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The Issues

In 2017, 219 million cases of malaria were identified by the WHO, and 435,000 people were killed. Pregnant women and children under 5 are particularly vulnerable, with children accounting for 61% of malaria-related deaths. Africa is the continent most affected by the disease, with 92% of cases. Major progress has been made since 2010, by the use of insecticide-treated mosquito nets, by preventive treatment (seasonal chemoprophylaxis for children, intermittent preventive treatment during pregnancy), by the development of rapid diagnostic tests, and by the use of artemisinin-based combination therapies, which have reduced mortality by 29% compared to 201017.

Naturally, there is still progress to be made, since only 50% of people are estimated to sleep under an insecticide-treated mosquito net, only 56% of children in the Sahelian Zone have benefited from intermittent chemoprophylaxis, and only 22% of pregnant women have benefited from the 3 doses of preventive treatment recommended during pregnancy. Early diagnosis and prompt treatment are the most effective means of preventing the deterioration of malaria and associated deaths; however only 52% of children with fever seek treatment at a health centre, and amongst these, 40% do not benefit from a rapid diagnostic test.


Solthis’ Action

Our priorities for 2019-2021:

  • improving care uptake through community mobilisation, use of rapid malaria tests as part of improving integrated mother-child management (IMCI), and integrated management of childhood fever (SAFIR and Optifare projects).
  • developing innovative approaches to the treatment of gestational malaria.




Country action




Health priority


Associated contents

Solthis' Report: “Managing Risk in Fragile States: Putting Health First! Optimising the Efficiency of the Global Fund’s Grants”

2014 |  Scientific Papers |  , ,


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“Managing Risk in Fragile States: Putting Health First!

Optimising the Efficiency of the Global Fund's Grants”

This evidence-based report is the result of a work over several months, including 4 missions (Guinea, Mali, Niger and Sierra Leone) and interviews with 140 stakeholders. Through this work, we identified bottlenecks in the implementation of the Global Fund's grants in the field, showing that the Global Fund's Risk Management Policy is not well-adapted to fragile states. The additional safeguard measures which have been put in place by the Secretariat after the investigations of the Office of the Inspector General were meant to mitigate the financial risks and to reassure donors. However, experiences in challenging operating environments clearly show that these measures are mainly focused on financial risks and have caused significant malfunctions that jeopardise both the impact and the sustainability of the programmes. In order to make progress and to cope with the challenges specific to fragile states, we think it is now time for the Board members and the donors of the Global Fund to opt for an ambitious and innovative policy, which would put financial risk at its proper place: behind risks to public health. The main recommendations we are addressing in the report aim to place the public health risk at the centre of the mechanism, by:
  • Improving the balance between the analysis and the management of the different risks.
  • Simplifying and clarifying the control procedures: limit the number of contractors and the levels of validation.
  • Defining indicators or objectives for terminating additional safeguard measures to encourage appropriation and capacity building.
  • Investigating the possibility of an increased presence of the Global Fund in the field, by missions of several weeks or several months.
  • Adapting the indicators and procedures of performance-based funding and accountability measures to fragile states.
Full version of the report in English here You can also read our 4-pages booklet here The article of Altermondes dedicated to this topic and the interview of the author Hélène Roger

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