Booster Program for Malaria Control in Africa. One Year Later: Progress and Challenges

Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Booster Program for Malaria Control in Africa One Year Later: Progress and Challenges 38880 World Bank Booster Program Update for Regional Event Striking Back at Malaria by Accelerating Country Action in sub Saharan Africa Dakar, Senegal September 12-15, 2006

CONTENTS ACRONYMS AND ABBREVIATIONS...iii I. BACKGROUND...1 II. WHERE ARE WE ONE YEAR LATER?...2 III. KEY CHALLENGES AND NEXT STEPS...4 Annex I: Booster Program Results Monitoring Matrix / Malaria Indicator Template Annex II: Summary of Expected Results for Board-approved Booster Projects PAGE ii

ACRONYMS AND ABBREVIATIONS ACT AIDS CDC HIV IDA IRS IVCC FY LLIN M&E MACEPA MDG MIRT MIT MMV MTEF MVI NGO PMI PRSC RBM SADC SWAp TBD TF UNDP UNICEF USAID WHO artemisinin-based combination therapy acquired immune deficiency syndrome Centers for Disease Control and Prevention human immunodeficiency virus International Development Association indoor residual spraying Innovative Vector Control Consortium fiscal year long-lasting insecticidal net monitoring and evaluation Malaria Control and Evaluation Partnership in Africa millennium development goal Malaria Implementation Resource Team malaria indicator template Medicine for Malaria Venture medium-term expenditure framework Malaria Vaccine Initiative non-governmental organization U.S. President s Malaria Initiative poverty reduction strategy credit Roll Back Malaria South African Development Committee sector-wide approach to be determined trust fund United Nations Development Program United Nations Children s Fund United States Agency for International Development World Health Organization PAGE iii

I. BACKGROUND Launch of the Booster Program. The World Bank Global Strategy and Booster Program for Malaria Control is the Bank s renewed commitment to malaria control designed to augment and reinvigorate existing programs in the framework of the Roll Back Malaria (RBM) partnership 1. The Africa Region translated this global strategy into an outcomes-driven assault on malaria in Africa. Launched in September 2005, the Booster Program for Malaria Control in Africa supports country-level efforts to deliver concrete and measurable results. The Program is expected to have a multi-year horizon, with the initial three-year Intensive Phase already well underway (July 1, 2005-June 30, 2008). Over this initial Phase, the Bank expects to commit approximately US$500 of IDA resources to support the Program in approximately 20 countries. 2 This list is not closed and the Bank will continue to exploit windows of opportunities depending on expression of interest and needs of countries. The Booster Program s Approach. The Program has a two-pronged approach that combines disease control with health system development to achieve results. It includes: Supporting a serious up-front effort by the World Bank to control malaria in Africa, using a combination of proven interventions; and Designing malaria control programs in countries to complement ongoing efforts by the Bank and other partners to strengthen and improve overall health systems. 1 The Roll Back Malaria Partnership is an international partnership founded by the Bank, WHO, UNCIEF, and UNDP in 1998. The Bank sits on the RBM Board. Other key partnership constituencies include: Endemic Countries (currently the Health Ministers of Tanzania, Nigeria, Benin, Sudan, and India) which represent countries on the Board; Foundations (UN Foundation and Gates Foundation, among others); NGOs; and the Private Sector (ExxonMobil, Bayer, and others). 2 Countries are selected based on burden of disease, readiness, and willingness to scale-up malaria control efforts. The World Bank s approach is country-led. The Program does not seek to articulate Bank projects ; rather, it seeks to contribute, in collaboration with key partners, to the implementation of national strategic and operational plans for malaria control as developed by the affected countries themselves. The Bank is financing, through these national plans, a combination of activities including, but not limited to: the distribution of long-lasting insecticide-treated bednets (LLINs); indoorresidual house spraying (IRS), where appropriate; and treatment with artemisinin-based combination treatments (ACTs) as older malaria treatments, such as chloroquine, though much cheaper are increasingly losing their effectiveness. Focus on Results. While project design under the Booster Program is flexible enough to allow for interventions to be tailored to specific country needs, the Bank s commitment to achieving concrete results is the same across all of the malaria programs which it supports. To this end, the World Bank has constructed a Results Monitoring Matrix or Malaria Indicator Template (MIT) (attached in Annex I) for tracking dollar investments and progress on coverage of key interventions, such as the use of insecticide-treated bed nets, access to antimalarial treatment of children, intermittent preventive treatment for pregnant women and indoor residual spraying. Achieving coverage targets for these interventions will reduce the burden of malaria, in terms of both sickness and deaths. The Matrix is meant to be a tool used regularly to hold ourselves, countries, and donors accountable for progress and results. The Program is assisting client countries to accelerate progress toward achievement of the Abuja targets by 2008. 3 Each country, based on its RBM Strategic Plan and health sector strategy more broadly, is assisted to set ambitious but achievable targets in accordance with country- 3 The Abuja targets were originally set for 2005, a schedule which proved very difficult to achieve in most countries. Broadly speaking, they call for at least 60% utilization of effective malaria prevention and treatment interventions. PAGE 1

