By Joy Phumaphi, Executive Secretary, ALMA
African countries and their partners have made significant progress to defeat malaria and to advance its broader health and development agenda. Between 2000 and 2015, the number of malaria cases and deaths declined by 42% and 66%, respectively. Underlying this progress were several important enablers, including sustained leadership, resource commitments, community participation and global solidarity. In 2017 alone, US$ 2.2 billion was invested in Africa. Spending on malaria has generated an estimated 36-to-1 return on investment.
However, malaria remains a leading health, social and economic development threat. Africa still accounts for over 90% of the global malaria burden. In 2017, 200 million Africans contracted malaria and 403 thousand died. Malaria reduces GDP by up to 1.3% and costs poor families up to 25% of annual household earnings, undermining economic stability and mobility. Resistance to insecticides and life-saving medicines is increasing, and affording more expensive, next-generation commodities will stress already stretched budgets and human resources.
To face these challenges and flattening aid, countries need innovative, multi-sectoral financing and accountability mechanisms. Currently, national strategic plans are only 57% financed through 2020—a US$3.4 billion gap. New sources of financing are necessary. Furthermore, engaging other sectors to take ownership for malaria and health will increase the efficiency and efficacy of the malaria response. Without immediate resourcing and accountability, the bold and ambitious goal of eliminating malaria by 2030 set in the AU’s Catalytic Framework will not be met.
Several countries are launching initiatives to expand ownership of malaria, implement innovative financing mechanisms and advocate for maintaining malaria high on the public agenda. Zambia is establishing an End Malaria Council to increased advocacy, mobilize resources, and drive action and accountability. Mozambique is convening a Malaria Advisory Council to coordinate multi-sectoral action on malaria. Eswatini is setting up a national malaria fund to mobilise new funding sources. Uganda is drafting legislation codifying a multi-sectoral framework, which includes an End Malaria Council, fund, and parliamentary forum. All these pioneering initiatives across Africa are supported with robust resource mobilization initiatives.
Several other countries are increasing domestic spending. Rwanda is reducing the cost of next-generation insecticides by 35% with the support of Unitaid, resulting in 99.3% indoor residual spraying (IRS) coverage. Ethiopia contributed an additional US $25 million for IRS. Nigeria committed US$18.7 million in Global Fund co-financing, unlocking an additional US$37 million, and is negotiating with development banks to secure another US$350 million.
Global Fund applications for 36 African countries indicate that domestic resource commitments have increased by 65% to US$1.65 billion for the 2018-2020 allocation period. However, it is essential that domestic financing continues to expand to close the US$3.4 billion gap and that existing financers continue to support the Global Fund, recognising that 2019 is its replenishment year.
As a multi-sectoral response to malaria takes shape, the private sector will be an increasingly critical partner. The private sector’s advanced technical capabilities, knowledge, innovation, technology, financial contributions, and advocacy will help governments strengthen the management and efficiency of the public health sector, laying a foundation for universal health coverage. The Africa Leadership Meeting: Investing in Health during this February’s AU Summit is a step in the right direction to unlock private and public sector investments and increase collaboration among global health organisations to better support countries. African leadership has shown the path to advancing innovative financing to end Malaria and through community action, shared responsibility and global solidarity we will end Malaria in our lifetime. The private sector can play an even more active role in the fight to eliminate malaria on the continent, including investing in vector control, early detection and treatment.