[Full Table of Contents]
[Executive Summary]

[Part I: Malaria Today] PDF version

  1. Introduction to the Global Malaria Action Plan
  2. Partnership's Vision and Targets
  3. Global Burden & Coverage Today
  4. Funding for Malaria Today

I. Malaria today

4. Funding for Malaria Today

Key messages

  • Funding for malaria has increased significantly over the past 5 years, reaching an estimated US$ 1.5 billion in 2007
    • Approximately half of the funds are provided by international donors, which have increased their financial support threefold between 2004 and 2007
    • National government spending is low in countries with the highest burden; 90% of African countries spend less than 15% of government expenditures on health
  • To reach RBM targets, funding will need to be about four times the current level

Funding is still a key factor limiting malaria control for many countries. For most countries, achieving the RBM targets for 2010 and 2015 and sustaining a high level of control will require a substantial increase in funding from both the international community and endemic countries. The current funding of US$ 1.5 billion is equivalent to less than 50 cents per person at risk. Recent studies by Snow et al comparing international funding commitments to populations at risk of stable P. falciparum transmission show significant variations in funding levels across regions and countries, with some high burden areas receiving relatively low international support.[46]Snow RW et al. International funding for malaria control in relation to populations at risk of stable Plasmodium falciparum transmission. PLoS Med, 2008, 5(7):e142.

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Endemic countries and the international community are making strides toward controlling malaria: all countries have started to implement their control programs and many have achieved at least partial successes. Awareness of malaria has risen significantly over the past decade, leading to unprecedented levels of funding.

However, a significant gap must be overcome between the current coverage with malaria interventions and what is needed to achieve the goal of universal coverage. The funds required to purchase and deliver these interventions are approximately 4 times the current world-wide malaria funding. While ambitious, this increase in funding is achievable if we continue to build on the positive trends of the past years.

Current Funding for Malaria Implementation

Limited national resources in high burden countries. Although the situation varies widely by region and by country, current national funding covers only a fraction of what is needed for the implementation of malaria control programs, especially in high burden countries. This is particularly true in Africa, where government budgets represent only 18% on average of total malaria funding.[47]Excluding private household spend. Based on total spending coming from government and international donors. See Appendix 3. Assumptions behind Current Burden, Coverage and Funding Estimates.

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In 2003, African leaders affirmed in the Maputo Declaration their commitment to increase financial support for the health sector to 15% of total government expenditure. Today, however, 90% of African countries remain below the 15% threshold.[48]Malaria Landscape Report 2007. Geneva, the Roll Back Malaria, 2007.

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Even if countries were to achieve the 15% target, their expenditures on key malaria interventions would still be substantially less than the estimated need. As shown in Figure I.4, government expenditures on health per capita are the lowest in regions with the highest malaria burden.

Figure I.4: Government expenditure on health in malaria-endemic regions

Note: Government expenditure on health per capita as regional weighted average; % of government expenditure on health as arithmetical average, 15% target agreed by African countries in Maputo Declaration (July 2003)
Source: Analysis based on WHO Health Statistics 2008; 2005 data

According to data from WHO and the main donor organizations, the share of government budget spent on malaria is substantially higher in Asia-Pacific than in Africa and represents the largest source of malaria funding in the Americas and in the Middle East and Eurasia. Detailed regional analyses of funding for malaria are presented in Part III: Regional Strategies.

Major sources of malaria funding. Money spent on malaria in 2007 amounted to an estimated total of ~US$ 1.5 billion (see Figure I.5). One fifth of these funds came from household purchases of malaria products (such as anti-malarial drugs or long-lasting insecticidal nets) principally through the private sector. Approximately 34% of funds came from national government expenditures dedicated to malaria, and the remaining funding came from international donors, which disbursed an estimated US$ 701 million. The Global Fund contributed to half of the disbursements from international donors.[49]As described in Appendix 3. Assumptions behind Current Burden, Coverage and Funding Estimates, these figures take into account actual disbursements as opposed to commitments.

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Figure I.5: Current sources of funds spent on malaria

a) Regional funding estimates not available for private household spend and other USAID. Therefore, summing regional funds presented in Part III – Regional Strategies only adds up to approx. $1.1 billion, see appendix 3 for methodology
Source: World Malaria Report 2008. Geneva, World Health Organization, 2008 (Government, UN Agencies, Bilaterals, EU); the Global Fund website; PMI operational plans; USAID website; World Bank Booster Program (see appendix on methodology); 2007 data

The trend is positive for international funding. As Figure I.6 illustrates, unprecedented amounts of money have poured into malaria control since 2004. Disbursements from international donors increased threefold from 2004 to 2007. Commitments for coming years are promising. 2008 disbursements are estimated to be ~US$ 1.1 billion, (more than four times 2004 amount) thanks to expected payouts of previous Global Fund rounds, increased scope of the U.S. President’s Malaria Initiative (PMI) (from 10 countries in 2007 to 15 countries supported in 2008) and the disbursements of money committed in Phase I of the World Bank Booster Program (~67% of Phase I commitments are expected to be disbursed by the end of 2008).

Figure I.6: Evolution of international funding disbursements for malaria

Source: World Malaria Report 2008. Geneva, World Health Organization, 2008 (Government, UN Agencies, Bilaterals, EU); GFATM website; PMI operational plans; USAID website; World Bank Booster Program (see appendix on methodology)

Both the Global Fund (US$ 9.7 billion for 2008-2010)[50]Funding shared with the two other diseases. Donors provide US$9.7 billion to the Global Fund; Initial Pledges for 2008 - 2010 Enable the Global Fund to Triple in Size. Geneva, The Global Fund to fight AIDS, Tuberculosis and Malaria, Press release, September 2007.

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and the World Bank (US$ 41.6 billion for the International Development Association’s 15th replenishment)[51]Estimate as of December 2007. Funding shared with other diseases and development priorities will finance projects over the three year period ending June 30th, 2011. have been highly successful in advocating for replenishments. While G8 donor countries are still far from reaching the aid pledges made to Africa in 2005 in Gleneagles, individual governments have increased their pledged funds and other donations for malaria. In April 2008, Prime Minister Gordon Brown announced the United Kingdom's government's pledge to donate 20 million bed nets. In July 2008, the President of the United States signed a reauthorization act that could increase US malaria funding to US$ 5 billion over the next five years.[52]The Tom Lantos and Henry J. Hyde United States Global Leadership on HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008.

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The World Bank is preparing Phase II of its Booster program with an aspirational lending target of at least ~ US$ 1.2 billion for sub-Saharan Africa. In addition, the World Bank's Board of Executive Directors has just approved over US$ 500 million for a project to support India’s efforts against malaria and other diseases, for which the amount for malaria could reach US$ 200 million,[53]US$ 121 million for malaria specific activities, US$ 52 million for management and policy strengthening (including significant inputs for malaria), and US$ 37 million not yet allocated potentially available for malaria. making it the largest single disease control investment in the history of the World Bank.

Increased Funding for Malaria Research and Development

Figure I.7 shows the steady increase in funding for malaria research and development over the past five years. In 2007, funding for malaria research and development is estimated at ~US$ 422 million. The two major donors (United States’ National Institutes of Health and the Bill and Melinda Gates Foundation) account for ~40% of estimated current funding for R&D. More than 60% of funds are directed to drugs and vaccines.

Figure I.7: Evolution of spending on malaria research and development

Note: Estimated $165M in funding from “other” donors based on Malaria R&D Alliance estimate for 2004; assumes all BMGF malaria funding is for R&D
Source: Bill ∓ Melinda Gates Foundation; National Institutes of Health website; Malaria R&D Alliance (2005)