lifting the burden of malaria: an investment guide for impact-driven philanthropy

8/8/2019 Lifting the Burden of Malaria: An Investment Guide for Impact-Driven Philanthropy

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Th Ct f High Ipact PhiathpSchool of Social Pol icy & Pract ice | Univers ity of Pennsylvania

Carol McLaughl in , Jennifer Levy , Kathleen Noonan, and Katherina Rosqueta

Lifting the Burden of MalariaA Ivtt Gid f Ipact-Div Phiathp

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Photo courtesy o Gene Dailey, American Red Cross, provided by VOICES or a Malaria Free Future.

Every thirty seconds a young child dies of malaria.

Each of those deaths is avoidable.


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lIFT InG THe burDen oF mAlArIAi

Lifting the Burden of MalariaA Ivtt Gid f Ipact-Div Phiathp

Carol McLaughl in , Jennifer Levy , Kathleen Noonan, and Katherina Rosqueta

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THe CenTer For HIGH ImPACT PHIlAnTHroPyiv

Table of ContentsABOUT THIS DOCUMENT i i

How we selected promising opportunities for philanthropists i

I . THE NEED fOr pHIlANTHrOpIC INvESTMENT IN MAlArIA CONTrOl 1

Malaria is a global priority for health and development 1

The global strategy to combat malaria 4

How philanthropists can help 6

Why invest now 7

What are the best investments in malaria control 8

II . TrEAT AND prEvENT NOw 10

Overview of malaria tools 1 1

Malaria tools are both inexpensive and cost-effective 14

Philanthropists can address the current gaps in the coverage of tools 15

Effective tool-delivery strategies 16

Addig ct ctait t div

Strategy 1: Extend the existing health system capacity throughcommunity health workers 17

Strategy 2: Enlist family members and community volunteers toeducate communities 20

Strategy 3: Piggyback on existing systems for delivery of bednets 24

Strategy 4: Scale-up community and household access to new ACTs 27

Hpig pcia va ppati

Strategy 5: Build training networks to prevent malaria in pregnancy 30

Strategy 6: Assist the most vulnerable in areas of conflict ornatural disaster 31

In-depth case study included in this section


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lIFT InG THe burDen oF mAlArIAv

I I I . BUIlD SySTEMS fOr THE lONg TErM 32

Strategy 7: Strengthen health system capacity througheffective par tnerships 34

Strategy 8: Leverage existing financing resources forsystem-wide change 36

Strategy 9: Create information networks to track outcomes,

monitor resistance, and predict epidemics 38Strategy 10: Prepare future health leaders from

malaria-affected countries 40

Iv. INNOvATE fOr THE fUTUrE 42

Strategy 11: Support innovation for new tools 44

Strategy 12: Innovate by harnessing the potential of the privatesector or applying new technology 48

v. TrANSlATINg gOOD INTENTI ONS INTO HIgH IMpACT pHIlANTHrOpy 51

1. Select your entry point supporting the global malaria strategy 51

2. Consider what region you want to target 54

3. Evaluate potential investments 55

4. Measure what matters after you have written the check 58

5. Incorporate proven strategies for successful public health efforts 62

rESOUrCES AND rEfErENCES 65

Glossary of acronyms and terms 66

Summary of philanthropic opportunities 67

Exemplary models and example agents mentioned in this report 68How we calculated cost per impact 70

Where to learn more 72

References and endnotes 74

About the authors 80

Acknowledgements inside back cover

About the Center for High Impact Philanthropy back cover


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THe CenTer For HIGH ImPACT PHIlAnTHroPyvi


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lIFT InG THe burDen oF mAlArIAv

ABOUT THIS DOCUMENT

In this guide, we provide independent, practical advice on how to invest

in malaria control in a way that maximizes the impact of philanthropic

dollars. For this document, we combined our analysis of available research,policy analyses, and program evaluations with the insights of a diverse set of

opinion leaders and practitioners.

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lIFT InG THe burDen oF mAlArIA

I . THE NEED fOr pHIlANTHrOpIC INvESTMENT IN MAlArIA CONTrOl

Every thirty seconds a young child dies of malaria. The disease kills more

than 5,000 people a day, primarily children in sub-Saharan Africa.

Each of those deaths is avoidable. The disease is both a product andan underlying cause of poverty, creating a vicious cycle of poor health

outcomes and underdevelopment. Fortunately, there are effective, low-cost

tools available for the prevention and treatment of malaria, as well as an in-

ternational consensus on a strategy to combat the disease.

