                                                                           development partners, OECD donor countries

                              New tools for detection and forecasting of epidemics         research & academia, private sector, endemic country governments, multilateral   Board, MERG, SRN
                                                                                           development partners, OECD donor countries

                              New tools for malaria interventions in complex emergencies   research & academia, private sector, NGOs, endemic country governments,          Board, CMWG, WIN, SRN, MMSS
                                                                                           multilateral development partners, OECD donor countries

                              Best practices for home management for ACTs identified &      endemic country governments, multilateral development partners, NGOs, private    SRN, CMWG, MIPWG, CWG, MERG
                              implemented                                                  sector, OECD donor countries, foundations

                              Improved understanding of best delivery mechanisms for       endemic country governments, multilateral development partners, NGOs, private    SRN, WIN, CMWG, MIPWG, MERG
                              ITNs & other commodities                                     sector

                              Development and testing of candidate vaccines                research & academia, private sector, endemic country governments, multilateral   Board, SRN, WIN, CMWG, MIPWG, MMSS
                                                                                           development partners, OECD donor countries

                              Vaccine candidate available for phase IV testing             private sector, research and acadamia                                            Board, SRN, WIN, CMWG, MIPWG, MMSS

                              R&D entities adopt and implement global research agenda      research & academia, private sector, endemic country governments, multilateral   Board, SRN, WIN, CMWG, MIPWG, MMSS
                                                                                           development partners, OECD donor countries




                                                                                                                                                                                                                                   35
                                                                                                                                                                                                            global strategic plan
Putting the strategy
into action                                                                                                                                                                                            2005 - 2015


2011 - 2015
 Priorities                Milestones                                                  RBM constituencies, with lead in bold                                                Partnership mechanism, with lead in bold
 Achieve malaria-related   New classes of safe and effective insecticides are widely   research & academia, private sector, multilateral development partners, OECD donor   Board, MMV, WIN, CMWG, MIPWG, MMSS
 Millennium Development    available                                                   countries, endemic country governments
 Goals
                           Local and regional research capacity expanded and used      endemic country governments, research & academia, private sector, multilateral       Board, SRN, WIN, CMWG, MIPWG, CWG
                                                                                       development partners, OECD donor countries, foundations, NGOs

                           Set of potential malaria vaccine candidates expanded        research & academia, private sector, multilateral development partners, OECD donor   Board, SRN, MVI, MIPWG, FWG, CWG, MMSS
                                                                                       countries, endemic country governments

                           Several vaccine candidates available for phase IV testing   private sector, research & academia                                                  Board, SRN, WIN, CMWG, MIPWG, MMSS




36
global strategic plan
2005 - 2015



                            Monitoring the


                        6
                            Global Strategic Plan
                            The RBM Partnership’s efforts to increase quality and accuracy of health management information
                            systems will be critical in assessing the progress of malaria control objectives. In addition, it will be
                            essential to strengthen sentinel systems in order to collect accurate data on malaria morbidity and
                            mortality.
                            The Partnership agreed to the following targets28:                                                By 2015:
                            By 2005, a significant increase in the number of vulnerable groups receiving                       • malaria morbidity and mortality are reduced by 75% in comparison with
                            recommended treatment and prevention measures, in accordance with the                               2005, not only by national aggregate but also particularly among the
                            Abuja targets.                                                                                      poorest groups across all affected countries;
                                                                                                                              • malaria-related MDGs are achieved, not only by national aggregate but
                            By 2010, particularly in the lowest two economic quintiles:                                         also among the poorest groups, across all affected countries;
                            • 80% of people at risk from malaria are protected, thanks to locally                             • universal and equitable coverage with effective interventions.
                              appropriate vector control methods such as insecticide-treated nets
                              (ITNs), indoor residual spraying (IRS) and other environmental and                              The RBM Global Strategic Plan will be monitored by using agreed indicators
                              biological measures;                                                                            and by ensuring adequate measurement and dissemination of the findings.
                            • 80% of malaria patients are diagnosed and treated with effective                                A core set of RBM indicators has been developed that monitor coverage and
                              antimalarial medicines, e.g. artemisinin-based combination therapy                              impact29. Tools such as Demographic and Health Surveys (DHS), Multiple
                              (ACT) within one day of the onset of illness;                                                   Indicator Cluster Surveys (MICS) and Malaria Indicator Surveys30 will be
                            • in areas where transmission is stable, 80% of pregnant women receive                            used as part of this process.
                              intermittent preventive treatment (IPT);
                            • malaria burden is reduced by 50% compared with 2000.


