MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

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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. 78 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.
2. Commission 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. 3. Develop and secure broad governmental buy-in for a plan to reduce reliance on donor resources for malaria control, including through gradual increases in domestic budget allocations. 4. Explore potential contributions from countries such as Oman that have a self-interest in continued low malaria transmission on Zanzibar. 3 | Financial Feasibility 79
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PHOTO: © SASJA VAN VECHGEL MALARIA
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ACKNOWLEDGEMENTS The feasibility as
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EXECUTIVE SUMMARY Over the past sev
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Financial Feasibility The optimal m
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INTRODUCTION BACKGROUND In October
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FIGURE 2.1: AVERAGE MONTHLY RAINFAL
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CHAPTER 1: TECHNICAL FEASIBILITY IN
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to below 1% with IRS (Bhattarai et
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DEFINING IMPORTATION RISK As illust
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those regions from where the greate
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PROBABILITY OF ACQUIRING INFECTION
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NUMBER OF INFECTED INDIVIDUALS achi
Page 29 and 30: PERCENTAGE OF INDIVIDUALS INFECTED
Page 31 and 32: the same time, it is expected that
Page 33 and 34: test, about 80% of infections could
Page 35 and 36: CHAPTER 2: OPERATIONAL FEASIBILITY
Page 37 and 38: DATA COLLECTION METHODS A robust su
Page 39 and 40: most secondary cases but would occa
Page 41 and 42: TABLE 5: RAPID RESPONSE ACTION FOR
Page 43 and 44: up. It will also allow for the iden
Page 45 and 46: TABLE 7: PRE-ELIMINATION AND ELIMIN
Page 47 and 48: essential components of an eliminat
Page 49 and 50: THE ZANZIBAR HEALTH CARE SYSTEM THE
Page 51 and 52: community needs to be aware that fe
Page 53 and 54: conditions. Health worker motivatio
Page 55 and 56: A key challenge will be that as an
Page 57 and 58: The ZMCP is relatively well staffed
Page 59 and 60: elaborate entomological surveillanc
Page 61 and 62: COMMUNITY INVOLVEMENT ON ZANZIBAR Z
Page 63 and 64: �� Communities should, as far a
Page 65 and 66: preventive measures, mainly related
Page 67: CONCLUSIONS This chapter considers
Page 70 and 71: elimination will raise two major fi
Page 72 and 73: INDOOR RESIDUAL SPRAYING As noted a
Page 74 and 75: analysis be conducted. Moreover, gi
Page 76 and 77: FIGURE 30: AVERAGE COST PER YEAR FO
Page 78 and 79: which are being explored by the glo
Page 83 and 84: REFERENCES Afridi MK (2009). Use of
Page 85 and 86: Jacobs, Lesley A (9/2007). Rights a
Page 87 and 88: Sandberg, Ingstad K, Bjune G (2007)
Page 89: World Health Organization, Global M
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MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

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