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oday, despite known cost-eective tools to treat and pre-

vent malaria, Aramata and Sinalys success story is all too

rare. Sinaly was one o the lucky ones. His mother was con-

dent enough to trust her intuition and resourceul enough

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I believe that if you show people a problem, andthen you show them the solution, they will be

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that a rapid scale-up plan is substantially more

cost-effective than a continuation of the currentfunding trajectory. This is due to the benefits

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TreAT AnD PreVenT noW

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5. Build training networks to prevent malaria in pregnancy

6. Assist the most vulnerable in areas of conflict or natural disaster

STrATEgIES IN THIS SECTION


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I I . TrEAT AND prEvENT NOw

The best way to save lives immediately is to close existing gaps in the delivery

of effective malaria control interventions to communities. In this section, we

rst describe key malaria tools, how to think about their cost and impact, andhow to increase access by supporting effective delivery programs. We then

highlight six strategies that philanthropists can take to immediately have an

impact in this area. For several models, we also include cost-impact proles.

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Extend existing health system capacity throughcommunity health workers

STrATEgy 1
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PromIsInG PrACTICe:

Cit ca aagt f chidhd i

achig th at qiti with if-avig tatt

proBlem: Many communities are far from clinics and do

not have access to mal aria treatment. At the same time, there

are severe shortages of al l levels of health workers. Combined

with widespread drug resistance to chloroquine and limited

access to new antimalarial medications, these factors can lead

to fatal outcomes.

solution: Lay health workers and community-managed

drug kits

successFul model: In communities more than 5km from

a healthcare facility, community health workers receive train-ing and supervision so that they can safely provide essential

health services. These health services include basic health

education and prevention, as well as diagnosis, treatment,

and/or referral for the most common life-threatening child-

hood illnesses, including malaria, diarrhea, and pneumonia.

The community health workers are affiliated with established

health clinics that provide training, supervision, and consis-

tent drug supply. When feasible, the health clinics also enable

timely transfer of sick children who need higher levels of ca re.

Research studies support the use of both lay health workers

and home-based care for malaria.44

exemplar agent: s c - In partnership

with the target countrys Ministry of Health, Save the Children

uses community case management (CCM) to deliver basic but

critical interventions to those without access. Although most

of its pilot CCM programs are less than five years old, mid-

term evaluations indicate that the programs are on track to

reach targets. Save the Children personnel have also taken

a leadership role in collecting evidence for the model and

sharing its core elements for use by other nongovernmental

organizations.

results: In 2002, Save the Children initiated a community

case management project in the Sikasso region of Mali, West

Africa. The project gave villagers increased access to essential

medications for malaria and dia rrhea by establishing over 450

village drug kits and training kit managers to treat patients

and refer those with signs of severe illness to affiliated health

centers. Household surveys showed that the use of appropriate

malaria treatment for all children in the target area increased

from 24% at baseline in 2002 to 56% i n 2004. A recent mid-

term evaluation of an expansion of the project to other districts

showed that 50% of children treated for malaria in project

districts received their therapy at the community level.45 More

recently, Save the Children has piloted the use of ACTs i n the

village drug kits using the CCM delivery platform.46

what diFFerence can the model achieve? Save

the Children has set a number of targets for its expanded

CCM project in Mali, which serves a target rural population

of 990,000 people, including 250,000 children under the

age of five.

2004-2009 (minimum) targets for change in intervention

coverage in the target population:

Children sleeping under a bednet the previous night:

increase from 8% to 30%

Children receiving therapy within 24 hours of fever onset:


Pregnant mothers receiving at least one dose of IPT:


Estimated number of child lives saved if the project reaches

its minimum targets:

2,500 (considering only the impact of the three malaria

interventions)

3,200 (if we consider the doubled use of oral rehydration

therapy for diarrhea treatment)

how much does this change cost? About $1000

per additional child life saved, when including the impact of

both malaria interventions and oral rehydration therapy for

diarrhea. The cost rises to approximately $1350 if we only

consider the impact of malaria inter ventions. The total cost for

this five-year project is $3.3 million, or roughly $3 per child

under the age of five per year in a population with 250,000

children.47

We based these figures on project data and targets from

Mali 2004-2009 and the Lives Saved Calculator of CHERG/

CSTS+.48 The figures only include the estimated impact on

deaths averted in children less than five years of age. They

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do not include the cost of medications and bednets, which

the Ministry of Health and other partners (e.g., UNICEF, Red

Cross) typically provide.

The models cost efficiency a rises from two sources. First, the

model relies on partners for referral, commodities, and cost-

sharing. Second, community health workers are addressing

several different priority health issues at once.

additional BeneFits: In addition to preventing death,

the interventions decrease sickness and disability in children.

