Malaria Landscape 2007 Executive Director's Report to the 13 th Board Meeting

INTRODUCTION This Landscape Report will assess: –Where we are today; –Where we want to go moving forward; and –What we need to do to get there.

OUTLINE Antimalarial Commodities: –ACTs & LLINs: Translating Distribution and Coverage into Usage –IRS & IPT –Taxes & Tariffs Global Impact: –Expanding Partnership Base –Key Advocacy Events in 2007 Country Success: –Measuring & Sustaining Impact –Country Examples –Integrated Mass Distribution Campaigns Resource Mobilization: –Tapping Existing & Additional Source Next Steps & Challenges Ahead Momentum has been gained across each area But old as well as new challenges remain

ANTIMALARIAL COMMODITIES ACTs POLICY SHIFT ACT Recommended First Line Treatment of uncomplicated malaria 10% In 2003, only 10% of countries recommended ACTs Today, 93%, or almost ALL do ACT recommended Other antimalarials recommended (CQ, SP) Non-malaria endemic area By 2006, that number had jumped to 79%

Antimalarial Commodities II ACTs  PROCUREMENT:  PROCUREMENT: Significant growth since 2003 and over the past year in the procurement of ACTs  USAGE:  USAGE: is still low as a result of:  High prices  Health System particularly distribution challenges  Training, information and education issues  Lack of information about availability and use  CHALLENGES:  Monotherapies  Counterfeits  Penetration of ACTs in the private sector Source: RBM Database, UNICEF, WHO Source: UNICEF & RBM, Malaria & Children, 2007

Antimalarial Commodities III LLINs GROWTH:GROWTH: Procurement of insecticide treated nets has grown exponentially since 2003 USAGE:USAGE: However, distribution is not always indicative of usage  Coverage and usage have been growing since 2000, but the most recent data suggests large increases, particularly , taking into account, for example, Ethiopia  This is attributable to intense nationwide LLIN distribution campaigns  Appropriate emphasis must be placed on replacement policies and behavioural change communication to translate coverage into usage Source: ( ) UNICEF Africa Malaria Report 2003, UNICEF & RBM, Children & Malaria 2007, (2007 Projections) Global Fund Round 7 Proposals Source: RBM Database, UNICEF, WHO

INDOOR RESIDUAL SPRAYING (IRS) As recently as 2003, only 12 countries (29%) in Africa implemented IRS, mainly to prevent and control epidemic malaria In 2007, 25 out of the 42 (60%) malaria endemic countries in WHO / AFRO have included IRS in their national strategy for malaria control In the malaria season a total of 5 million units/structures were sprayed, protecting 21 million people Challenges remain: Shortage and inconsistent financing Routine Spraying No IRS Pilot spraying or plans to pilot Non-AFRO Source: WHO/AFRO, Implementation of Indoor Residual Spraying of Insecticides for Malaria Control in the WHO African Region, October 2007.

INTERMITTENT PREVENTIVE TREATMENT (IPT) POLICY SHIFT 2005 From the WHO/UNICEF World Malaria Report From the RBM/UNICEF Malaria & Children 2007 IPT recommended IPT NOT recommended Non-malaria endemic area No data 50% About 50% recommending IPT ALL Now almost ALL do

Malaria No More VOICES Foundation for Innovative New Diagnostics Global Business Council UNITAID Islamic Development Bank Global Impact Expanding Partnership Base  Alignment & Harmonization of all partners is key to the success of all of our work – other global health partnerships are trying to achieve the same thing Innovative Vector Control Consortium UK Coalition Against Malaria International Health Partnership

KEY ADVOCACY EFFORTS & EVENTS IN 2007 G8 Summit Africa Malaria Day GF Replenishment Targeted Advocacy Reports Released in 2007 MalariaChampions Leadership Summit US Congress Malaria Coalitions

Country Success Evidence for impact is growing in, for example, Eritrea, Namibia, Swaziland, Zambia, and Zanzibar Success is often a result of a combination of factors: –Strong commitment from national government; –Multiple interventions (LLIN, IRS, IPT, et al.) implemented simultaneously; –Free nationwide LLIN distribution campaigns; –Partnership –Additional resources from donors; –Timely data collection to document impact.

Country Success Eritrea Source: East and Southern Africa Annual Malaria Review and Planning Conference, Conference Report, August 2006.

Country Success Namibia & Zambia Namibia Out-Patient Department Malaria Cases ( ) Zambia: Trends in Malaria Deaths ( ) Source: East and Southern Africa Annual Malaria Review and Planning Conference, Conference Report, August Source: HMIS, found in Dr E Chizema Kawesha & Dr F Masaninga, Business Plan Process and Achievements - Zambia Experience, National Malaria Control Programme.

Country Success - Zanzibar Source: Ministry of Health and Social Welfare, Zanzibar Malaria Control Programme, Overview of Malaria Situation in Zanzibar, presentation, 19 July 2006.

Country Success - Swaziland Source: East and Southern Africa Annual Malaria Review and Planning Conference, Conference Report, August 2006.

Resource Mobilization: Existing USD 1 billionAlmost USD 1 billion was available for Endemic Countries in Africa in 2007 USD 2-3 billionSignificant increase but Some sources estimate at least USD 2-3 billion is required annually for malaria control USD 7 billionMore recent estimates place the figure closer to USD 7 billion per annum not enough is going to SUFIOf the 1 billion available in 2007, not enough is going to SUFI one-third of countriesAbout one-third of countries applying to the GF Round 7 were planning for SUFI Source: Global Fund Disbursement Reports, Round 6 & 7 Global Fund Proposals

Resource Mobilization: Additional Round 7 Achievements:  Successful malaria proposals gained:  >USD 450 million for Phase I  >USD 1 billion for the entire 5 years Harmonization Working Group  Support from the Harmonization Working Group greatly improved a country's chances of succeeding Source: Global Fund % positiveTRP-TRP +Type of support HWG intensive support package* Limited or no support Total for Africa

Next Steps & Challenges Ahead: Secure more resources from more sources, including national funding Expand SUFI planning and operations to all 45 Malaria Endemic Countries in Africa The Challenge of Large Countries Move towards or maintain outstanding performance scorecards Build upon and bring the success of Round 7 to Round 8 Coordinated support and action: One Global Malaria Business Plan Verified data sources: Malaria Indicator Surveys