April 24, 2005—In a house in a small village in Eritrea, a family sleeps under insecticide treated bed nets.
The family lives in an area deemed a high risk malaria area.
Only a few years ago, the family of four would have been in danger of contracting malaria. As a result, some family members would have died.
But today Eritrea, one of the poorest countries in the world, stands out as a success story in controlling malaria.
The statistics are compelling. The number of people dying from malaria has dropped by between 55 to 65 percent since 1999. Mortality of children under five years of age dropped by 53 percent, while there was a 64 percent drop in the death rate for older children and adults.
“In 1991, our death toll among pregnant women from malaria was very high,” Eritrea’s Health Minister, Saleh Meky says.
“Today, it is non-existent.”
The World Bank has been the largest single donor to Eritrea’s malaria control program with the money channeled through the HAMSET (HIV/AIDS, Malaria, STDs and TB) Control Project.
Chris Walker, the Bank’s Lead Health Specialist in East and Southern Africa describes the Eritrean experience in dealing with malaria as outstanding.
“The Bank has been supporting the government of Eritrea in implementing its first class malaria strategy and providing a range of equipment and supplies, including bed nets and insecticides,” Walker says.
Eritrea has used a range of proven strategies for malaria control. An important part of this is to reduce human contact with mosquitoes. Insecticide treated bed nets have been vital to the program with the use of the nets significantly increased in high risk areas.
Walker says there are now more than 850,000 nets are being used in Eritrea with the numbers increasing.
“It’s become a major very cost effective way of dealing with the problem,” he says.
“The nets are either free to the most needy or else very heavily subsidized. The ones that are being used also require being re-treated once a year. That is often where this process falls down in other countries. But again in Eritrea it’s worked well as of the 800,000 odd bed nets, at least half a million of them are being re-treated every year.”
“There is a considerable demand for these nets. In fact we’re now switching to a different type of bed net which has a longer lasting insecticide associated with it. They have to be re-treated once every five years. But the general demand is quite high.”
Eritrea’s Health Minister attributes a large part of the country’s success to community involvement in Eritrea’s health programs. Walker agrees.
“One of the striking things about the health sector in Eritrea is the community involvement,” he says.
“The government pays a lot of attention to getting messages out to the local people in the local language, of which there are several different ones. They have a good organization which manages to mobilize people from time to time as needed.”
As an example, Walker cites people being called up to fill the holes on river banks which fill with water and which are where mosquitoes commonly breed.
“This is a simple and effective thing that can be done and they tend to mobilize people at the community level to do that kind of thing, which is something you don’t see in many countries.”
World Bank involvement in malaria control in Eritrea has also prompted other changes.
“If you go back five years, Eritrea used indoor spraying very extensively. But that’s been cut back a lot with this project,” he says.
“We’ve also introduced other kinds of insecticides which are more environmentally friendly than those they were using. Spraying though still continues, according to the extent of the malaria problem and the behavior of the mosquito in a particular area.”
The HAMSET project has also resulted in improvements to the country’s heath sector. Diagnosis and treatment is now provided at the community level through trained community health workers. More than 6000 community health workers have been trained in the management of malaria and provided with stocks of antimalarial drugs.
“We have tried very hard to only do things potentially within the capacity of the government to afford and handle from the technical point of view. So most things we have done have been fairly modest in scope but have proved to be quite effective“ Walker says.
“I should also add that we’re not the only players on the block with this. USAID and the Global Fund are also quite involved with the malaria program, although the Bank is the largest single donor.”
However Walker does sound a note of caution.
“The thing we have to guard against is that the malaria program doesn’t become a victim of its own success – in the sense that because transmission rates are already relatively low by African standards, people can declare victory and move onto something else. That’s a sure way to have a major resurgence of the problem.”