Malaria
Preparation of GMAP2

Questionaire related to the preparation of GMAP2

Burgess COMMENTARY

Peter Burgess

Call to action

yes no

Is the call to action at the start of the document compelling?
no If so, why? If not, why not?
NO ... every initiative over the last 50 years has had stirring words in the documentation preamble, and in the end not much has been accomplished relative to the resources deployed. Think back to all the wonderful declarations at the Almaty Summit in 1978.

How can the call to action be improved?
The call to action would be improved if there were some believable numbers related to past performance both in terms of the improvement in the state of the malaria problem and the costs that have been incurred to get this change in state. A number is worth a thousand words ... but the numbers have to be meaningful.

Chapter 1

Chapter 1 introduces the RBM Partnership, summarizes progress under the first GMAP, shows the link between this document and the Global Technical Strategy for Malaria, introduces the common milestones, targets and vision, explains the purpose and structure of the document and provides ideas for how the document can be kept up to date.

yes no

Does the chapter succeed to introduce RBM?
no

Does the chapter summarize progress under the first GMAP?
no

Does the chapter clearly show the link between this document and the WHO Global Technical Strategy for Malaria?
no

Does the chapter introduce the common goals well?
no

Is the purpose of the document clearly described?
no

Is the structure clearly laid out?
no

Does it provide interesting ideas on how the document could be kept relevant?
no

Do you have any suggestions on how the chapter could be improved?
The overview observation might well be that the need for GMAP2 is that GMAP1 has not been very successful, therefore we must do some more along the same lines. I don't find this very compelling at all. To start off it would be good if we knew how much GMAP1 has cost, where the money came from, where the money has gone and what has been achieved. There are many examples of progress being used to justify the program, but the 'accounting' of progress relative to cost is virtually non-existent. Worse, some of the progress has been achieved at the non-financial cost of increased resistance to the various interventions being used. GMAP1 had almost no integration of the various possible interventions to get the best ... most cost effective long term outcomes, and at this stage it seems that the same lack of integrated strategy is going to be repeated.

Chapter 2

In chapter 2 the global case for investing in malaria is built. The returns are expressed in terms of economic development, household prosperity, and health systems. The chapter also demonstrates the costs of failing to achieve the 2030 goals and allowing malaria to resurge.

yes no

Does this chapter build a convincing case for investment in malaria?

Does this chapter clearly demonstrate the costs of failing to achieve the 2030 goals and allowing malaria to resurge?

Do you have any suggestions for strengthening the “case for investment”?
The case for investment in better health is easy to make. This being the case, why is it that world health is in such a bad place almost 40 years after the Health Summit in Almaty ion 1978. Spending money on health and investing in health are two very different things, and the metrics being used by the international community equates spending (disbursement) with success which can best be described as stupid and self serving.

Do you have any other suggestions on how the chapter could be improved?
In accounting there is the concept of the reporting entity and the reporting boundary. The public looks at a corporate entity and this entity does financial reporting around the profit performance of this entity, which translates into decisions about stock market investment and what stock prices ought to be. It is not at all clear what reporting entity is going to be used in the evaluation of performance for GMAP2 just as there was no clarity in GMAP1. What we do know is that huge amounts of money were raised and disbursed under GMAP1 and we do know that there has been some progress. What we don't know is whether this progress is more or less than what might have been considered a reasonable expectation ... in other words has the program been effective or not ... has the program been efficient ... what has worked and what has not. None of this seems to be known, yet the amounts of money consumed has been enormous.

Chapter 3

Chapter 3 describes how malaria fits in the new development agenda and the broader political landscape; the influence of social, environmental and biological factors, and the status regarding malaria research and innovation.

yes no

Does the chapter help to position malaria in the broadening global development agenda?

Does the chapter succinctly summarize the main social, environmental and biological factors that influence malaria transmission and our response?

Does the chapter provide an accurate overview of the status in malaria research and innovation?

