Donor and domestic financing for malaria in 35 eliminating countries (1990–2017)

Donor financing for malaria has declined since 2010 and this trend is projected to continue for the foreseeable future. Such budget reductions have a significant potential impact on lower malaria burden countries actively pursuing elimination: typically a lesser priority for donors compared to high-burden nations. While domestic spending on malaria has been increasing, it still varies widely between countries, both in terms of spending levels and its pace of growth. A clear understanding of spending patterns and trends in donor and domestic financing is essential to uncover investment gaps and opportunities.

Building on the Institute for Health Metrics and Evaluation’s annual assessment Financing Global Health, data were collected from organizations that channel development assistance for health to the 35 countries actively pursuing malaria elimination. Where possible, development assistance for health (DAH) was categorized according to spending on specific malaria interventions. A diverse set of data points were used to estimate government health expenditure on malaria, including WHO’s World Malaria Report and government reports (when available). Projections were made using regression analyses, taking recipient country averages and earmarked funding into account.

Since 2010, DAH for malaria has been steeply declining for the 35 countries actively pursuing malaria elimination (from $176 million in 2010 to $62 million in 2013). The Global Fund to Fight AIDS, Tuberculosis and Malaria is the largest external financier for malaria, providing 96% of the total external funding for the disease in 2013, with vector control interventions being the highest cost driver in all regions. Domestic expenditure on malaria, while increasing, has not kept pace with diminishing DAH or national economic growth (as measured by GDP), leading to the risk of future gaps in delivery of services that are required to achieve malaria elimination.

Despite past gains, and variable growth in domestic financing, total funding available for malaria is declining in elimination settings. Health financing trends suggest that substantive policy interventions will be needed to ensure that malaria elimination is adequately financed and that available financing is efficiently targeted to the most impactful interventions in order to deliver the best value for money.

Source: This brief summary is based on a recently published paper: Shretta R, Zelman B, Birger ML, Haakenstad A, Singh L, Liu Y and Dieleman J. Tracking development assistance and government health expenditures for 35 malaria-eliminating countries: 1990–2017. Malaria Journal (2017);16:251. The full paper can be read here.