Overview of anti-malaria commodity issues based on preliminary gap analysis

Sylvia Meek (Malaria Consortium), Mark Pearson, Linda Westberg, Jody Tate & Kieh Christopherson

Dunn June 2014

1. Funding and commodity gaps are large.• We cannot achieve malaria control and elimination unless

we fill them2. We need better gap information for planning and advocacy.• Consider a regional real-time system to monitor financial

flows and gaps3. There are many systems barriers to access• Build on successes with community health workers• Better engage with private labour project owners to protect

migrant workers.4. Artemisinin resistant malaria will not be eliminated unless

today’s strategies are inclusive of marginalised high risk populations.

Key Messages

• WHO (August 2012) model: o Cambodia, Myanmar, Thailand, Vietnam (2013-15)o Needs $604m, Available $185m. Gap $419 million

• WHO Western Pacific (early 2012) plan analysis:o Cambodia, China, Laos, Myanmar, Thailand, Vietnam

(2012- 2016)o Needs $768m. Available $396m. Gap $372 million

• Malaria 2012 meeting background paper model:o Asia-Pacific Region (2013-15)o Gap $1.69 billion ($684m. excluding India & China)

Information from modelling exercises gives a higher estimate than national plans

• Wide range of epidemiological settingso Blanket assumptions for multiple

countries not possible• Variation in malaria risk within

countries affects coverage targetso And those at highest risk are often

remote or mobile costs of delivery are higher

• Strategies in region are dynamico More countries re-orienting to

elimination• Rates of spending not predictable• Not only funding but also systems

issues influence access

Why are good gap analysis data so elusive?

• Development partners and governments agree to a common approach to estimating financing gaps for commodities that can be implemented efficiently and kept up to date

• Consider establishing a real-time online system to monitor financial flows and gaps (initially in Greater Mekong and hosted by ERAR?)o Saving time and effort, information ready when needed,

encouraging transparency• APLMA to hold governments and funders to account for

maintaining and sharing accurate informationo by monitoring the completeness of gap analysis datao by collating new data at end of 2014

Recommendation 1: Common approach to estimate funding gaps

Issue: exact gap for malaria commodities is not known. Data are often incomplete, incomparable or not up to date

• APLMA advocates and acts to ensure that the large and variable regional and country funding needs are met in a sustainable way. o Develop sustainable financing models (review existing

models in region)o Request external funding while levels of domestic funding

increaseo Ensure efficient use of resources from private sector and

civil society as well as government.

Recommendation 2: Advocate for sustainable fundsIssue: The information we have for some countries on overall funding needs (including commodity needs) and on overall funding gaps show that the gaps are large in absolute terms

• Strategies

• Users

• Commodities

• Systems

Issues influencing access to antimalarial commodities

• Elimination strategies need consistently high commodity access

• Fewer treatments are needed as malaria declines, but more diagnostic tests

• Decision to stop prevention, when risk declines, is difficulto Premature cessation may lead to reversal of progress

• Access to commodities in neighbouring countries important to prevent malaria re-introduction

• Regional aspect also important for eliminating artemisinin resistant malaria

How Strategies Influence Access

• Populations at highest risk often have lowest accesso Mobile and migrant populationso Static populations in hard-to-reach areaso Often marginalised ethnic minorities – language and

cultural barriers• Occupational risk from working or sleeping outdoors at

night (e.g. rubber tappers, miners, security forces)o Need alternative protection measures – not widely

available.• User preferences, understanding and knowledge of where

to find commodities affect access

User issues

• Quality is critical

• Need for more surveillance of counterfeit drugs• Some private providers selling untreated nets, sub-

therapeutic doses of drugs etc.

• Use of diagnostics limited in private sector

• Acceptability affected by presentation, other characteristics

Commodity-specific issues affecting access

• Weak procurement and supply stockouts

• Global Fund systems have sometimes hampered access

• Health workers number, distribution and quality affecting access

• Decentralisation and integration can lack of specialist skills where needed - if not planned well

Systems and Access

• A positive finding: community health workers are extending access to remote and mobile populations.o Broadening the role of volunteer malaria workers (within

reason) may be a benefit, as it increases community appreciation and provides more skills refreshment

• In addition to making continued efforts to cover their commodity financing gaps, APLMA should work to ensure national health systems provide equitable access to commodities.

• APLMA to review successful initiatives to assess which may suit high-risk groups Tax-funded user fee exemptions (Malaysia) Free health care and accessible services (Sri Lanka)

Recommendation 3: Design health systems to ensure equitable access

Issue : Health systems barriers to access are impeding progress to Universal Health Coverage

• Governments need to engage with the private sector to effectively control malaria

• APLMA could play a key role in promoting intersectoral collaborations

• APLMA could consider implications of Trans-Pacific Partnership – to enhance, not to limit access to affordable generics?

Recommendation 4: Governments engage with the private sector to better control malaria.Issue: Private sector already plays an important role in supplying anti-malaria commodities - especially for hard to reach and marginalised communities which lack access to public services

• Develop country-specific strategies based on regional lessons to improve access to malaria care and commodities in these groups

• APLMA to offer high level promotion of strategies to minimise discrimination of marginalised groupso Bring issues to MOH

planningo Share best practices

among countries

Recommendation 5: Access for hard-to-reachIssue: Hard to reach, remote, marginalised populations are the key groups at risk of malaria but geographically difficult to locate. The provision of health care to such populations costs more per capita than for less remote populations

• Regional approaches are needed to engage major employers of migrant labour, providing guidance on approaches to malaria control and recommending codes of practice

• APLMA could explore needs for guidance/legislation on appropriate malaria care of migrant labour

Recommendation 6: Access for mobile and migrant populationsIssue: Mobile and migrant populations are of particular concern because they could potentially contribute to the spread of artemisinin resistant malaria parasites.

Thank you