Dear Colleagues
Over the past five years there has been a major increase in the fund flows related to anti-malaria interventions. It is expected that in 2008, there will be more than $1 billion disbursed related to malaria work.
But it is interesting to note that the easy sound bite about child death ... "A child dies in Africa because of malaria every 30 seconds" ... or "some 3,000 children under 5 years of age die in Africa every day" remain the same now as they were two and three years ago. Is this lazyness on the part of the PR people ... or is this because the impact of the funding is insignificant.
With so much funding, it is reasonable to expect that there will be some cost accounting and performance analysis. President Bush made it clear that this was going to be a characteristic of the President's Malaria Initiative (PMI) and everyone talks about the importance of performance metrics. But in reality, the presently available performance metrics are simplistic and merely confirm that certain activities have been carried out ... which is a start ... but there is little about how effective these activities are in addressing the burden of malaria.
What is the goal? To reduce the burden of malaria in the society.
What is the burden of malaria? There are many elements of which the following are important. How much cost does this have?
1... High mortality among young children
2... High mortality among pregnant women
3... Mortality among all other groups in the population
4... Morbidity among all groups in the population ... which has a big economic impact when working age adults are incapacitated
5... Lost working time due to malaria
6... Cost of anti-malaria interventions
...1... Medical care
...2... Personal protection (coils, sprays, etc)
...3... Personal protection (bednets)
...4... Interior residual spraying (IRS)
...5... Source control ... larvaciding
...6... Adult mosquito control ... ULV adulticiding
What are the key metrics that show progress and relate progress to the costs of the associated anti-malaria activities?
1... Reduction in mortality among young children
2... Reduction in mortality among pregnant women
3... Reduction in mortality among all other groups in the population
4... Reduction in morbidity among all groups in the population
5... Reduction in lost working time due to malaria
6... Reduction in the cost of needed anti-malaria interventions
...1... Medical care
...2... Personal protection (coils, sprays, etc)
...3... Personal protection (bednets)
...4... Interior residual spraying (IRS)
...5... Source control ... larvaciding
...6... Adult mosquito control ... ULV adulticiding
7... Reduction in the prevalence of malaria parasite in the human host
8... Reduction in the prevalence of malaria parasite in the mosquito population
9... No emergence of resistance in any of the anti-malaria interventions
10.. No environmental damage
11.. No negative side effects for the human population
What is the cost? What is the optimum cost? How to get the least cost and the most benefit for anti-malaria interventions
...1... Medical care
...2... Personal protection (coils, sprays, etc)
...3... Personal protection (bednets)
...4... Interior residual spraying (IRS)
...5... Source control ... larvaciding
...6... Adult mosquito control ... ULV adulticiding
...7... Cost of data collection, data logistics, data analysis and administration
The metrics described here are a lot more substantive than anything that seems to be available at the present time in the malaria sub-sector ... though there will be around $1 billion disbursed in 2008 to address the malaria component of African health.
The international relief and development sector does not have a good track record on financial control, cost accounting and related matters. The good news is that there is some discussion of the need for performance metrics. The bad news is that what currently goes for performance metrics is very limited in quality and comprehensiveness.
With limited performance metrics ... performance is compromised. The cost is huge. Good management information is possible. Good management information is used in the corporate sector, but good management information is almost entirely absent in the public sector, and especially in the international relief and development sector. This is obscene, and serves only those that want to rip off the system or are engaged in activities that have little or no value.
Your comments are welcome.
Peter Burgess
The Tr-Ac-Net Organization
Sunday, December 23, 2007
Friday, December 21, 2007
Performance Metrics
Dear Colleagues
The international relief and development sector is very weak on performance metrics, and so also is the medical profession.
WHO and others in the health and international relief and development community have worked for a long time to develop useful performance metrics about the malaria situation and the activities being funded.
The outcome shows, however, that there has been a serious absence of accounting input and the basics of cost accounting are missing.
Instead of measuring how much it has cost to do various things, and what has been achieved by doing these things in terms of the reduction of the burden of malaria in the community, there is instead a set of measures that simple show how much "coverage" has been achieved for the subject intervention.
Coverage versus cost shows something about the efficiency of the operation ... but nothing about the efficacy of the activity. Does the activity actually reduce the burden of malaria or not ... and how much does that cost?
Top leadership has made bold statements about the need for good performance metrics. Whenever President Bush has spoken about the President's Malaria Initiative (PMI), a very large US international commitment for health, he always adds in something about performance metrics. Unfortunately the examples he gives are usually simply about quantities delivered rather than the reduced burden impact to be achieved.
Even though I have tried to find quality information about cost effectiveness of mosquito and malaria control interventions, there is very little that is available. I am sure there is information in some archive, but it is not easy to find, and less easy to access and use.
Even though there is increased funding for malaria control, it is not enough to eradicate malaria unless it is used in the very best way possible. That requires data and decision making that is focused on cost effectiveness and multi-year results.
The Tr-Ac-Net Organization in cooperation with the Integrated Malaria Management Consortium (IMMC) has set out to provide a way for these data to be collected and stored in an easily accessible form for operational and analytical use. The goal is a low cost way to do this, and have it in a useful form for decision making.
Sincerely
Peter B in New York
The Tr-Ac-Net Organization
The international relief and development sector is very weak on performance metrics, and so also is the medical profession.