Do you have any suggestions on how the chapter could be improved?
Interesting for me is that this chapter gets round to the idea that a disease focus for global health development assistance is a wrong approach and that the malaria initiatives ought to be an integral part of public health policy and practice, AND that this should reach to the community level. My experience suggests that it is in the community where health happens, and unless health interventions reach the community they are mere exercises in bureaucratic irrelevance. I was also interested to see a link to integrated vector management, and would like to see much more of the content from this WHO report integrated into the main GMAP2 strategy rather than just having it hanging on the outside. There is a lot of good words and rather few words that show these good thoughts will ever be part of funded practice especially at the community level.

Chapter 4

In chapter 4 actions to facilitate progress in seven critical areas are provided, with illustrative examples and case studies. Important documents/ resources are also called out.

Please select the topics below that you would like to provide input into, which will the be followed by questions on each topic. More than one topic may be selected.

Section 4.1 - Leveraging the broadening development agenda to work across sector and borders.

Section 4.2 - Financing landscape and resource mobilization.

Section 4.3 - Improving policies and the enabling environment.

Section 4.4 - Strengthening and integrating in health systems.

Section 4.5 - Engaging communities to keep people at the center of the response.

Section 4.6 - Strengthening the evidence to inform the response.

Section 4.7 - Fostering and sharing innovation and solutions.

Section 4.1 - Leveraging the broadening development agenda to work across sector and borders.

yes no

Do you find the proposed actions in the different areas useful?
THE VERSION OF THE DRAFT REPORT THAT I HAVE DOES NOT SHOW ANY DETAIL FOR 4.1 TO 4.7. THIS MAY BE BECAUSE WHO HAS MADE A MICROSOFT XML DOCX DOCUMENT AVAILABLE WHICH DOES NOT OPEN CORRECTLY WITH LIBRE OFFICE SOFTWARE, OR IT MAY BE INFORMATION HAS NOT BEEN PREPARED YET.

Do you find the examples/case studies helpful?

Are you able to suggest alternative or additional actions?

Do you have other examples/case studies to share?

Are you familiar with other important resources (e.g. tools, documents) in this area that you think should be mentioned?

Do you have any other suggestions for improving this section?
The idea of working across sectors has been in play since the 1980s, but not easy to implement when most development organizations are organized along sector lines. I argued in the 1980s that the community level had the advantage of being a place where all sectors had to deliver in order for people to progress ... however practically all projects are designed within sector silos, or in the case of health, the further silo of a disease within the sector. Getting a focus on enviro-socio-economic performance at the community level can be instrumental in getting cross sector integration. Expecting this to happen within government ministries or within established international aid organizations is wishful thinking.

Section 4.2 - Financing landscape and resource mobilization.

yes no

Do you find the proposed actions in the different areas useful?

Do you find the examples/case studies helpful?

Are you able to suggest alternative or additional actions?

Do you have other examples/case studies to share?

Are you familiar with other important resources (e.g. tools, documents) in this area that you think should be mentioned?

Do you have any other suggestions for improving this section?
The financing landscape still works on the basis of pretty presentations with rather little of verifiable performance data. There will be donor fatigue unless there is a major upgrade in the accounting and the performance metrics. The potential for success exists, but this will not happen when money is wasted, and the reality is that we have little idea how much of the money is being wasted and how much of the money is delivering amazing results.

Section 4.3 - Improving policies and the enabling environment.

yes no

Do you find the proposed actions in the different areas useful?

Do you find the examples/case studies helpful?

Are you able to suggest alternative or additional actions?

Do you have other examples/case studies to share?

Are you familiar with other important resources (e.g. tools, documents) in this area that you think should be mentioned?

Do you have any other suggestions for improving this section?
Improving the enabling environment is not going to happen until there is accounting and accountability. The fact that people want the international malaria financial assistance may have nothing to do with malaria and all to do with the money. The systems of accounting in place are weak and it is difficult to differentiate between money well spent and money diverted to other uses. The disbursing agencies have ignored this issue for decades.

