What are national governments willing to pay for malaria control?

In 2013 national/domestic funding accounted for 20.4% of the US$2.6 billion in global support used to control and eliminate malaria, although it is not clear whether this is governmental, private or a mix.[i] The 2016 World Malaria Report (WMR) reports that, “Total funding for malaria control and elimination in 2015 is estimated at US$ 2.9 billion.[ii] This total represents just 46% of the Global Technical Strategy for Malaria 2016–2030 (GTS) 2020 milestone of US$ 6.4 billion.”

If domestic funding at the previous rate were to meet this milestone, endemic countries would need to put forward $US1.3 billion themselves, not to mention the fact that domestic funding may be needed even more as uncertainties increase in bilateral and multi-lateral sources. Of the coming from governments, US$ 612 million was direct expenditures through national malaria control programmes (NMCPs) while US$ 332 million was expenditures on malaria patient care. While domestic funding for malaria in African countries has increased in absolute terms over the years, it still remains a smaller proportion of total funding.[iii]

Governments in endemic countries characterized by a large portion of the poor, may in fact not contribute a fair share of malaria expenditure. Households are often said to bear the brunt of malaria financing through out-of-pocket expenditure for both treatment and prevention. While we do not have specific figures for malaria, we note that the overall out-of-pocket (OPP) expenditure by households in Nigeria for health care averaged 69.3% between 2010 and 2014.[iv]

Ghana has a national health insurance scheme that may reach up to two-thirds of the population. Costs of fever/malaria episodes therefore should covered by membership, although one is required to pay annual premiums.[v] Still a large portion of the population still pays out-of-pocket.

Although malaria funding from all sources has been increasing over the years, it has recently stagnated at a level approximately 45% of that level targeted to eventually eliminate the disease.  In many countries households still bear the brunt of malaria costs, both for treatment and prevention.

Benefits of investments in interventions like community health workers do help bring malaria care closer to the community at a cost people can afford.[vi] More financial support is needed to scale these up, especially by mobilizing in-country governmental, corporate and non-governmental resources.

[i] Kates J and Wexler A. Global Financing for Malaria: TRENDS & FUTURE STATUS.

Kaiser Family Foundation, December 2014 http://kff.org/report-section/global-financing-for-malaria-introduction/

[ii] World Health Organization. World Malaria Report 2016. ISBN 978-92-4-151171-1. Geneva: World Health Organization, 2016

[iii] Korenromp EL, Hosseini M, Newman RD, Cibulskis RE. Progress towards malaria control targets in relation to national malaria programme funding. Malaria Journal 2013, 12:18 Page 2 of 9 http://www.malariajournal.com/content/12/1/18

[iv] World Health Organization. Global Health Expenditure Database: Nigeria. Accessed 6 February 2017. http://apps.who.int/nha/database/Key_Indicators_by_Country/Index/en?COUNTRYKEY=84700

[v] Tawiah T, Asante KP, Dwommoh RA, Kwarteng A, Gyaase S, Mahama E, Abokyi L, Amenga-Etego S, Hansen K, Akweongo P, Owusu-Agyei S. Economic costs of fever to households in the middle belt of Ghana. Malar J. 2016 Feb 6;15:68. doi: 10.1186/s12936-016-1116-x.

[vi] Sunguya BF, Mlunde LB, Ayer R, Jimba M.. Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review. Malar J. 2017 Jan 3;16(1):10. doi: 10.1186/s12936-016-1667-x.

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