specific baseline data, monitoring and evaluating capacity, and service delivery opportunities. Achievement of the targets in the national plan is a joint effort with all RBM Partners in the country. II. WHERE ARE WE ONE YEAR LATER? Programs. Over the first year of the Booster Program s operation, nine projects have been approved by the World Bank s Board of Directors, including projects in eight countries and a multi-country, multi-sector Senegal River Basin Water Resources Development Project, in Senegal, Mauritania, Mali and Guinea. The total population estimates of people living in areas covered by these nine projects is approximately 130.3, of whom approximately 17.5% (or 22.8 ) are children under five years of age and approximately 4.2% (or 5.5 ) are pregnant women. Six additional projects are currently in the pipeline, which include support through a Multi-donor Trust Fund for South Sudan. Table 1 lists all current IDA funds committed and planned for the Program by country through the Intensive Phase. Of the US$500 target for the Phase, the Bank is on track to commit US$427.5 by the end of FY08. Table 1: Status of Projects in the Booster Program Board Approved Amount (US$) Board Dates Eritrea 2 Jun. 2005 DRC 30 (Grant) Aug. 2005 Zambia 20 Nov. 2005 Niger 10 Jan. 2005 Burkina Faso 12 Apr. 2006 Ethiopia (MDG TF) 20 (Grant) May 2006 Benin 31 (Grant) Jun. 2006 Senegal River Basin (Regional) 42 Jun. 2006 Malawi 5 July 2006 TOTAL TO DATE 172 FY2007 and FY 2008 Pipeline (indicative amounts subject to change) Senegal 5 Oct. 2006 Nigeria 180 Dec. 2006 Kenya 20 Jun. 2007 South Sudan (MultiDonor TF) 30.5 TBD Mozambique 10 TBD Ghana 10 TBD TOTAL FY06-08 427.5 Donor Harmonization. One of the major outcomes of the Paris Conference on the Booster Program (launch of the Africa Region activities) was the creation of a working group co-chaired by the RBM Secretariat and the World Bank and including key partners to prepare an action paper on donor harmonization. This group presented the paper entitled Harmonization for Impact in Malaria Control, which was developed around the principle of the 3 Ones in HIV/AIDS (One Strategic Plan, One Monitoring and Evaluation Framework, One National Implementation structure), during the RBM Forum in Yaoundé, Cameroon in November 2005. The paper addresses key bottlenecks in harmonization which include: accountability and oversight, country capacity, donor practices, financing, Monitoring and Evaluation (M&E), global subsidies and options for moving forward. Currently, the final draft has been endorsed by the RBM Board. Global Consultations. The Roll Back Global Malaria Forum in Yaounde, Cameroon gave the Africa Region the opportunity to sit with all major partners to review and assess bottlenecks in malaria control. Meetings with Ministers of Health and senior government officials of endemic countries were also held to discuss specific concerns under the Program. Cross-border Booster Programs. The Senegal River Basin Booster was delivered in fiscal year 2006 as part of a Regional Senegal River Basin Water Resources Development Project, which covers Mali, Guinea, Senegal, and Mauritania. Other regional programs will be pursued/developed in FY07 and FY08, in West Africa and Southern Africa, in collaboration with the South African Development Committee (SADC) and other regional fora. In addition, the Booster team has reached out to colleagues working in Education and Infrastructure Development to determine how projects in nonhealth sectors might contribute to malaria control. PAGE 2