Older children, pregnant women, and adults also benefit fromdecreased sickness and death. In addition, the community

case management strategy commonly addresses pneumo-

nia, a leading killer of children.49 Health planners are now

considering ways to adapt the strategy to deliver interven-

tions to treat newborn infections, childhood malnutrition, and

HIV/AIDS. This model also builds local capacity for reaching

the poorest of the poor, who experience a disproportionate

burden of illness and death.

F b C C M , Save the Childrens b: .v.

R (0) 1-44 (R@v.) D. Dv M (41) 5-05

(DM@v.).

CASE SNApSHOT

c Community health workers bringlife-saving treatments to families currently without access

i Decrease childhood death and illness

from malaria, diarrhea, and other common conditions

c (, m) Additional %of target population with coverage: +22% (bednet use),+34% (prompt therapy), +63% (IPT pregnancy)

p Aver-age annual cost per child under the age of five (as reportedby the nonprofit) is roughly $3

e Roughly $1000 peradditional child life saved for Mali program

*See page 70 for how we calculated cost per impact.

Image provided by Save the Children


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Enlist family members and communityvolunteers to educate communities

STrATEgy 2


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PromIsInG PrACTICe:

edcatig, iizig, ad chagig havi i citi

thgh vt twk

proBlem: When community members do not trust their

health providers, do not understand the importance of effec-

tive malaria tools, or lack the ski ll to use those t ools correctly,

they often will underuse or misuse these tools. Key constraints

to the regular use of malaria tools include shortages of trained

health care workers, low rates of literacy i n target populations,

diverse cultural beliefs, and language barriers.

solution: Educate and empower the community to take

appropriate actions to prevent malaria and seek treatment

within 24 hours of symptom onset. Use a system of commu-

nity volunteers and locally-tailored healt h messaging.

successFul model: The c g m is an

innovative and effective way to convey health messages to

large populations. This particular model has been unique in

its ability to overcome the usual difficulties associated with

training, supervising, and sustaining a large number of com-

munity volunteers, and is able to achieve universal coverage

of households.

Programs using this model create a vast network of commu-

nity volunteers that mobilize and educate their neighbors. For

every 10 to 15 households, a volunteer mother is selected. A care group consists of 10 to 15 volunteers. Each care

group meets twice monthly with a staff health promoter to

learn a new health message or skill focused on child survival.

After the care group meeting, all volunteers are responsible

for making individual visits to their assigned households near

their home and teaching other mothers the health lessons that

they learned in the care group. This volunteer-based saturation

system ensures that behavior-change communications reach

every household.

Care group meeting topics include the appropriate use of in-

secticide-treated bednets for malaria; oral rehydration therapy

to treat diarrhea; breastfeeding; and when to seek care at

health clinics (e.g., when a child has a fever).

exemplar agent: w rf originally developed

the Care Group model in Mozambique. World Relief and oth-

er NGOs (such as Food for the Hungry, Plan International,

Curamericas, Red Cross, and Africare54) have since replicated

the model in a diverse range of settings. The Mozambique

project was the subject of an external impact evaluation that

confirmed the positive health impact that the project had esti-

mated using its own household survey.

results: World Reliefs project in Gaza province, Mo-

zambique mobilized 2,315 women to reach nearly 25,000

households in a rural district. An independent external evalu-

ation of the Mozambique program found a 49% reduction

in infant mortality and a 42% reduction in mortality among

children under the age of five in the program communities. 55

In addition, the volunteer networks also implemented a health

information system and collected vital events such as births,

deaths, and childhood illness, thus filling a critical gap in reli-

able health data.

what diFFerence can the model achieve? Beloware selected results of World Reliefs Care Group program

serving a rural population of 160,000 in Malawi (including

37,000 children) before and aft er a four-year program. In Ma-

lawi, malaria is responsible for about 30% of child deaths.

Estimated number of child lives saved:

~ 473 (considering only the impact of the three malaria

interventions)

~ 1,114 (when also considering additional areas such

as nutrition, breastfeeding, and pneumonia therapy

that Care Groups address)

program

staFF

program

director

care group = 10 To 15 volunTEERS onE volunTEER PER 10 To 15 HouSEHolDS

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how much does this change cost? About $1200

per additional child life saved, when including all of the child

health interventions that the Care Groups addressed (~$2800

if we only consider the impact of the malaria interventions).

The total cost for the four-year project in Malawi was $1.3

million or roughly $8 to $10 per child under the age of five

per year in the target area. We do not include the cost of

medications and bednets, as the Ministry of Health or other

partners typically provide these. For these figures, we used

project data from Malawi 2000-2004, the Lives Saved Cal-

culator of CHERG/CSTS+, and data from the USAID Child

Survival Grants Program.56 The figures only include impact on

deaths averted in children under five years of age.

additional BeneFits: In addition to preventing death,

Care Group interventions also decrease sickness and disabili ty

in children. Older children, pregnant women, and healthy adults

also benefit from decreased sickness and death. Furthermore,

the Care Group platform can introduce microcredit, literacy,

and income-generating skills t o rural women and households.

