Mobilizing resources with an investment case to mitigate cross-border malaria transmission and achieve malaria elimination in 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
• malaria financing
• co-financing
• return on investment
• cross-border collaboration

Responsible Editor Maria Nilsson

Responsible Editor Maria Nilsson

Acknowledgments

The IC was commissioned by the South African National Department of Health (NDOH). The work was undertaken by the Malaria Elimination Initiative (MEI) at the University of California, San Francisco (UCSF) Global Health Group; the Modelling Simulation Hub, Africa; and the Clinton Health Access Initiative (CHAI). The authors acknowledge the invaluable contributions from provincial health departments and treasuries from Limpopo, KwaZulu-Natal, and Mpumalanga, the National Department of Health (Malaria Program and Finance Division), and National Treasury (Public Finance and Intergovernmental Relations Divisions) to inform the resource mobilisation strategy. The authors thank the TTT members for their time to see through the goal of resource mobilisation for malaria elimination.

Author’s contributions

AK, RB, and KF contributed to the investigation (collected primary data through key informant interviews), AY, RB, and AK contributed to formal analysis (performed the data collation and analysis), SPS and JN also contributed to the formal analysis (interpreted the data for the work), and MB, YP, and DM contributed to the conceptualisation of the study. AK and SPS contributed to the methodology and writing (original draft and preparation) the manuscript. All authors contributed to critically revising the manuscript for important intellectual content. All authors approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Paper context

This paper details a five-step resource mobilisation strategy for malaria elimination implemented in South Africa. The strategy facilitated the South African government’s decision to create two domestic financing mechanisms for malaria: (1) a conditional grant and (2) a co-financing mechanism for malaria source reduction activities in southern Mozambique. Government decision-makers recognised that a significant increase in malaria financing now will yield a return on investment through the reduction of malaria-associated morbidity and mortality.

Notes

¹ 2019 Medium Term Expenditure Framework period is 2019/20 to 2011/2022 financial years.

Additional information

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.