The Malaria Implementation Resource Team (MIRT). Many Bank staff members in the Africa Region are working with countries and partners to develop and implement malaria programs. To support and coordinate these efforts, the Africa Region has established the MIRT, which reports to the director of Human Development in the Africa Region. The team consists of a coordinator and two specialists, with additional two specialists in the process of being hired. In addition, MIRT draws upon the expertise from various sectors and departments within the Bank to provide support to the Program, and to the Task Teams, as needed. MIRT has four mandates: 1. To provide support to task teams that are preparing and implementing malaria programs and ensure the overall quality of the program; 2. To forge partnerships within the Bank as well as external partnerships, and lead the dialogue with partners on all aspects related to the Program in the Africa Region; 3. To strengthen and coordinate monitoring and evaluation, including monitoring the results template; and 4. To promote knowledge sharing among staff and partners and to coordinate external communications in the Program. Partnerships. No single donor is providing the resources sufficient to bring malaria under control. The Booster Program is therefore firmly embedded within the Roll Back Malaria Partnership, to which the Bank remains totally committed. The three major financiers the World Bank, US, and Global Fund meet periodically to discuss overall strategy, implementation progress, and country-bycountry implementation bottlenecks. In 2006, the Bank hosted one such meeting in January (in Washington) and the Global Fund hosted a meeting in May (in Dakar). In addition to working with US and Global Fund colleagues, the Booster Program team is working closely with WHO, UNICEF, Exxon Mobil, the Bill and Melinda Gates Foundation, civil society organizations (e.g. the CORE Group), and others involved in the fight against malaria in Africa to move the Program forward. Examples of partnership activities include: US Presidential Initiative for Malaria Control (PMI), which includes USAID, the Department of Health and Human Services, and the Centers for Diseases Control and Prevention (CDC). There is an expanding potential for partnership with PMI on monitoring and evaluation, pooling of resources, procurement, commodity and supply chain management. For example, we are working together in Mozambique to support one country operational plan based on filling country-identified gaps. Exxon Mobil. A proposal for support for monitoring and evaluation has been submitted to Exxon Mobil for potential funding. A decision is expected by the end of September 2006. The Global Fund. The Bank is working with the Global Fund to identify key challenges and areas for collaboration to overcome important bottlenecks to successful implementation of malaria control programs. In this context, work is underway with the Global Fund to see how we can improve the timely availability of critical commodities at the country level. WHO. The Booster Program works with and follows technical guidance of the World Health Organization, the lead technical partner in the RBM Partnership. For instance, we are in discussions with WHO regarding implications for scaling-up at the country-level of the switchover from chloroquine to ACTs and the appropriate use of IRS. PAGE 3

