Michael MacDonald of the U.S. President's Malaria Initiative Talks Partnerships and Co-Financing

In light of the economic climate, companies are trying to reduce costs without reducing impact. Tell us about your experience with cost-sharing.

In terms of co-financing with the private sector, we've had some good experiences with bed net distributions that have gone out through NGOs working on HIV/AIDS in Africa. Our collaboration with the Global Business Coalition in Zambia was strong because it took a well-established program with a well-established network, and used those networks to distribute 500,000 insecticide-treated bed nets that were acquired by private sector companies.

What we would like in these relationships with the private sector in terms of co-financing is long-term relationships. This is not a short-term relationship. We're in it for the long haul.

Do you feel cost-effectiveness also comes in the form of sustainability? How do we get to sustainability?

If we take a long-range view of malaria, a number of countries are bringing malaria prevalence down to low levels. Once you've got malaria prevalence down, you need more diagnostics and better surveillance systems to track if there is an outbreak somewhere in the country. It becomes a health systems issue. As malaria prevalence goes down, you move from a need for a disease- specific intervention to a need for systems strengthening.

As we look forward, we need to look more into systems strengthening, including coming back to the issue of capacity building and job development. We can develop career structures for young African public health professionals so that they won't need to go of to work as a clinician in Europe and America, but they can instead work with public health in their own country.

How can companies leverage the synergies between HIV/AIDS, TB and malaria programs to keep costs down?

Malaria exacerbates HIV and HIV exacerbates malaria. There's great room for synergy between HIV and TB programs and malaria programs. For example, in terms of laboratory strengthening, the microscope that you use for TB is the same that you use for malaria. Bed net distribution schemes like the one we undertook with GBC in Zambia can work with existing home-based care programs for HIV/AIDS, leveraging their established networks to get bed nets to people in hard-to-reach areas.

Young girls having their first and second pregnancy are most biologically at-risk for malaria-this is the same demographic that HIV programs are targeting. As HIV programs have empowered youths to take control of their lives, to believe that HIV no longer has to be an accident. we can combine with that message that malaria no longer has to be an accident. We can empower youths who've taken control of their lives vis-à-vis HIV, to take control of their lives vis-à-vis malaria.

What is the biggest single challenge facing malaria control efforts today?

The critical issue is capacity. In one country where I've worked, they said receiving a Global Fund grant was like sucking on a firehose. They didn't have the financial management and human resources capacity to put that money to use efficiently-these are things that are bread and butter for the private sector.

So you see a role for business competencies in malaria partnerships?

I see the private sector getting involved in a couple of ways-certainly there's more money needed for bed nets, spraying and drug treatment, but there's also a need for core competencies.

You look at malaria programs and it's really a marketing problem. Here we have a product-whether it's bed nets or indoor residual spraying-and we have information about how to use them. Then we're trying to bring the product and the information together- that's marketing. That's something that consumer product companies do day in and day out, so there's a lot of room here for collaboration with the private sector.

You've said accounting skills are as important as entomology skills.

I'm an entomologist, but what malaria programs need more than entomologists are accountants-a lot of the need is in areas like financial management and human resource management.

There is a huge human resource crisis in Africa- migration and the HIV/AIDS pandemic have devastated the public health sector's human resources. This is the kind of thing that businesses face all the time. Businesses know how to address these problems and ask key questions: Is there task shifting that can be done? Are there ways to increase the retention of health professionals in rural areas?

There's also a need for communications competencies. There has been an information and communications technology revolution in Africa-you can't go anywhere without hearing a cell phone. We need to capitalize on that. We currently have a program in Zanzibar, where a cell phone company has donated server time that we're using to send SMS messaging with epidemiological data, which helps us to better track the disease.

• Chevron’s Dr. Richard Wilkins: Getting sustainable results in the drive to end malaria
• Management Guide: Read the full guide for business action on malaria
• Malaria Collaboration: Learn more about the Corporate Alliance on Malaria in Africa
• Government Partnership: Visit the website of the President’s Malaria Initiative