F b C G M, W R b: .. C F

(44) 451-19 (@.).

CASE SNApSHOT

c Reach all households with critical healtheducation using mothers and household volunteers

i Decrease childhood death and illnessfrom malaria, diarrhea, and other common conditions

c (m) Additional % target popu-lation with coverage: +51% (bednet use), +39% (promptmalaria therapy), and +30% (IPT pregnancy)

p Average annual cost per child under the age of five (asreported by the nonprofit) is about $8 to $10

e Roughly $1200 peradditional child life saved

Ipact f Ca Gp i maawi 2000-2004

0% 10% 20% 30% 40% 50% 60% 70% 80%

percent oF target population

PREgnAnT MoTHERS RECEIvIng

AT lEAST onE DoSE of IPT

CHIlDREn RECEIvIng MAlARIA THERAPy

wITHIn 24 HouRS of fEvER

CHIlDREn SlEEPIng unDER A

bEDnET (ITn) THE nIgHT PRIoR To SuRvEydelivery

indicator

31%

61%

35%

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9%

60%

BeFore

aFter


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Including the cost of transportation from

manufacturers to the villages and of follow up

by trained volunteers, the total price of getting

each net to the hut is under $10. Since the net

lasts five years and typically two children sleep

under it, the protection is about $1 per child per

year. Roughly every hundred nets in use will save

the life of one child a year and prevent many

dozens of debilitating occurrences of malaria.

Jerey Sachs,

writing about the Measles Initiative58

Piggyback on existing systems for deliveryof bednets

STrATEgy 3
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proBlem: Getting bednets to remote areas is difficult,

especially in areas where there are no functional health

systems or transportation networks.

solution: Integrate bednet distribution with mass vaccina-

tion campaigns

successFul model: In sub-Saharan Africa, mass

vaccination campaigns against polio, measles, and tetanus

reach over 90% of children in target populations. A cost-

effective way to distribute bednets is to integrate them into

these mass vaccination campaigns, taking advantage of theirexisting logistics. The model first integrates bednet distribu-

tion and malaria prevention education into existing vaccine

campaigns. It ensures that families install the bednets during

hang up campaigns, and makes sure that they continue to

use them through keep up campaigns run by community

volunteers.

exemplar agent implementing the model:

the measles initiative and the new expanded partner-

ship, the alliance For malaria prevention

The Measles Initiative is a partnership between the Red Cross,

the United Nations Foundation, UNICEF, the U.S. Centers for

Disease Control and Prevention, and the World Health Organi-

zation. Since 2001, it has supported the mass vaccination of

over 600 million children in more than 60 countries. After its

success in reaching more than 90% of the targeted age group

during each campaign, the Measles Initiative began integrat-

ing other lifesaving interventions, including insecticide-treated

bednets, into its campaigns. Children now receive a package

of interventions: measles vaccine, Vitamin A, a dose of de-

worming medication (Mebendazole), and, at minimum, one

free insecticide-treated bednet per household with children

under five. The integrated delivery strategy is not only able

to reach the poorest households, but is also able to keep

distribution costs low.60 In Ghana, for example, the marginaloperational cost per net delivered was only $0.32. The Initia-

tive now delivers bednets i n over 15 countries.

what diFFerence can the model achieve?

Based on data from Ghana, household ownership of bednets

increased from 4% to over 90% after the campaign. The per-

centage of children sleeping under the nets increased from

4% to approximately 60%.61

This graph underscores the importance of moving from

bednet ownership to sustained, proper use, as the current

gap represents a critical missed opportunity for prevention.

Community education programs (such as Care Groups, p. 22)

can help close this gap.

PromIsInG PrACTICe:

Itgat dt dititi with vacciati capaig

0% 20% 40% 60% 80% 100%

percent oF target population

HouSEHolD ownERSHIP

of bEDnETS

PERCEnTAgE of CHIlDREn

SlEEPIng unDER bEDnETS

Ipact f bdt Capaig i Ghaa

delivery

ind

icator

4%

90%

4%

60%

BeFore

aFter

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how much does this change cost? 100,000

bednets delivered through vaccine campaigns can save the

lives of roughly 1,000 children.62 With sustained and proper

use, these bednets can save two to three times this number.

