1. World Health Organization
24 June, 2018
Improving Support for National Malaria Control
Dr Sergio Spinaci WHO/ HQ
Global Malaria Programme
APPMG, London, 6 March 2006

2. Progress to Date: International funding
World Health Organization
Progress to Date: International funding
24 June, 2018
From 1999 to 2004 Global malaria control resources have increased 60 times
Funding for Africa has increased as follows (million US$)
250
205
200
165
Millions (US$)
Have seen significant increase in international funding for malaria control over the last few years this has been accompanied by scaled up efforts not only by bilateral and multilaterals but also numerous public-private partnerships, African research and control initiatives and new funding sources for malaria research.
With the exception of Eastern Europe / Central Asia, spending generally grew in all regions between 1999 and The fastest growth was in sub-Saharan Africa. Since 2001, Sub-Saharan Africa has received more than 75% of funds. (Source: TB and malaria: trends in donor funding. HLSP institute. Technical Brief 01/ )
Estimates of resources needed for malaria prevention and control
The estimated cost to support the minimum set of malaria interventions required to achieve the 2010 Abuja targets and the Millennium Development Goals for malaria by 2015 for 82 countries with the highest burden of malaria is around US$ 3.2 billion per year----US$ 1.9 billion for African countries. [Source: Addressing HIV/AIDS, Malaria and Tuberculosis: The resource needs of the Global Fund 2005 – GFATM. Geneva ] Earlier estimates for scaling up malaria interventions suggested that US$ 2.5–4.0 billion was needed for 50–70% coverage. [Source: World Malaria Report 2005, World Health Organization (Roll Back Malaria) and Unicef, 2005.]
This is contributing to a new found optimism but also a challenge not to waste the resources on non-sustainable systems that don't reach the population in the districts.
150
Global financing 95
100 48 53 50 22 10
1999
2000
2001
2002
2003
2004
Source: Waddington et al. HLSP,

3. Approved Malaria GFATM Grants in AFR as of February 2006
World Health Organization
24 June, 2018
Approved Malaria GFATM Grants in AFR as of February 2006
Round 1-5 Approved grants total: million for 2 years and billion for 5 years
Providing on-going support to 60 Malaria grants in 35 countries and 1 regional entity
Disbursed till date: 46% of 2 year totals and 25% of 5 years
Phase 2: 8 grants have moved to phase 2
Non AFRO
An increase in international funding available for malaria over the period 1999 to 2004, with a dramatic rise in 2001 because of the Global Fund. The Global Fund reported that total international disbursements for malaria prevention and control were in the order of US$ 295 million in 2004 and that out of this, the Global Fund accounted for US$ 135 million of this. In addition, it is estimated that approximately US$ 300 million is provided annually by domestic sources. (Source: Addressing HIV/AIDS, Malaria and Tuberculosis: The resource needs of the Global Fund 2005 – GFATM. Geneva )
No Grant
One Grant
Two Grants
Four Grants

4. Progress to Date: Investment in R&D
World Health Organization
Progress to Date: Investment in R&D
24 June, 2018
R&D Investment 2004 – US$ 323 million
Slide shows composition of global malaria R&D investments
Expenditures on malaria R&D
A modest proportion (less than 2%) of the funding was earmarked for research and development. From R&D funding was broadly static – it did not increase in line with the overall increase in malaria funding. (Source: TB and malaria: trends in donor funding. HLSP institute. Technical Brief 01/ )
The alliance of malaria research organisations estimated that in 2004, the total investment in malaria research and development amounted to US$323 million.
In October 2005, the Gates foundation became the largest single donor to malaria research in the world (previously this was the US Government) with the commitment of US$258.3 million to studying the disease and developing treatments.
Spending on malaria vaccines as a component of malaria R&D has been growing fast from $42,3 million in 1999 to $62,7 million in 2002 (see Table 3).
Estimates of resources needed for malaria R&D
The report of the Malaria Research and Development Alliance (2005) points out that if malaria was funded at the average rate of funding for all conditions, it would receive over $3.3 billion in annual R&D funding; it currently receives about 9% of that amount (Source: Malaria Research and Development, Assessing an Assessment of Global Investment, 2005)
The continual development of new anti-malarials will cost at least US$ 30 million per year, possibly more after 2006 when more projects move into the expensive phase of clinical development. [Source: World Malaria Report 2005, World Health Organization (Roll Back Malaria) and Unicef, 2005.]
Source: Malaria R&D Alliance 2005

