Malaria: MDG and beyond

World Malaria Day is observed every year on April 24 to express solidarity with all programmes and actions taken to prevent and reduce malaria around the world. Observance of the day also provides the opportunity for malaria affected countries to learn from each other's experiences. Although malaria is not a public health threat in Bangladesh, it is indeed a major disease in 13 districts of Bangladesh posing risk to 13.25 million people.  The climatic condition of all those districts favours transmission of the disease though the degree of prevalence varies. For example, three Chittagong Hill Tracts (CHT) districts -- Khagrachhari, Rangamati and Bandarban sharing borders with India and Myanmar alone report more than 80 per cent cases of malaria victims including deaths.
The good news is that Bangladesh is on track in achieving the millennium development goal (MDG) as regards reducing malaria prevalence (310/ 100,000 population) and malaria deaths (0.6/ 100,000 population). A gradual declining trend has been observed in these two indicators over the last few years. Besides, Bangladesh has already achieved the MDG for proportion of children under five sleeping under insecticide treated bed nets (90 per cent) and proportion of children under five who are treated with appropriate anti malarial drugs (90 per cent).
However, this success should not dilute our focus. Success of malaria control and prevention can be largely attributed to The Global Fund to fight AIDS, TB and Malaria (GFATM) which has been funding the National Malaria Control Programme (NMCP) since 2007. NMCP has established an effective partnership among government and the BRAC-led NGO consortium for strengthening and enhancing the malaria control programme. This partnership has leveraged the programme and increased the coverage including the hard-to-reach areas in terms of access to malaria treatment, prevention and awareness raising activities among the community. To sustain this achievement, secure source of funding is a must. With this in mind, Bangladesh is also observing the Malaria Day under the theme 'Invest in the future, Defeat malaria', which was set globally in 2013 -- a three-year communication campaign aimed at achieving MDG regarding malaria.  
Available tools of malaria prevention and treatment are effective. Yet, this effectiveness sometimes proves to be a problem itself for long term sustainability. Historically, it has been observed that whenever there was any improvement in malaria control, a shift of focus took place causing resurgence of malaria. We should not let this happen and for this, sustainable source of funding is very important. If enough resources are not available, it will not be possible to provide early diagnosis and prompt treatment (EDPT) at community level free of cost. It will become very difficult for the people to pay for these services especially for the CHT people who are in a financially disadvantageous position.    
There are some other challenges which also need to be addressed. Drug resistance, particularly Artemisinin-based combination therapy (ACT), has been observed in neighbouring countries. The same phenomenon might be observed in Bangladesh in near future. A growing trend of insecticide resistance is also being observed. Many asymptomatic malaria cases are left unidentified. Difficulty to trace mobile people such as Jhum cultivators and forest goers is still a problem. Decreasing immunity of the communities of endemic areas and inadequacy of health facilities due to shortage of skilled human resources are also some of the major challenges. Besides, some changes have been observed in climatic conditions such as early and interrupted rainfall, increase in humidity and temperature which favour vector mosquito breeding. This is believed to be the primary reason for sudden upsurge of malaria cases in 2014 as similar upsurge was observed in some parts of India also.  
Achieving MDG is not the end of the fight against malaria. The above mentioned challenges will continue to pose a threat even after 2015. Sustainable source of fund is essential for devising an effective mechanism to face these challenges. Bangladesh and other malaria-prone countries should put in place strong political mobilisation and advocacy to highlight malaria as a global high priority health issue so that shortage of resources does not impede further progress. Globally, an annual shortage of USD 3.6 billion threatens to slow down the progress of work. If the malaria fund is hurt globally, it will also impact Bangladesh. So, the national programme should consider alternative funding mechanism in case GFATM is not available.  Or else, the success achieved so far could be lost within a very short period of time.

Dr Moktadir Kabir is a senior programme manager in the Malaria Control Programme at BRAC, and Zayed Bin Islam is deputy manager, communications in the Health, Nutrition and Population programme at BRAC