EXECUTIVE SUMMARY
Malaria prevention and control is a major foreign assistance objective of the U.S. Government. In May 2009, President Barack Obama announced the Global Health Initiative, a comprehensive effort to reduce the burden of disease and promote healthy communities and families around the world. Through the Global Health Initiative, the United States will help partner countries improve health outcomes, with a particular focus on improving the health of women, newborns, and children.
The President’s Malaria Initiative (PMI) is a core component of the Global Health Initiative, along with family planning, maternal and child health, nutrition, HIV/AIDS, and tuberculosis.
PMI was launched in June 2005 as a 5-year, $1.2 billion initiative to rapidly scale up malaria prevention and treatment interventions and reduce malaria-related mortality by 50% in 15 highburden countries in sub-Saharan Africa. With passage of the 2008 Lantos-Hyde Act, funding for PMI was extended and, as part of the GHI, the goal of PMI was adjusted to reduce malariarelated mortality by 70% in the original 15 countries by the end of 2015.
PMI began supporting activities in Mali in 2007 in close collaboration with the National Malaria Control Program (NMCP) as well as international and national partners. With the coup d’état of March 22, 2012, in which the democratically elected president was overthrown by the military, the U.S. Government and many other donors suspended foreign aid to the Government of Mali until a democratic solution to the political crisis could be achieved. For PMI, this meant suspending all assistance and funding to the NMCP and other Ministry of Health (MOH) entities.
The U.S. Department of State authorized some PMI activities on humanitarian grounds, such as procurement and distribution of essential malaria commodities; however, the bulk of PMI projects were temporarily suspended. Following intervention by the Economic Community of West African States and the international community, Malians agreed on a consensual transitional government currently in place. In late July/early August 2013, the people of Mali democratically elected a new president who was sworn in on September 4, 2013. As a result, the U.S. Government lifted all restrictions on U.S. foreign assistance to Mali and authorized immediate return to normal bilateral relations with the Government of Mali, including direct support to the MOH.
Malaria is the primary cause of morbidity and mortality in Mali, particularly among children under five years of age. The disease is endemic to the central and southern regions (where over 90% of Mali’s population lives), and considered epidemic in the north. In 2013, the national health management information system (Système Local d’Information Sanitaire [SLIS]), reported 2.3 million clinical cases of malaria in health facilities and 1680 fatal malaria cases.
There has also been an increase in the number of suspected cases that were confirmed by laboratory means, from 52% in 2012 to 80% in 2013. However, given the inherent difficulties with the health information system, the SLIS data should be viewed with caution.
Since the 2006 Demographic and Health Survey (DHS), Mali has demonstrated significant progress in scaling up malaria prevention and control interventions, especially in vector control.
Results from the 2012 DHS indicate a 50% reduction of under-five mortality rates from 191 deaths per 1,000 live births in 2006 DHS to 95 deaths per 1,000 live births in the 2012 DHS.
Household ownership of at least one insecticide-treated bed net (ITN) increased from 50% in 2006 to 84% in 2012, and 69% of children under age five had slept under an ITN the previous night in 2012 compared with 27% in 2006. However, the same 2012 DHS survey also reported an increase in malaria parasite prevalence rates from 38% in 2010 to 52% in 2012.
Mali is the recipient of a $26 million 5-year Global Fund Round 6 malaria grant to support procurement of long-lasting insecticide-treated nets (LLINs) and artemisinin-based combination therapies (ACTs) and has been approved for Phase 2 funding. However, the Round 6 grant was suspended in 2010 because of misappropriation of funds. As a result, PMI has procured emergency stocks of ACTs and rapid diagnostic tests (RDTs) to ensure sufficient quantities are available in-country. Mali’s Round 10 Global Fund malaria proposal was recommended for funding; pre-disbursement assessment and negotiations with Population Services International, the new principal recipient and a consolidated version of the two malaria grants was signed in May 2013 with a total budget of approximately $123 million. The consolidated grant focuses on nationwide implementation of integrated community case management and a 2015 universal LLIN campaign. During the Global Fund malaria grant negotiation process, PMI contributed to filling several commodity gaps including LLINs, ACTs, and RDTs, in order to meet the annual national needs. In May 2014, Global Fund commodities such as ACTs, LLINs, and lab diagnostic kits, began to arrive in Mali.
While universal access to malaria prevention and control measures is the goal, pregnant women and children under five remain the focus of PMI efforts since they are the most vulnerable to malaria infection. The activities that PMI is proposing to support with FY 2015 funding align with the new 2013–2017 National Malaria Control Strategy and Plan, complement activities supported in the Global Fund malaria grant, and build on investments made by PMI and other partners to improve and expand malaria-related services.
