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Encourage countries to strengthen their own health systems, DfID told Encourage countries to strengthen their own health systems, DfID told
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The UK needs to do more to encourage poor countries to strengthen their own health systems so that aid for malaria has a more lasting impact, a government watchdog said on Wednesday.The UK needs to do more to encourage poor countries to strengthen their own health systems so that aid for malaria has a more lasting impact, a government watchdog said on Wednesday.
The Department for International Development (DfID) spent £252m on tackling malaria in countries including Nigeria, Ethiopia and India in 2011-12. It estimates that it will spend £494m in 2014-15, making the UK the third-largest donor on malaria behind the US and the Global Fund to fight Aids, Tuberculosis and Malaria.The Department for International Development (DfID) spent £252m on tackling malaria in countries including Nigeria, Ethiopia and India in 2011-12. It estimates that it will spend £494m in 2014-15, making the UK the third-largest donor on malaria behind the US and the Global Fund to fight Aids, Tuberculosis and Malaria.
While DfID's programmes use proven interventions such as bednets, which compare favourably with global benchmarks for cost-effectiveness, the department has further to go to demonstrate that it has fully secured value for money, said the National Audit Office (NAO).While DfID's programmes use proven interventions such as bednets, which compare favourably with global benchmarks for cost-effectiveness, the department has further to go to demonstrate that it has fully secured value for money, said the National Audit Office (NAO).
"Sustained impact depends as much on changing attitudes and behaviours of populations at risk, as it does on distributing nets and drugs," it said."Sustained impact depends as much on changing attitudes and behaviours of populations at risk, as it does on distributing nets and drugs," it said.
In Tanzania, for example, the provision of bednets was followed up by an information campaign, which increased the number of distributed nets actually hung by 21 percentage points. However, the exercise had limited effect on overall bednet use because logistical problems delayed the follow-up campaign reaching parts of the country soon after net distribution. DfID's agent lacked the means to ensure consistent rollout. Progress likewise failed to meet expectations in Nigeria, where the agent focused on bednet coverage, limiting work on increasing use.In Tanzania, for example, the provision of bednets was followed up by an information campaign, which increased the number of distributed nets actually hung by 21 percentage points. However, the exercise had limited effect on overall bednet use because logistical problems delayed the follow-up campaign reaching parts of the country soon after net distribution. DfID's agent lacked the means to ensure consistent rollout. Progress likewise failed to meet expectations in Nigeria, where the agent focused on bednet coverage, limiting work on increasing use.
In another complication, nets issued in 2010 in Nigeria are reaching the end of their expected life and replacement is looming as a critical issue. Free distribution has increased public awareness of nets, but has also raised expectations that they are a "free good". The NAO says retailers now find it hard to sell nets, and firms unwilling or unable to change production to longer-lasting nets have left the industry.In another complication, nets issued in 2010 in Nigeria are reaching the end of their expected life and replacement is looming as a critical issue. Free distribution has increased public awareness of nets, but has also raised expectations that they are a "free good". The NAO says retailers now find it hard to sell nets, and firms unwilling or unable to change production to longer-lasting nets have left the industry.
"Free distributions of imported bednets reduce incentives for households to purchase nets from retailers," said the NAO. "We found no evidence that the mass distributions the department had supported in Nigeria were accompanied by effective measures to stimulate weak commercial markets.""Free distributions of imported bednets reduce incentives for households to purchase nets from retailers," said the NAO. "We found no evidence that the mass distributions the department had supported in Nigeria were accompanied by effective measures to stimulate weak commercial markets."
DfID has funded the introduction of rapid diagnostic tests in public health services to increase the number of people diagnosed before receiving treatment and reduce unnecessary drug consumption. The introduction of tests in Senegal in 2007 increased the number of people tested for malaria from 4% to 86% over three years, reducing the number of fever cases prescribed with malaria drugs by 57%. But coverage was incomplete in the countries visited by the NAO, and still lower in the private sector, where many people obtain treatment.DfID has funded the introduction of rapid diagnostic tests in public health services to increase the number of people diagnosed before receiving treatment and reduce unnecessary drug consumption. The introduction of tests in Senegal in 2007 increased the number of people tested for malaria from 4% to 86% over three years, reducing the number of fever cases prescribed with malaria drugs by 57%. But coverage was incomplete in the countries visited by the NAO, and still lower in the private sector, where many people obtain treatment.
The NAO urges DfID to make more systematic comparisons between multilateral and bilateral aid to see whether it is getting enough value for money from multilateral funds. DfID's malaria plans foresee a 71% increase in multilateral funding from £46m to £79m, compared with a 56% rise in bilateral spending from £70m to £110m in the period 2011-12 to 2014-15.The NAO urges DfID to make more systematic comparisons between multilateral and bilateral aid to see whether it is getting enough value for money from multilateral funds. DfID's malaria plans foresee a 71% increase in multilateral funding from £46m to £79m, compared with a 56% rise in bilateral spending from £70m to £110m in the period 2011-12 to 2014-15.
In its report, the NAO said DfID needs to leverage more developing country resources while obtaining the best value from its own bilateral programmes and from the support it channels through multilateral organisations.In its report, the NAO said DfID needs to leverage more developing country resources while obtaining the best value from its own bilateral programmes and from the support it channels through multilateral organisations.
African governments have missed targets they set in 2001 in Abuja, Nigeria, to spend 15% of government money on health. Forty-six governments signed the Abuja declaration, but only three of DfiD's 18 priority countries consistently met the target, according to the NAO.African governments have missed targets they set in 2001 in Abuja, Nigeria, to spend 15% of government money on health. Forty-six governments signed the Abuja declaration, but only three of DfiD's 18 priority countries consistently met the target, according to the NAO.
"Developing countries do not yet have the systems and infrastructure needed to tackle the diseases themselves. It is important, therefore, that the department pursues visible increases in country government resources to expand local capacity and effort, in order that the UK effort contributes to continuous improvement," said the NAO."Developing countries do not yet have the systems and infrastructure needed to tackle the diseases themselves. It is important, therefore, that the department pursues visible increases in country government resources to expand local capacity and effort, in order that the UK effort contributes to continuous improvement," said the NAO.
Despite recent progress, malaria infects about 219 million people each year, killing an estimated 655,000. There has been a significant increase in spending on malaria since 2008, but funding from donors – other than the UK – and host governments is levelling off.Despite recent progress, malaria infects about 219 million people each year, killing an estimated 655,000. There has been a significant increase in spending on malaria since 2008, but funding from donors – other than the UK – and host governments is levelling off.
The World Health Organisation says an estimated $5.1bn is needed every year between 2011 and 2020 to treat malaria in the 99 countries with continuing transmission. While many countries have increased domestic financing, the total available in 2011 was $2.3bn – less than half of what is needed.The World Health Organisation says an estimated $5.1bn is needed every year between 2011 and 2020 to treat malaria in the 99 countries with continuing transmission. While many countries have increased domestic financing, the total available in 2011 was $2.3bn – less than half of what is needed.
Justine Greening, international development secretary, said: "The NAO has recognised that DfID programmes are effective in saving lives as well as demonstrating good value for money. The UK is playing its part by improving access to life-saving drugs, increasing the use of bednets and investing in developing new technologies to tackle malaria and reduce the spread of resistance."Justine Greening, international development secretary, said: "The NAO has recognised that DfID programmes are effective in saving lives as well as demonstrating good value for money. The UK is playing its part by improving access to life-saving drugs, increasing the use of bednets and investing in developing new technologies to tackle malaria and reduce the spread of resistance."
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