UNICEF. Collaboration has begun with UNICEF on a joint work aimed at boosting health systems to accelerate child survival and malaria control in 12 countries. An important meeting took place in April 2006 at the UNICEF headquarters in New York to launch this work. The Bill and Melinda Gates Foundation. The Bank has collaborated with the Foundation in Zambia in the preparation of a Malaria Control and Evaluation Partnership in Africa (MACEPA), with the Gates contribution totaling US$35, alongside the Bank Malaria Booster Program commitment of US$20. We have also initiated discussions to explore the potential for providing strengthened implementation support to countries. Non governmental organizations (NGOs). The Bank sees NGO s as a crucial partner in the fight against malaria in Africa. In this regard, we have had the opportunity to meet with NGO partners (e.g. the CORE Group, Global Health Council, and African NGO networks from Kenya, Tanzania, Uganda and Zambia) both within the Bank and outside to explore synergies and potential areas for collaboration. For example, in DR Congo, with Bank support, the government is contracting out NGOs and civil society organizations to provide implementation support to national programs in Booster project areas. The Bank looks forward to continued engagement and joint work at the country level in the coming months. Coming together to address challenges: Regional Event in Dakar September 12-15, 2006 Striking Back at Malaria by Accelerating Country Action in sub Saharan Africa. The Booster Program is organizing this opportunity for more than 20 endemic countries as well as RBM partners and other key malaria control actors, to share implementation experience and take stock of major initiatives to date, highlighting successes, challenges and the way forward with regard to a sub-set of critical issues (i.e. Strategic Planning and Gap Analysis, Supply Chain Management (including procurement), Rollout of ACTs, M&E, and Transparency for Planning) which need to be addressed if targets are to be achieved. The preparation of this event was done jointly with all key partners through an external guidance committee constituted by MIRT. III. KEY CHALLENGES AND NEXT STEPS While there have been achievements in a relatively short time, there are some critical challenges to be addressed. Progress has been made in coordination and harmonization, but we have a long way to go before achieving Harmonization for Impact. The level of coordination and harmonization among partners to achieve key outcomes that is required is highly labor intensive, especially since the Booster will not be implemented solely by the health sector. Toward this end, the Regional Event: Striking Back at Malaria by Accelerating Country Action in sub Saharan Africa has been organized to create an opportunity for experience-sharing regarding country-level implementation to scale-up for impact and reach targets. Concrete recommendations for addressing a sub-set of critical issues and moving forward will be generated and disseminated. Lack of reliable data and poor monitoring and evaluation are critical constraints. There are a number of issues concerning the quality of currently available data. Many countries have rudimentary information. This is due to several reasons such as weak surveillance and M&E systems, human resource constraints, and insufficient capacity for program planning. In the past, the Bank and other donors have not focused enough on monitoring and evaluation to achieve results. Through a results monitoring tool and an action plan, the Bank is maintaining a strong focus on effective monitoring and evaluation of Booster Programs. Comprehensive and tailored monitoring and evaluation plans are being put in place in the initial design for each program. We PAGE 4

are also developing a strong monitoring and evaluation system for the overall program and are working with other major partners to agree on the modalities of recurrent monitoring. The Results Monitoring Matrix, the MIT, has been presented at various meetings with global partners. We need to hold each other accountable at the global, regional and national levels, to ensure that we focus on results and see real impact in malaria control on the ground. Introduction of ACTs may initially slow progress toward the treatment coverage target of 60% access within 24 hours. Ensuring prompt access to effective treatment with ACTs is an important goal of the RBM partnership. However, there are challenges to the introduction of ACTs into countries: (a) a viable financing mechanism that deals with the significant demand on country budgets given the high cost of the drugs; and (b) insufficient support to effectively phase in the integration of ACTs nationwide because of difficulties in defining transition plans and in addressing supply chain issues such as procurement and distribution. In addition to working at the country level to help address these issues, we are also working with partners to seek innovative solutions at the global level. The Bank is working with a group of partners to define both the architecture and mechanism of a global subsidy for ACTs. Need to channel more public resources toward achieving Millennium Development Goal (MDG) targets at the country-level. While IDA resources are critical, the Bank s continuing engagement in the macro-economic dialogue at the country level will seek to ensure adequate and long term sustainability of budget resources for malaria control efforts. We will work with countries to include funding for malaria in country Medium-Term Expenditure Frameworks (MTEFs), which is important in securing longer term sustainability of activities in countries and achieving results. Insufficient capacity at the country level is an issue, as we scale-up malaria control efforts. In this context, the Bank is working with partners to strengthen implementation support to countries. Commodity procurement remains a critical challenge for countries to bring malaria under control. Some countries are having to wait over 6 months to receive long-lasting insecticide-treated bednets and malaria treatment (ACTs), with the commodities arriving after the rains have passed. At the same time, drug companies warn that s of tablets of malaria medicines may have to be destroyed in the next few months because orders from the developing world are substantially below original forecasts (Sanofi-Aventis, the French-based pharmaceutical group, has warned Financial Times, July 24). Clearly, if the world is serious about getting critical commodities to children who need them, more efficient ways must be found. The Bank is working with partners on solutions, but the situation is urgent. Prior to the Regional Event in Dakar, a training will be conducted on malaria supply chain management (including procurement) with 19 National Malaria Control Program Managers to build capacity at the country level (September 10-11). Building on health system constraints. Weak health systems need to be improved, both for sustainability and to ensure that a more vigorous effect to control malaria does not distort the rest of the system. Efforts to strengthen malaria control activities will need to take into account systemic constraints in human resource, drug procurement and management, planning and budgeting, and monitoring and evaluation. It will be important for countries to strike the right balance in addressing both disease-specific interventions and support for health systems. For example, in Burkina Faso, the Bank is strengthening the health system through a sectorwide approach while encouraging the prioritization of a rapid long-lasting insecticidetreated bednet scale-up to accelerate progress toward the Abuja targets. The Bank is working with partners to address these issues in the context of its overall health dialogue at country level. PAGE 5

