Estimating the risk of declining funding for malaria in Ghana: the case for continued investment in the malaria response

Abstract

Background: Ghana has made impressive progress against malaria, decreasing mortality and morbidity by over 50% between 2005 and 2015. These gains have been facilitated in part, due to increased financial commitment from government and donors. Total resources for malaria increased from less than USD 25 million in 2006 to over USD 100 million in 2011. However, the country still faces a high burden of disease and is at risk of declining external financing due to its strong economic growth and the consequential donor requirements for increased government contributions. The resulting financial gap will need to be met domestically. The purpose of this study was to provide economic evidence of the potential risks of withdrawing financing to shape an advocacy strategy for resource mobilization.

Methods: A compartmental transmission model was developed to estimate the impact of a range of malaria interventions on the transmission of Plasmodium falciparum malaria between 2018 and 2030. The model projected scenarios of common interventions that allowed the attainment of elimination and those that predicted transmission if interventions were withheld. The outputs of this model were used to generate costs and economic benefits of each option.

Results: Elimination was predicted using the package of interventions outlined in the national strategy, particularly increased net usage and improved case management. Malaria elimination in Ghana is predicted to cost USD 961 million between 2020 and 2029. Compared to the baseline, elimination is estimated to prevent 85.5 million cases, save 4468 lives, and avert USD 2.2 billion in health system expenditures. The economic gain was estimated at USD 32 billion in reduced health system expenditure, increased household prosperity and productivity gains. Through malaria elimination, Ghana can expect to see a 32-fold return on their investment. Reducing interventions, predicted an additional 38.2 clinical cases, 2500 deaths and additional economic losses of USD 14.1 billion.

Conclusions: Malaria elimination provides robust epidemiological and economic benefits, however, sustained financing is need to accelerate the gains in Ghana. Although government financing has increased in the past decade, the amount is less than 25% of the total malaria financing. The evidence generated by this study can be used to develop a robust domestic strategy to overcome the financial barriers to achieving malaria elimination in Ghana.

Keywords: Benefits; Costs; Economic; Financing; Funding; Ghana; Investment case; Malaria.

Fig. 1

Baseline scenario (business as usual)

Fig. 2

Fully-funded scenario (predicted impact of interventions as outlined in the NSP)

Fig. 3

Better net use scenario (predicted impact of interventions as outlined in the NSP plus better use of nets at the household level)

Fig. 4

Health system acceleration scenario (predicted impact of interventions as outlined in the NSP plus better use of nets at the household level plus health system strengthening for improved health-seeking behaviours and more effective case management of malaria)

Fig. 5

Reverse scenario 1 (predicted impact of removing IRS, SMC and reducing LLIN coverage by 50%)

Fig. 6

Reverse scenario 2 (predicted impact of removing IRS and SMC)

Fig. 7

Predicted P. falciparum cases by zone for all modelled scenarios. Predictions of impact of interventions vary by zone (Upper line = clinical cases; Lower line = reported cases)

Fig. 8

Predicted number clinical cases and deaths 2000–2029 for the baseline, HSA and reverse scenarios (removing IRS, SMC and reducing LLIN coverage by 50%)

Fig. 9

Cost projections for the HSA (elimination) scenario 2018–2030 (median, ± 25%). Elimination is predicted to cost a total of USD 961.3 million over 10 years (2020–2029) with the HSA scenario