Average costs are about $10 to $12 per long-lasting bednet

delivered. This includes a $5 to $7 unit cost per net, $3 for

delivery platform, logistics, and staff, and $2 for community

education.63

Here are sample cost-per-impact profiles for such programs in

two different African settings: Malawi ($580 to $870 per child

life saved) and Ghana ($1560 to $2350 per child life saved).

Assuming similar costs and coverage change achieved, the

main driver of the difference in the profil es is the addressable

burden from malaria at the outset of the project. Prevention

programs are most efficient when they target the individuals

most at risk (e.g., young children) and the communities with

the most malaria cases and deaths at baseline (e.g., Malawi).

Assumptions behind the estimates:

Use of long-lasting insecticide-treated bednet (LLITN);

one child sleeps under each net; nets last 3 years; 60%

of children actually sleep under the net (conservative

estimates)

Costs: $1 million dollar gift effectively covers the costs of

distributing 100,000 bednets

Impact is estimated only for decreased malaria death in

children < 5 years old

Range shown in impact estimates above reflects varying

protective ability of bednet from 50% to 75%

additional BeneFits: Bednets prevent sickness and

disability due to malaria in both children and adults. Cost-

impact estimates will improve markedly (and the number of

lives saved will increase) if two children sleep under each net,

and if nets are used properly for five to seven years. The num-

ber of lives saved could double or triple if there is consistent

and proper use of the bednets each night.

F , T M Iv b: .v./.

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CASE SNApSHOT

c Deliver insecticide-treated bednets to allhouseholds using integrated campaigns

i Decrease childhood death and illnessfrom malaria

c (g) Additional % population whoown bednets (+86%) and regularly use bednets (+56%)

p Average $10to $12 (cost of each long-lasting bednet delivered)

e $500 to $2500 peradditional child lif e saved (depending on the amount ofmalaria and the country demographics)
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Scale-up community and household access tonew ACTs (Artemisinin Combination Therapy)

STrATEgy 4
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Example o AC packaging with pictorial instructions. Image provided by PSI Malaria Department

PromIsInG PrACTICe:

ovc div ttck ad ica acc t af

ad ffctiv aaia tatt

proBlem description: Families most in need do not

have timely access to quality malaria medication that works

(i.e., artemisinin combination therapy (ACT)). Technological

issues, manufacturing supply, and financing are no longer the

primary constraints. From 2004 to 2006, annual production of

new combination ACTs increased from 4 million to 100 million

doses. Funding for malaria drugs from international sources

such as the Global Fund increased tenfold in the last decade.66

Instead, the primary challenge is now delivery. African coun-

tries need new investments to strengthen their capacity so that

they can get the available ACTs into communities.

key constraints: Lack of trained persons in malaria-

affected countries who can secure available funding and

unblock implementation bottlenecks; counterfeit and poor

quality drugs in the privat e sector; low literacy and knowledge

at the household level.

promising model: Use malaria control associates to roll

out ACTs to communities on a national scale. This model con-

sists of two parts. First, develop national-scale programs that

consider the entire value chain of ACT medication delivery,

from drug procurement and culturally appropriate packaging

to care-seeking and use by mothers in rural villages. Second,

train a cadre of young professionals malaria control associ-

ates in each target country. The malaria control associates

will work to ensure effective medication delivery by resolv-

ing implementation barriers as they come up at each step

in the process. Associates will be primarily from the malaria-endemic nations themselves, and will assume country-level

positions after training. The training includes time working wi th

experienced malaria staff and an 11-month, multi-country

apprenticeship in which the associates work on clearing the

bottlenecks that interfere with efforts to scale-up access to

new malaria medications.

h


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Build training networks to prevent malaria inpregnancy

STrATEgy 5
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Te rapid diagnostic test shown here allows both proessional and lay health

workers to diagnose malaria quickly, allowing the patient to be treated

eectively. Image provided by Western Pacic Regional Ofce, WHO.

Photo provided by David Robertson, Drive Against Malaria

Assist the most vulnerable in areas of conflict ornatural disaster

STrATEgy 6
http://www.msf.org/http://www.msf.org/http://www.msf.org/http://www.epicentre.msf.org/http://www.thementorinitiative.org/http://www.thementorinitiative.org/http://www.thementorinitiative.org/http://www.epicentre.msf.org/http://www.msf.org/http://www.msf.org/


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treat and

prevent now

malaria

control

innovate For

the Future

Build systems For

the

long term

buIlD sysTems For THe lonG Term

7. Strengthen health system capacity through effective par tnerships

8. Leverage existing financing resources for system-wide change

9. Create information networks to track outcomes, monitor resistance,

and predict epidemics

10. Prepare future health leaders from malaria-affected countries



43/92


I I I . BUIlD SySTEMS fOr THE lONg TErM

In the previous section, we discussed models that address the current

constraints to the immediate delivery of malaria tools. In this section, we look

at ways to bolster the critical supporting health system to enable sustainable,long-term impact.