Operational challenges to Booster projects. While the Bank is pleased to have approved 9 projects over the Booster Program s first year of operation, the program is facing many of the challenges mentioned above in the early phase of implementation. Among them are: continued severe procurement and supply delays in many countries for LLINs and ACTs despite improved global supply for both; inadequate prioritization of malaria control by country governments and concomitant accountability for results on a continuing basis despite some progress accomplished in these areas; need for real-time, in-country implementation support to assist countries in overcoming bottlenecks and the translation of policy to practice (i.e. rollout of ACTs in the context of resource constraints); and financing constraints that prevent countries from achieving nationwide coverage with critical interventions. The Way Forward. During the second year of implementation of the Booster Program, the Bank looks forward, in collaboration with countries and partners, to translating the committed finances into results and to expanding the resource base even further to support country strategic plans (e.g. Nigeria). In addition, the Bank will work closely with RBM partners to further refine and implement a results monitoring system to track investments and outcomes. Conclusions of the Regional Event in Dakar will help inform the next steps for how best to work together to address critical challenges to accelerate action on malaria control at the country level. PAGE 6

Annex I: Booster Program Results Monitoring Matrix / Malaria Indicator Template

Annex II: Summary of Expected Results for Board-approved Booster Projects

Malaria Related Components and Activities BOOSTER PROGRAM FOR MALARIA CONTROL IN AFRICA ONE YEAR LATER: PROGRESS AND CHALLENGES ANNEX II Summary of Expected Results for Board-approved Booster Projects (last updated: September 5, 2006) WB IDA Commitments/ Disbursements to Date (US$ ) Estimated Population Covered by the Project BENIN: Malaria Control Support Project Board date: June 2006 Component 1: Improving Case Management and Access to Treatment: This component will improve malaria treatment capacity principally in the public health sector and pre-selected non-governmental organizations capable of basic health care management (private sector health services will be provided with information and training as well). Component 2: Scaling up Prevention Activities: This component will consist mainly of large scale distribution of LLINs to vulnerable populations as part of a broader community-wide campaign and introduction of Intermittent Preventive Treatment (IPT) for pregnant women attending prenatal visits. Component 3: Strengthening Monitoring and Evaluation: This component will strengthen malaria M&E and data management for the overall national program at both central and operational levels in coordination with key partners. Component 4: Program Management, Capacity Development and Promoting Regional Cooperation 31 / 0 7.65 Example of Expected Results The project aims to distribute about 3.2 LLINs and treat about 3.7 people (2.5 children <5) with ACTs over the next 4 years. By the end of 2007, 1.4 LLINs are expected be delivered to children <5. Over the 4-year life of the project, about 1.8 LLINs will be distributed to pregnant women. By the end of 2007, a national malaria M&E framework and operational plan will have been developed and endorsed by the Ministry of Health. BURKINA FASO: Health Sector Support and Multisector AIDS Project Board date: April 2006 The Booster aspect of the project aims to support the scale-up of long-lasting treated bednets, improve access to ACTs, as well as improve malaria financing and implementation at district level. Long-lasting ITNs (LLINs) procured with project financing and distributed at a highly subsidized price through a mixture of private social marketing channels as well as local and community health services (with even lower prices or free distribution targeting children under 5 and pregnant women). 12 / 0 13.5 An initial procurement of 600,000 LLNs is being finalized, and the project is expected to finance at least 1.5 LLNs over the next 4 years, with a special focus on the approximately 2.1 children <5, as well as the approximately 543,000 pregnant women. Approximately US$5 worth of ACTs will be financed through the project over the next 4 years, which will be sufficient to purchase an initial stock of ACTs for the population, and to provide ACTs at nominal cost to children (e.g, about 10 cents per dose). But financing remains insufficient to subsidize distribution to adults or at community/village level. Government is still determining its prioritization and implementation strategy, and is seeking additional sources of financing (e.g., Global Fund).

