Date Published: July 22, 2008
Publisher: Public Library of Science
Author(s): Robert W Snow, Carlos A Guerra, Juliette J Mutheu, Simon I Hay, Sanjeev Krishna
Abstract: BackgroundThe international financing of malaria control has increased significantly in the last ten years in parallel with calls to halve the malaria burden by the year 2015. The allocation of funds to countries should reflect the size of the populations at risk of infection, disease, and death. To examine this relationship, we compare an audit of international commitments with an objective assessment of national need: the population at risk of stable Plasmodium falciparum malaria transmission in 2007.Methods and FindingsThe national distributions of populations at risk of stable P. falciparum transmission were projected to the year 2007 for each of 87 P. falciparum–endemic countries. Systematic online- and literature-based searches were conducted to audit the international funding commitments made for malaria control by major donors between 2002 and 2007. These figures were used to generate annual malaria funding allocation (in US dollars) per capita population at risk of stable P. falciparum in 2007. Almost US$1 billion are distributed each year to the 1.4 billion people exposed to stable P. falciparum malaria risk. This is less than US$1 per person at risk per year. Forty percent of this total comes from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Substantial regional and national variations in disbursements exist. While the distribution of funds is found to be broadly appropriate, specific high population density countries receive disproportionately less support to scale up malaria control. Additionally, an inadequacy of current financial commitments by the international community was found: under-funding could be from 50% to 450%, depending on which global assessment of the cost required to scale up malaria control is adopted.ConclusionsWithout further increases in funding and appropriate targeting of global malaria control investment it is unlikely that international goals to halve disease burdens by 2015 will be achieved. Moreover, the additional financing requirements to move from malaria control to malaria elimination have not yet been considered by the scientific or international community.
Partial Text: The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFTAM) [1–3] was established in January 2002 as an independent financing body to attract, manage, and disburse funds to control these three major diseases of poverty. This innovative mechanism for results-based health care financing had by the end of 2007 committed US$10 billion to 136 countries [1,2]. The GFATM responds to nationally documented demand for antimalarial interventions and commodities. Countries are encouraged to submit proposals every year, which are reviewed independently by a technical review panel before the GFATM board makes a decision [4,5]. The GFATM state that their funding priorities are to countries/regions with the highest disease burdens and weakest financial capacity to support disease control [1,6]. By the end of 2006 GFATM support represented an estimated 64% of all international funding for malaria control worldwide [6,7]. Rather than displace international support for malaria, new funding initiatives have emerged in recent years parallel to the GFATM, notably the World Bank global strategy and booster program  and the US President’s Malaria Initiative (PMI) . Bilateral agencies also continue to expand their support to countries as part of combined efforts to meet the Millennium Development Goals (MDG) [10,11]. As the funding capacity for global malaria control increases, it is important to examine the allocation of financing in relation to the distribution of populations most at risk of the disease; that is, to measure the equity of disbursements.