Estimated Global Resources Needed to Attain International Malaria Control goals/Estimation Des Ressources Necessaires Au Niveau Mondial Pour Atteindre Les Objectifs Internationaux En Matiere De Lutte Contre le paludisme/Estimacion De Los Recursos Mundiales Necesarios Para Alcanzar Los Objetivos Internacionales De la Lucha Antimalarica

Introduction Globally, there are more than a million malaria-related deaths each year. About four-fifths of these are in Africa. (1) Effective interventions that reduce death and illness from malaria are still not widely accessible in most malaria-endemic countries. The World Health Assembly in 2005 urged Member States to establish policies and operational plans to ensure that at least 80% of those at risk of, or suffering from, malaria benefit by 2010 from major preventive and curative interventions, so as to ensure a reduction in the burden of malaria of at least 50% by 2010 and 75% by 2015. (2) These targets are echoed in the Roll Back Malaria Partnership Global Strategic Plan 2005-2015. (3) The United Nations Millennium Declaration set a target to halt and begin to reverse the global incidence of malaria by 2015. (4) Achieving these targets will require additional financial resources. Comparison of estimated costs with present investments should help accelerate mobilization of funds and identify important country-level gaps. This paper presents the methods used to construct a model for estimating the total financial costs of scaling up malaria control over 2006-2015 to achieve internationally agreed objectives and targets for the 81 most heavily affected malaria-endemic countries of the world's 107 malaria-endemic countries and territories. Pessimistic and optimistic scenarios with different assumptions about the effect of interventions on the needs for diagnosis and treatment provide upper and lower bounds of the estimation. The exercise includes a set of widely recommended interventions. Besides commodities and distribution costs, we included costs for necessary health system strengthening activities (programme costs in Figures 1-4), especially for community health workers, training, communication, operational research and monitoring and evaluation. We did not include costs for running health facilities since the bulk of interventions will be delivered at the peripheral level, and effective prevention and treatment of malaria should reduce the number of severe malaria cases requiring hospitalization. While we included the costs of technical assistance for national programmes, we did not consider those required at international level for managing such assistance, monitoring and evaluation, and research and development. The analysis estimates the total cost of scaling up malaria control in each country, including the costs of existing levels of interventions. The needs calculated are then compared to current health expenditures and funding for malaria control by country. Methods A detailed description, including assumptions and calculations, is available in the working paper Methodology for estimating the costs of global malaria control (2006-15), at http://www.who. int/malaria/costing. To arrive at the cost estimates, we selected countries for the analysis, estimated the population in need of each intervention, prepared scale-up scenarios, and calculated country-specific costs. All costs are calculated in 2006 US$. Countries The 81 countries included (listed in Table 3, available at: http://www.who. int/bulletin) are those which have significant populations at risk of Plasmodium falciparum malaria. The remaining malaria-endemic countries in the world are mainly affected by vivax malaria. The malaria risk there is highly variable, making the estimation of needs for prevention difficult. The inclusion of these countries could skew the estimates towards addressing problems which are not central to achieving the Millennium Development Goals. While the importance of vivax malaria should not be underestimated and its control may be challenging, these countries, with few exceptions, do not need external financial support for malaria control. Based on these criteria, all endemic countries in Africa south of the Sahara (but no country in North Africa) have been included. …