Malaria poses a major public health challenge in Africa, infecting 174 million people annually and killing 596,000. [1] It hinders socioeconomic development, but increased investment in malaria control between 2001-2011 yielded $73-91 billion in economic returns, far outweighing the $5.4 billion invested. [2] While aid for malaria has increased over the last decade, domestic funding is growing too slowly. [3] Sustainable domestic financing will require 1) increasing health budgets, 2) innovative funding mechanisms, 3) evidence for decision making, and 4) cross-sectoral integration for efficiency. [4] The Roll Back Malaria Partnership advocates for these approaches and supports countries by sharing lessons

1. Challenges and Implementation of Domestic
Financing for Health:
Malaria
Domestic Financing for Health: Invest to Save Lives
Addis Ababa, 11-12 November 2013
Dr Silvia Ferazzi
Roll Back Malaria Partnership

2. Malaria is a key public health challenge in Africa
People at risk
• 3 billion in the world
• 726 million in Africa
Number of cases
• 219 million in the world
• 174 million in Africa
Number of deaths
• 660,000 in the world
• 596,000 in Africa
Map of malaria risk - Source: Malaria Atlas Project 2012
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3. Malaria hinders socio-economic development
Direct benefits
from case and
death reduction
• Improved lifetime productivity (fewer work days lost to illness
and death): Average productivity gain of 1-5 days per case
averted (Mc Kinsey, 2006)
• Economic return for companies: through a PPP initiative, in
Zambia 3 companies gained an annualized rate of return of
28%
Overall, in Africa 2001-2011:
Total benefit
from reduced
malaria burden
+
$5.4 billion in malaria control
↓
$73-91 billion in economic return
=
14 to 17 times the investment)
• More income for poor families: Malaria accounts for 25% of
household expenditures
Additional
benefits
• More educated workforce (better school attendance and
performance)
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4. Resurgence //Sustaining achievements
Cohen et al. Malaria Journal 2012
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5. Remarkable increase in aid for malaria over the past
10 years – what next?
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6. Domestic funding is progressing too slow
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7. Ensuring sustainable domestic funding
3. Develop
evidence/tools for
decision making
1. Increase budget
allocations
Development loans (IDA/Reg. Banks)
Development aid (budget support)
Investment of revenue collection
Ministers of
Finance
Heads of
State
Ministers of
Health
4. Promote intra- and
intersectoral integration
for better value for
money
2. Implement
innovative mechanisms
to counter
unpredictability and
increase efficiency
PPPs
Debt relief/Debt conversions
Results based financing
Trust funds
Risk pooling
Sustainable financing plans
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8. 1. Increased budget allocations for health – RBM
advocacy
 Work with Heads of States: African Leaders Malaria
Alliance → African Union
 Contribution with advocacy and evidence in key
MOH/MOF processes:
–High Level Dialogue, Tunis (AfDB; HHA)
–Africa Health Forum (WB, USG, HHA)
–Roundtable on Sustainable Finaicng for malaria and
Health sector (UK)
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9. 2. Domestic innovative financing – RBM support to
share lessons and promote pilot initiatives
 Annual RBM Ministerial
Session has focused
repeatedly on domestic
innovative financing
 Piloting a PPP pay-forperformance model in
Mozambique
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10. Domestic innovative financing – report at 2013 RBM
Ministerial Session
Innovative use of
taxation
 Use of taxes on tobacco, alcohol, GSMs, air tickets (Benin)
 De-taxation of bed nets/insecticides/drugs (Burkina Faso, Côte d'Ivoire)
Community health
insurances and feebased measures
 Health insurance schemes (Burkina Faso, Ethiopia, Ghana, Mali, Sierra Leone, Sudan, Yemen, Zambia)
 Community health insurance (Burkina Faso, Rwanda)
 Extension to malaria of fee for health services (Liberia, Yemen)
 Exemption from medical fees (Côte d'Ivoire)
Co-financing and
extension of services
from PS
 Malaria financing task force with private sector (Malawi)
 Expansion of partnership with telecommunication companies (Yemen)
 Discussion for corporate responsibility action on malaria with private sector (Sierra Leone)
 Dialogue with private sector for extension of interventions from workplace to communities (Zambia)
Solidarity funds/other
pool funding
 Presidential initiative for free care (Benin)
 Pooled financing scheme for MDG support (Ethiopia)
Pay for performance
mechanisms
 Introduction of result based financing approach (Yemen)
 CHWs cooperatives funded based on performance including test/treat malaria (Rwanda)
 Proof of concept pilot of a pay-for-performance model in consultation with private sector (Mozambique)
Cost efficiencies
 Pooled purchase/management of commodities (Benin, Burkina Faso, Côte d'Ivoire, Ethiopia, Mali, Rwanda)
 Use of the VPP of the Global Fund (Comoros, Ghana, Liberia, Togo)
 Voluntary pooled procurement and the procurement through WHO (Yemen)
 Planned participation in SADEC initiative for pooled procurement (Swaziland)
 Plans for local manufacturing of LLINs (Rwanda, Swaziland)
 Integration in comprehensive health packages (Rwanda, South Africa, Sudan, Yemen)
 Purchase agreements with private sector for better procurement efficiency (Côte d'Ivoire, Zambia)
 National pharmaceutical procurement unit envisaged (Sierra Leone)
 Unified national health information system (Sierra Leone)
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11. RBM support: improve evidence and tools for decision
making
• DFID-funded project with
RBM for Strengthening the
Use of Data for Malaria
Decision Making in Africa
• Africa ARM (Advocacy for
Resource Mobilization) as
joint undertaking of RBM
Malaria Advocacy Working
Group and Harmonization
Working Group
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12. Need to engage non-Health Sectors
http://online.wsj.com
Military
http://keystoneschool.com
Infrastructure Projects
Education
Also important, better integration of interventions with other sectors allows
for more efficient management of common costs and take advantage of
financing processes in other areas for malaria outcomes
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