Funding for malaria control 2006-2010: a comprehensive global assessment

Abstract

Background: The last decade has seen a dramatic increase in international and domestic funding for malaria control, coupled with important declines in malaria incidence and mortality in some regions of the world. As the ongoing climate of financial uncertainty places strains on investment in global health, there is an increasing need to audit the origin, recipients and geographical distribution of funding for malaria control relative to populations at risk of the disease.

Methods: A comprehensive review of malaria control funding from international donors, bilateral sources and national governments was undertaken to reconstruct total funding by country for each year 2006 to 2010. Regions at risk from Plasmodium falciparum and/or Plasmodium vivax transmission were identified using global risk maps for 2010 and funding was assessed relative to populations at risk. Those nations with unequal funding relative to a regional average were identified and potential explanations highlighted, such as differences in national policies, government inaction or donor neglect.

Results: US$8.9 billion was disbursed for malaria control and elimination programmes over the study period. Africa had the largest levels of funding per capita-at-risk, with most nations supported primarily by international aid. Countries of the Americas, in contrast, were supported typically through national government funding. Disbursements and government funding in Asia were far lower with a large variation in funding patterns. Nations with relatively high and low levels of funding are discussed.

Conclusions: Global funding for malaria control is substantially less than required. Inequity in funding is pronounced in some regions particularly when considering the distinct goals of malaria control and malaria elimination. Efforts to sustain and increase international investment in malaria control should be informed by evidence-based assessment of funding equity.

Figure 1

Bar chart of amounts disbursed by different funding sources 2006–2010. The blue “Government” portion refers to the amounts disbursed by national governments within their own country.

Figure 2

Scatter plots of populations at risk and patterns of funding. Panel A shows total funding over the period 2006–2010 against size of the population at risk of PfPv per country. Panel B shows annualized funding per capita against size of the population at risk of PfPv per country.

Figure 3

Bar chart of assessment of equitable funding in the Americas. Bars represent annualized per capita funding in each malaria endemic country in the region relative to the line of equity, defined as the theoretical level if regional funding was perfectly distributed to countries according to populations at risk. The divisions in the bar demonstrate the relative external and government contribution. For the Americas, the line of equity is US$0.93 per capita per year. Countries labelled in red are in the process of moving from controlled low-endemic malaria to elimination [53]. The y axis indicates by what factor the national per capita-at-risk funding differs from the line of equity.

Figure 4

Bar chart of assessment of equitable funding in Africa+. Details as described for Figure 3. For Africa+, the line of equity is US$1.60.

Figure 5

Bar chart of assessment of equitable funding in CSE Asia. Details as described for Figure 3. For CSE Asia, the line of equity is US$0.33.