The changing scene among international donors points to a need to re-evaluate domestic contributions to finance malaria and other health and development programs.Â Ethiopia is an example where policy thinking along those lines is underway.Â The Voice of America (VOA) points out that, â€œEthiopia stands out because it already has reached a 60% reduction in the mortality rate of children under five years old.â€ This progress has been facilitated by a decade of economic growth. VOA notes that although United States aid contributions to Ethiopia are now being reduced, Ethiopia is considering finding more domestic resources by scaling up a health insurance scheme that has been successfully piloted in thirteen districts.
Ghana has a long experience with its National health Insurance Scheme.Â The World Bank reports that â€¦
Ghana spends less than 5 percent of its GDP on health, slightly below average for a country at its income level. According to the 2009 World Health Organization (WHO) National Health Accounts, 47 percent of total health spending in Ghana is private (37 percent paid out of pocket and 10 percent paid by private insurance and other private risk-pooling mechanisms). Of the 53 percent public spending share, the NHIS accounts for some 30 percent of public spending on health and 16 percent of total health spending. According to the NHIS, active membership in 2010 was 8.16 million, some 34 percent of the population. Since 2005, outpatient visits have increased by a factor of 23, inpatient service by a factor of 29, and expenditures by a factor of 40. (Schieber G, Cashin C, Saleh K and Lavado R. Health Financing in Ghana. International Bank for Reconstruction and Development/The World Bank, 2012, Washington DC)
There are some caveats with health insurance. â€œAlthough the benefit package of insurance is generous, insured people still incurred out-of-pocket payment for care from informal sources and for uncovered drugs and tests at health facilities. Nevertheless, they paid significantly less than the uninsured.â€Â In addition ability to pay premiums initially or in subsequent years is a concern. Obviously poorer people are affected more by the premiums, and that was why people were hopeful about Affordable Medicines Facility malaria (AMFm) though out of pocket (OOP) expenditure was still required of the poor. The Global Fund did not cancel AMFm when its Board last met, but it did bundle the concept into existing and future malaria grants should countries wish to do so, leaving this subsidized treatment option, often through the informal private sector, in limbo.
Funding levels are not the only concern in reaching and sustaining malaria targets. One also needs to concentrate on how the resources are being used. The Guardian recently described how top-down commodity distribution approaches need to be complimented with bottom-up community approaches. Without community understanding and demand net deliveries from donors may sit in warehouses for months and when they reach the community they may be used as fishing nets or even wedding dresses, according to The Guardian.
International partners are quite aware of the need for better use of resources. The World Health Organizationâ€™s Global Malaria Program GMP in revising its guidelines for malaria treatment in 2010 stated that, â€œThe scale up of diagnostic testing will improve patient care (and) make more efficient use of scarce resources (emphasis added).â€
Overall domestic funding has accounted for about one-fifth of total malaria expenditure in recent years. While this may not be enough, it is this contribution and better use of available funds that may pull us through to 2015.