5. Progress to date: Treatment and Prevention - AFRO
World Health Organization
24 June, 2018
Trends in IPT Adoption and Implementation,
Adoption and Implementation ACTs,
Number of countries
This slide is from some of the slides of the AFRO presentation in Tunis. It is just to show that there has been progress in the countries in Africa. But it is slow. The focus is on commodities without the sustainable financing mechanisms or structural elements necessarily in place. The next slides will explain some reasons why.
Move quickly thru this slide

6. Challenges The country-level perspective
World Health Organization
24 June, 2018
Complex funding flows
Parallel and complex financial management systems
Multiple actors at every level (Funders, contractors, technical support)
Limited resources and weak absorptive capacity
Unsure political commitment
Little or no budgetary allocation; Non-release; Unpredictable
Ill-defined mechanism to mobilize in-country resources
Limited capacity to absorb resources at all levels
Burden of Disease
Resistance to drugs
Getting the commodities to the end user
Sergio- Last three slides: Most of the information is on the slides. I will leave it up to you to follow the slides or not. You probably have some specific points that you want emphasise that you have thought about.
Key institutional challenges contributing to increase in malaria specific mortality over last decade:
- Complex financial systems call for coordination capacity and administrative resources that often are not available. Additional concern of sustaining activities if financing unsustainable (e.g., Global Fund)
- Economic downturns and less national public money spent on health generally
- Growing resistance to drugs and insecticides - Chloroquine resistance has directly contributed to increased in malaria-specific mortality in last 15
Years
- General health system weaknesses, primary health care at provincial and district level
- Do we have enough production capacity for: key commodities (e.g. ACTs, LLITNs)? And effective supply chain management systems? how to rectify the “market” failure?

7. Challenges The country-level perspective (2)
World Health Organization
24 June, 2018
Surveillance and Monitoring
Self diagnosis and treatment
Institutional Arrangement and Coordination
Complex structure; Bureaucracies
Central push with inadequate buy-in or management capacity at periphery
District management and weak capacity to develop and implement local policies and inadequate training on malaria control. More effective synergies needed between central and peripheral coordination and policies (Alilio et al., 2004)
Example of decentralization of malaria implementation in Tanzania (Alilio et al., 2004):
In the 1980s the Tanzania national malaria program shifted from centrally managed program to locally managed programs at the district level and the integration of malaria control into District Health Services. This transferred the functions of planning and budgeting, control of financial resources and implementation of malaria control interventions to the district level. Evaluation over the next decade showed that there was a lack of an implementation strategy and low priority given to malaria interventions leading to increased drug resistance, increased overall incidence and unchanging case-fatality rates.
Assessing the magnitude and measuring targets difficult because of extent of self diagnosis and treatment. Currently there is about 30-40% over-diagnosis

8. Institutional Arrangement for Malaria Control in Nigeria – Complex!!!
NMCP
Strategic functions
Partners Forum:
Leverage Resources
Technical Support
Implement Activities
37 SMCP
Operational + Strategic functions
774 LGA MCP
Operational functions
> 2000 Wards
Operational functions
Stakeholders:
Manufacturers
Commercial
Consumers
Interest Groups
Community Dev Committee
2.5m Households

9. World Health Organization
WHO Support
World Health Organization
24 June, 2018
Coordination and communication among Global partners
Standardization of intervention measures
Regional capacities to link country-level research, surveillance and implementation
Optimize strong presence in countries and established relationship with MoH to act as intermediary of financial resources, research and technical output
Broad country presence – Maternal Child Health, Health Action in Crisis, other disease programmes
Ensure better integration in health systems strengthening activities and development processes
Need to exploit WHO public health leadership in regions and countries and its relationship with MoHs to align global policies/ financing with what is operationally at the national and sub-national level
WHO has a role in satisfying the demand for better communication about malaria – emphasizing the cost-effective interventions; positioning malaria within broader health systems development. WHO's substantial regional and country presence gives it an advantage in understanding the technical and administrative problems that challenge effective control strategies.
It also has an important role and comparative advantage in strengthening weak systems of translating international and national policies into operational activities at the district level.
Opportunistic but strategic alliance between technical expertise, money and politics for country operations
Ensure better integration in health systems strengthening activities and development processes.
Almost two-thirds of the development agencies that responded to the survey identified malaria as a priority - either specifically, or as part of wider disease control or poverty alleviation work. For some, their interest in malaria related to its importance in poverty reduction a contributing to the MDGs. Malaria as a priority did not necessarily mean high funding for malaria-specific activities – some agencies concentrated on more general types of funding. (Source: TB and malaria: trends in donor funding. HLSP institute. Technical Brief 01/ )