GLOBAL FINANCING, COMMODITIES AND SERVICE DELIVERY
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 and US$ 1.2 billion for the others (38)). Earlier estimates for scaling up malaria interventions suggested that US$ 2.5–4.0 billion was needed for 50–70% coverage (58). Of this total cost, LLINs would account for about 10%, ACTs—which as of 2004 cost over 10 times as much as conventional monotherapies—for around 36% and rapid diagnostic tests for around 17% (38). Programme costs involving improvement of health infrastructure, human resources and monitoring and evaluation would cover about 19% of costs. The remaining 17% would be directed towards specialized interventions such as against malaria in pregnant women in Africa, epidemic control and the treatment of severe and complicated episodes (38).
In most of the countries with a high malaria burden, the financial gap between what funds are needed and what are available remains large. Understanding the financial resources available for control activities is an important part of monitoring efforts. In general, government expenditures on health are lowest in those countries and regions with the highest burden of malaria, both for absolute per capita expenditures and for health expenditures as a proportion of all government expenditures (Fig. 40). The Maputo Declaration in July 2003 (59) reaffirmed the commitment of African governments to increase financial support for the health sector to a target level of 15% of all government expenditures. In most African countries, private and out-of-pocket expenditures on malaria prevention and treatment are high relative to government expenditure (60). In addition, among African households, out-of-pocket expenditures on malaria prevention and treatment as a proportion of annual income are greatest in the poorest households (61).
1. Sources of national financing
From available data, governments are the main source of funding for malaria control programmes, accounting for 71% of financial contributions in Africa, 80% in Asia and 96% in the Americas (Fig. 41). The remaining contributions represent a mix of bilateral donations, foundations, multilateral lending agencies and international donations. The precise breakdown of nongovernmental contributions is not specified by all of the programmes.
2. The Global Fund to Fight AIDS, Tuberculosis and Malaria
The GFATM, which started disbursements of grants for malaria control in 2003, has become an important international source of additional funding for scaling up malaria control (Fig. 42). In accordance with the RBM recommendation, the GFATM endorses the use of ACTs as the choice of antimalarial treatment for countries affected by drug-resistant falciparum malaria, in particular in Africa.
By the end of its first four funding rounds up to the end of 2004, the GFATM had US$ 3.1 billion dollars of committed funds, of which 31% has been targeted to support proposals for control of malaria. In 2003–2004, US$ 200 million was disbursed to 28 countries in Africa, 15 countries in Asia and 4 countries in the Americas. Malaria allocations on a five-year basis now total about US$ 1.8 billion, with the approved commitments for 2005–2006 totalling US$ 881 million. Up to this point there has been a longer than anticipated time lag in the implementation of GFATM grants; by September 2004 a total of US$ 130 million had been disbursed, but only eight malaria grants totalling US$ 33 million had already concluded one year in operation.