PROGRESS & IMPACT SERIES Number 1 . March 2010 Malaria Funding & Resource Utilization: The First Decade of Roll Back Malaria WHO Library Cataloguing-in-Publication Data Malaria funding and resource utilization: the first decade of Roll Back Malaria. 1.Malaria - prevention and control. 2.Malaria - therapy. 3.Financing, health. 4.Program evaluation. 5.International cooperation. I.Global Partnership to Roll Back Malaria. II.Johansson, Emily White. III.Cibulskis, R. E. IV.Steketee, Richard W. ISBN 978 92 4 159916 0 (NLM classification: WC 765) © 2010 World Health Organization on behalf of the Roll Back Malaria Partnership Secretariat All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). Some photographs are subject to licensing fees and may not be reproduced freely; all photo enquiries should be addressed to the Roll Back Malaria Partnership Secretariat at the address listed below. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization, the Roll Back Malaria Partnership Secretariat or any of its individual Partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps, where present, represent approximate border lines for which there may not yet be full agreement. The financial data provided in this report were assembled from November 2009 through January 2010 (inclusive). Due to the constant updating of financial information by funding agencies, some numbers in this report may have changed during this time interval; not all numbers are adjusted to a single date. Such changes are generally minor and do not, at the time of publication, affect the overall picture of funding support for the Roll Back Malaria effort over this most recent decade. All monetary amounts are reported in US dollars. The mention or appearance in photographs of certain manufacturers and/or their products does not imply that they are endorsed or recommended by the World Health Organization, the Roll Back Malaria Partnership Secretariat or any of its individual Partners in preference to others of a similar nature. Although every effort has been made to ensure accuracy, the information in this publication is being distributed without warranty of any kind, either expressed or implied. In no event shall the World Health Organization, the Roll Back Malaria Partnership Secretariat or any of its individual Partners be liable for any damages incurred as a result of its use. The named authors alone are responsible for the views expressed in this publication. Photo credits | Front cover and pp. 15, 19, 27, 35, 46, 53, 55, 57, 59, 73: © Bonnie Gillespie/Johns Hopkins University | p. 5: © John Brown/mondolibrary | p. 6: © Les Stone/Sygma/Corbis | p. 8: © Georgina Goodwin & Vestergaard Frandsen | p. 10: © Yann Arthus-Bertrand/Corbis | pp. 13, 23: © David Jacobs | p. 16: © Ann Johansson/Corbis | p. 21: © JGI/Jamie Grill/Blend Images/Corbis | p. 24: © Howard Davies/Corbis | p. 28: © Thomas Lee/mondolibrary | pp. 38, 67: © Ron Haviv | p. 43: © Thomas Omondi/mondolibrary | p. 45: © Pascal Deloche/Godong/Corbis | p. 63: © Vestergaard Frandsen | p. 65: © Steven Vidler/Eurasia Press/Corbis | p. 69: © Andy Aitchison/Corbis | p. 75: © Pallava Bagla/Corbis | p. 77: © William Campbell/Corbis | p. 78: © Charles & Josette Lenars/Corbis | p. 81: © Richard T. Nowitz/Corbis | pp. 83, 85, 87, 89, 91, 93, 95: © Visuals Unlimited/Corbis Enquiries | Roll Back Malaria Partnership Secretariat | Hosted by the World Health Organization | Avenue Appia 20 | 1211 Geneva 27 | Switzerland | Tel.: +41 22 791 5869 | Fax: +41 22 791 1587 | E-mail: [email protected] | Design | Print CONTENTS CONTENTS Abbreviations...........................................................................................................................................4 Acknowledgements ................................................................................................................................7 Foreword ..................................................................................................................................................9 Executive Summary ..............................................................................................................................11 Key Points ...........................................................................................................................................14 I. Introduction ........................................................................................................................................17 