tions to malaria research and control is further compounded by the variability in the quality and accuracy of the data that are available. Even if accurate data were widely and easily available, they would likely fail to answer three critical questions: Was the amount spent insufficient, sufficient, or excessive? Was it spent well? Did it have an effect?
For all of the reasons discussed above, the committee decided that the danger of presenting somewhat erratic information outweighed any possible benefit. Because the data were easier to obtain and verify, and because U.S. government funding of malaria activities was of particular interest to the committee, the limited discussion that follows focuses on U.S. government funding of malaria.
Four U.S. government agencies fund malaria activities: USAID, the Centers for Disease Control (CDC), the Department of Defense (DOD), and the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH).
Established in 1961 within the Department of State, USAID is the foreign assistance arm of the U.S. government. Highly decentralized, the various USAID offices and regional bureaus involved in malaria projects around the globe include the Office of Health in the Bureau of Science and Technology, and the Health, Nutrition, and Population Offices in the four regional bureaus for Africa, Asia, Latin America and the Caribbean, and the Near East. In addition to the bureaus, USAID has overseas “missions,” each supervised by a mission director, the U.S. country ambassador, and, in Washington, the respective regional bureau. Malaria projects are supported from one or more funding accounts, including the Health Account, Child Survival Fund, the Development Fund for Africa, the Economic Support Fund, Population Account, and the Agriculture, Rural Development, and Nutrition Account. In addition, USAID relies on an estimated 10,000 nongovernmental organizations, consultants, and contractors worldwide to help implement all of its projects.
In fiscal year (FY) 1989, USAID allocated $421 million to health, child survival, and AIDS activities, of which nearly $22 million (5.2 percent) was obligated to malaria research and control. This is fairly consistent with the pattern for each of the last seven fiscal years, during which the agency has allocated between 5 and 7 percent of its health budget to malaria-related activities (Table 3-1).
From 1985 through 1989, a little more than half of USAID malaria funds