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