Over the past few years everyone has been worried about the willingness and ability for donor nations to provide continued support for malaria control efforts – either multilaterally through Global Fund contributions, or bilaterally.Â Recent changes at the Global Fund itself reinforced these financial fears.Â What may have been overlooked is the financial health of recipient countries themselves.
Donor support for malaria control provides major assistance for commodities, but usually is not expected to support the running of the basic health system from which those commodities are delivered to people in need of prevention or treatment services.Â Recent news from two malaria endemic countries in southern Africa call into question the basic ability of governments to provide basic human and material health infrastructure.
The BBC reports that, “Britain is calling for urgent action to prevent a Greece-style financial crisis in Malawi, one of the world’s poorest countries, where recent political turmoil, a suspension of foreign aid, and an abrupt currency devaluation have conspired to leave the new government with a gaping hole in its budget.”
The new president believes that there is less need to worry because of existing pledges for cash that suspended last year because of the increasingly autocratic behavior of her predecessor.Â But it is often easier to turn off the financial tap than turn it back on.Â Donors become wary and wait and see.
Likewise the behavior of political elites is causing concern in Swaziland. According to IRIN the International Monetary Fund is withdrawing support from the country where government spending currently exceeds its revenue. While there has been a revenue from the Southern African Customs Union since 2008, a more proximate cause of financial woes is “The spending habits of King Mswati III – sub-Saharan Africaâ€™s last absolute monarch – and the royal household are routinely splashed across newspapers, from the overseas shopping trips of his 13 wives to a â€œbirthday presentâ€ for the king this year of a multimillion-dollar private jet.”
IRIN notes that “About two-thirds of Swazilandâ€™s 1.1 million population live in chronic poverty in a food insecure country that also has the world’s highest HIV/AIDS prevalence, with one in four people aged 15-49 infected.” This is not an environment where malaria can be eliminated, as is the goal of the South African Development Community.
Controlling and eliminating malaria in the context of a strong health system requires political will.Â Some countries are making great strides. Maybe the African Leaders Malaria Alliance can be a forum for applying peer pressure for ‘good political behavior’.