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PromIsInG PrACTICe:

stgth atia adhip ad aagt capacit t apid

ca-p aaia itvti

In Zambia, the national government, together with the

malaria control and evaluation partnership

in aFrica (MACEPA, a program atpath), teamed up with

a range of stakeholders to address the system constraints

and hurdles to rolling out a comprehensive national malaria

control program. Their goal is to decrease malaria incidence

in Zambia by 75%.

Since 2006, Zambia has made substantial progress.

Highlights include:76

Distributing 5 million bednets

Implementing two state-of-the-art national malaria indicator

surveys to assess malaria burden and coverage (2006

and 2008)

Rolling out rapid diagnostic testing in all districts

Expanding and improving Zambias household spraying

program, reaching more than 500,000 homes in urban

and surrounding areas, and exceeding the goal of 85%

coverage

Providing any pregnant woman seeking prenatal care at apublic clinic with an insecticide-treated net for herself and

for any child under age five years li ving with her

This work is achieving impact. Zambias 2008 National

Malaria Indicator Survey has provided conclusive evidence

that the countrys efforts are directly improving the health of

the people. In just a few years, Zambia has raised the bar in

malaria control and made rapid progress:77

Since 2006, malaria parasite prevalence in children has

been reduced by 50%

Two-thirds of Zambian households are now covered with

at least one insecticide-treated net or a recent indoor

spraying

More than 80% of pregnant women received at least one

dose of preventive medicine, and more than 65% received

two or more doses

Through committed leadership, a strong united partnership,

and innovative approaches, Zambia is now a global leader in

managing malaria control based on sound data and program

accountability. Zambia is investing in approaches that will

predictably eliminate malaria deaths and economic burden.

Having developed the capacity to rapidly impact malaria,

Zambia is well-positioned to move to the next phase of malaria

control: eliminating the disease as a health and economic

impediment. Critical next steps involve sustaining and building

on these gains.

Now that this Gates Foundation-funded pilot of MACEPA has

shown demonstrated results in Zambia, it has set up a Learning

Community where other African governments can learn from

one another and share their successes and challenges.

Next steps include replicating this successful model in other

interested African nations such as Tanzania, Ethiopia,

Mozambique, and Malawi. Philanthropists could play a critical

role in funding these new partnerships or supporting the

Learning Community.

F b MACEPA , Bj C PAH (b@.) v

PAH b: ://../ .

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http://www.path.org/projects/malaria_control_partnership.phphttp://www.path.org/projects/malaria_control_partnership.phphttp://www.path.org/projects/malaria_control_partnership.phphttp://www.path.org/http://www.path.org/projects/malaria_control_partnership.phphttp://www.path.org/projects/malaria_control_partnership.phphttp://www.path.org/http://www.path.org/projects/malaria_control_partnership.phphttp://www.path.org/projects/malaria_control_partnership.php


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sis, and Malaria q v

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Leverage existing financing resources forsystem-wide change

STrATEgy 8
http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/


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PromIsInG PrACTICe:

Tappig it th Ga Fd patf f fiacig

The gloBal Fund to Fight aids, tuBerculosis,

and malaria(Global Fund) currently provides more than

65% of international malaria funding, and is the main source

of funding for malaria medications and control programs.

It has developed a performance-based, demand-led model in

which malaria-endemic countries develop a national malaria

strategy and submit applications to the Fund based on their

priorities and needs. However, the poorest and most needy

countries often lack the technical capacity to put together

competitive applications.

Private dollars can make a critical difference. For example,in the case of Equatorial Guinea, a private donation of $1

million dollars towards technical assistance led to the design and

development of a national strategy. This strategy formed the

basis for a successful application to the Global Fund for $26

million dollars to finance the national malaria program in

the country.78

Four ways to use the scale and eFFiciency oF

the gloBal Funds Financing mechanism

1. Give to the Global Fund directly (see right for

considerations)

2. Support on the ground organizations that can increasethe capacity for successfully obtaining and imple-

menting malaria control programs with Global Fund

dollars. These NGOs work t hrough the Country Coor-

dinating Mechanisms (CCMs) which bring all relevant

stakeholders together in each country. The contacts

and membership for CCMs in all Global Fund grant

countries are available in the country section of the

Global Fund website: www.theglobalfund.org/pro-

grams/search.aspx?lang=en&component=Malaria

3. Support Friends of the Global Fund, which advocates

and supports the mission of the Global Fund (see www.

theglobalfight.org for U.S. Friends organizat ion)

