Description
Introduction
Over the past decades there have been remarkable reductions in the global number of malaria deaths. But malaria cases in Africa remains unchanged, and the 2030 target is not in sight. Many technologies have been tried. They have often shown promising results. However, their effects are difficult to trace, e.g., in the statistics of the World Malaria Reports.
Malaria will not disappear, be eliminated, or eradicated unless the number of cases comes down.
Malaria hits the hardest in populations that are left the furthest behind across the Sustainable Development Goals (SDG). While malaria is often dubbed a disease of poverty, multisectoral action is almost always selective – focused on providing or financing health sector inputs and services.
The Comprehensive Multisectoral Framework for Action – Malaria and Sustainable Development reveals a vicious cycle between lack of development and high levels of malaria. The analysis also shows that countries successful in reducing the number of malaria cases have also concurrently and comprehensively progressed across SDGs.
Objectives: To explore in real-life how the vicious cycle can be turned into a virtuous one.
Methodology
The design is exploratory real-life implementation research in uncharted territory. Over three years, four countries participate with each three districts where the vicious cycle grinds the hardest. Pathfinding, innovation, evaluation, and documentation is fostered through a structured interactive try, learn, and share process.
The theory is that setting free and stimulating governance and demand-side along three parallel pathways A) progress on the 17 SDGs in five groups; (B) climb five steps to become malaria-smart; and (C) take political, technical, and public accountability will amplify conventional development and malaria interventions and lead to lasting results.
Base lines are set, and participating districts identified through Pathfinder Impact and Investment Case Studies (PIICS). The PIICS comprise review of disaggregated SDG data, interviews and FDGs with key informants. The latter involve simulating effort and effect.
Results and discussion
The pathfinding is in early phase. Preliminary results show (1) frustration among national malaria programmes of not reaching elimination milestones, and realization of the intrinsic interrelationship with development; (2) resistance to change within the malaria community; (3) insufficient resources to fund technologies and fiercer competition among an increasing number of actors; (4) other sectors have difficulties seeing why they should engage and how – the technology focus makes them believe that malaria is a health sector issue; (5) increasing donor fatigue towards continuing funding dedicated malaria programmes without a plausible end in sight; and (6) omnipresent silo thinking, culture, systems and practice.
Comprehensive multisectoral action is necessary, complex, and must navigate all these challenges. If there is will there is way.
Conclusion
Those hardest hit agree that lasting results can only be achieved by inversing the vicious cycle between development and malaria; focus should be at the district level; it is uncharted territory; and we should dare to try.
Acknowledgement
The Pathfinder Endeavour is a partnership between UNDP, WHO, UNHabitat, RBM-Partnership to End Malaria, and ministries of local government and health in four countries.
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