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Mar 23, 2023 •264 likes •379 views

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 BILATERAL VERSUS MULTILATERAL FUNDING IN MALARIA ENDEMIC COUNTRIES MSc in

  1. 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 BILATERAL VERSUS MULTILATERAL FUNDING IN MALARIA ENDEMIC COUNTRIES

  2. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine AGENDA General Overview 1 Dr. Farah Jawitz (South Africa) Background Information 2 Ms. Samantha Fien-Helfman (USA/Guatemala) Analyses of Issues 3 Dr. Grace Mzumara (Malawi) Selected Case Studies 4 Dr. Elisha Ngetich (Kenya) Opportunities 5 Mr. Martin Merello (Argentina) Conclusions 6 Dr. Farah Jawitz (South Africa)

  3. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine General Overview 2000-2015 2016-2030 Incidence declined by 18% Global Technical Strategy for Malaria Deaths reduced by 48% presents a roadmap for malaria control and elimination, and supports the WHO 7-year increase life expectancy Sustainable Development Goals. in Sub-Saharan Africa Past Initiatives Commitments WHO Malaria Eradication Program Reduce new cases by 90% Malaria Roll Back Malaria Partnership Elimination in 35 countries by 2030 Medicines for Malaria Venture Prevent the re-establishment of malaria

  4. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine Background: Malaria financing Bilateral Approach Multilateral Approach Direct Contributions Multilateral Financing 1950-1980: Push for malaria 1980-Present : Proliferation of eradication. Primarily bilateral, or multilateral funding and creation of even unilateral, financing Global Fund in 2002. sources. Motivated by the donor imperative of Donors motivated by need to pooling and advancing a common exert control over aid flows and global cause. be visible. Today: The UK is a major direct funder Politicized and fragmented and of Malaria programs worldwide and the did not respond to transnational third largest donor to the the Global nature of disease. Fund (7% of DFID’s total financing) . 1980-1990: Increasing resistance led to resurgence in malaria Reviews by DFID and independent incidence rates. Highlighted need auditors: Global Fund is “one of the for coordination/cooperation to world’s most effective aid institutions”. address the disease.

  5. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine Analysis of Issues: Progress to Eradication Achievements Current status Statistics Future Goals New malaria cases $ 35.7 Billion: 2021 – 2025: 659 million long-lasting Different phases of where there are no insecticide treated bed 4.2 million lives saved elimination. control activities have nets. increased by 53%. 11 high burden countries $41.6 Billion: 2026 – 2030: Reduced health (India most improved). 4.5 million lives saved Number of malaria commodity prices and deaths between 200- 21 countries towards ‘No improved procurement Address challenges: 2015 have decreased Malaria’ status by 2020. efficiencies. by 48%. Resistance to insecticides Strengthened health Need for primary health systems, e.g. medicine care investment endemic Sub-standard antimalarials supply chain, data countries. systems, service Decrease in investment in delivery. malaria programs

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

  7. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine Selected Case Study: Nigeria 1/3 Observations & Figures Geography $286.8 million Global Fund aid £572,000 (DFID) - 2017 Bilateral Help World Bank, USAID, WHO, UNICEF & the Further Donors Affordable Medicines Facility-malaria National Malaria Program Main on-going programmes Comments • 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.

  8. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine Selected Case Study: Uganda 2/3 Observations & Figures Geography $488 million Global Fund aid $58 million (DFID) – (2012-2015) Bilateral Help US President’s Malaria Initiative, World Health Organization, United Nations Children’s Fund Further Donors (UNICEF) and other RBM partners. National Malaria Control Programme Main on-going programmes Comments • 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.

  9. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine Selected Case Study: Tanzania 3/3 Observations & Figures Geography $602 million Global Fund aid £15.25 million (DFID) – (2011-2015) Bilateral Help The President’s Malaria Initiative, WHO & Further Donors UNICEF The President’s Malaria Initiative Main on-going programmes Comments • $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.

  10. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine Opportunities for Improvement Recipient country’s : High United Kingdom: High Approachability PERFORM UNDERTAKE FOSTER ABSORPTIVE RESPONSIBLE SUSTAINABLE CAPACITY EVALUATION PROCESSES Objective Objective • Maximization Achieve 15% of country • Reduce out of pocket cost for expenditure on Global Health health system use • Public health impact? • Public and private sector Drivers Drivers collaboration? • Prevention and treatment • Access to clear information on • UK’s influence in the fight against • Stakeholder’s partnerships (PPPs) other on going programmes malaria? • Strong financial & management • External support to manage systems available resources efficiently Minimization • Lean reporting mechanisms • Continuous learning practices • Public health global risk? Roadblocks Roadblocks • Financial burden of disease? • Antimalarial resistance • Low level of readiness to receive • Out of pocket expenditure in LMICs? • Need to double funding targets large financing commitments to meet 2020 goals without overflowing current administration

  11. MSc in International Health and Tropical Medicine Centre for Tropical Medicine and Global Health Nuffield Department of Medicine Conclusion 1. DFID role 5. Future targets 3. Main problems UK is the second largest international Increase funding Increasing resistance to antimalarials donor and is one of the premier 15% GDP expenditure on health and insecticide, plateau in overseas financiers for malaria control and development aid, transnational elimination initiatives. nature of the disease, 4. Financial Expectation 2. Bilateral vs. Multilateral Significant increase in financing for malaria is needed Recognized benefits of giving to multilateral agencies for globally in order to meet future targets. coordination, leverage, accountability, and expertise but challenges regarding capacity and sustainability.

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