                            28 These targets are in line with the targets proposed by the Millennium Development Project. www.unmillenniumproject.org/documents/malaria-complete-lowres.pdf
                            29 Roll Back Malaria. Framework for monitoring progress & evaluating outcomes and impact. Geneva, World Health Organization, 2000

                              (WHO/CDS/RBM/2000.25; http://mosquito.who.int/cmc_upload/0/000/012/168/m_e_en.pdf).                                                                                    37
                                     global strategic plan
Monitoring the Global
Strategic Plan                      2005 - 2015




       "Increasing the quality of
       health information systems
       will be critical."
38
global strategic plan
                                                                                                                                                                                                                                                                  Monitoring the Global
2005 - 2015                                                                                                                                                                                                                                                              Strategic Plan


This strategic plan concentrates on reducing poverty by controlling                                 MDG indicators agreed for reporting to the United Nations Assembly are                              Table 2 summarizes RBM Partnership priorities for monitoring and evaluating
malaria in support of reaching universally agreed MDGs. The main focus                              shown on the United Nations Statistics Division database. If priorities                             the Global Strategic Plan for each of the three main time periods covered by
of the monitoring activities will be to track progress in the two lowest                            are addressed in an effective and timely way, this will document the                                the global strategic framework. The focus remains on the achievement of
socioeconomic groups. Such information is available thanks to the survey                            effectiveness of the RBM Partnership.                                                               objectives. Milestones reflect both global and national agendas.
methodologies mentioned above.




Table 2: Monitoring & evaluation
2005

  Priorities                            Milestones                                                                RBM constituencies, with lead in bold                                                                 Partnership mechanism, with lead in bold
  Achieve Abuja coverage                Bi-annual World malaria report                                            multilateral development partners, endemic country governments, NGOs, private                         MERG, Board, WIN, CMWG, MIPWG, CWG
  targets in Africa and                                                                                           sector
  increase coverage
  elsewhere                             Mid-decade United Nations report on RBM                                   multilateral development partners, endemic country governments, NGOs, private                         MERG, Board, WIN, CMWG, MIPWG, CWG
                                                                                                                  sector
  System strengthening
                                        Create tools/mechanisms to allow tracking of RBM                          multilateral development partners, research & academia, endemic country                               MERG, WIN, CMWG, MIPWG
                                        milestones and Abuja Plan of Action                                       governments, NGOs, private sector, OECD donor countries, foundations

                                        Coverage in lowest household income quintiles estimated                   multilateral development partners, endemic country governments, NGOs, private                         MERG, WIN, CMWG, MIPWG
                                                                                                                  sector, OECD donor countries, foundations

                                        Coverage estimated for interventions used in complex                      multilateral development partners, NGOs, endemic country governments, operational                     MERG, WIN, CMWG, MIPWG
                                        emergencies                                                               research, private sector, OECD donor countries, foundations

                                                                                                                  research and academia, endemic country governments, NGOs, private sector, OECD                        MERG, WIN, CMWG, MIPWG, FWG
                                        Tracking of household expenditures on malaria                             donor countries, foundations




30 Roll Back Malaria/MEASURE Evaluation / World Health Organization / UNICEF. Guidelines for core population coverage indicators for Roll Back Malaria: to be obtained from household surveys. Calverton, MEASURE Evaluation, 2004 (http://rollbackmalaria.org/partnership(wg/wg-monitoring/docs/

  GuidelinesForCorePopulationFINAL9-20_Malaria.pdf).



                                                                                                                                                                                                                                                                                                    39
                                                                                                                                                                                                      global strategic plan
Monitoring the
Global Strategic Plan                                                                                                                                                                            2005 - 2015

2006-2010
 Priorities                   Milestones                                             RBM constituencies, with lead in bold                                            Partnership mechanism, with lead in bold
 Achieve, maintain and        Sentinel systems for measuring malaria morbidity and   research and academia, endemic country governments, multilateral development     MERG, Board, SRN, WIN, CMWG, MIPWG
 exceed agreed RBM targets    mortality                                              partners, NGOs, private sector, OECD donor countries, foundations
 (as indicated in strategic
 approach)                    Tracking financial flows for malaria control             research and academia, OECD donor countries, multilateral development partners   FWG ,MERG

                                                                                     multilateral development partners, endemic country governments, NGOs, private
                              Abuja progress report                                  sector                                                                           MERG, Board, WIN, CMWG, MIPWG, CWG

