Living with malaria?

Sonia Shah continues her terrific malaria journalism with this piece on elimination. She successfully and succinctly drives home the equity argument (previously discussed here):

When public health leaders want to control a disease, they devote the majority of their resources to the areas of greatest need. When their goal is eradication, they must spend their resources on areas where eradication is most likely — the areas with the least need.

If eradication campaigns fail, resources and political capital will have been lavished on the lowest priority areas with the lightest burdens.

Well said. On the other hand, we must also support strength. Good national malaria control programs on the cusp of a sustainable end should be rewarded. How do we best balance this tension?


2 Responses to “Living with malaria?”

  1. 1 Pavak October 12, 2010 at 7:00 am

    I think the challenge here is in classifying success- is a program making tremendous gains because of excellent execution and creative thinking or has a drought wiped out most of the mosquito population in a region. Should a distinction be made even between the two scenarios in terms of the allocation of addition resources? Is a program stagnating because it’s underfunded, understaffed but incredibly well run in the face of a terrible epidemic?

    That sort of complexity in definition has led to great inequalities in the education space, for example, and policies based on the idea generally run the risk of being driven by externalities rather than programmatic successes or faults.

  2. 2 naman October 12, 2010 at 11:49 am

    Great thoughts Pavak. That complexity is why decentralized (read: national for most places) planning and allocation for malaria is our best long-term bet. Grant-based mechanisms of international support such as the Global Fund, in spite of their necessary political limitations, have the potential to make such distinctions in program applications.

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