The U.S. government's efforts to help control malaria around the world are coming under close scrutiny in Congress, where critics complain that the country's anti-malaria programs are ineffective at a time of rising incidence in Africa. Some senators are seeking to reform the way the U.S. development assistance agency spends its malaria money.
The U.S. Agency for International Development, USAID, provides $80 million dollars a year in aid to individual countries to defeat malaria.
The World Health Organization estimates that the disease kills one million people a year, mostly children in sub-Saharan Africa.
U.S. Senator Sam Brownback, a member of the majority Republican Party from Kansas, says the disease is curable with current treatment and prevention methods and asks why U.S. foreign aid has not helped conquer it. "I traveled to Uganda, I've been in the Sudan, met with officials from the U.N., met with individuals from these countries, and the best that really I've concluded is we're spending most of our money on consultants and on meetings and not on getting care taken out in the field," he said.
Senator Brownback is not alone in this view. At a hearing of a U.S. senate committee that oversees government operations, University of Toronto law professor Amir Attaran criticizes the Agency for International Development for spending too little of its budget on anti-malaria drugs or insecticide treated bed nets and indoor sprays that would kill the mosquitos that transmit the parasite. "The medicines aren't being bought, they aren't being given to the patients. When we do food aid as the United States, we actually provide the food, we provide the commodity. When we do malaria aid, we don't provide the commodities. That's wrong," he said.
Mr. Attaran says the U.S. money is largely devoted to paying American private advisers to provide technical assistance to governments. He, the senator, and other critics also complain that the agency refuses to account for its spending publicly so it can protect disclosures regarding the private contractors.
USAID acknowledges that just five percent of its malaria budget goes for treatment and prevention goods. But it argues that most of its grants are not designed to tackle a specific disease. Deputy assistant administrator Michael Miller told the Senate hearing that the agency, using private contractors, supports broader programs such as those to enhance child and maternal survival, of which malaria control strategies might be a part.
He rebuts criticism that U.S. efforts have failed. Mr. Miller says the increase in global anti-malaria financing to which Washington contributes and technologies such as better drugs and insecticide treated bed nets are too recent to be evaluated. "For the first time, the tools, the political will, and the funding are in place in sufficient amounts, sufficient levels, to really have an effect. But any summary judgment of the progress or lack of progress is not supported by sufficient data at this time and is simply premature in our view," he said.
Still, Senator Brownback has introduced legislation to revise USAID's priorities. It would require the agency to spend most of its anti-malaria budget on what he calls proven life-saving interventions, new drugs, insecticide soaked bed nets, and indoor spraying.
But one observer believes the measure goes too far. The program director for an African malaria control program funded by the private U.S. Gates Foundation, physician Kent Campbell, warns against diverting money from USAID's technical assistance programs.
Rather, he calls on Congress to provide the extra money needed for malaria treatment and prevention commodities to the Global Fund, an international agency that grants money for AIDS, tuberculosis, and malaria programs to developing countries. "Yes, there are many egregious examples of technical assistance running amok. But there are also as many or more examples where technical assistance has been well thought out, has supported the capacity of national governments to move forward in malaria and other issues. So I ask you to not move everything to commodities, but to keep a balanced view," he said.
The chairman of the Senate hearing, Republican Tom Coburn of Oklahoma, a physician, says the options include increasing USAID's anti-malaria budget or stripping the money from the agency and giving it to the Global Fund. But before deciding, he says he will pressure USAID to better explain how it is currently spending its money. "I'm going to find out, I can tell you that. I'm going to find out where every penny that goes with this malaria program is spent, no matter what," he said.