Mobilizing resources with an investment case to mitigate cross-border malaria transmission and achieve malaria elimination in South Africa

Figures & data

Figure 1. South African malaria risk map 2018 [7].

Table 1. The five-step resource mobilisation strategy is outlined in Table 1.

Step in Resource Mobilization Strategy	Methods	Outcomes
1. Identify the problem February 2018–May 2018	Key informant interviews were conducted with national and provincial malaria officials to collect information on the current malaria response, financing trends, and the challenges to achieving national malaria elimination and mobilising resources towards the response.	The key informant interviews provided insight into how to address the challenges to fund malaria elimination in SA and the possible avenues to advocate for funding. This information served as the foundation of the resource mobilisation strategy. These meetings facilitated collaboration among government stakeholders on the malaria elimination goal.
2. Identify key stakeholders March 2018–June 2018	The IC Technical Task Team (TTT) was formed at the beginning of the IC study comprising members from NDOH, research institutions, and partner organizations. The full list of TTT members is in the Appendix.	The TTT informed the development of the strategy (e.g. budget request and financing mechanisms), offering advice on interventions to include in the IC study and to fund to achieve the elimination goal.
3. Generate economic evidence through the IC study February 2018–August 2018	Using a malaria transmission model, a cost–benefit analysis of malaria elimination was conducted through simulating three scenarios to achieve malaria elimination.	Findings predicted that national malaria elimination is achievable by 2026 and is good value for money, with a national return on investment (ROI) of US$4.2 realised in SA plus an additional ROI of US$3.01 realised in southern Mozambique.
4. Submit a budget request informed by the IC findings August 2018	The NDOH, with technical support from the TTT, presented a malaria budget request to the South African National Treasury [8].	NDOH successfully mobilised approximately US$ 21M for the three-year 2019 Medium Term Expenditure Framework (MTEF) period, which equated to a 36% increase from the 2018/19 malaria budget. This is recurring funding that is renewed annually.
5. Mobilise additional malaria financing and create new financing mechanisms August 2018−April 2019	The TTT engaged with multiple stakeholders to determine the most suitable financing mechanisms.	The South African government provided approximately US$ 4.1M for malaria control efforts in southern Mozambique.

Table 2. Malaria conditional grant performance indicators.

Conditions

The following priority areas must be supported through the grant: Malaria surveillance, prevention, treatment Mobile active testing units Testing and treating through active testing in the community Malaria vector control Indoor residual spraying Integrated vector management activities Programme management strengthening for malaria elimination Hiring of staff for approved malaria posts

Performance Indicators

Number of malaria-endemic municipalities with >95% indoor residual spray (IRS) coverage Percentage confirmed cases notified within 24 h of diagnosis Percentage of confirmed cases investigated and classified within 72 h Percentage of identified health facilities with recommended treatment in stock Percentage of identified health workers trained on malaria elimination Percentage of population reached through malaria information education and communication (IEC) on malaria prevention and early health-seeking behaviour interventions Percentage of vacant funded malaria positions filled Number of malaria camps refurbished and/or constructed

Box 1. Summary of main lessons learnt.

Government officials that make long-term health financing decisions found the combined epidemiological and economic methods to analyse the costs and benefits of malaria elimination to be innovative and useful. A clearly documented budget request for malaria elimination was an effective tool to present the challenges to malaria elimination, a plan of action, funding requirements, and to propose financing options. The most challenging aspect was to finalise the budget request for malaria elimination within the deadlines of the South African Budget Process. It required close collaboration with the Department of Health and National Treasury to align on objectives and to collate the IC findings alongside inputs from multiple stakeholders. It was critical to continually engage national and provincial government officials during the budget process to provide information/data and respond to queries. Presenting at budget meetings where all key stakeholders were present proved to be the most effective mode of communication.

National Department of Health. National Malaria Control Programme - malaria epidemiology and situation analysis. In: Department of Health, editor. Cape Town,South Africa: Government of South Africa; 2018.

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Njau J, Silal SP, Kollipara A, Fox K, Balawanth R, Yuen A, et al. Investment case for malaria elimination in South Africa: a financing model for resource mobilization to accelerate regional malaria elimination. Malaria J. 2021;20:1–16.

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