WHO and others in the health and international relief and development community have worked for a long time to develop useful performance metrics about the malaria situation and the activities being funded.
The outcome shows, however, that there has been a serious absence of accounting input and the basics of cost accounting are missing.
Instead of measuring how much it has cost to do various things, and what has been achieved by doing these things in terms of the reduction of the burden of malaria in the community, there is instead a set of measures that simple show how much "coverage" has been achieved for the subject intervention.
Coverage versus cost shows something about the efficiency of the operation ... but nothing about the efficacy of the activity. Does the activity actually reduce the burden of malaria or not ... and how much does that cost?
Top leadership has made bold statements about the need for good performance metrics. Whenever President Bush has spoken about the President's Malaria Initiative (PMI), a very large US international commitment for health, he always adds in something about performance metrics. Unfortunately the examples he gives are usually simply about quantities delivered rather than the reduced burden impact to be achieved.
Even though I have tried to find quality information about cost effectiveness of mosquito and malaria control interventions, there is very little that is available. I am sure there is information in some archive, but it is not easy to find, and less easy to access and use.
Even though there is increased funding for malaria control, it is not enough to eradicate malaria unless it is used in the very best way possible. That requires data and decision making that is focused on cost effectiveness and multi-year results.
The Tr-Ac-Net Organization in cooperation with the Integrated Malaria Management Consortium (IMMC) has set out to provide a way for these data to be collected and stored in an easily accessible form for operational and analytical use. The goal is a low cost way to do this, and have it in a useful form for decision making.
Sincerely
Peter B in New York
The Tr-Ac-Net Organization
Thursday, December 20, 2007
Increased Funding
Dear Colleagues
Malaria has been underfunded for about 40 years. As a consequence many areas in the tropics continue to have high levels of malaria for all or part of the year.
But in the years since 2000, there has been a substantial increase in the funding available, and the idea of eliminating malaria in the foreseeable future is now, once again, on the table.
It is anticipated that there will be in excess of $1 billion disbursed in the fight against malaria in 2008.
But even though there is increased funding being promised, there are some serious questions about how much will be achieved. Though there is talk about performance metrics, it is apparent that most measurement presently being done relates merely to the activities being undertaken, and very little to the ultimate benefit.
If the funds are used badly, even though there is adequate funding, the results will unsatisfactory. This is not acceptable, and is the driving force behind Tr-Ac-Net's commitment to deploying a range of performance metrics to measure the cost effectiveness of malaria control interventions.
Sincerely
Peter Burgess
The Tr-Ac-Net Organization
Malaria has been underfunded for about 40 years. As a consequence many areas in the tropics continue to have high levels of malaria for all or part of the year.
But in the years since 2000, there has been a substantial increase in the funding available, and the idea of eliminating malaria in the foreseeable future is now, once again, on the table.
It is anticipated that there will be in excess of $1 billion disbursed in the fight against malaria in 2008.
But even though there is increased funding being promised, there are some serious questions about how much will be achieved. Though there is talk about performance metrics, it is apparent that most measurement presently being done relates merely to the activities being undertaken, and very little to the ultimate benefit.
If the funds are used badly, even though there is adequate funding, the results will unsatisfactory. This is not acceptable, and is the driving force behind Tr-Ac-Net's commitment to deploying a range of performance metrics to measure the cost effectiveness of malaria control interventions.
Sincerely
Peter Burgess
The Tr-Ac-Net Organization
The Malaria Crisis
Dear Colleagues
Over the past few years, and thanks to a great extent to the work of Jeffrey Sachs, the malaria crisis in Africa has become quite well known. The phrase "3,000 children die in Africa every day from Malaria" has been repeated many times, and now appears frequently in the mainstream media.
If six Boeing 747 airliners full of children were to crash in a day's time, this would be a catastrophic event ... but the same number dying quietly from malaria passes unnoticed.
More children die every day from malaria than were killed in the USA as a result of the terrorist events of 9/11/2001.
But what is particularly concerning is that malaria ought not to be killing anyone.
This blog aims to address some of the issues around the present malaria situation, and the issues around the fund flows and activities being deployed to reduce the burden of malaria. It is written primarily by Peter Burgess of the Tr-Ac-Net community with the help of experts associated with the Integrated Malaria Management Consortium.
Sincerely
Peter Burgess
The Tr-Ac-Net Organization
Over the past few years, and thanks to a great extent to the work of Jeffrey Sachs, the malaria crisis in Africa has become quite well known. The phrase "3,000 children die in Africa every day from Malaria" has been repeated many times, and now appears frequently in the mainstream media.
If six Boeing 747 airliners full of children were to crash in a day's time, this would be a catastrophic event ... but the same number dying quietly from malaria passes unnoticed.
More children die every day from malaria than were killed in the USA as a result of the terrorist events of 9/11/2001.
But what is particularly concerning is that malaria ought not to be killing anyone.
This blog aims to address some of the issues around the present malaria situation, and the issues around the fund flows and activities being deployed to reduce the burden of malaria. It is written primarily by Peter Burgess of the Tr-Ac-Net community with the help of experts associated with the Integrated Malaria Management Consortium.
Sincerely
Peter Burgess
The Tr-Ac-Net Organization
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