Strengthening health systems in rural Africa: towards a pro-poor strategy to reach Abuja targets and millennium development goals
The Roll Back Malaria initiative (RBM) was launched in 1998, and was endorsed by African heads of state at the Abuja summit in 2000, with the goal of halving malaria deaths by the year 2010. At its inception, RBM recognised that its aims could only be achieved by strengthening the weak health systems that prevail in most malaria endemic countries, in order to improve access of poor people to essential medication, vital health care and preventive measures. It has been argued that the effectiveness of programmes to tackle malaria and in particular to deliver insecticide treated nets (ITNs) could be improved by linking them to vertical campaigns used to deliver other disease specific interventions e.g. lymphatic filariasis elimination, measles vaccination. We raise a number of concerns with campaign-style delivery of malaria control interventions, most importantly that it fails to address and risks detracting from the critical need to provide adequate resources to strengthen and support health delivery systems in Africa. We argue that resources directed towards malaria must be used to maximum effect - both to reduce the burden of malaria and strengthen public and private health systems in general. In addition, there is a need for well evaluated large (national) scale programmes which trial alternative approaches to delivering ITN subsidies, such as vouchers, subsidised goods and other innovative approaches. The article concludes that targeting subsidies on ITNs to those who really need them and concentrating untargeted subsidies towards insecticide treatment serves to improve both equity and efficiency. Funding Artemisinin based combination therapy and strengthening the health systems needed to deliver these and other life saving drugs is also of critical importance in the fight to roll back malaria.
British Medical Journal 2004;328(7448):1229-1132