Breaking the Bottlenecks to Fighting Malaria in Africa



In Koraro, Ethiopia, bed nets provided through the Millennium Villages Project aim to reduce the incidence of malaria, which kills 3 million people annually, mostly pregnant women and children.

Photo credit: CNHDE/Sesen

Imagine drawing up the blueprints to save millions of lives, yet without the means or the currency to make those plans a reality. This is a fundamental problem faced by many countries ravaged by malaria, which kills an estimated 3 million annually.

Countries are formulating robust and achievable plans to effectively prevent and treat malaria, but are forced to wait for life-prolonging medicines and other key health commodities to arrive and be distributed. Despite comprehensive national malaria control plans, a complex process of fund transfers, tenders and approvals and a shortage of key anti-malarial commodities can lead to delays of months or years long.

"Without question, these bottlenecks are the biggest challenge in fighting malaria," says Awash Teklehaimanot, director of the Malaria Program at the Earth Institute and head of the Center for National Health Development in Ethiopia (CNHDE).

Ensuring smooth and fast transport of such commodities between countries and producers is a critical component to any national malaria strategy. Led by the Earth Institute at Columbia University, "Breaking the Bottlenecks," or BTB, is a groundbreaking component of the Quick Impact Initiative, a plan endorsed by the United Nations 2005 World Summit, to accelerate anti-malarial efforts in 10 African countries. Key stakeholders of the initiative, including National Malaria Control Program Managers, unanimously agree that bottlenecks related to the disbursement of money from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and logistics of procurement are among the most formidable challenges to rolling out prevention and treatment strategies.

Breaking the Bottlenecks is being lead and coordinated by Awash Teklehaimanot and Yesim Tozan, project facilitator from the Malaria Program and former Earth Institute Fellow based in New York. The BTB team, which also involves experienced health experts from CHNDE, works with Quick Impact countries to achieve a rapid scale-up of control efforts by the year 2008. They hope to expedite direct transfers of commodities to countries by eliminating monetary transactions among key partners and level the distribution channels. Breaking the Bottlenecks is a two-pronged approach that involves:

  • Providing technical expertise for full-scale Quick Impact plans, identifying problem areas to achieving national scale-up and formulating strategies to solve them.
  • Working with partners to streamline procedures and practices for effective implementation of plans and mobilizing resources for country-led responses.

The in-country technical assistance provided is designed to complement existing skills of national teams and efforts of partner agencies, and thus will expand the collective reach of all stakeholders in participating countries.

Jeffrey D. Sachs, director of the Earth Institute and a leader of the Malaria Quick Impact Initiative, has called BTB "the hotline service" for country program managers. "We’re the people they call when they need to find out about funding, or any related issues that need fixing," said Yesim Tozan.

Teklehaimanot and Tozan are working with the World Health Organization, the Roll Back Malaria Partnership, the Global Fund, private companies such as pharmaceuticals and bed net manufacturers, and others to coordinate "direct transfer of anti-malarial commodities to countries through pooled procurement," said Tozan.

Currently, CNHDE's office in Addis Ababa is heading the BTB efforts on the ground. Thanks to generous grants in support of the Quick Impact Initiative, a new coordinating office in Mali will soon oversee operations in West African countries.  Support from the Blaustein Foundation and Wealth and Giving donors is directly helping advance the reach and scope of Breaking the Bottlenecks.