Global Health Policy
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June 08, 2006
President's Malaria Initiative: PEPFAR Phase II?
Posted by Myra Sessions at 04:17 PM
This morning, First Lady Laura Bush hosted a press conference to discuss the successes and next steps for the President’s Malaria Initiative (PMI). According to the USAID press release, the malaria initiative is a $1.2 billion, five-year effort that was launched last year in three countries (Angola, Tanzania and Uganda) and will soon be expanded to include four more: Malawi, Mozambique, Rwanda and Senegal. The grand mission of the initiative is to reduce malaria deaths in these countries by 85 percent.
Clearly modeled after the President’s other flagship initiative - PEPFAR - the PMI operates on many of the same basic principles including concentrating resources in a few countries to achieve significant and measurable results. However, this program replication is happening without a clear understanding of how well the model is working. PEPFAR clearly has achieved results, but is it an efficient use of resources? How does this model, including funding levels, results and impact, compare with other health financing programs? Is this the right future direction for foreign aid?
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Comments
This 85% target is very interesting. I am told it affected the selection of countries, skewing them towards countries with pre-existing strong anti-malaria programs because it will be easier to get them to 85%. Should PMI be working in the countries where it is most likely to reach its target, or should it focus resources in underserved or poor performing countries in an effort to really make a difference?
Posted by: Celina Schocken at June 8, 2006 04:33 PM
A USAID fact sheet lists four main areas of activity: insecticides, bednets, artemisinin combination therapies, and preventative treatment during pregnancy. Concerning drugs specifically:
PMI activities include purchasing ACT drugs; setting up management and logistics systems for their distribution through the public and private sectors; and training health care workers and community caregivers in their use.I would be very interested to know how they are integrating that work with existing global health efforts, or even existing U.S. activities under PEPFAR.
Posted by: Jessica Wolf at June 8, 2006 04:52 PM
Even if PMI chooses countries with existing anti-malaria programs, an 85% drop that can be attributed to PMI is still an 85% drop: starting in countries with some existing infrastructure to work with can be a good call to learn good practices to apply when they get to the most poorly performing countries.
Posted by: David Evans at June 8, 2006 07:22 PM
Going from 75 to 85%, or 80 to 85% might not be very difficult though. If the country program already has strong infrastructure and a solid team, what is PMI really adding? What will that teach us about how to fix poorly performing country programs?
I also have to question how much of this really should be attributable to PMI. Jumping on board a winning program, which everyone knows is a winner, shouldn't earn as many kudos as trying to improve a poor performer.
Posted by: Celina Schocken at June 9, 2006 11:03 AM