Investing in Malaria at the Country Level: removing the financial burden on the poor

wmdlogoWorld Malaria Day 2015 is continuing a 3-year theme of promoting continued financial resource commitment to control and eliminate the disease. Investing in malaria can take many forms, the most obvious of which is the large donor agency grants from the Global Fund (GFATM), the US President’s Malaria Initiative (PMI), DfID, and the World Bank Malaria Booster Program, a name a few. International and local businesses and corporations also provide a share usually through their corporate social responsibility and employee health projects.

Cost recovery systems are not uncommon

Cost recovery systems are not uncommon

The global financial crisis that began in 2008 lingers in many corners of the world, and has caused thoughtful concern since then about how global disease control efforts can be sustained. In relation to malaria, this concern must take account of the fact that when interventions (ITNs, ACTs, RDTs, IPT) are scaled up and sustained, incidence will drop and the nature of programming and financial commitments will change. A greater emphasis on surveillance, identification of hotspots, response to epidemics, and import of cases from neighboring countries will take the foreground. All this will still require financial support, but where will it come from?

Many of the frontline malaria elimination countries in Africa do not receive external financial support but rely on their own national treasury. As incidence in other endemic countries drops, will the same be expected of them? It is important therefore to look at the current pattern on national commitment to funding malaria control and eventual elimination, including whether countries are devoting 15% of their annual budgets to health. Unfortunately in many countries household out-of-pocket expenditures for malaria services form the bulk of national funding for the disease, a major burden in terms of health equity.

medicine shops are a common place for out-of-pocket malaria  expenditures

medicine shops are a common place for out-of-pocket malaria expenditures

Cost recovery schemes have been tried in Burkina Faso. Rwanda has instituted community insurance programs. Yet these efforts still put a major financial burden on the poor. Ironically, while the poor pay more, the rich, both individuals, and corporations (national and multi-national) in malaria endemic countries conduct illicit financial transfers out of the country or evade local taxes.

Ultimately the challenges of political accountability for results and financial management within countries to citizens, domestic civil society and other non-state actors must be resolved if governments are going to take on a growing role for eliminating the malaria burden within their borders. Monetary investments alone cannot eliminate malaria. Political will must also be invested to close financial gaps, mobilize resources from various sectors and create a true partnership to end malaria.

(A longer version of this article will appear in the March 2015 issue of Africa Health.)

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