MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

portion of those costs). Before this target is reached, investment
income should only be used to fund the ZMCP if it is absolutely
necessary and funds cannot be secured elsewhere. Once this
target is reached, annual returns can be used to fund revolving
ZMCP costs. In years when investment income exceeds these
costs, it can be reinvested in the endowment. This will allow for
a cushion above the endowment target level that can be drawn
down in years in which investment income is too low to cover
costs. The treaty should allow for the endowment to be drawn
down only in the case that other funds, including investment
income from the fund, are not sufficient to cover core operating
costs of the program.
Emergency Debit Fund
Although some donors may be unwilling to fund ZMCP’s
recurring costs when incidence is so low and their attention has
shifted to other priorities, they may be more likely to contribute
to the costs of controlling a malaria outbreak. A financing
option that could interest donors is an “emergency debit fund,”
similar to a bank account, that can be drawn on by the Zanzibar
government to prevent or control outbreaks. The fund would be
donor-managed and, as with a bank account, a certain portion
of the fund could be lent out or used for other purposes by the
donors. The Zanzibar government would be permitted to draw
on this account under certain conditions, such as demonstrated
good management of other government funds and a clear, acute
need for emergency funding to prevent or control malaria
resurgence.
Even though all of the funds would not be kept in reserve at
all times, donors would guarantee a certain level of funding
that Zanzibar could draw on. Ideally, multiple donors provide
this debit account guarantee so that if one donor cannot meet
its commitments, others can supplement. To discourage this
scenario, poorly performing donors could be required to deposit
a larger share of their commitment to the fund or pay a higher
portion of administrative costs (Lane and Glassman, 2008).
The primary benefit of a financing mechanism such as this
for Zanzibar is that it provides a guaranteed source of funding
for outbreak response expenses. This will only be effective
at preventing resurgence, however, if Zanzibar maintains a
well-functioning surveillance system. This will be particularly
challenging if financing for recurring ZMCP expenses is not
secured. A risk with this type of financing mechanism is that it
could cause the Zanzibar government or foreign donors to place
less priority on funding ZMCP’s revolving preventive activities,
since there is financial security in case of an emergency. A
possibility for discouraging this would be to make disbursement
from the emergency fund conditional on a demonstrated effort
toward prevention, though this may be difficult to operationalize.
For these reasons, this option for innovative financing is least
appealing and viable. However, if other sources of financing can
be secured, an emergency fund such as this could be a valuable
additional security against malaria resurgence in Zanzibar.
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Regional Funding Pool
The Zanzibar population would not be the only beneficiary
of a sustained control or elimination program in Zanzibar. As
tourists and migrant workers can carry malaria back and forth
across borders, other populations are vulnerable to the level of
malaria in Zanzibar and can directly benefit from its reduction
or elimination. For example, many tourists and migrant
workers travel between Zanzibar and Oman, a country that
has eliminated malaria. When malaria is present in Zanzibar,
the Oman government must spend time and money screening
tourists returning from Zanzibar. These same arguments apply
to other countries trying to control malaria that have frequent
population movement back and forth to Zanzibar.
The fact that governments in Oman and other countries
experience a direct benefit from malaria elimination in
Zanzibar suggests that they might be willing to invest in its
cost. A regional funding pool could be set up with contributions
from governments who have a particular interest (financial or
otherwise) in malaria control/elimination in Zanzibar. Funds
from these regional partners could either be donated annually
to cover revolving ZMCP costs, or could be used toward the
endowment fund or emergency debit fund discussed above.
These regional partners are connected by their joint interests in
coordinated malaria control or elimination. Zanzibar experiences
a direct benefit from its partners eliminating malaria as well. For
example, were mainland Tanzania to embark on elimination,
the costs of malaria control and surveillance in Zanzibar would
go down significantly. It is thus sensible to set up a regional
partnership in which partners contribute to a fund for Zanzibar’s
malaria elimination while Zanzibar promises to commit funds to
other partners who embark on elimination in the future.
CONCLUSION
The challenges that Zanzibar will face maintaining steady financing
for its malaria program—regardless of whether the ZMCP
embarks on elimination or continues with sustained control—
are significant and should be addressed imminently, alongside
deliberations about whether elimination should be pursued. The
global health community is becoming increasingly conscious of
the negative impact that aid volatility and unpredictability have
on health programs and innovative financial mechanisms are
being proposed. Zanzibar can make the strong case to donors
that even modest setbacks in malaria funding can have serious
morbidity and mortality consequences. But the MOH will have
to work closely and creatively with donors and advisors to come
up with financing solutions that meet the needs of Zanzibar’s
malaria program.
The recommended next steps to address this significant
challenge include:
1. Begin 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.