Determinants of malaria program expenditures during elimination: case study evidence from select provinces in the Philippines

PLoS One. 2013 Sep 27;8(9):e73352. doi: 10.1371/journal.pone.0073352. eCollection 2013.

Abstract

...Even though eliminating malaria from the endemic margins is a part of the Global Malaria Action Plan, little guidance exists on what resources are needed to transition from controlling malaria to eliminating it. Using Philippines as an example, this study aimed to (1) estimate the financial resources used by sub-national malaria programs in different phases during elimination and (2) understand how different environmental and organizational factors may influence expenditure levels and spending proportions. The Philippines provides an opportunity to study variations in sub-national programs because its epidemiological and ecological diversity, devolved health system, and progressive elimination strategy all allow greater flexibility for lower-level governments to direct activities, but also create challenges for coordination and resource mobilization. Through key informant interviews and archival record retrieval in four selected provinces chosen based on eco-epidemiological variation, expenditures associated with provincial malaria programs were collected for selected years (mid-1990s to 2010). Results show that expenditures per person at risk per year decrease as programs progress from a state of controlled low-endemic malaria to elimination to prevention of reintroduction regardless of whether elimination was deliberately planned. However, wide variation across provinces were found: expenditures were generally higher if mainly financed with donor grants, but were moderated by the level of economic development, the level of malaria transmission and receptivity, and the capacity of program staff. Across all provinces, strong leadership appears to be a necessary condition for maintaining progress and is vital in controlling outbreaks. While sampled provinces and years may not be representative of other sub-national malaria programs, these findings suggest that the marginal yearly cost declines with each phase during elimination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Costs and Cost Analysis*
  • Humans
  • Malaria / epidemiology
  • Malaria / prevention & control*
  • Philippines / epidemiology

Grants and funding

This study was supported by grants from the Bill and Melinda Gates Foundation, the World Health Organization Philippines Country Office, and the Asia Pacific Malaria Elimination Network through a grant from the Australian Agency for International Development (AusAID). Technical assistance and in-kind contributions were provided by the Philippines Department of Health. Lasse S. Vestergaard is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization. Mario Bauquilod and Christine J. Candari are staff members of the Philippines Department of Health. Their views expressed in this publication do not necessarily represent the views of the Government of the Philippines. No individuals from the Bill and Melinda Gates Foundation and the Asia Pacific Malaria Elimination Network had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.