FOREWORD

The launch of Roll Back Malaria (RBM) in 1998 was a catalyst for renewed global commitment to tackle a disease that affects 3.2 billion people and has devastating effects on health and development. Malaria exacts its greatest toll on the world’s poorest and most marginalized. It kills at least one million people a year, yet it is treatable and largely preventable with the tools available now. The ambitious RBM goal of halving the global burden of malaria by 2010 remains an imperative for the global community.

This is the first comprehensive report by RBM on the burden of malaria in the 107 countries and territories at risk of malaria transmission, and on countries’ progress to control the disease. The Africa Malaria Report 2003 from WHO and UNICEF focused on the region where the burden of cases and deaths remains the highest. This new report looks at all regions, including the tropical areas of the Americas and Asia where up to 20% of deaths occur.

During the 1980s and 1990s, the burden of malaria increased in Africa as a result of drug and insecticide resistance and a general deterioration of primary health services. Malaria also increased in intensity in the Eastern Mediterranean and South-East Asia subregions after the interruption of eradication efforts, and re-emerged in several Central Asian countries as a significant threat to health. The emergence and spread of parasite resistance to previously effective low-cost drugs has, in particular, posed a major challenge for control efforts in all regions. The need to prevent both malaria infections and subsequent illness as well as to provide access to prompt treatment using newer combinations of effective drugs is ever more urgent.

This report from WHO and UNICEF indicates that despite the tremendous challenges which remain, significant progress in the battle against malaria has been made in all malaria-affected regions. Following the initial phase of developing national control plans and obtaining financial support for these plans, most countries have begun to implement the recommended tools and strategies to reach those most at risk of malaria. The RBM partnerships that have developed in support of these country programmes have provided further impetus in moving forward to scale up access to malaria prevention and treatment for those most at risk.

There are many encouraging examples in this report of where these efforts are now beginning to bear fruit. However, much more needs to be done to remove the obstacles that continue to hamper progress. In particular, there is a significant gap between the resources needed for effective malaria control in the countries with the highest burden and what is presently available. Financial support and commitment to malaria control have increased during the past two years, but a much higher level of sustained donor assistance will be required for the foreseeable future if we are to successfully scale-up malaria control efforts.

Our organizations remain firmly committed to working with the RBM partners on behalf of communities ravaged by malaria. With a high level of sustained commitment by all, there is every reason to believe that during the second half of this decade we can stop and reverse the forward march of malaria and that many fewer communities will be affected by this eminently controllable disease.