The Blind Hydra
USAID Policy Fails to Control Malaria

AEI's working paper series
Download file The full text of this paper is available here (Adobe Acrobat PDF).


Although several papers in academic journals have discussed the efficacy of individual malaria programs, and other publications have analyzed the functioning of the United States Agency for International Development, this is the first comprehensive analysis of the Agency's overall approach to malaria control. USAID is found wanting: its lack of transparency makes detailed economic assessments of performance impossible; its organizational structure and methods of information management hinder opportunities for collaboration with other donors and prevent necessary assessments of ongoing programs; it avoids accountability for program performance by deflecting responsibility onto contractors; it fails to condition funding for these contractors on relevant outcome measurements; it has influenced the construction of a system wherein the vast majority of funding for malaria either never leaves the United States or funds the employment of U.S. citizens; it ensures continued Congressional support by maintaining key beltway contractors who lobby for increased funding; it spends less than five percent of its malaria budget purchasing actual life-saving interventions; and lastly, it bases its choice of malaria interventions on extraneous political consideration, not on best practice, unnecessarily costing lives.

Based on this analysis, this paper recommends several steps to improve USAID's performance. First, it should increase the transparency of its programs and funding decisions. Such a move will instigate necessary upgrades in organization and data management, improve the Agency's capacity to work with other donors and allow external experts to contribute useful suggestions for performance improvements. Second, USAID should ensure that programs have the necessary funding and scope to achieve success--a sustainable reduction in the malaria burden--and measure their progress with appropriate interim results. At present, USAID spreads its funds too thinly to run such robust programs. By focusing on fewer countries, USAID could provide tangible results, lowering criticism of its performance and establish best practice models for other countries to follow, saving more lives. Third, where its comparative advantage lies in providing technical assistance, it should coordinate with other agencies that provide actual medical interventions (bed nets, insecticides, drugs) in order to ensure a robust effort. Lastly, it must not inhibit countries from using interventions that its staff opposes for reasons other than effectiveness in combating malaria.

If USAID cannot do take these steps, Congress should reallocate USAID's malaria budget to another agency.

Roger Bate is a resident fellow, and Benjamin Schwab a research assistant, at AEI.

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About the Author


  • Roger Bate is an economist who researches international health policy, with a particular focus on tropical disease and substandard and counterfeit medicines. He also writes on general development policy in Asia and Africa. He writes regularly for AEI's Health Policy Outlook.
  • Phone: 202-828-6029
  • Assistant Info

    Name: Katherine Earle
    Phone: (202) 862-5872

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