4. Support activities to build capacities and pri-

vate sector partnerships inside the malaria-

affected country through organizations such

as the gloBal Business coalition on

hiv/aids, tuBerculosis and malaria

(www.gbcimpact.org/)

considerations For philanthropists

Supporting Global Fund activities directly or indirectly has the

following advantages for individual philanthropists:

Efficiency Leverages the Global Funds performance-

based, demand-led model, as well as its rigorous account-

ability/evaluation frameworks

Transparency Information about every Global Fund grant

disbursement is publicly available on their website

Ensures that supported programs are embedded in national

responses to the diseases Has the advantage of providing support from within a large

pool of funds:

Administrative costs are met by interest income on

overall funding, allowing 100% of gifts to go directly

to grants

Provides sustainability for grants

Provides potential exit strategy, if needed, for private

donors

The primary tradeoff for individual donors directly support-

ing the Global Fund has been the loss of the ability to main-tain contact with programs and recipient communities on the

ground. Also, given the very large government donations to

the Fund, individuals may not want their dollars to go into a

big pot where they might lose control of where money is

invested and may be uncertain if their dollars have the most

incremental impact in relation to the size of the donation.

In response to the unique needs of individual donors, the

Global Fund has recently developed a new program for gifts

of $1 million and over. When there is reciprocal agreement

by recipient nations, this program can earmark such dona-

tions to particular country grants, creating a direct association

with particular activities, and giving private donors the abilityto follow the results. In addition, private donors can actively

participate in the governance of the Global Fund through

private sector or foundation constituencies, each of which

controls a seat on the Global Fund board.

F b , Gb F bwww.theglobalund.org/en/ Dv Ev, M,

Pv S R Mbz [email protected], b (Gv) +41 91 1.

h
http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/programs/search/index.aspx?lang=en&component=Malariahttp://www.theglobalfund.org/programs/search/index.aspx?lang=en&component=Malariahttp://www.theglobalfight.org/http://www.theglobalfight.org/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfight.org/http://www.theglobalfight.org/http://www.theglobalfund.org/programs/search/index.aspx?lang=en&component=Malariahttp://www.theglobalfund.org/programs/search/index.aspx?lang=en&component=Malariahttp://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/http://www.theglobalfund.org/EN/


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Multi-drug resistantP. falciparum, which includes decreased

sensitivity and possible resistance to artemisinin, has been

recently found in Cambodia bordering Thailand.79

Create an information network to trackoutcomes, monitor drug resistance, andpredict epidemics

STrATEgy 9


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PromIsInG PrACTICe:

Cat/xpad a wd atiaaia itac ifati twk

proBlem: One major reason behind the failure of previous

international campaigns to eradicate malaria in the 20th

century was the emergence of drug-resistant malaria and

insecticide-resistant mosquitoes. These same problems now

threaten the large investment that the global community is

making to roll-out effective new drug combinations to replace

these failed drugs.

solution: By creating an antimalarial resistance information

network, the global effort to control malaria will have a public

resource to guide antimalarial drug treatment and prevention

policies and to confirm and characterize the emergence of

new resistance to antimalarial drugs. In this way, it will be able

to contain the spread of resistance.

program model: The antimalarial resistance informa-

tion network should consist of open-access global databases

containing clinical, in vitro, molecular, and pharmacological

data, and networks of reference laboratories that will support

these databases and related surveillance activities.81

exemplar agent: There is currently an effort underway

to develop such a network. The worldwide antima-

larial resistance network (wwarn) is an inter-

national group of scientists conducting research in the field

of antimalarial drug resistance. WWARN will develop open,

web-based tools to provide malaria control managers, surveil-

lance programs, and policymakers with up-to-date evidence of

temporal and geographic trends in antimalarial drug resistance

at the global scale and in real time. Their goal is to get the

right drugs, to the right people, at the right time.

F , WWARN b: ..//.

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http://www.wwarn.org/home/http://www.wwarn.org/home/http://www.wwarn.org/home/http://www.wwarn.org/home/


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Prepare future health leaders from malaria-affected countries

STrATEgy 1 0
http://www.accordiafoundation.org/programs/infectious-diseases-institute/index.htmlhttp://www.accordiafoundation.org/programs/infectious-diseases-institute/index.htmlhttp://www.fic.nih.gov/http://www.fic.nih.gov/http://obtoure.africa-web.org/http://obtoure.africa-web.org/http://www.fic.nih.gov/http://www.accordiafoundation.org/programs/infectious-diseases-institute/index.html


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o Public Health at BRAC University, Dk,

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BRAC, v v

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b .

