Searching for Sustainable Malaria Financing
By Theresa Ndavi
In Kenya, communicable diseases such as HIV, tuberculosis (TB), and malaria, continue to contribute significantly to the high burden of disease. Malaria is a leading cause of illness and death with an estimated 3.5 million new clinical cases diagnosed each year and 10,700 deaths (CDC). Data from the Kenya Health Information System shows that in 2023, 16 percent of patients seeking outpatient services were suffering from malaria. About 70 percent of the country’s population is at risk of infection, including millions who live in endemic zones like the lake and coastal regions and areas affected by seasonal transmission. Young children and pregnant mothers are especially at risk of severe illness from malaria.
The evolution of the malaria-carrying mosquito species makes it especially difficult to eradicate the disease. For instance, the country is now battling a new variant, Anopheles stefensi, which is becoming a major source of illness in Garissa and Turkana counties.
“To achieve equity in the face of declining external funding, Kenya needs more local investments in health and efficient use of existing resources.”
Malaria’s Impact on Poverty
A case of malaria can negatively impact a household’s finances and exacerbates poverty. As Kenya seeks to achieve universal health coverage through ensuring equitable access to quality healthcare by removing financial barriers, it is imperative for the country to increase efforts in domestic resource mobilization. These efforts should be led by both national and county governments who would mobilize enough local resources for impactful malaria interventions.
According to the most recent Kenya National Health Accounts report, in the 2018/2019 fiscal year, approximately 7 percent of total health expenditure was spent on malaria, which translates to KES 32.3 billion (US$319.7 million). While the Government of Kenya and partners have made significant investments to the prevention, control, and treatment of malaria over the years, there are gaps that remain and need to be addressed. For instance, households contributed over one-third (36 percent) of total health expenditure in the 2018/2019 fiscal year, a significant sum often spent through direct (out-of-pocket) payments for malaria services. External support from donors, in particular the U.S. President’s Malaria Initiative (PMI) and the Global Fund, contributed 14 percent of all the funds spent on malaria in Kenya in the same year. The government is commended for continually increasing its on-budget allocation to malaria activities, but more needs to be done to reduce the financial burden on families, harness the potential of increased funding from the private sector, and plug in any gaps that may arise from declining donor support, which currently provides the majority of the country’s life-saving key commodities.
Reliance on external support leaves the beneficiaries of malaria interventions vulnerable should funding decline. At the same time, when families spend their minimal resources on malaria services, they divert funds from other critical areas, including savings for economic advancement. It therefore remains essential for the government to mobilize adequate domestic resources for malaria activities.
A recent Ministry of Health analysis, supported by PROPEL Health, showed that if we rapidly scale up the coverage of certain interventions (diagnosis and treatment; distribution and use of insecticide-treated bed nets; social and behavior change campaigns; and indoor residual spraying), malaria cases would significantly decline over time. The analysis also noted that every Kenyan shilling invested in key interventions will result in a return on investment of KES 5.26 in the long run.
To achieve this would require an injection of more domestic funds through increased on-budget allocation by national and county governments to levels adequate to meet targets. Another opportunity is to introduce mandatory prepayment schemes that cover malaria to replace out-of-pocket expenditure. Additionally, private health insurance could be linked to the mandatory national insurance schemes. Kenya continues to look at strategic opportunities to deploy sustainable and high-impact interventions while ensuring there is value for money in them. Investing locally in malaria solutions will benefit the health of the population in the long-run and is a more sustainable solution.
Theresa Ndavi is a technical advisor for health financing with the PROPEL Health project in Kenya.
