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Domestic investments rbm
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
1
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)
2
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)
7
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
8
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
11
Editor's Notes
Since 2000, resources dedicated to the fight against malaria have increased considerably, from less than US$200 million in 2004 to US$1.8 billion in 2010. We have probably reached a plateau
Domestic funding ahs grown much more slowly, and more significantly outside Africa than in Africa, where there are also problems of reliability of data and conflicting trends. As documented in the WMR some countries have invested significantly, other have decreased – this is often but not always consistent with increased funding for health.
The RBM strategy envisions increased domestic spending based on 4 priority action areas.
RBM has supported and participated in various efforts have been made to facilitate this dialogue, notably in the context of the High-Level Dialogue between Ministers of Finance and Ministers of Health from Africa which was organized by the African Development Bank and Harmonization for Health in Africa in July 2012, as well as the in the Africa Health Forum devoted to Finance and Capacity for Results, which was organized during the 2013 Spring Meeting of the World Bank Group and the International Monetary Fund and which was co-hosted by the World Bank and the State Department Office of Global Health Diplomacy of the United States Government, again in collaboration with Harmonization for Health in Africa. Last but not least, the UK Permanent Secretary for International Development hosted a roundtable on sustainable financing for malaria and the health sector with Ministers of Finance and other donors on the margins of the Annual Meeting of the World Bank Group and the International Monetary Fund.
A broad range of options for domestic investments can also come from innovative financing. The RBM Ministerial Session with Ministers of Health, which happens each year in May back to back with the RBM Board, has focused more than once on innovative financing, to provide the Ministers an opportunity to interact on progress in using innovative financing mechanisms in support of malaria financing targets. A recent review made by the Clinton Health Access Initiative focusing on malaria financing noted opportunities, some of them already implemented or planned, from airport taxes, taxes on harmful products, incentives to private donations, prize-linked savings, community health insurance schemes, health trust funds, pooled commodity procurement, "net purchase sweepstakes" and other mechanisms to ensure sustainable financing of malaria interventions.
To improve the prospects for more domestic financing, health actors and decision makers need to have convincing evidence and arguments to use. A couple of relevant initiatives in which the RBM Partnership is involved: 1. As of July 2013, a DFID-funded project for Strengthening the Use of Data for Malaria Decision Making in Africa has been located at the RBM Secretariat to coordinate the generation of an evidence base, the updating of country resource requirements and the identification of efficiency gains and the targeting of resources. 2. Also, the RBM Malaria Advocacy Working Group, in collaboration with the harmonization Working Group, has recently established a new process, called Africa ARM (Advocacy for Resource Mobilization) and has initiated discussions to solicit best practices to populate a country level toolkit and assess country needs in terms of advocacy strategy support and capacity.