                                                                                     multilateral development partners, endemic country governments, NGOs, private
                              MDG progress reports                                   sector                                                                           MERG, Board, WIN, CMWG, MIPWG, CWG

                                                                                     multilateral development partners, endemic country governments, NGOs, private
                              World malaria report every two years                   sector                                                                           MERG, Board, WIN, CMWG, MIPWG, CWG




2011-2015
 Priorities                   Milestones                                             RBM constituencies, with lead in bold                                            Partnership mechanism, with lead in bold
 Achieve malaria-related      End-decade MICS                                        multilateral development partners, operational research, endemic country         MERG, Board, WIN, CMWG, MIPWG, CWG
 Millennium Development                                                              governments, NGOs, private sector
 Goals
                              MDG progress reports                                   multilateral development partners, endemic country governments, NGOs, private    MERG, Board, WIN, CMWG, MIPWG, CWG
                                                                                     sector

                              World malaria report every two years                   multilateral development partners, endemic country governments, NGOs, private    MERG, Board, WIN, CMWG, MIPWG, CWG
                                                                                     sector




40
                                                                                                                                                                                                                                               Risk management




                                                      7
                                                                                           Risk management
                                                                                           Table 3 summarizes risk mitigation strategies that can aid the RBM Partnership in assessing and meeting
                                                                                           potential obstacles to fully and effectively implement the Global Strategic Plan.




Table 3: Principal risks and risk mitigation measures to implementing the Global Strategic Plan

 Principal Risks                                                                             Risk Mitigation Measures
 Major partners do not buy into the key elements of the plan                                 All RBM Partnership constituencies have had the opportunity to discuss and comment on the draft strategy

                                                                                             The RBM Partnership Board has reviewed the strategy before its finalization and approval

                                                                                             The RBM Partnership Secretariat will undertake strategic communication in support of the global strategic plan

                                                                                             The RBM Partnership Secretariat will ensure that all RBM Partners are supported in using their comparative advantage effectively in partnership mechanisms

 Inadequate financing to ensure intensive implementation of malaria control in the short      Continuous advocacy by the RBM Partnership Secretariat and all partners for resources to be directed to malaria control, with emphasis on achieving outcomes
 term
                                                                                             Advocacy will include examples of recent large-scale success around the world, as in Brazil, Eritrea, several states in India, and Vietnam

 Inadequate financing for the RBM Partnership Secretariat to fulfil its mandate in support     Development and execution of a resource mobilization plan by the Resource Mobilization Subcommittee of the RBM Partnership Board.
 of partners
                                                                                             Strong emphasis on the added value of the RBM Partnership Secretariat

 Shortages of commodities prevent effective implementation despite the availability of       Intensify efforts to stimulate the production and distribution of commodities for prevention and treatment of malaria, especially ITNs and ACTs
 funds

 The poor cannot afford to pay for commodities in many of the malaria-endemic countries      Advance discussions on a high-level global subsidy, as recommended in the Institute of Medicine Report entitled Saving lives, buying time: economics of malaria drugs in
                                                                                             an age of resistance (see footnote 23).

