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Malaria experts criticise World Bank

BMJ 2006; 332 doi: (Published 04 May 2006) Cite this as: BMJ 2006;332:1050
  1. Balaji Ravichandran
  1. BMJ

    Malaria experts from around the world have accused the World Bank of publishing false statistics and approving ineffective malaria control measures. They have called on the bank to relinquish its funding to other agencies better equipped to fight the disease.

    Writing in the online edition of the Lancet, the experts, led by Amir Attaran from the University of Ottawa in Canada, suggested that since the launch of the Roll Back Malaria programme, the bank has consistently decreased the funds it allotted for malaria control programmes around the world, and particularly in Africa.

    The World Bank had claimed that its malaria programmes in India and Brazil were highly successful, resulting in reduction rates as high as 98% in the state of Maharashtra in India. But, in their report Professor Attaran and colleagues, highlighting several statistical inconsistencies, write: “Because we were refused access to the original data source, we cannot discern the cause of the Bank's many statistical errors, and particularly whether those errors arise from unintentional mistakes or from intentional data falsification or fabrication. Most of the statistical errors we located exaggerate the performance of the Bank's projects.”

    The authors add that the bank also wasted money on the distribution of chloroquine in areas of India where chloroquine resistant falciparum malaria was prevalent and treatment failure rates with chloroquine exceeded 15%, despite the World Health Organization's recommendations to use only artemisinin derivatives under such conditions.

    They conclude that the World Bank should have no role beyond providing “unprogrammed financing” and that it should wind down its malaria projects with “speed and grace.”

    The response from bank, published alongside the article in the Lancet, is one of dismissal and optimism. Defending its malaria programme, Jean Louis Sarbib, senior vice president of the bank's Human Development Network, and colleagues say that the accusations of financial concealment are untrue, that the statistics advanced by the bank were consistent with all other available data, and that chloroquine is still the first choice drug in India because “52.5% of 1 781 336 laboratory confirmed cases of malaria in 2003 were due to [Plasmodium] vivax” (as opposed to P falciparum).

    In reply to the suggestion that the World Bank should hand over its control programme to Global Fund for AIDS, Tuberculosis and Malaria (GFATM), Mr Sarbib and his colleagues reaffirmed the cooperation between the bank and the global fund and added that it will work to avoid “wasteful overlaps and gaps.”

    The Lancet editorial preceding these articles note that malaria was conspicuously absent from the policy speech of Paul Wolfowitz, group president of the World Bank, which he made in Jakarta on 11 April, despite the response from the bank that it has renewed its commitment to malaria and achieving results. The experts' article is available at (doi: 10.1016/S0140-6736(06)68545-0), with links to the other two articles.

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