Philosophy.  According to the WHO website, Roll Back Malaria “is not a project or program.  It is a social movement that is part of broader societal action for health and human development.” (WHO, 2000)  This concept of societal action for health development in addressing the global problem of malaria stems from the view of malaria as a developmental and poverty issue.  Malaria in these terms can be seen as part of a vicious cycle in economic depression both at the family and the community level.  Within a household, illness from malaria can lead to as much as a 25% loss in earnings. Continued bouts of malaria are known to slow children’s cognitive and social development, and in school age children will slow their educational progress.  Families affected by malaria are less likely to plant and harvest crops, and when they do they are more likely to plant less labor-intensive crops, rather than crops that generate greater revenue but require more energy.  At the national level, malaria can cost a country upwards of 6% of its Gross Domestic Product, taking away resources that might otherwise be invested in infrastructure, preventative health care or social programs that would benefit the population. 


Strategy.  As stated earlier, the basic strategy of Roll Back Malaria is to empower individual countries to enact malaria programs that they might not otherwise be able to afford by mobilizing cooperative expertise and outside monetary support.  The WHO advocates four basic approaches to accomplish the overarching reduction goal of 50% by 2010:  prompt access to treatment, prevention and control in pregnant women, vector control, and prediction and containment of epidemics.  (WHO, 2003)  In this respect, each country is encourage to devise a Country Specific Plan (CSP) to address its unique problems.  As a continent, Africa set personal goals to assure that 60% of its population would have access to treatment of acute disease within 24 hours, 60% of at risk populations including children under 5 and pregnant women would have access to preventive measures such as impregnated mosquito nets, and 60% of pregnant women would have access to intermittent preventive treatment.  To encourage investment in malaria programs, tariffs and taxes on necessary supplies are waived and debt relief is provided.  The RBM program has established the following strategic directions to lead the work being done in individual countries:  to have an integrated approach addressing issues common to primary prevention measures and major communicable diseases, to promote equity by focusing on disadvantaged populations and establishing basic standards of health care, to incorporate primary prevention in the initiatives, to increase media involvement through partnership, to strengthen advocacy at the political and professional levels, to enhance the role of health professionals, to support communities and families in basic prevention, to mainstream the concepts of RBM, and to continue to forge new partnerships in the RBM initiatives. (WHO, 2001)


Timetable. Roll Back Malaria was established with an embedded timetable to guide progress.  The preparatory phase was planned to go from June, 1999 to December, 1999.  The piloting phase as designed to be a two-year trial and pilot phase in selected areas from January, 2000 to December, 2000.  The operational phase is scheduled to run from 2002 to 2006.  So far, many countries have become involved and begun to see impressive gains in their individual fights against the malaria burden in their regions.  An 18 month trial in Sri Lanka using treated bed nets saw an 80% decrease in malaria infections and a similar trial in Vietnam saw malaria infection drop 95%.  Plans are underway in sub-Saharan Africa to distribute high-tech bed nets over the next 5 years to more than 60 million homes.  This program is a good example of outside subsidy and local health programs working together as the price of the nets are expected to drop by 50% from US$ 4 to US$2, and will be distributed free of charge from health facilities for those who cannot afford them.(WHO, 2000)



Malaria is a tremendous global problem in the new millennium   As resistance of both mosquitos and the parasites to the currently used insecticides and treatments emerge and expand, the world faces the possibility of seeing a rise in the incidence of malaria.  The control and decrease of malaria will be attainable only through the commitment of communities to address the problem.


Within the communities, success can be attainable through the methodical application of the basic tenents of the global eradication scheme of preparation, attack, consolidation and maintenance.  Local programs must plan ahead assuring commitment and adequate infrastructure prior to beginning the process.  When initiating the attack phase, programs must address all aspects of the disease addressing mosquito populations, mosquito access to humans, and rapid and adequate treatment of infected individuals.  During the consolidation phase, communities must be diligent to monitor for new infection and address issues that might have led to cracks in the system like decreased adherence to the use of bed nets or allowing water to become stagnant.  Finally, programs must not abandon the gains accomplished during the previous three phases when they finally reach the maintenance phase.  They must continue to monitor on a periodic basis and adhere to the basic practices that allowed them to achieve success.  With sound fundamentals, an enduring commitment to eradication and adequate resources the global problem of malaria can be addressed and the world can see the end a deadly and costly disease.



Useful Resources

Burton Bogitish and Thomas Cheng, Human Parasitology, (Saunders College Pub: Philadelphia, 1990)




Bailey, Norman T.J., M.A., The Biomathematics of Malaria,  (Charles Griffin and Company LTD: London,



Bloland, Peter B., Drug Resistance in Malaria, (WHO: Geneva, 2001)


 Burton Bogitish and Thomas Cheng, Human Parasitology, (Saunders College Pub: Philadelphia, 1990)


Bruce-Chwatt, Leonard Jan,  Essential malariology (Heinemann Medical Books: London, 1980)


Clyde, David F. 1987. Recent Trends in the Epidemiology and Control of Malaria. Epidemiologic Reviews, Vol.

            9: 21-243.


Garnham, P.C.C., Malaria parasites and other haemosporidia, (Blackwell: Oxford, [c1966])


Holder AA, “Malaria Vaccines” Proceedings of the National Academy of Sciences of the United States of America,

            Vol. 96, Issue 4, 1167-1169, February 16, 1999.


Knox, E.G.  Acheson, R.M. et. Al. Epidemiology in health care planning : a guide to the uses of a scientific

            method / edited for the International Epidemiological Association and the World Health Organization (Oxford

University Press: Oxford, New York, 1979)


Krier, J.P. and J.R.Baker (Eds.) Parasitic Protozoa, Vol. 7, 2nd Edition (Academic Press, New York, N.Y. 1980)


Krishna, Sanjeev, “Science, Medicine and the Future:  Malaria”, BMJ 1997;315:730-732 (20 September)


Phillips RS, “Current status of malaria and potential for control.” Clin Microbiol Rev 2001 Jan;14(1):208-26


Poland GA, Murray D, “Science, medicine, and the future New vaccine development “BMJ 2002;324:1315-1319

(1 June)


 R. Mansell, Migrants and malaria in Africa (University of Pittsburgh: Pittsburgh, 1965)


Slater, A.F.G. and A. Cerami. 1992. Inhibition by chloroquine of  a novel haem polymerase enzyme activity

            In malaria trophozoites. Nature 355:167-169.


Wang R, Doolan DL, et al. “Induction of antigen-specific cytotoxic T lymphocytes in humans by a malaria DNA

vaccineScience 1998; 282: 476-480


Whitty CJM, Rowland M, “Science, Medicine and the Future:  Malaria”  BMJ 2002;325:1221-1224

(23 November)


WHO Technical Report Series 805, Practical Chemotherapy of Malaria, (WHO: Geneva, 1990).


World Health Organization, Rollback Malaria: A Global Partnership, (WHO, 2003)


World Health Organization, Rollback Malaria,, (WHO, 2000)