MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

Financial Feasibility
The optimal method of determining the economic attractiveness
of an elimination program would be a cost-benefit analysis–i.e.,
do the direct (e.g., lower morbidity and higher productivity) and
indirect (e.g., potential higher tourism) benefits of achieving
and sustaining elimination outweigh the costs of the program?
This type of analysis is highly complex and was not possible in
this assessment. Instead, the analysis presented here is purely
financial, estimating whether elimination will save the MOHSW
money in the medium-term by reducing annual spending below
sustained control. As such, this analysis should be interpreted
and used appropriately–the MOHSW may decide that the
possible benefits, including the national pride of being malaria
free, justify an elimination program even if it is not cost-saving.
The core results of the financial analysis include:
�� Elimination will not be cost-saving in the medium-term (25
years) under any of the scenarios analyzed.
�� If vector control is entirely withdrawn, which is only possible
following a dramatic reduction of importation risk, annual
elimination spending will eventually fall below sustained
control. However, it is unlikely that the necessary reductions
in importation risk will be achieved through improved
control on the mainland alone; screening of travelers may
also be required. Depending on the extent and cost of that
border screening, maintaining elimination will cost between
4% more and 18% less than sustained control annually.
�� Even if the least expensive elimination scenario is reached (i.e.,
no vector control or border screening) elimination will not
generate cost savings on a cumulative basis until after 2050.
�� Increased spending on surveillance and diagnosis is the
primary driver of the higher cost of elimination, with these
categories combined comprising between 35-65% of average
annual costs of the elimination scenarios compared to just
15% of sustained control costs.
�� The period of achieving elimination will be 60-89%
more expensive than sustained control. Compared to
that elimination phase, the ongoing cost of preventing
reintroduction will then range from 5% higher (the most
feasible and likely scenario) to 30% lower (the best possible
scenario).
�� The average annual per capita cost of elimination over the
25-year period will be $2.97 under the most likely elimination
scenario. The equivalent per capita cost for sustained control
over that period is estimated to be $1.88.
�� Regardless of whether or not the Zanzibar MOHSW decides
to pursue malaria elimination or sustained control, consistent
financing for the malaria program will need to be secured to
avoid resurgence of malaria. This will require a significant
change in the approach to malaria funding for Zanzibar to
enable long-term financial commitments not tied to the
burden of disease.
�� To address the challenge of unpredictable funding flows,
we recommend that the Government of Zanzibar develop
appropriate solutions through:
! Engaging in active discussions with its principal health
and malaria donors to agree on the financial needs to
achieve its malaria goals in the medium-term and explore
approaches to ensure predictable financing.
! Commissioning a detailed assessment of the potential
use of innovative financing mechanisms, including an
earmarked tax and/or endowment fund, to increase the
predictability of malaria financing.
! Developing and securing broad governmental buy-in for
a plan to reduce reliance on donors resources for malaria
control, including through gradual increases in domestic
budget allocations.
Exploring potential contributions from countries such as Oman
that have a self-interest in continued low malaria transmission
on Zanzibar.
ANNUAL DIFFERENCE BETWEEN SUSTAINED CONTROL AND
ELIMINATION COSTS
100%
80%
60%
40%
20%
0%
-20%
-40%
Executive Summary
2011 2013 2015 2017 2019 2021 2023 2025 2027 2029 2031 2033
SCENARIO 1: NETS > 75% EFFECTIVE COVERAGE, IMPORTATION RISK REDUCES
FROM 2 TO 1/1000 INHABITANTS PER YEAR
SCENARIO 2A: NO NETS AFTER 2030, IMPORTATION RISK REDUCES FROM 2 TO
0.4/1000 INHABITANTS PER YEAR (INCLUDES BORDER SCREENING)
SCENARIO 2B: WITHOUT BORDER SCREENING
SUSTAINED CONTROL
YEAR
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