Section 4.4 - Strengthening and integrating in health systems.

yes no

Do you find the proposed actions in the different areas useful?

Do you find the examples/case studies helpful?

Are you able to suggest alternative or additional actions?

Do you have other examples/case studies to share?

Are you familiar with other important resources (e.g. tools, documents) in this area that you think should be mentioned?

Do you have any other suggestions for improving this section?
I think this was recommended at the Almaty conference in 1978. Why is it still an agenda item? The international experts have chosen a different path for decades in large part because the management metrics have been missing and experts have been allowed to do what they want without any accountability.

Section 4.5 - Engaging communities to keep people at the center of the response.

yes no

Do you find the proposed actions in the different areas useful?

Do you find the examples/case studies helpful?

Are you able to suggest alternative or additional actions?

Do you have other examples/case studies to share?

Are you familiar with other important resources (e.g. tools, documents) in this area that you think should be mentioned?

Do you have any other suggestions for improving this section?
Engaging communities is not enough ... these are code words for the experts having a conversation with some of the community leaders. What is really needed are interventions that fully involve the community in getting their health situation improved. The development community must get beyond development tourism into something with deep substance.

Section 4.6 - Strengthening the evidence to inform the response.

yes no

Do you find the proposed actions in the different areas useful?

Do you find the examples/case studies helpful?

Are you able to suggest alternative or additional actions?

Do you have other examples/case studies to share?

Are you familiar with other important resources (e.g. tools, documents) in this area that you think should be mentioned?

Do you have any other suggestions for improving this section?
Strengthen the evidence should be replaced with the idea that there is going to be effective cost accounting so that decision makers and communities know how much an intervention costs, and are able to connect that piece of factual data with the results being achieved. There must be a big focus on getting disaggregated data that is relatively easy to validate rather than merely country level data that are easy to fudge and will never be called out.

Section 4.7 - Fostering and sharing innovation and solutions.

yes no

Do you find the proposed actions in the different areas useful?

Do you find the examples/case studies helpful?

Are you able to suggest alternative or additional actions?

Do you have other examples/case studies to share?

Are you familiar with other important resources (e.g. tools, documents) in this area that you think should be mentioned?

Do you have any other suggestions for improving this section?
One of the best ways to share information about innovation and solutions is to share the financial costs and the progress achieved of different interventions in different locations. What is most cost effective will emerge and then the best practice can be replicated. As things stand at the moment the people with the best PR and GeeWiz presentations get center stage and the low cost highly effective groups are pushed into the shadows.

Final Comments

Please provide any final comments on the draft document here. You might like to consider the following questions: yes no Does the draft meet your expectations?

Are there any areas that you think receive too much attention and could be shortened?
The chapter that I really want to see is Chapter 5. It is well known in management circles that the metrics are a big factor in the performance. During GMAP1 the metrics have been difficult to validate and likely to be to a great extent self-serving. There is virtually no cost performance information, virtually no community level information and it seems that a lot of the results are derived from quite small studies that may or may not have any validity at scale. In other words, past processes for measurement need to be revamped to get meaningful metrics.

Are there any topics, information, graphics or figures that could be added to strengthen the draft? (Documents, graphics, figures, etc. can be emailed directly to gmap2@gmap2.org. By sending this material you are agreeing to their potential use in the final document.)

Do you have any ideas for additional graphics, or to improve the graphics in the document ? (Graphics can be emailed directly to gmap2@gmap2.org. By sending this material you are agreeing to their potential use​in the final document.)

How might you use this document? In the light of this response, please explain if you find the draft useful/how its usefulness could be increased?
The chapter that I really want to see is Chapter 5. It is well known in management circles that the metrics are a big factor in the performance. During GMAP1 the metrics have been difficult to validate and likely to be to a great extent self-serving. There is virtually no cost performance information, virtually no community level information and it seems that a lot of the results are derived from quite small studies that may or may not have any validity at scale. In other words, past processes for measurement need to be revamped to get meaningful metrics.