Malaria Related Components and Activities BOOSTER PROGRAM FOR MALARIA CONTROL IN AFRICA ONE YEAR LATER: PROGRESS AND CHALLENGES ANNEX II The malaria component of the project aims to Boost Malaria Control Interventions at the district level through (i) IPT for pregnant women, (ii) ACTs for first-line treatment o f malaria, (iii) Scale-up coverage of longlasting insecticidal nets (LLINs) and (iv) Technical Assistance and Operational Research. WB IDA Commitments/ Disbursements to Date (US$ ) Estimated Population Covered by the Project DR CONGO: Health Sector Rehabilitation Project Board date: August 2005 30 / 0 20.0 Example of Expected Results Over 2.5 long-lasting nets will be procured by the end of the project and a majority of those will be distributed to the 4,000,000 children under 5 over the next 4 years. In addition, over 400,000 doses of preventive treatment for pregnant women will be provided, and over 6.6 doses of ACTs will be provided primarily to children <5. ERITREA: HIV/AIDS/STI, TB, Malaria and Reproductive Health Project (HAMSET II) Board date: June 2005 HAMSET II will continue to support Eritrea s highly successful multipronged strategy for malaria control through the following: (i) maintain and increase the coverage and use of ITNs, (ii) improve the management of fever at the community and health station levels, (ii) ensure the availability and accessibility of antimalarials and complementary drugs, (iii) identify the most effective methods of vector control and how they can be best targeted, (iv) introduce new effective malaria control commodities such as LLINs and ACT, and (v) identify and implement the most appropriate methods for reducing malaria morbidity and mortality in pregnant women. The Bank with other Partners will provide predictable financing for those critical inputs for primary health service delivery that cannot be efficiently financed at woreda (district) level through a block-grant mechanism. It will have a specific focus on controlling malaria, and will serve as the initial entry point in Ethiopia for the Bank s Malaria Control Booster Program. It will support: (a) Commodities via the procurement on the international market of key inputs for accelerated implementation of the Health Service Extension Package such as vaccines, contraceptives, long-lasting insecticide treated mosquito nets, malaria drugs, insecticides and spray pumps, emergency drugs, and other equipment to be provided free of charge as part of the HSEP; (b) Capacity building activities in several areas, including in monitoring and evaluation as well as operational research at MOH level; (c) Strengthening procurement and logistics, especially in international procurement, the Central Medical Store and the national distribution system. 2 / 0.04 4.7 ETHIOPIA: Protection of Basic Services Project Board date: May 2006 20 (as part of an MDG Trust Fund) / 0 46.8 Over 3 long-lasting nets are planned for distribution by the end of 2007, primarily to Ethiopia s approximately 12 children <5. A substantial portion of the gap to reach the remainder of the children is being financed by the Global Fund. Also by the end of 2007, the project aims to reach over 2.2 people with ACTs. In addition to the above, the project will also support the revitalization of Ethiopia s indoor-residual house spraying program (given the importance of spraying due to the epidemic/outbreak prone nature of malaria in parts of Ethiopia), which has decayed over the years (both infrastructure and trained personnel), with a particular focus on stemming future malaria outbreaks/epidemics.

