Challenges and Implementation of Domestic Financing for Health: Malaria Domestic Financing for Health: Invest to Save Lives Addis Ababa, November 2013 Dr Silvia Ferazzi Roll Back Malaria Partnership

1 Malaria is a key public health challenge in Africa Map of malaria risk - Source: Malaria Atlas Project 2012 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

2 Malaria hinders socio-economic development Total benefit from reduced malaria burden More income for poor families: Malaria accounts for 25% of household expenditures More educated workforce (better school attendance and performance) Additional benefits + 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) Overall, in Africa : $5.4 billion in malaria control $73-91 billion in economic return = 14 to 17 times the investment) Economic return for companies: through a PPP initiative, in Zambia 3 companies gained an annualized rate of return of 28%

3 Resurgence //Sustaining achievements Cohen et al. Malaria Journal 2012

4 Remarkable increase in aid for malaria over the past 10 years – what next?

5 Domestic funding is progressing too slow

6 Ensuring sustainable domestic funding Ministers of Finance Ministers of Finance Ministers of Health Ministers of Health 1. Increase budget allocations 2. Implement innovative mechanisms to counter unpredictability and increase efficiency Sustainable financing plans Development loans (IDA/Reg. Banks) Development aid (budget support) Investment of revenue collection Debt relief/Debt conversions Risk pooling Results based financing Trust funds 4. Promote intra- and intersectoral integration for better value for money Heads of State PPPs 3. Develop evidence/tools for decision making

7 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)

8 : 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-for- performance model in Mozambique

9 Domestic innovative financing – report at 2013 RBM Ministerial Session Community health insurances and fee- based measures Co-financing and extension of services from PS Solidarity funds/other pool funding Pay for performance mechanisms Cost efficiencies 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) 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) 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) Presidential initiative for free care (Benin) Pooled financing scheme for MDG support (Ethiopia) 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) 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)

10 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

11 Need to engage non-Health Sectors Education Infrastructure Projects Military 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