27 February 2017
This blog was the result of my preparing for the recent RBM meeting in Geneva. I hope it will be useful for any of you on National Malaria Contol Programs. It is about the need for:
Formation of National Inter-Ministerial Boards for Malaria Control
Extensive malaria control projects using Larval Source Management - such as improved irrigation and drainage systems - often need large capital investments and thus borrowing from international banks. However Ministries of Health are not accustomed to borrow for such capital projects because they don’t usually have sources of revenue to pay back the loans. In contrast, other Ministries which also manage water such as the Ministries of Agriculture, Hydroelectric Power and Water Resources usually fund most of their projects by borrowing. They can repay loans because they have sources of revenue such as the sale of cash crops, food crops, electricity and water.
For this and other practical reasons, it would be valuable for Directors of National Malaria Control Programs to ask the Minister of Health take the lead in forming an Inter-Ministerial Board for Malaria Control which can borrow for capital portions of integrated projects for Larval Source Management. The Minister would have to ask the national leader (President or Prime Minister) to establish an Inter-Ministerial Board for Malaria Control and get cooperation from the other Ministers. This is one of the primary measures recommended for inter-ministerial approaches to control of water-associated diseases such as malaria (Gaddal 1985, PEEM 1994, Jobin 1999).
For instance, if a large swampy area needs to be drained, the Ministry of Health might be able to employ men with shovels who could dig the field drains. But the field drains must carry the water to a low place where large drainage pumps can be used to pump the water to a nearby river, or back to irrigation supply canals. These pumps and related pipe systems could be funded under a loan which the Inter-Ministry Board could request.
Suppression of malaria in agricultural zones of Africa has been shown to boost agricultural productivity significantly, providing a source of increased income for loan repayment (Jobin 2014a, 2014 b).
A good example of this kind of cooperative drainage project which benefitted several ministries can be seen in the history of reclamation of the historic Pontine Marshes of Italy, southwest of Rome. Although a classical source of malaria and the focus of extensive rural poverty in Italy, when these marshes were surrounded by dikes in 1930, there was a major change in the picture. Ditches were dug by an army of men with shovels, and pumps were installed to lift the water up over the dikes into the sea. The former marshes then became the most productive agricultural area in Italy. They still are, half a century later. In the process, anopheline mosquito breeding was eliminated, marking the beginning of the Italian campaign to eliminate malaria which finally succeeded in 1962. Thus the project benefitted the Ministry of Health, the Ministry of Agriculture, and in this case the Ministry of Rural Housing because villages were established for poor Italian paisanos to inhabit and farm the reclaimed marsh (Snowden 2006).
Gaddal et al, 1985, “The Blue Nile Health Project: a comprehensive approach to the prevention and control of water-associated diseases in irrigated schemes of the Sudan.” el Gaddal AA. J Trop Med Hyg. 1985 Apr;88(2):47-56.
PEEM 1994 – Annual Reports of the Panel of Environmental Experts for Management of Vector Control (PEEM), Robert Bos, WHO Geneva, 1981-1994.
Jobin 1999, “Dams and Disease – Ecological design and health impacts of large dams, canals and irrigation systems.” Taylor and Francis publishers, London.
Frank M. Snowden 2006, “The Conquest of Malaria: Italy, 1900–1962”(New Haven Press).
Jobin WR 2014a “Increased economic productivity after suppressing malaria
transmission in 14 African countries” African Policy Journal, v9 Apr.
Jobin WR 2014b “ Suppression of malaria transmission and increase in economic productivity in African countries from 2007 to 2011” Malaria World Journal; 5(4).