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