fied on the basis of health grounds as well as economic considerations, and it encouraged control where eradication was not feasible (World Health Organization, 1969). The shift from malaria eradication to control necessitated a long-term commitment of personnel and financial resources and, unlike eradication, did not offer the potential for time-limited and dramatic results. Politicians were often reluctant to embrace the concept of control, which was not well understood.

The World Health Assembly also urged that malaria control strategies be integrated into the basic health services programs of each country. For some countries, where national malaria services had been run by a centralized organization and a single strategy, this proved to be particularly difficult. The result of this integration was a dramatic decrease in funding for malaria; money was shifted into programs for family planning, smallpox eradication, and multipurpose health services (Farid, 1980). By the early 1970s, changing priorities and responsibilities within the nations that had supported eradication caused a further erosion of support for malaria-related activities. The U.S. Agency for International Development (USAID), with the assistance of the PHS, contributed $375 million to 26 nations over a 20-year period (Howard, 1972). By 1974, the PHS had stopped funding eradication efforts in all but two countries, Nepal and Haiti (Smith, 1974). Similarly, UNICEF's contribution to eradication, which had risen to as much as $8.8 million in one year, began to be phased out by 1973 (Brown et al., 1976).

The combined withdrawal of international funding meant that the financial and technical responsibilities for malaria control would rest almost entirely within individual nations, many of which did not have adequate resources, technical expertise, or the administrative infrastructure to effectively carry out such programs. The situation was particularly serious for countries or regions that had made progress against malaria and for which a drop in technical and financial support would ultimately lead to a resurgence of the disease.

After the 1978 International Congress on Primary Health Care, the responsibility for malaria control in many countries was shifted further to those in the basic health services and to peripheral health workers. This integration was, for the most part, not smooth. Peripheral health workers were overburdened with other tasks and often lacked the technical competence to monitor and direct malaria control operations.

1970 to Present

As the international pool of funding for malaria eradication and control was drying up, a movement in the United States to halt the use of DDT was taking shape. In 1972, under pressure from environmental and conser-

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement