Vertical and horizontal equity of funding for malaria control: a global multisource funding analysis for 2006-2010
Background International and domestic funding for malaria is critically important to achieve the Sustainable Development Goals. Its equitable distribution is key in ensuring that the available, scarce, resources are deployed efficiently for improved progress and a sustained response that enable...
| Main Authors: | , , , |
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| Format: | Others |
| Language: | en |
| Published: |
BMJ Publishing Group Ltd.
2017
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| Online Access: | http://epub.wu.ac.at/5961/1/e000496.full.pdf http://dx.doi.org/10.1136/bmjgh-2017-000496 |
| Summary: | Background International and domestic funding for
malaria is critically important to achieve the Sustainable
Development Goals. Its equitable distribution is key in
ensuring that the available, scarce, resources are deployed
efficiently for improved progress and a sustained response
that enables eradication.
Methods We used concentration curves and
concentration indices to assess inequalities in malaria
funding by different donors across countries, measuring
both horizontal and vertical equity. Horizontal equity
assesses whether funding is distributed in proportion to
health needs, whereas vertical equity examines whether
unequal economic needs are addressed by appropriately
unequal funding. We computed the Health Inequity Index
and the Kakwani Index to assess the former and the latter,
respectively. We used data from the World Bank, Global
Fund, Unicef, President's Malaria Initiative and the Malaria
Atlas Project to assess the distribution of funding against
need for 94 countries. National gross domestic product
per capita was used as a proxy for economic need and
"population-at-risk" for health need.
Findings The level and direction of inequity varies across
funding sources. Unicef and the President's Malaria Initiative
were the most horizontally inequitable (pro-poor). Inequity
as shown by the Health Inequity Index for Unicef decreased
from -0.40 (P<0.05) in 2006 to -0.25 (P<0.10) in 2008, and
increased again to -0.58 (P<0.01) in 2009. For President's
Malaria Initiative, it increased from -0.19 (P>0.10) in 2006
to -0.38 (P<0.05) in 2008, and decreased to -0.36 (P<0.10)
in 2010. Domestic funding was inequitable (pro-rich) with
inequity increasing from 0.28 (P<0.01) in 2006 to 0.39
(P<0.01) in 2009, and then decreasing to 0.22 (P<0.10) in
2010. Funding from the World Bank and the Global Fund
was distributed proportionally according to need. In terms of
vertical inequity, all sources were progressive: Unicef and the
President's Malaria Initiative were the most progressive with
the Kakwani Indices ranging from -0.97 (P<0.01) to -1.29
(P<0.01), and -0.90 (P<0.01) to -1.10 (P<0.01), respectively.
Conclusion Our results suggest that external funding of
malaria treatment tends to be allocated to countries with
higher health and economic need but not in proportion
to their relative health need and income when compared
to other countries. While malaria eradication might
require funders to disproportionally allocate funding that
goes beyond (financial and health) need, our analysis
highlights that funders might potentially be targeting in
excess certain countries. Regular assessments of need
and greater coordination among donors are necessary
for equitable resource allocation, to improve and sustain
progress with malaria control and elimination. |
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