Paris

A major global initiative that aims to halve the world's malaria burden by 2010 will fail unless it is speedily revamped, according to the scheme's first major external evaluation.

A panel chaired by Richard Feachem, director of the Institute for Global Health in California, says that the project, Roll Back Malaria (RBM), needs stronger leadership, a management overhaul and tight focus on a small number of countries where its ideas stand a chance of being put into practice.

The RBM initiative was launched in 1998 by the World Health Organization (WHO), as a partnership with the World Bank and the United Nations, and has since been joined by more than 90 other partners. It aims to direct a comprehensive global effort against the disease, which affects up to 500 million people and kills a million of them each year.

The evaluation was made by seven experts in research, health and economics. It found RBM successful in advocacy and in building a consensus about priorities: after languishing for decades, malaria research and control is high on political and scientific agendas, it says. Funding has almost doubled since 1998 to around $200 million in 2002, $35 million of which is channelled directly through RBM (see News Feature, page 426).

At a summit in April 2000, 44 of Africa's 50 malaria-affected countries pledged to support RBM's main goals — particularly that, by 2005, 60% of sufferers get immediate access to treatment. But progress has been sporadic. Only a handful of countries have increased funding and staff to anywhere near the required levels. RBM's own projects, the evaluation says, have too often been implemented in isolation from the broader health policies of recipient nations.

The report adds that RBM and its partners have given inadequate, even conflicting, technical advice to governments. It recommends the creation of technical support networks to collate the best advice, and of an independent governance board to which the RBM secretariat should be accountable. It calls on RBM to reorganize its efforts, focusing on 8–12 countries that have the political commitment to enable rapid progress.

David Heymann, executive director of WHO's communicable diseases division, says the report agrees with an internal review done last year. “The external evaluation has been very useful,” he says. “By the end of this year we expect to have strengthened the partnership based on its recommendations.”