The Symposium was opened by Dr. Christian Lengeler from the Public Health and Epidemiology Department of the Swiss Tropical Institute. Dr Lengeler pointed to the convincing results that can be obtained by the use of preventive methods, such as IRS (indoor residual spraying) and ITN (insecticide-treated nets), to control malaria in Sub-Saharan Africa. Experience has shown that both methods are equally effective and the chosen method will therefore depend on "making a reasonable choice considering operational feasibility and availability of resources". It is essential that these control vectors are implemented "on a large scale, in a sustainable manner and with a maximum level of health service integration". Several implementation models of IRS and ITN have been validated.
Addressing the issue of access to malaria treatment in the private sector, Dr. Ambrose D. Talisuna, Assistant Commissioner of the Department of Health Services Epidemiological Surveillance Unit, Ministry of Health of Uganda, touched on the difficulties of deployment of ACTs (artemisinin-derivative based combination therapies). Acknowledging the efficiency of these drugs, he argued that their financing remains burdensome for most of the affected populations. Dr. Talisuna emphasized the need for an international fund to subsidize ACTs. He also proposed to move "beyond global subsidies" through "non-ambiguous policies, regulations and better product surveillance".
Looking beyond prevention and treatment, Dr. Don de Savigny, from the Public Health and Epidemiology Department of the Swiss Tropical Institute reviewed the relationship between the tools and the healthcare system itself, emphasising the issue of inequitable access. Dr. de Savigny asserted that the issue is "not a technical failure, as interventions work, but more a pressing need to fix the delivery service". Low coverage is affecting the efficiency of the different preventive and treatment methods. In order to resolve this issue the overall healthcare system needs to be strengthened. Dr. de Savigny pointed out that this needs to be done especially at the district level, given their strategic role in the fight against malaria. "There is no single magic bullet; improving healthcare systems will have a large impact on malaria control and treatment."
Returning to the issue of the efficient delivery of malaria therapies, Dr. Franco Pagnoni, of the Implementation Research and Methods Unit of the UNICEF/UNDP/WB/WHO Special Programme for Research and Training in Tropical Diseases, first described the Home Management for Malaria (HMM) approach. HMM concentrates on delivery of effective treatment for uncomplicated malaria cases and by seeking to prevent the occurrence of severe malaria in remote areas where self-treatment is common and sometimes inappropriate. Working at the household level, trained community-based providers make the necessary drugs available and inform the users. The main current challenge is to incorporate ACTs in the HMM strategy. Research is still ongoing, but the preliminary results obtained in Ghana and Nigeria are encouraging. Another challenge ahead is to scale up HMM and later to move to an integrated approach to childhood fevers.
In his concluding statement, the session's chairman, Pierre Olliaro, of the UNICEF/UNDP/WB/WHO Special Program for Research and Training in Tropical Diseases (TDR), recognised that these "tools are not perfect", but are "good enough to be deployed". He also observed the need for further studies on how these methods actually perform and how they improve the access to malaria prevention and treatment.
