Malaria was a top priority of Dr. Gro Harlem Brundtland when she assumed the leadership of WHO in 1998, convinced by African leaders that malaria was a heavy burden on the health and economies of many countries. The Global RBM Partnership was created to “reduce the burden of malaria throughout the world.” It was developed not as a WHO program, but as a loose confederation of endemic country governments, other UN organizations, bilateral aid donors, foundations, NGOs, community groups, research and teaching institutions, and others—all the relevant parties in malaria control. A small Secretariat within WHO was to serve the needs of RBM, with leadership drawn from the external partners. Although not without problems, RBM is the most significant development in consolidating worldwide efforts to control malaria since the end of the era of malaria “eradication” in the 1960s (which largely bypassed Africa).
The African summit on Roll Back Malaria, held in Abuja, Nigeria in April 2000 is an RBM milestone. The summit was attended by delegates from 44 of the 50 malaria endemic countries in Africa, including 19 heads of state and many other high-level officials of member countries. Top-level representation from WHO, the World Bank, the African Development Bank, and several other major donors helped to further raise the profile of the meeting and underscore the importance of tackling the malaria problem. Hundreds of millions of dollars in assistance were pledged (although most did not materialize). Ambitious, but potentially achievable targets for the year 2005 were adopted by the summit participants (Table 1-4).
In early 2002, several of the “core” RBM partners commissioned an evaluation of the organization and its progress by a seven-member team of experts, led by Richard Feachem (who shortly thereafter was named head of the Global Fund for AIDS, TB and Malaria). The evaluation, published in August 2002 (Feachem, 2002), documented both achievements and “serious constraints” that threaten progress in phase 2, defined as mid-2002 to 2007.
The accomplishments include raising the profile of malaria and increasing global funding—funding for malaria control doubled in RBM’s first 3 years. The constraints centered on a lack of progress in getting activities under way quickly at the country level. RBM may not be able to achieve a “significant reduction in the global burden of malaria by 2007” given the pace of progress, which could undermine the partnership if not rectified.
Three major reforms and two tactical changes were recommended: