Challenges and Implementation of Domestic Financing for Health:

Malaria

Domestic Financing for Health: Invest to Save LivesAddis Ababa, 11-12 November 2013

Dr Silvia FerazziRoll Back Malaria Partnership

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Malaria is a key public health challenge in Africa

Map of malaria risk - Source: Malaria Atlas Project 2012

People at risk• 3 billion in the world• 726 million in Africa

Number of cases• 219 million in the world

• 174 million in Africa

Number of deaths• 660,000 in the world

• 596,000 in Africa

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Malaria hinders socio-economic development

Total benefit from reduced

malaria burden

• More income for poor families: Malaria accounts for 25% of household expenditures

• More educated workforce (better school attendance and performance)

Additional benefits

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Direct benefits from case and

death reduction

• Improved lifetime productivity (fewer work days lost to illness and death): Average productivity gain of 1-5 days per case

averted (Mc Kinsey, 2006)

Overall, in Africa 2001-2011:

$5.4 billion in malaria control ↓

$73-91 billion in economic return =

14 to 17 times the investment)

• Economic return for companies: through a PPP initiative, in Zambia 3 companies gained an annualized rate of return of

28%

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Resurgence //Sustaining achievements

Cohen et al. Malaria Journal 2012

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Remarkable increase in aid for malaria over the past 10 years – what next?

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Domestic funding is progressing too slow

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Ensuring sustainable domestic funding

Ministers ofFinance

Ministers ofHealth

1. Increase budget allocations

2. Implement innovative mechanisms to counter

unpredictability and increase efficiency

Sustainable financing plans

Development loans (IDA/Reg. Banks)

Development aid (budget support)

Investment of revenue collection

Debt relief/Debt conversions

Risk pooling

Results based financing

Trust funds

4. Promote intra- and intersectoral integration

for better value for money

Heads of State

PPPs

3. Develop evidence/tools for decision making

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1. Increased budget allocations for health – RBM advocacy

Work with Heads of States: African Leaders Malaria Alliance → African Union

Contribution with advocacy and evidence in key MOH/MOF processes:

–High Level Dialogue, Tunis (AfDB; HHA)

–Africa Health Forum (WB, USG, HHA)–Roundtable on Sustainable Finaicng for

malaria and Health sector (UK)

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:

2. Domestic innovative financing – RBM support to share lessons and promote pilot initiatives

Annual RBM Ministerial Session has focused repeatedly on domestic innovative financing

Piloting a PPP pay-for-performance model in Mozambique

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Domestic innovative financing – report at 2013 RBM Ministerial Session

Community health insurances and fee-based measures

Co-financing and extension of services from PS

Solidarity funds/other pool funding

Pay for performance mechanisms

Cost efficiencies

Innovative use of taxation

Use of taxes on tobacco, alcohol, GSMs, air tickets (Benin) De-taxation of bed nets/insecticides/drugs (Burkina Faso, Côte d'Ivoire)

Health insurance schemes (Burkina Faso, Ethiopia, Ghana, Mali, Sierra Leone, Sudan, Yemen, Zambia) Community health insurance (Burkina Faso, Rwanda) Extension to malaria of fee for health services (Liberia, Yemen) Exemption from medical fees (Côte d'Ivoire)

Malaria financing task force with private sector (Malawi) Expansion of partnership with telecommunication companies (Yemen) Discussion for corporate responsibility action on malaria with private sector (Sierra Leone) Dialogue with private sector for extension of interventions from workplace to communities (Zambia)

Presidential initiative for free care (Benin) Pooled financing scheme for MDG support (Ethiopia)

Introduction of result based financing approach (Yemen) CHWs cooperatives funded based on performance including test/treat malaria (Rwanda) Proof of concept pilot of a pay-for-performance model in consultation with private sector (Mozambique)

Pooled purchase/management of commodities (Benin, Burkina Faso, Côte d'Ivoire, Ethiopia, Mali, Rwanda) Use of the VPP of the Global Fund (Comoros, Ghana, Liberia, Togo) Voluntary pooled procurement and the procurement through WHO (Yemen) Planned participation in SADEC initiative for pooled procurement (Swaziland) Plans for local manufacturing of LLINs (Rwanda, Swaziland) Integration in comprehensive health packages (Rwanda, South Africa, Sudan, Yemen) Purchase agreements with private sector for better procurement efficiency (Côte d'Ivoire, Zambia) National pharmaceutical procurement unit envisaged (Sierra Leone) Unified national health information system (Sierra Leone)

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RBM support: improve evidence and tools for decision making• DFID-funded project

with RBM for Strengthening the Use of Data for Malaria Decision Making in Africa

• Africa ARM (Advocacy for Resource Mobilization) as joint undertaking of RBM Malaria Advocacy Working Group and Harmonization Working Group

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Need to engage non-Health Sectors

Education

http://keystoneschool.com

Infrastructure Projects

Military

http://online.wsj.com

Also important, better integration of interventions with other sectors allows for more efficient management of common costs and take advantage of

financing processes in other areas for malaria outcomes