Malaria Related Components and Activities BOOSTER PROGRAM FOR MALARIA CONTROL IN AFRICA ONE YEAR LATER: PROGRESS AND CHALLENGES ANNEX II WB IDA Commitments/ Disbursements to Date (US$ ) Estimated Population Covered by the Project Example of Expected Results MALAWI 4 : Health Sector Support Project - Additional Grant Board date: July 2006 The project aims to complement the investments of other donors, including the Bank under an ongoing sector-wide approach, by providing a modest investment to support the: 1) Design and implementation of a sustainable monitoring and evaluation system of the health sector-wide approach as a whole with a special focus on Malaria 2) Scale-up existing, physical, financial, technical and human capacity for M&E on the central and district level 5 / 0 12.7 The additional financing is focusing exclusively on monitoring and evaluation of results. NIGER 5 : Institutional Strengthening and Health Sector Support Project Board date: January 2006 The project s focus is still being refined, and the Bank team is participating in the development of the revised Niger malaria control strategic plan, which the project will support. Key priorities are likely to include support to scale-up ACTs, as well as improve communications for behavior change to improve net utilization. 10 / 0 SENEGAL RIVER BASIN: Senegal River Basin Multi-purpose Water Resources Development Project Board date: June 2006 11.6 The Booster Program sub-component will support the planned activities will comprise the following: (i) mass distribution of long-lasting insecticide treated bednets; (ii) Health impact and mitigation activities of water resource development activities, including the mass treatment for schistosomiasis and other soil-transmitted helminthes; (iii) community mobilization in support of mass treatment; and (iv) disease surveillance and operational research 42 / 0 2.0 The Booster sub-component aims to provide long-lasting treated nets to at least 80% of children in the Senegal River Basin over the next 5 years. In total, the project aims to provide about 2 long-lasting nets over the next 5 years to those living in the River Basin. The project will also support out de-worming activities, given the exposure due to water-related agricultural activities, as well as finance health impact assessments (and risk-mitigation measures when needed) to monitor the health impact of irrigation and infrastructure development. 4 An increased Booster Response (in terms of $) may be developed as the national malaria control plan is updated, and implementation/absorption bottlenecks are clear. 5 Additional financing for the Niger project came relatively late in the project development cycle. In addition, Niger s new malaria control strategic plan has been developed only in the past few months. Given this, the TTL and malaria team have begun work with the Niger authorities to finalize the project s response to the needs outlined in the strategic plan.

Malaria Related Components and Activities BOOSTER PROGRAM FOR MALARIA CONTROL IN AFRICA ONE YEAR LATER: PROGRESS AND CHALLENGES ANNEX II WB IDA Commitments/ Disbursements to Date (US$ ) Estimated Population Covered by the Project ZAMBIA: Zambia Malaria Control Booster Project Board date: November 2005 Component 1 (a): Strengthening the health system to improve malaria service delivery through district basket pooled funding: The project will finance the supply and distribution of insecticide treated bed nets (ITNs), increase the coverage of indoor residual spraying (IRS) in eligible areas led by the District Health teams, provision of the rapid diagnostic tests (RDTs) and microscopes to improve diagnostic accuracy, and case management and support for intermittent presumptive treatment of pregnant women (IPT). Component 1 (b): Improved environmental health management: This subcomponent of the project will finance activities aimed at improving the management of health care waste associated with malaria control and the environmental monitoring for impact of insecticide use. Component 2: Community Malaria Booster Response (COMBOR): This component will provide support to strengthen local capacities to effectively prevent, control and treat malaria and mitigate some of the demand-side constraints to effective malaria control programming. Component 3 (a): Program Management: This component will support strengthening the capacity of the National Malaria Control Centre to provide technical leadership and coordination of the implementation of the national program. AFR BOOSTER TOTALS 20 / 0.34 US$172 11.3 130.3 Example of Expected Results The Project will support the procurement and distribution of about 1 long-lasting treated nets to children <5 over the next year (there are about 2.8 children <5 in Zambia living at risk of malaria), with a primary focus on the upcoming malaria transmission season beginning in November. Together with other partners such as the Global Fund, the Gates Foundation, and USAID, Zambia hopes to have 80% of its population at risk (11.3 people are at risk) covered with LLINs by 2008. The project will finance approximately US$2 in support of indoor-residual house spraying over the next 3 years in about 10 districts (the Global Fund and USAID are supporting IRS in other districts). The project will help to strengthen human resource capacity in Zambia with US$3 over the next 3 years.