Funding gaps across the African continent may hinder the achievement of the global target for malaria elimination by 2030, a new survey has said. The survey, Malaria Futures for Africa (MalaFa), is the first systematic attempt in many years to collate expert African views on malaria policy. It found that countries in Africa are highly unlikely to meet the 2030 deadline in the fight against malaria if considerable changes did not occur in funding and delivery.
The survey was released on Tuesday in Abuja, Nigeria’s capital. The failure of the Millennium Development Goal 6 for 2015 – to combat HIV/AIDS, malaria, and other diseases – brought about the 2030 target. In May 2015, the World Health Assembly adopted a global strategy by the World Health Organisation (WHO) with a vision to make the world free of malaria in 2030. The ultimate goal is to reduce malaria cases and deaths by 90 per cent and to make at least 35 countries free of malaria as compared to that of 2015.
Though monumental progress has been made, malaria still remained lethal, especially in Africa. The mosquito-borne disease continues to be a major public health problem in 97 countries – particularly, in Sub-Saharan Africa, where an estimated 90 per cent of all malaria deaths still occur, according to a 2017 WHO Malaria Report. This is despite the fact that the African Union’s “Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa by 2030” adopted the 2030 target by providing concrete financial and political commitments to eliminate malaria in Africa.
MalaFA (Malaria Futures for Africa) is an opinion research study commissioned in 2018 by Novartis Social Business to capture the thoughts of 72 African malaria experts in 15 sub-Saharan African countries. The countries included Nigeria, Ghana, Kenya, Ethiopia, Niger among others. Health ministers, members of parliament, senior civil servants working in health, heads of national malaria control programs and representatives of academia and non-governmental organizations (NGOs) working on malaria were interviewed. A minimum of four interviews was conducted per country.
The researchers said they embarked on the study because African voices, which are key to the fight against malaria, are not heard enough when decisions are made about policy and resource allocation. They said the world will not be free from malaria until Africa is free. “The disease costs the African economy more than $12 billion every year and slows down the economic growth of countries with high malaria rates by 1.3 per cent. This is why we felt this work was so important at a time when we need to refocus and recommit to push forward the new global malaria agenda and look towards a future where no one dies of malaria,” a preface in the report read.
Donor support and philanthropy provide the majority of funding but this is unsustainable, according to most participants. Though there were mixed feelings on the likelihood of meeting the 2030 malaria target, respondents in the academia and NGOs raised fears that maintaining the current funding mechanism would jeopardise chances of meeting the targets. Particularly in West Africa, donor support for malaria was seen as waning, perhaps in reaction to a perception that programs are not achieving promised targets. Many said that donor support is not always aligned with national policies and the situation on the ground.
Nearly all respondents felt strongly that International donors need to give countries autonomy over malaria policy and resource allocation so they have the power to make decisions on how best to implement malaria prevention, diagnosis, and treatment in their own countries. But the study participants were worried that donors are not convinced that the money is well spent. Earlier this year, PREMIUM TIMES reviewed an audit report by Global Fund which indicted seven African countries for squandering millions of foreign aid for malaria, TB and HIV.
Domestic financing for malaria is vital but most respondents thought it was inadequate and needs to be stepped up. Some mentioned there was a gulf between what public officials are saying about the allocation of domestic funds and the actual amounts dedicated to malaria programmes. In many countries, malaria is just one of several health priorities and competes with other infectious diseases for funding. In some countries, malaria is counted as part of the general costs of health delivery services. Some ministries of finance prioritise spending on non-health areas such as infrastructure and security. In West Africa, over half of the respondents thought that monitoring of funds was inadequate and reporting of malaria caseload “patchy”, making it difficult to measure effectively how much progress has really been made.
‘THERE IS HOPE’
Though the target 2030 seemed bleak in countries in Africa where malaria still claims the life of a child every two minutes, rays of hope were expressed during the launch of the survey. Richard Kamwi, a board member of the RollBack Malaria (RBM) movement said there is still hope that programme managers and the ministers guarded by “our heads of state can surely eliminate malaria throughout the African continent within our lifetime”. But for the elimination of malaria to be a reality, he said, there are a number of conditions that must be specified. “Presidents should sustain financing, mount sectoral approach(es), cross border corroboration, regulation, human resource development and delivering effective proven interventions,” Mr. Kamwi noted.