I have been involved with analysis of malaria control performance for a number of years. A lot of money has been disbursed, but relatively small progress has been achieved ... and very little that is sustainable. I saw the webpage below on malaria, and commented as follows:

Dear Colleagues
Part of the problem with malaria control is that much of the available money is very badly used. Some of the money is completely wasted or misappropriated and some of the problem is that the approach is convenient and easy rather then being cost effective and sustainable. Several billions dollars has been wasted ... with very little accounting and accountability
Peter Burgess
@truevaluemetric www.truevaluemetrics.org

Malaria

Malaria, a preventable and curable disease, is the fifth leading cause of death worldwide and poses a significant threat to both health and economic progress in Africa and throughout the developing world.

What is the problem?

Malaria is caused by a parasite spread to humans through the bite of infected mosquitoes. If let untreated, it can cause severe complications and death. Malaria is prevalent in tropical and subtropical regions that receive significant amounts of rainfall and maintain warm temperatures year-round. Worldwide, malaria kills between 700,000 and 1,000,000 people every year.

In the 1640s, Europeans used bark from the cinchona tree containing quinine to treat malaria, and in 1820 quinine was first extracted and isolated as an antimalarial drug. In the 20th century, cloroquine and artemisinins were also discovered to be effective at combatting malaria. However despite almost 400 years of innovation and scientific discovery in antimalarial medication, every 45 seconds a child in Africa will die from malaria.

Who is affected by malaria?

Malaria is a serious problem in parts of South America, Southeast Asia, and Africa. In Sub-Saharan Africa, the most common mosquito is an incredibly effective carrier of malaria. Pregnant women and children are the biggest groups targeted; 90 percent of annual deaths from malaria occur in Africa, and 70 percent of deaths occurring in children under 5. With 50 percent of the world's population at risk for infection, an estimate $12,000,000,000 is spent per year on costs related to malaria such as medicine, hospital visits, and funeral costs.

Why has malaria only been eradicated in parts of the world?

In the United States, malaria has been eradicated since the 1950s. Barriers preventing eradication in areas with high infection, like Africa, include political instability, extreme poverty, and adoption of anti-malaria strategies.

Poverty: Many citizens living in areas with high risk of infection are unable to afford medication. In countries where families may live on less than $2 a day, even the seemingly negligible cost of $5 for a mosquito net that will save lives is difficult to afford. Anti-malaria medication may cost even more than nets. While medication is often free of charge in public health clinics, estimates indicate that 60% of malaria patients in Sub-Saharan Africa buy their medication from the private sector. Patients may be unable to take the work off necessary to travel to a health clinic, especially if they live in isolated, rural areas. Even if patients are able to receive treatment, 65% of malaria cases are treated without a diagnostic test, paving way for drug resistance.

Adoption and use of mosquito nets: Actual adoption and use of mosquito nets is a barrier often faced by aid organizations. Data shows that nearly half of Africans who have access to nets refuse to sleep under them. This may be partly due to the limits of the ventilation provided by the nets, which is a challenge in the hot and humid environments where malaria thrives. Aid groups debate the most effective ways to distribute nets and ensure their appropriate use.

Political Instability: In countries plagued by war and political turmoil, ruling parties may be resistant to receiving foreign aid, even if that aid comes in the form of mosquito nets or antimalarial drugs. While key prevention techniques, such as sleeping under mosquito nets treated with pesticide, and treatment options are well known, areas with political instability are often unable to successfully implement strategies to curb malaria infection.

While The World Health Organization estimates an increase from $1.5 billion to $1.8 billion in international funding for malaria control between 2009 and 2010, this number still falls short of the $6 billion needed for worldwide malaria control.

How is the problem being addressed?

Three components are needed for successful malarial prevention and treatment:

* __ Affordable malaria medication: Many organizations are working with drug companies in the private sector to provide affordable malarial medication for developing countries. In countries where malaria can account for up to 40 percent of all public health expenditures, the need for a reliable and affordable source of medication is great.
* __ Insecticide-treated nets (ITNs): ITNs have proven to be the most cost effective method of malaria prevention. Nets that emit insecticide are placed around beds to protect sleeping families. New technologies are emerging to create long lasting insecticide-treated nets (LLINs) that will emit insecticide for up to five years. In mid-2010, the World Health Organization estimated 40 percent of families in Africa owned at least one ITN.
* __ Affordable diagnostic tests: Distribution of cheap and reliable diagnostic tests could increase scientists' ability to track different strains of malaria. Diagnostic tests can help reduce drug-resistance by determining the best course of treatment for individual patients.