Box 1: Framework for Malaria Control Financing ........................................................................20 Box 2: Sources of Information and Methods of Analysis ...........................................................22 II. Funding Needs for Malaria Control ...............................................................................................25 RBM PROGRESS & IMPACT SERIES RBM PROGRESS & IMPACT III. Funding Sources and Allocations for Malaria Control ..............................................................29 IV. Management and Use of Funding for Malaria Control ..............................................................39 V. Making the Money Work: 12-Country Assessment (Africa) ......................................................47 VI. Conclusions and Future Issues .....................................................................................................79 References .............................................................................................................................................82 Annex 1. Technical Notes ....................................................................................................................84 Annex 2. Global Burden of Malaria ....................................................................................................90 Annex 3. Interventions to Control Malaria ........................................................................................92 Annex 4. Anticipating Future Funding ................................................................................................94 MALARIA FUNDING AND RESOURCE UTILIZATION: THE FIRST DECADE OF ROLL BACK MALARIA MALARIA FUNDING AND RESOURCE UTILIZATION: 3 ABBREVIATIONS ACT Artemisinin-based combination therapy AFRO WHO Regional Office for Africa AMRO WHO Regional Office for the Americas CQ Chloroquine DAC Development Assistance Committee (http://www.oecd.org/dac) DHS Demographic and Health Survey EFR Enhanced Financial Report—a Global Fund financial reporting system EMRO WHO Regional Office for the Eastern Mediterranean EURO WHO Regional Office for Europe GAVI Global Alliance for Vaccines and Immunisation GFATM The Global Fund to Fight AIDS, Tuberculosis and Malaria GMP Global Malaria Programme HIV Human Immunodeficiency Virus IDA International Development Association (World Bank Group) IHME International Health Metrics and Evaluation, University of Washington IPT Intermittent preventive treatment IPTp IPT for pregnant women RBM PROGRESS & IMPACT SERIES RBM PROGRESS & IMPACT IPTi IPT for infants IRS Indoor residual spraying (with insecticides) ITN Insecticide-treated mosquito net LLIN Long-lasting insecticide-treated mosquito net MDGs Millennium Development Goals MERG Monitoring and Evaluation Reference Group MICS Multiple Indicator Cluster Survey MIS Malaria Indicator Survey NMCP National Malaria Control Programme OECD Organisation for Economic Cooperation and Development MALARIA FUNDING AND RESOURCE UTILIZATION: THE FIRST DECADE OF ROLL BACK MALARIA MALARIA FUNDING AND RESOURCE UTILIZATION: 4 PAHO Pan American Health Organization PPR Per-person-at-risk RBM Roll Back Malaria RBM PROGRESS & IMPACT SERIES RBM PROGRESS & IMPACT RDT Rapid diagnostic test SEARO WHO Regional Office for South East Asia SP Sulfadoxine-pyrimethamine SPR Slide positivity rate SUFI Scale Up for Impact UNICEF United Nations Children’s Fund USAID United States Agency for International Development US-PMI United States President’s Malaria Initiative WHO World Health Organization WPRO WHO Regional Office for the Western Pacific MALARIA FUNDING AND RESOURCE UTILIZATION: THE FIRST DECADE OF ROLL BACK MALARIA MALARIA FUNDING AND RESOURCE UTILIZATION: 5 6 MALARIA FUNDING AND RESOURCE UTILIZATION: THE FIRST DECADE OF ROLL BACK MALARIA RBM PROGRESS & IMPACT SERIES ACKNOWLEDGEMENTS ACKNOWLEDGEMENTS This report was written by Emily White Johansson (United Nations Children’s Fund [UNICEF]), Richard Cibulskis (World Health Organization [WHO]), and Richard Steketee (Malaria Control and Evaluation Partnership in Africa [MACEPA], a programme at PATH). While this report benefited greatly from the feedback provided by the individuals named below, final responsibility for the content rests with the authors. Information that was critical to the compi- We thank the following people for their admin- lation of this report was obtained from the istrative