Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments.
Bottom Line: However, this assistance was inadequate for 50 countries representing 61% of the worldwide population at risk of malaria-including ten countries in Africa and five in Asia that coincidentally are some of the poorest countries.More efficient targeting of financial resources against biological need and national income should create a more equitable investment portfolio that with increased commitments will guarantee sustained financing of control in countries most at risk and least able to support themselves.Wellcome Trust.
Affiliation: Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute, Nairobi, Kenya. email@example.comShow MeSH
Related in: MedlinePlus
Mentions: Among the 81 endemic countries that have received some international assistance for malaria control since 2002, 26 (32%) continue to receive less than $1 per person at risk in an average year by 2009 (figure 1 and table). However, there has been substantial improvement since 2007 when 47 (61%) of 77 recipient countries were funded at this level (figure 1). The greatest improvements in funding since 2007 have been in Africa, with modest changes in the Americas and, with the exception of Sri Lanka and Papua New Guinea, almost no change across much of southeast Asia (figure 1). Overall there is a strong correlation between funding provided since 2002 and populations at risk of stable transmission across the 81 countries that received funding (figure 2; r=0·76, p<0·001). Although countries with bigger populations at risk tend to get more donor assistance, there are important anomalies. Five countries (Azerbaijan, Suriname, São Tomé and Príncipe, Equatorial Guinea, and Swaziland) were in receipt of more than $10 per person at risk and all were countries with small at-risk populations: 0·05% of the worldwide stable-risk population but receiving 0·9% of the yearly malaria funding commitment. 13 countries by 2009 received more than $4 per person at-risk per year (figure 1), compared with only three countries in 2007 (figure 1); these countries represent 2% of the worldwide population at risk of stable malaria transmission in 2009, but receive 11·8% of the annualised international funding commitment. 37% of people living under stable malaria transmission in 2009 were in India, which received only $0·03 external development assistance per person at risk, and China, which received only $0·28, or 2% of total annualised donor funding for malaria. Neither country is poor, although large sectors of their population live in poverty, and arguably they might be seen as able to fund national malaria control from domestic resources. We use these examples here to illustrate how donor assistance does not always scale with populations at risk.
Affiliation: Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, Kenya Medical Research Institute, Nairobi, Kenya. firstname.lastname@example.org