As countries in Asia become economically prosperous, external grant funding to eliminate malaria – as cases fall – may no longer be in place in the near future. Dr Christoph Benn warns at the World Economic Forum on Asean in Hanoi that unless new and unconventional finance mechanisms are found, malaria could come back with a cutting vengeance if there are funding shortfalls – with the emergence of drug-resistant forms of the mosquito-borne disease in the Greater Mekong Sub-region.
Malaria remains one of the deadliest diseases in history despite the great progress we have made against it. The number of malaria cases and deaths in Asia has halved in less than 15 years. This is a remarkable success as we witness and learn from countries such as Sri Lanka who are celebrating their third anniversary of being malaria-free this September.
While we are on the right track and one last big push can eliminate malaria for good in this region, we stand at a crossroads where progress against this global health challenge is stalling.
After years of progress in the fight to eliminate malaria, robust economic growth across Asia means traditional financing sources may no longer be in place in the near future. As countries become increasingly developed and economically prosperous, we will see a reduction in external grant funding.
This is a challenge as many countries – despite being more developed – don’t have mechanisms fully in place to fund disease elimination activities. As a result, public health programmes suffer during this period of transition. Further compounding this are the declining case counts for malaria, making it harder to justify and secure domestic funding as compared to other more “hot topic”, widespread diseases.
With the emergence of drug-resistant forms of malaria in the Greater Mekong Sub-region looming over us, we must ensure we don’t lose our sense of urgency as history has shown that when we ease the brakes on malaria, it comes back with a cutting vengeance.
There is a pressing need to create new and unconventional finance mechanisms to ensure our progress against malaria is not hampered by a funding gap, or that it falls off the priority list of countries. At the heart of success in our approach against malaria will be innovation. But this does not simply mean identifying the next headline-grabbing breakthrough. We must instead look to inject fresh energy into the effort to stop malaria by considering other funding mechanisms.
Here are some examples:
Blended finance for impact
We are increasingly seeing governments across Asia demand new forms of health financing – particularly innovative and blended financial models – to ensure progress against the disease remains unchecked by funding concerns. However, funding must go beyond malaria for this to work.
As we approach the last mile of malaria elimination in many countries, the demand for financing will begin to shift from malaria commodities and specific interventions (i.e. malaria community workers) to universal access and integrated health services.
Asian Development Bank (ADB), the Global Fund and Asia Pacific Leaders’ Malaria Alliance (APLMA) have joined forces to address these challenges. ADB is in the process of establishing a Regional Health Fund (RHF), which will blend loans and grants to increase health financing efforts by countries.
The fund has a target size of $100 million to $150 million of grant funding, which will be multiplied many times over using other ADB resources. It aims to provide a “one-stop blended finance shop” for governments to access finance targeting of whole-of-system health programs to expedite regional health goals such as malaria elimination.
Elevating the private sector’s role in malaria elimination
Private companies have a broad range of expertise and capabilities that can increase the public sector’s response from data management, supply chain logistics, awareness campaigns and the deployment of new technologies to hard-to-reach areas. However, we must also consider how funding from the private sector’s role can be creatively applied and fully utilised.
The good news? Companies already realise that solving pressing health challenges go hand-in-hand with sound financial performance and that malaria cost control is a cost-effective business investment.
The past 25 years have proven that GDP per capita growth in countries not affected by malaria has been five times higher than in countries with a heavy malaria burden. This is further demonstrated by the fact that when companies invest in the health of their workers, we see a reduction in costs. It also enables people to safely move across borders, bringing a range of benefits for both economic development zones and tourism.
Noteworthy platforms such as M2030, which was launched earlier this year by APLMA, help unite business partners across Asia with consumers and health organisations to become champions in the fight against malaria.
These businesses bring different layers of benefit to the program such as: creating a sense of public ownership and urgency around this disease; innovative financing models; and creative, fresh approaches to old problems. M2030 will also offer a new model for funding malaria, where all funds will help bridge gaps and address malaria-related priorities.
Tipping the scales against malaria
The Global Fund will enter its sixth replenishment in 2019, with discussions revolving around its significance in the fight against HIV, TB and malaria. This is important as a successful replenishment ensures the Global Fund will have adequate funds to continue supporting as many countries in Asia and the Pacific as possible in the next five years in their efforts to eliminate malaria.
The world is currently at a tipping point in our fight against malaria. Malaria elimination is within our grasp and this is a crucial opportunity to push progress forward rather than risk the dangers of backsliding. Smart partnerships and innovative financing solutions are key to banishing malaria from this region – and the world – once and for all.
Dr Christoph Benn, a clinician and public health specialist, is senior advisor at the Global Fund to Fight AIDS, Tuberculosis and Malaria and board member of the Singapore-based Asia Pacific Leaders’ Malaria Alliance (APLMA).