The warning comes amid suspicions among some donors that certain African countries have been diverting aid money for purposes other than anti-malaria programmes.

 

Malaria kills more than one million people each year, mainly in Africa where a child dies from the disease every 30 seconds.

 

As Haru Mutasa reports from Burundi, if donors decide to stop financing medicines and mosquito net distribution when they meet in Geneva on April 26, children such as Emmanuel Nizigama may pay the price:

 

Four-year-old Emmanuel has already contracted malaria three times this year.

 

"He has a fever and can't stop shivering," his mother Jacqueline says.

 

Emmanuel (R) has had malaria
three times this year

"It started yesterday when he came back from school. I’m getting worried now."

 

She peels away the blue mosquito net covering her son and gently nudges him awake.

 

He is weak and feverish but able to put on his shoes in preparation for the journey ahead.

 

Ten minutes later, they make their way through the village of Ndava to the health centre. There are no buses or taxis and even if there were, Jacqueline could not afford them.

 

But she is luckier than most in rural Burundi. The health centre she is walking to is just 15 minutes away. Some mothers take over an hour to reach the nearest health facility.

 

The centre is always inundated with patients and Jacqueline quietly joins the end of the queue with her son.

 

Eventually, a nurse aide comes to get their details and leads them to the laboratory to take a blood sample.

 

The seemingly simple procedure – the prick of a needle – leaves Emmanuel in tears, and his mother patiently tries to console him. 

 

"This is the third time in a year he has had malaria," says Jacqueline tiredly.

 

Drug resistance

 

With $10.7 million in aid Burundi has achieved the following:

·   More than 2 million people treated with new drugs

·   378 health units and 26 hospitals supplied with anti-malaria equipment

·   9 high-malaria burden provinces can do quick malaria tests

·   More than 250,000 mosquito nets distributed to pregnant women and children

·   More than 500 health service providers trained to fight malaria

"The first time I gave him some tablets I bought from the kiosk and he got better. A few weeks later he got sick again and I gave him more tablets," says Emmanuel's mother.

 

"I even made him and all of my other children sleep under the net in the bedroom. But he still got sick."

 

She lets Emmanuel put his head on her lap while they wait for the results of the test. The slight bulge on her stomach is noticeable and she confirms that she is pregnant with her seventh child.

 

The test comes back positive and Emmanuel is given a different drug this time, more effective than the older malaria resistant drugs still on the market in Africa.

 

"No child has died here since we started administering the new drug," says Phinees Ntakiyiruta, the nurse at Ndava health centre.

 

"In the past we used to see 10 people dying from malaria every week, now we get two a month."

 

Costly drugs

 

Many families cannot afford to
pay for malaria drugs

The new wonder drugs, known as ACTs, quickly destroy malaria parasites from the body, reducing the chances of transmission to other people.

 

But they are more expensive than the older sulphur-based anti-malaria drugs such as Fansidar. An adult dosage of 24 tablets costs $2.40 compared to 10 cents for previous drugs.

 

More than half of Burundi’s population live on less than $1 a day and almost 90% live on less than $2 a day.

 

The decade-long civil war that ended in 2003 led to the internal displacement of thousands and destroyed the country's infrastructure.

 

Burundi's population has since been vulnerable to poverty, malnutrition and diseases.

 

"Famine can easily trigger and exasperate the spread of malaria," says Fabio Pompetti who heads Medecins sans Frontieres in Burundi.

 

"There is not enough land for the people here. They farm on small plots and there is little or no full scale commercial farming taking place."

 

Donor dependency

 

Mothers like Jacqueline, who cannot afford to buy ACTs, receive these drugs at subsidised prices and sometimes free of charge, because of donor grants channelled through the so-called Global Fund for malaria, TB and aids.

 

"Where will I get the drugs and mosquito nets if the clinic does not get any more? Am I supposed to just watch my family die?"

Emmanuel's mother, Jacqueline Nizigama

For Jacqueline, whose entire family suffers from recurring bouts of malaria, the grant money has been her lifeline.

 

Now, this lifeline might be cut short if the next round of funding talks, due to start in Geneva on Wednesday, does not come up with the money to fund malaria programmes in Burundi.

Donors have complained that some of the funding simply disappeared in certain African countries and threatened not to go ahead with further pledges.

Kenya is a good case in point. The East African nation has been asked to account for $10 million of its share of the Global Fund that has gone missing.

Fear

 

Burundi's clinics have won
victories in the war on malaria

But Burundi did put donor aid to good use.

 

Clinics and hospitals have been receiving medicines and an effective policy on distribution of mosquito nets as well as education of health workers is underway. 

 

"If I do not get the drugs and mosquito nets free I can not afford to buy them. The nurse told me how I must keep myself safe from malaria too because I am pregnant," says Jacqueline Nizigama.

 

"Where will I get the drugs and mosquito nets if the clinic does not get any more? Am I supposed to just watch my family die?"

 

All pictures taken by Arjen Westra