I was glad to read of a new $110 million initiative for insecticide-treated bednet distribution, which we find one of the better-established ways to spend money to improve lives.

But what does this mean for you if you’ve been giving to a malaria charity? Do independent bednet distributions now run the risk of being redundant with the new one? Has USAID provided enough funding that your donation is no longer as needed?

Unfortunately, we have no way of answering this question. While there are some attempts to coordinate government aid, we know of no one asking questions like “How much total room is there for funding distribution of bednets? How can we make sure that all the malaria organizations are on the same page? How can we track the extent to which individual donations are still needed?”

If donors focused on how to have real impact (as opposed to, say, fictions about where “their” money goes), such a question would be extremely important to them.

Aid Watch on questionable claims of success against malaria:

Real victories against malaria would be great, but false victories can mislead and distract critical malaria efforts. Alas, Mr. and Mrs. Gates are repeating numbers that have already been discredited. This story of irresponsible claims goes back to a big New York Times headline on February 1, 2008: “Nets and New Drug Make Inroads Against Malaria,” which quoted Dr. Arata Kochi, chief of malaria for the WHO, as reporting 50-60 percent reductions in deaths of children in Zambia, Ethiopia, and Rwanda, and so celebrated the victories of the anti-malaria campaign. Alas, Dr. Kochi had rushed to the press a dubious report. The report was never finalized by WHO, it promptly disappeared, and its specific claims were contradicted by WHO’s own September 2008 World Malaria Report, by which time Dr. Kochi was no longer WHO chief of malaria.

Video with the Gateses available here.

The Disease Control Priorities Report says:

The recommended treatments for malaria in areas with resistance to single drugs are combination treatments, preferably artemisinin combination therapy (ACT) (WHO 2001a, 2001b, 2003a, 2005).

But, knowing that your charity of choice runs this program is not sufficient to know that they’re improving lives. Bill Brieger at Malaria Matters points to this article in the WSJ which says:

Cures for malaria are largely designed for adults; the pills are often bitter and too big to swallow for children, who account for most of the more than one million people killed each year by the mosquito-borne disease, malaria experts say.

Bill Brieger adds:

Three challenges that are not mentioned in the article include -

• For one, when drugs are made available for free or at reduced cost only for children, there will be leakage into wider use as health workers or medicine shop keepers will provide multiple packets of the child drugs to satisfy their adult clients/customers.
• A second unmentioned challenge is the tendency to overprescribe malaria drugs, especially among adults. The answer to this is case management that includes diagnosis using a laboratory, but more likely rapid diagnostic tests, which can be used at the primary care level.
• Finally there is the issue of compliance. Artemisinin-based combination therapy generally is taken twice a day for three days. If medicine providers do not counsel clients on the need for full compliance children may swallow only a few doses and not only fail to be cured but also contribute to drug resistance.

Malaria case management is a complicated process that begins with the drug manufacturer and ends in the home. All partners along the way must be [vigilant] if children’s lives are to be saved.