                                                                                             Implement and monitor pro-poor approaches to malaria control



                                                                                                                                                                                                                                                                        41
                                                                                                                                                                                                                                           global strategic plan
                                                                                                                                                                                                                                     2005 - 2015
Annex 1: Abuja Declaration                                                                 Development partners were called upon to cancel in full the debt of poor and heavily       Annex 2: Malaria-related Millennium Development
By signing the declaration, African heads of state rededicated themselves to the           indebted countries within Africa in order to release resources for poverty alleviation     Goals
principles and targets of the Harare Declaration of 1997. They committed themselves        programs such as RBM, and to allocate substantial new resources of at least US$ one        Eradicate Extreme Poverty (MDG 1)
to an intense effort to halve malaria mortality for Africa by 2010 by implementing         billion per year to RBM.                                                                   • Malaria keeps poor people poor, costing Africa US$ 12 billion per year in lost GDP
strategies and actions for Roll Back Malaria (RBM), as agreed at the summit.                                                                                                             and consuming up to 25% of household incomes and 40% of government health
                                                                                           Additional resources are also needed to stimulate the development of antimalarial             spending.
In addition, they agreed to:                                                               vaccines appropriate for Africa and to provide similar incentives for other antimalarial
• catalyze actions at regional level to ensure implementation, monitoring and              technologies. The collaboration between research institutions within Africa and partners   Achieve Universal Primary Education (MDG 2)
     management of RBM initiative actions at country level to provide resources to         throughout the world should be strengthened and sustained to ensure that research          • Malaria, a leading cause of illness and absenteeism in children and teachers, impairs
     facilitate achievement of RBM objectives;                                             knowledge and program experience is fully used.                                               attendance and learning and can cause lasting neurological and cognitive damage in
• work with partners towards stated targets, ensuring the allocation of necessary                                                                                                        children.
     resources from private and public sectors and from nongovernmental organizations;     The heads of state themselves pledged to:
     and                                                                                   • implement the agreed Plan of Action within their own countries;                          Reduce Child Mortality (MDG 4)
• create an enabling environment in their countries that will permit increased             • develop mechanisms to facilitate the provision of reliable information on malaria        • Malaria is the leading cause of child mortality in Africa, accounting for 20% of all
     participation of international partners involved in malaria control activities.          to decision-makers at household, community, district and national levels, enabling         child deaths.
                                                                                              them to take appropriate action;
The heads of state resolved to initiate appropriate and sustainable action to strengthen   • reduce or waive taxes and tariffs for mosquito nets and materials, insecticides,         Improve Maternal Health (MDG 5)
health systems to ensure that, by 2005:                                                       antimalarial drugs and other recommended goods and services needed for malaria          • Malaria is four times more likely to strike pregnant women than other adults, and
• at least 60% of those affected by malaria have rapid access to, and are able to             control strategies;                                                                        has life-threatening implications for both mother and child.
     correctly use, affordable and appropriate treatment within 24 hours of the onset of   • allocate the resources required for sustained implementation of RBM’s planned
     symptoms;                                                                                actions;                                                                                Combat HIV/AIDS, Malaria and Other Diseases (MDG 6)
• at least 60% of those at risk from malaria, particularly children under five years and    • increase support for research (including operational research) to develop a vaccine,     • Malaria control will reduce morbidity and mortality due not only to malaria but to
     pregnant women, benefit from the most suitable combination of protective personal         other new tools and improve existing ones;                                                 other diseases (e.g. people living with HIV/AIDS are at greater risk of contracting
     and community measures such as insecticide-treated nets and other accessible,         • commemorate this Summit by declaring 25 April “Africa Malaria Day” each year;               malaria).
     affordable interventions to prevent infection and suffering; and that                 • call upon the United Nations to declare 2001-2010 the decade for malaria; and
• at least 60% of all pregnant women at risk from malaria, especially those in their       • explore and develop traditional medicines in the area of malaria control.                Develop a Global Partnership for Development (MDG 8) and provide access to affordable
     first pregnancies, have access to chemoprophylaxis or intermittent preventive                                                                                                     and essential drugs.
     treatment.                                                                            The heads of state mandated the Government of Nigeria to report the outcome of this        • Malaria medicines are currently expensive and in short supply; the public-private
                                                                                           summit on Roll Back Malaria to the next Organization of African Unity (OAU) summit for        partnerships currently under way to improve access to affordable malaria drugs can
The heads of state called upon all countries to undertake and continue health system       follow-up action. In addition, they requested the Regional Committees of the African          serve as a basis for improving access to other essential medicines.
reforms that will promote community participation and joint ownership of RBM activities    and Eastern Mediterranean Region to follow up the implementation of this Declaration
to enhance their sustainability. Health systems should make diagnosis and treatment of     and regularly report to the OAU and seek collaboration with United Nations agencies
malaria available as peripherally as possible and accessible to the poorest groups. Home   and other partners.
treatment kits, in particular, should be made readily available. In addition, countries
must continue to maximize vigilance to prevent the re-emergence of malaria.


42
Malaria Transmission




                       Malaria endemicity
                             Very high
                             High           MARA
                                            Hay SI, Guerra CA, Snow RW. Determination of country populations at malaria risk of different endemicities: report on agreement to
                             Moderate       perform work (APW) for WHO/Roll Back Malaria. Oxford, Oxford University, Department of Zoology, TALA Research Group, August 2004
                             Low            (M50/370/19).

                             No malaria     (http://rbm.who.int/partnership/wg/wg_monitoring/docs/apw_report_oxford.pdf, accessed 5 April 2005).




                                                                                                                                                                             43
global
strategic
plan ROLL BACK
            MALARIA
  2005-2015




                              faire reculer le paludisme
                          hacer retroceder el paludismo
www.rollbackmalaria.org       fazer recuar o palludismo