COUNTRIES MSc in International Health and Tropical Medicine Centre - - PowerPoint PPT Presentation

BILATERAL VERSUS MULTILATERAL FUNDING IN MALARIA ENDEMIC COUNTRIES

The following is part of a training exercise for MSc Students in International Health and Tropical Medicine, University of Oxford

* equal contribution from all co-authors

General Overview

• Dr. Farah Jawitz (South Africa)

Opportunities

• Mr. Martin Merello (Argentina)

Selected Case Studies

• Dr. Elisha Ngetich (Kenya)

Analyses of Issues

• Dr. Grace Mzumara (Malawi)

Background Information

• Ms. Samantha Fien-Helfman (USA/Guatemala)

1

Conclusions

• Dr. Farah Jawitz (South Africa)

2 3 4 5 6

MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

AGENDA

Incidence declined by 18% Deaths reduced by 48% 7-year increase life expectancy in Sub-Saharan Africa

2000-2015

WHO Malaria Eradication Program Malaria Roll Back Malaria Partnership Medicines for Malaria Venture

Past Initiatives

Global Technical Strategy for Malaria presents a roadmap for malaria control and elimination, and supports the WHO Sustainable Development Goals.

2016-2030

Reduce new cases by 90% Elimination in 35 countries by 2030 Prevent the re-establishment of malaria

Commitments

MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

General Overview

1980-Present: Proliferation of multilateral funding and creation of Global Fund in 2002. Motivated by the donor imperative of pooling and advancing a common global cause. Today: The UK is a major direct funder

• f Malaria programs worldwide and the

third largest donor to the the Global Fund (7% of DFID’s total financing). Reviews by DFID and independent auditors: Global Fund is “one of the world’s most effective aid institutions”.

Multilateral Financing Bilateral Approach Multilateral Approach

1950-1980: Push for malaria

• eradication. Primarily bilateral, or

even unilateral, financing sources. Donors motivated by need to exert control over aid flows and be visible. Politicized and fragmented and did not respond to transnational nature of disease.

Direct Contributions

1980-1990: Increasing resistance led to resurgence in malaria incidence rates. Highlighted need for coordination/cooperation to address the disease. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

Background: Malaria financing

Achievements Statistics

New malaria cases where there are no control activities have increased by 53%. Number of malaria deaths between 200- 2015 have decreased by 48%. $ 35.7 Billion: 2021 – 2025: 4.2 million lives saved $41.6 Billion: 2026 – 2030: 4.5 million lives saved Address challenges: Resistance to insecticides Sub-standard antimalarials Decrease in investment in malaria programs

Current status

Different phases of elimination. 11 high burden countries (India most improved). 21 countries towards ‘No Malaria’ status by 2020. Need for primary health care investment endemic countries.

Future Goals

659 million long-lasting insecticide treated bed nets. Reduced health commodity prices and improved procurement efficiencies. Strengthened health systems, e.g. medicine supply chain, data systems, service delivery.

MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

Analysis of Issues: Progress to Eradication

Bilateral Financing Multilateral Financing

Global Platform for action: large scale aid delivery Leveraging specialist action delivery mechanisms and technical expertise. Coordinate and maintain global standards for specific actions on a larger scale. Neutral ground for development assistance in conflict areas. Enhance community specific interventions, meet country specific needs. More control over use of funds and recipients. More likely to build country system capacities. Some countries, such as Nigeria, Uganda and Tanzania receive DFID financing bilaterally to complement initiatives under the multilateral Global Fund.

MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

Analysis of Issues: Types of Financing

Global Fund aid $286.8 million Bilateral Help £572,000 (DFID) - 2017 Further Donors World Bank, USAID, WHO, UNICEF & the Affordable Medicines Facility-malaria Main on-going programmes National Malaria Program

• Highest malaria burden in the world and is critical to the Global Fund achieving its malaria eradication goals.
• High levels of corruption and security challenges affect implementation.
• Government failed to meet this willingness-to-pay requirement.
• Demonstrated constraints regarding its ability to administer and manage a large grant.
• 43% reduction in deaths due to malaria between 2000 and 2016.

Observations & Figures Geography Comments

MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

Selected Case Study: Nigeria 1/3

Global Fund aid $488 million Bilateral Help $58 million (DFID) – (2012-2015) Further Donors US President’s Malaria Initiative, World Health Organization, United Nations Children’s Fund (UNICEF) and other RBM partners. Main on-going programmes National Malaria Control Programme

• Demonstrated significant capacity challenges in absorbing large amounts of funding.
• Global Fund Audit 2012-2015: 46% disbursed, despite need.
• Several hospitals have no anti-malarial medication.

Observations & Figures Geography Comments

MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

Selected Case Study: Uganda 2/3

Global Fund aid $602 million Bilateral Help £15.25 million (DFID) – (2011-2015) Further Donors The President’s Malaria Initiative, WHO & UNICEF Main on-going programmes The President’s Malaria Initiative

• $589 million from the Global Fund has been disbursed
• 650,000 rural families to receive insecticide treated bed nets
• Despite this, the prevalence of malaria rose from 9 to 14% between 2012 and 2016.

Observations & Figures Geography Comments

MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

Selected Case Study: Tanzania 3/3

Objective PERFORM RESPONSIBLE EVALUATION UNDERTAKE SUSTAINABLE PROCESSES FOSTER ABSORPTIVE CAPACITY Recipient country’s : High United Kingdom: High Approachability

• Public health impact?
• Public and private sector

collaboration?

• UK’s influence in the fight against

malaria?

Maximization

• Public health global risk?
• Financial burden of disease?
• Out of pocket expenditure in LMICs?

Minimization

• Achieve 15% of country

expenditure on Global Health

Drivers

• Prevention and treatment
• Stakeholder’s partnerships (PPPs)
• Strong financial & management

systems

• Lean reporting mechanisms

Roadblocks

• Antimalarial resistance
• Need to double funding targets

to meet 2020 goals

Objective

• Reduce out of pocket cost for

health system use

Drivers

• Access to clear information on
• ther on going programmes
• External support to manage

available resources efficiently

• Continuous learning practices

Roadblocks

• Low level of readiness to receive

large financing commitments without overflowing current administration MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

Opportunities for Improvement

• 2. Bilateral vs. Multilateral

Recognized benefits of giving to multilateral agencies for coordination, leverage, accountability, and expertise but challenges regarding capacity and sustainability.

• 1. DFID role

UK is the second largest international donor and is one of the premier financiers for malaria control and elimination initiatives.

• 4. Financial Expectation

Significant increase in financing for malaria is needed globally in order to meet future targets.

• 3. Main problems

Increasing resistance to antimalarials and insecticide, plateau in overseas development aid, transnational nature of the disease,

• 5. Future targets

Increase funding 15% GDP expenditure on health

MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine

Conclusion