Mobilizing resources with an investment case to mitigate cross-border malaria transmission and achieve malaria elimination in South Africa

Aparna Kollipara; Devanand Moonasar; Ryleen Balawanth; Sheetal P Silal; Anthony Yuen; Katie Fox; Joseph Njau; Yogan G Pillay; Mark Blecher

doi:10.1080/16549716.2023.2205700

Mobilizing resources with an investment case to mitigate cross-border malaria transmission and achieve malaria elimination in South Africa

Glob Health Action. 2023 Dec 31;16(1):2205700. doi: 10.1080/16549716.2023.2205700.

Authors

Aparna Kollipara¹, Devanand Moonasar^{2

3}, Ryleen Balawanth⁴, Sheetal P Silal^{5

6}, Anthony Yuen⁴, Katie Fox¹, Joseph Njau⁷, Yogan G Pillay^{2

8}, Mark Blecher⁹

Affiliations

¹ San Francisco Global Health Group, Malaria Elimination Initiative at the University of California, San Francisco, CA, USA.
² National Department of Health, Malaria Vector and Zoonotic Disease Directorate, Pretoria, South Africa.
³ School of Public Health and Health Systems, University of Pretoria, Pretoria, South Africa.
⁴ South Africa Regional Office, Clinton Health Access Initiative, Inc. (CHAI), Pretoria, South Africa.
⁵ Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
⁶ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK.
⁷ JoDon Consulting Group, Health Economist, Lilburn, GA, USA.
⁸ Affiliate Center for Innovation in Global Health, Georgetown University, Washington, DC, USA.
⁹ Public Finance Division, National Treasury, Pretoria, South Africa.

Abstract

South Africa's effort to eliminate malaria is significantly challenged by a large number of imported malaria cases, especially from neighbouring Mozambique. The country has a funding gap to achieve its malaria elimination goals (prior to 2019) and is ineligible to receive a national allocation from the Global Fund. The findings of an IC were utilised to successfully mobilise resources for malaria elimination in South Africa in 2018. A five-step resource mobilisation strategy was implemented to highlight financing challenges and leverage the economic evidence from an IC for malaria elimination in South Africa. South Africa's malaria programme implements control and elimination activities in three malaria-endemic provinces (KwaZulu Natal, Limpopo, and Mpumalanga). Driven by the IC findings, the South African government took an unprecedented step and increased total domestic malaria financing by approximately 36%, from the 2018/19 to the 2019/20 financial years through the creation of a new conditional grant for malaria. The IC findings predicted that malaria control in southern Mozambique is a prerequisite to eliminate malaria in South Africa. Based on this, the South African government also allocated funding towards a co-financing mechanism to support malaria control efforts in southern Mozambique. The IC findings assisted the South African National Department of Health to make a convincing case to key government decision-makers to invest in national malaria elimination and maximise economic returns in the long run. The South African government is the first in Southern Africa to mobilise a significant increase in domestic malaria financing to address the financial sustainability of both national and regional malaria elimination efforts. Continued surveillance activities will be required to prevent the re-establishment of malaria transmission even after malaria elimination is achieved in South Africa. Information sharing and close collaboration with provincial and national government officials were key to the successful outcome.

Keywords: Resource mobilisation; co-financing; cross-border collaboration; malaria financing; return on investment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Africa, Southern
Financing, Organized
Humans
Malaria* / epidemiology
Malaria* / prevention & control
Mozambique / epidemiology
South Africa / epidemiology

Grants and funding

Funding for this study was provided through a grant from the Bill & Melinda Gates Foundation (OPP1160129) to the Global Health Group of the University of California, San Francisco. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.