World Bank Failed in Malaria Control Efforts, Experts Say

The World Bank has failed to fulfill its pledge to provide up to $500 million on malaria control activities worldwide, published false data to indicate successes in reducing malaria prevalence and wasted money on treatments that were known to be ineffective, according to an opinion piece written by a group of health experts published in the online edition of Lancet on Tuesday, the New York Times reports. The authors, led by Amir Attaran, an associate professor of population health at the University of Ottawa, recommend that the bank phase out its malaria control efforts and hand over management of funds for such projects to the Global Fund To Fight AIDS, Tuberculosis and Malaria. Bank officials acknowledge that the agency has had problems with its malaria control efforts in the past, but say it has made significant progress over the past year. Bank officials also deny publishing false reports or funding ineffective treatments (Dugger, New York Times, 4/25). The co-authors of the report include health experts from the University of Oxford, the London School of Hygiene and Tropical Medicine and the Prince Leopold Institute of Tropical Medicine in Antwerp, Belgium (Kirka, Associated Press, 4/24).

Pledges, Staffing
The World Bank in 1998 joined other international organizations in launching the Roll Back Malaria initiative, which aimed to help to cut deaths from the disease in half by 2010. The bank during a 2000 meeting of African leaders in Abuja, Nigeria, pledged to provide $300 million to $500 million to help African countries achieve the RBM goal. But between 2000 and 2005, the bank only committed $100 million to $150 million for malaria control in earmarked funding and an unspecified amount in nonearmarked funding, according to the bank's April 2005 accounting records. How much the bank actually spent on malaria control programs is unknown because the bank does not make its accounting details public, according to the authors (Attaran et al., Lancet, 4/25). "The most disturbing fact, however, is that the bank actually does not know, and at best guesses, how much money it spends or loans for malaria" the authors write (The Monitor/AllAfrica.com, 4/24). In addition, the authors say that by 2002 the bank had no staff members working on malaria control efforts, compared with seven staff members when RBM was launched (New York Times, 4/25). Although the bank recognized its failures and in 2005 reinvigorated its malaria control efforts with a new program -- the Global Strategy and Booster Program -- it is "inadequate to reverse the bank's troubling history of neglect for malaria," the authors write (Boseley, Guardian, 4/25).

False reports, Ineffective Treatment
The bank spent roughly $1.8 million to purchase more than 100 million tablets of chloroquine to treat malaria in India, even though the World Health Organization said the malaria parasite had become resistant to the drug, according to the authors (New York Times, 4/25). "Had a doctor or pharmacist behaved as the bank did, the person would be condemned and possibly sued for medical malpractice," the authors write (Lancet, 4/25). In addition, the bank said its programs helped reduce malaria prevalence in Brazil by 60% between 1989 and 1996. However, Attaran and colleagues say malaria prevalence declined by only 23%. The authors call on the bank to undergo an independent review of its past actions. According to the authors, the bank is "unfit for any operational role whatsoever in malaria control" (Guardian, 4/25). They add that the bank should allocate $1 billion to other agencies, particularly the Global Fund, to take up that role (Laurance, Independent, 4/25).

World Bank Response to Funding, Staffing Shortages
In an online Lancet opinion piece published on Tuesday, bank officials say that in the past "overall efforts by the bank in malaria control were understaffed and underfunded," but the bank did not conceal or renege on its pledges (Sarbib et al., Lancet, 4/25). According to World Bank Vice President Jean-Louis Sarbib and colleagues, the bank provides funding to governments at a national level, which makes it almost impossible to track how the money is spent (Guardian, 4/25). "[I]t is not easy, and sometimes not even possible, to know exactly how much input from a specific donor went to a specific activity, be it malaria control or any other disease control effort," the authors write (Lancet, 4/25). Suprotik Basu, a World Bank public health specialist in the Africa region, acknowledged that when many staff members working on malaria control left because they felt a lack of commitment from the bank, they were not replaced (New York Times, 4/25). However, the bank now has more than 40 staff members working on malaria control, Basu said. "We've managed in a year's time to turn around a relatively large ship," Basu said, adding, "The bank is beginning to live up to what it could do for malaria fighting in Africa" (Associated Press, 4/25).

Response to Ineffective Treatment, Recommendations
The bank said it funded the use of the relatively inexpensive chloroquine to treat malaria in India because the malaria parasite primarily found in the country was not resistant to the drug. "On the basis of available information, India stood to get good value for money by spending scarce resources wisely in accordance with local realities," the bank's officials write (New York Times, 4/25). They also dismissed the recommendation that the bank open itself to an independent investigation (Associated Press, 4/24). In addition, they said the Global Fund does not have enough staff members in Africa to monitor funding, while the bank does (New York Times, 4/25). Basu said that developing countries want the World Bank to remain involved in global malaria control efforts (Reaney, Reuters, 4/24). Bank officials on Monday said the agency has recently approved $62 million in funding through its Booster program, which will be directed toward the Democratic Republic of the Congo, Eritrea, Niger and Zambia. An additional $130 million allocated for projects in Benin, Burkina Faso, Ethiopia and other countries is expected to be released by June (Dell'Amore, United Press International, 4/24).