Tracking spending on malaria by source in 106 countries, 2000-16: an economic modelling study

Abstract

Background: Sustaining achievements in malaria control and making progress toward malaria elimination requires coordinated funding. We estimated domestic malaria spending by source in 106 countries that were malaria-endemic in 2000-16 or became malaria-free after 2000.

Methods: We collected 36 038 datapoints reporting government, out-of-pocket (OOP), and prepaid private malaria spending, as well as malaria treatment-seeking, costs of patient care, and drug prices. We estimated government spending on patient care for malaria, which was added to government spending by national malaria control programmes. For OOP malaria spending, we used data reported in National Health Accounts and estimated OOP spending on treatment. Spatiotemporal Gaussian process regression was used to ensure estimates were complete and comparable across time and to generate uncertainty.

Findings: In 2016, US$4·3 billion (95% uncertainty interval [UI] 4·2-4·4) was spent on malaria worldwide, an 8·5% (95% UI 8·1-8·9) per year increase over spending in 2000. Since 2000, OOP spending increased 3·8% (3·3-4·2) per year, amounting to $556 million (487-634) or 13·0% (11·6-14·5) of all malaria spending in 2016. Governments spent $1·2 billion (1·1-1·3) or 28·2% (27·1-29·3) of all malaria spending in 2016, increasing 4·0% annually since 2000. The source of malaria spending varied depending on whether countries were in the malaria control or elimination stage.

Interpretation: Tracking global malaria spending provides insight into how far the world is from reaching the malaria funding target of $6·6 billion annually by 2020. Because most countries with a high burden of malaria are low income or lower-middle income, mobilising additional government resources for malaria might be challenging.

Funding: The Bill & Melinda Gates Foundation.

Figure 1

Malaria spending by source, 2000–16 Total malaria spending over time by source (A) and scaled to represent 100% of all malaria spending (B). Estimates shown in 2018 US$.

Figure 2

Malaria spending by country characteristics, 2000–16 Total malaria spending by 2016 malaria elimination status (A), 2018 World Bank income group (B), and 2017 Global Burden of Disease region (C). Income group specifies where the resources were spent, not the source of the funds; very few resources were spent in the high-income super-region. Estimates are shown in 2018 US$.

Figure 3

Malaria spending per malaria incident case in controlling (A), eliminating (B), and malaria-free (C) countries, 2016 Estimates are shown in 2018 US$. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. LCA=Saint Lucia. Marshall Isl=Marshall Islands. Solomon Isl=Solomon Islands. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.

Figure 3

Malaria spending per malaria incident case in controlling (A), eliminating (B), and malaria-free (C) countries, 2016 Estimates are shown in 2018 US$. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. LCA=Saint Lucia. Marshall Isl=Marshall Islands. Solomon Isl=Solomon Islands. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.

Figure 4

Composition of malaria spending by source and malaria cases per 100 000 people, 2016 Malaria incident cases from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017.