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Scaling-Up for Impact (SUFI): A Two-Year Progress Report

 
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Every year, malaria infects more than 500 million people around the world. The burden is highest in Africa, where more than 90 percent of the world’s approximately 1 million malaria deaths occur annually.

Children in many parts of Africa suffer from malaria about four times each year and it is one of the leading causes of child deaths on the continent, yet the disease is completely preventable and treatable.

The impact of the disease extends far beyond the health of victims. Malaria exacts a broad toll on human and economic prosperity, from direct prevention and treatment costs to lost wages and suffering by individuals, to diminished workforce productivity, to broader market inefficiencies that then curtail trade and investment. In total, malaria is estimated to cost Africa about US$12 billion annually in lost gross domestic product (GDP), slowing GDP growth by as much as 1.3 percent per year.

While staggering, none of these malaria facts is new—certainly not to generations of Africans who continue to suffer from the disease. What is new is that malaria control in Africa has reached a crossroad: effective interventions to control the disease now exist but must be provided on a scale to benefit all who need them.

In April 2005, the World Bank released its revised malaria control framework: the Global Strategy and Booster Program. Through consultative discussions with client governments, development partners in the Roll Back Malaria (RBM) Partnership, a World Bank vice-presidential steering committee (comprised of five World Bank vice presidents) and the Bank’s Board of Executive Directors, the Bank found that efforts had fallen far short of expectations and earlier promises made at the RBM Abuja Summit in 2000. The Bank developed a new strategy outlining a way forward for the institution, including suggestions for a substantial increase in financing from the International Development Association (IDA), the arm of the World Bank that provides interest-free loans and grants to the world’s poorest countries. Malaria was deemed to be a fundamental obstacle to human and economic development, especially in Africa. It also was recognized that achieving many of the Millennium Development Goals would be challenging, if not impossible, without its control.

Following the release of the global strategy, the Booster Program for Malaria Control in Africa was launched in September 2005 translating the global strategy into a results-focused effort to bring the disease under control on the continent. Through this program, the World Bank brought to the fight a long-term commitment and pledged to leverage its unique relationships with ministries of health and of finance in participating countries, as well as its convening power with donor countries. The Booster Program has a ten-year horizon and we established a target of US$500 million in IDA resources for Phase I of the Booster Program (July 2005–June 2008) to support the rapid scale-up of proven malaria interventions in approximately 20 countries through tailored designs aimed at supporting national malaria control programs.

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As a founding member of the RBM Partnership, the Bank through the Booster Program for Malaria Control in Africa seeks to contribute to the joint efforts of countries and partners in reaching the coverage targets—“Abuja Targets.” As the Booster Program supports national malaria control strategic plans, the Bank’s role is one of partner, along with organizations that work together with countries to achieve the targets of their national malaria control plans.

One of the underlying principles that has fueled the rapid demand for IDA resources under the Booster Program has been a desire by client countries to “front-load” malaria control efforts. Unlike many other public health problems, malaria cannot be satisfactorily controlled with incremental approaches, largely because its vectors are too efficient. Successful malaria control requires bold, decisive steps to obtain widespread coverage of key proven malaria-control interventions quickly, followed by a phase where those gains are sustained through recurrent public health services.

This concept of a heavy up-front effort as opposed to a more incremental approach has been termed “Scaling-Up for Impact” or “SUFI” in the development community.

The Booster Program for Malaria Control in Africa is driven by five key components.

  1. It is country led, seeking to contribute to—not orchestrate—plans developed by the affected countries themselves. Countries that choose to participate in the Booster Program reallocate part of their resources from their IDA envelopes, putting that sum toward malaria control. With countries taking the lead role in malaria control and prioritizing their own resources, there is increased accountability on the part of participating countries and a greater likelihood of sustainability.

  2. It emphasizes both effective scale-up of interventions and the strengthening of health systems. This dual strategy helps to distribute urgently needed medicines and bednets and simultaneously builds health system capacity for long-term sustainability.

  3. It operates through partnerships. Partnerships are at the core of the Booster Program and are critical to the successful control of malaria in Africa. The Booster Program is firmly embedded within the RBM Partnership, to which the World Bank remains fully committed.

  4. It provides flexible, cross-border and multisector funding. These funding mechanisms allow for a rapid scale-up of proven interventions, as well as the ability to react to unforeseen circumstances.

  5. It monitors results against monies spent. Insufficient data and poor monitoring and evaluation have been critical constraints to assessing progress and maintaining accountability. The program is working with partners to strengthen monitoring and evaluation (M&E) efforts at global, regional and country levels. Baseline data has been collected in Booster Program countries and areas where projects have begun implementation. In addition, every Booster Program project has a comprehensive monitoring and evaluation component tailored to the national context. At global level, the World Bank has developed a Malaria Scorecard for tracking dollar investments and coverage progress for key interventions, such as the use of insecticide-treated bed nets, access to anti-malarial treatment for children, intermittent preventive treatment for pregnant women and indoor residual spraying. We are currently working with our RBM partners to transform this scorecard into a joint accountability framework.

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