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Network 1 A . I

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b v

v. T -

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exap f sccf Taiig Iitiativ

Inectious Diseases Institute, Uganda T

b/ . P v A

v v .

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(.., , v, b ),

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http://www.accordiaoundation.org/aa/JointUgandaMalariarainingProgram.html

E-: [email protected]

Fogarty International Center: Global Inectious Disease raining Program T

b U.S. v

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k v .

http://www.c.nih.gov/programs/training_grants/index.htm

C: D. Bb S, P D

: (01) 40-94

John P. Grant School o Public Health at BRAC University I I

C D D R, B. T b

- MPH -

.

http://www.bracuniversity.ac.bd/I&S/sph/index.htm

E-: [email protected] ( )

Malaria Research and raining Centre (MRC)University o Bamako, Mali C

D E P D Uv M (

Uv Bk), MRC vv v

v

b M, , A.

http://obtoure.arica-web.org/
http://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://actmalaria.net/home/http://actmalaria.net/home/http://actmalaria.net/home/http://actmalaria.net/home/http://www.accordiafoundation.org/programs/infectious-diseases-institute/training/index.htmlhttp://www.fic.nih.gov/programs/training_grants/gid.htmhttp://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://obtoure.africa-web.org/http://actmalaria.net/home/http://actmalaria.net/home/http://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://www.bracuniversity.ac.bd/I&S/sph/index.htmhttp://obtoure.africa-web.org/http://www.fic.nih.gov/programs/training_grants/gid.htmhttp://www.accordiafoundation.org/programs/infectious-diseases-institute/training/index.html


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InnoVATe For THe FuTure

11. Support innovation for new tools

12. Innovate by harnessing the potential of the private sector or applying

new technology


treat and

prevent now

malaria

control

innovate For

the Future

Build systems For

the

long term


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Most experts agree that in high transmission areas,

f b .83

Iv . INNOvATE fOr THE fU TUrE

In this section, we highlight key areas where capital is needed for the discovery

of new tools and improved delivery methods.

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54/92


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Support innovation for new toolsSTrATEgy 11


55/92


Focus organization current projects

v

m v i(..)

A global program working to accelerate

the development of safe, effective, and

affordable malaria vaccines

The Malaria Vaccine Initiatives portfolioincludes three vaccine candidates currently

in clinica l development. Worldwide, there

are currently over 20 vaccine candidates in

different stages of bench or clinica l testing.

d

t F f i

n d

(.f.)

A partnership between academic, public,

and private entities that is dedicated to

the development of rapid, accurate, and

affordable diagnostic tests

The Foundation for Innovative

New Diagnostics currently researches

and improves available diagnostic tests

to ensure their accuracy in the field.

n m

m f m v

(..)

A nonprofit organization that was

created to discover, develop, and deliver

effective and affordable antimalarials

through public-private partnerships

The organizations portfolio contains

over 30 projects, and has the largest and

most diverse portfolio of antimalarial drug

projects in history.

i f ow h

(../)

The first nonprofit pharmaceutical company

in the U.S., OneWorld Health is dedicatedto developing affordable medications for

neglected diseases

The supply of natural ACT is limited, as it

comes from the wormwood plant, which

requires time to grow and harvest. OneWorld

Healths Artemisinin Project is working to

produce a semi-synthetic ACT so that a con-

stant and affordable source of ACT will be

available to communities who need it most.

mq c

i v c c

(.. )

A major research consortium that is

developing new and better ways to

control the transmission of insect-borne

disease; five leading research institutions

are members of the part nership.

IVCC works to develop improved

insecticides. It is also creating information

systems to track resistance and vector sit es,

allowing malaria control groups to make

better decisions about the best times to

re-treat homes/bednets with insecticides.

Fdig pptiti i ivativ ach


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57/92


58/92


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Use the reach and assets o the business sector to strengthen malaria control

Te Corporate Alliance on Malaria in Arica (CAMA) v Gb

B C HIV/AIDS, b, M. CAMA j v

b v

-, b , v v

v z. I -k b k

.www.gbcimpact.org/cama

Invest in local companies producing malaria control commodities

Acumen Fund: A b v

v v q. M v

b AC. www.acumenund.org

Support ranchise medicine shops

Child and Family Wellness (CFW) Shops. I K R, HS

F -- b CFW. S q . T

b v b

v v. T v

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www.cwshops.org

Innovate by harnessing the potential of theprivate sector or applying new technology

STrATEgy 1 2
http://www.gbcimpact.org/about-gbc/camahttp://www.gbcimpact.org/about-gbc/camahttp://www.gbcimpact.org/about-gbc/cama


59/92


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lifting the burden of malaria: an investment guide for impact-driven philanthropy

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