According to a report, published on December 4th, 2019 by the World Health Organization,  there were 228 million cases of malaria in 2018, which resulted in 400,000 deaths. Most victims were young children in Africa. That is a far cry from targets set in 2015 for the near-elimination of malaria by 2030.  These targets depended on a $6 billion a year being poured into malaria-control efforts. Funding in recent years, however, has been about $3 billion a year. More money would surely help. But substantial gains can be made by doing things more efficiently—something at which malaria programmes have been dismal.

Stopping malaria relies on three things: insecticide-treated bed nets to prevent nocturnal mosquito bites; the spraying of homes with insecticides; and the treating of pregnant women and children with rounds of preventive medication. These are all “imperfect tools, often used imperfectly”, says Pedro Alonso, head of the malaria programme at the World Health Organisation. Countries usually deploy the same package of measures everywhere, even though infection rates and their seasonal patterns vary a lot between regions, and particularly between cities and the countryside. Transmission reaches a peak in the rainy season, when mosquitoes are abundant, so preventive mass-treatment of children then can make a huge difference. Regional variations are particularly pronounced in large countries like Nigeria—a place that, by itself, accounts for a quarter of the world’s malaria cases.

The typical approach of a malaria-control programme is to bombard a country with bed nets and then use whatever cash remains for sporadic rounds of preventive medication. But in many big cities, such as Dar es Salaam and Nairobi, cases are few and far between, so deploying nets there is a waste. Overspending on nets at the expense of other things happens partly because nets are easy to count—a feature that aid programmes are particularly fond of. Results which cannot be attributed directly to money a donor spends tend to fall further down that donor’s list of priorities. This kind of reasoning tips the scales, because foreign aid accounts for two-thirds of the money spent on malaria.

Excerpts from Tropical disease: Malaria infections have stopped falling, Economist, Dec. 7, 2019