David Hercot

As expected, the release of new malaria death estimates by IHME  (last week in the Lancet) has sparked numerous reactions and comments on all sides. BMJ

gives a pretty good overview of the debate. Richard Horton finds it a bit shameful that WHO criticises the data  instead of engaging in reasoned discussion on ways to improve the estimates. We have had these sterile arguments, remember the maternal mortality row.

It’s time to move beyond a debate on the methods used to arrive at the numbers.  Because in the end these remain just estimates, using the same raw data, but applying different data crunching ‘hocus pocus’. The CGD website features a good blog post explaining the difference in sausages applied by both approaches. Beside an increased number of deaths in Africa (as compared to WHO estimates), what differentiates both approaches is the proportion of adult deaths due to malaria in Africa mainly. And that difference has been created by hypotheses made by Murray’s team.

In this whole debate, hypotheses and assumptions seem to be the main discussion point. We do need assumptions, because as Alex Perry put it : “we really don’t know what’s going on out there”. The reality is that reliable information is very scarce for most of Africa. So then what? Some argue that we need more research and better monitoring and evaluation. In times of reduced global health funding there is a push for more evidence to get the most out of each penny. But first things first, people out there need access to quality health care. There are many people who should get access to drugs and diagnostics who simply don’t get it. So it’s fine to improve the quality of global estimates but we shouldn’t forget that the aim of all this is to improve people’s health. So perhaps we shouldn’t lose too much time discussing who is the least wrong.

Both estimates agree that the fight against malaria has made good progress over the last years. That’s great news. Yet, we will need sustained efforts at the implementation level in the coming years to maintain a steady rate of progress.

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