GMAP Resource Mobilization Strategy 2012-2015 - Roll Back ...

Resource Mobilization Strategy for the 2012-2015 Phase of Implementation of
the Global Malaria Action Plan
(May 2012)
Table of Content
Executive Summary
1. Introduction
2. Context
2.1 GMAP environment
2.2 Funding trends and funding gap
2.3 Health and development context
2.4 Economic return of investment in malaria
Box 1 - Return on investment in malaria - Examples from three African countries
3. Resource needs and funding patterns
3.1 Overview of needs and funding
3.2 Needs and funding from a regional point of view
3.3 Needs and funding from a sectoral point of view
3.4 Are the GMAP data on resource needs still valid?
3.5 Funding target of this resource mobilization strategy
4. Funding sources and resource mobilization scenarios
4.1 Domestic investments
4.2 Multilateral funding mechanisms: Global Fund, World Bank and Regional Banks
4.3 OECD/DAC donor governments
4.4 Aid from emerging economies
4.5 Philanthropy and private sector’s social investment
4.6 Innovative financing
4.7 Resource mobilization scenarios
5. Resource mobilization strategy overview
Box 2 - Cost efficiencies in LLIN procurement
6. SWOT analysis, roles and responsibilities and budgetary implications
6.1 Fundraising capacity of the RBM Partnership: SWOT analysis
6.2 Roles and responsibilities in the RBM Partnership
6.3 Budgetary implications
7. Conclusions and Recommendations
Annexes
Annex I Summary of PESTEL analysis of the GMAP resource mobilization environment
Annex IIa. Aid investment in malaria control from OECD/DAC and BRIC governments and simulation of
increased investments
Annex IIb. Domestic investment in health and malaria control from high-burden African countries and
simulation of increased investments
Annex III. Explanatory note on the resource mobilization scenarios
Annex IVa. and IVb. Terms of Reference and Membership of the Resource Mobilization Sub-
Committee
Annex V. Papers produced in preparation for the Resource Mobilization Strategy and other sources
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Executive Summary
At its 19 th Meeting in December 2010, the RBM Board decided to create a Resource Mobilization Sub-
Committee with the objective of developing a resource mobilization strategy, including traditional and
new donors and innovative financing mechanisms, aimed to fill the funding gap for the 2012-2015
phase of implementation of the Global Malaria Action Plan (GMAP). This document presents the
proposed strategy and related recommendations.
Funding for malaria has increased dramatically in the past decade – with commitments from less than
US$200 million in 2004 to US$1.8 billion in 2010 – and has led to an unprecedented record of results
and impact. There are clear indications that the international community is maintaining commitment,
and including funding commitment, to the goals that first prompted the creation of the RBM Partnership
and the launch of the 2008-2015 GMAP. At the same time, it is also recognized that maintaining the
current annual income level, or even increasing it only marginally, is not adequate to provide all the
resources that are needed to achieve the 2015 GMAP Objectives and Targets, namely to reduce global
malaria deaths to near zero, to reduce global malaria cases by 75% and eliminate malaria in ten new
countries.
In this context, the Global Fund's capacity to finance the fight against the three diseases over the next
few years is of particular concern to the malaria community. Estimates of the resources that the Global
Fund could make available in the period 2012-2015 have evolved over the past few months. As of
today, the Global Fund resources are likely to be far less in the near future than what they used to be in
prior rounds and, also importantly for the GMAP targets, these funds may not be available until very
late into the timeframe of implementation of this strategy. The Global Fund estimates are still evolving
and this strategy tries to mitigate this uncertainty by also focusing on other funding options.
The aim of this resource mobilization strategy is to propose to the RBM Partners a menu of possible
approaches to raise sufficient, predictable and sustainable resources for malaria prevention, control
and elimination over the next few years. This document is meant to propose directions for the RBM
Partnership to guide strategic deployment of efforts and mobilization of influential actors, both internally
within the Partnership and externally in the development community and in endemic countries, to
maximize funding for the GMAP.
Resource requirements for global malaria prevention, control and elimination were estimated in the
GMAP to amount to some US$6.1 billion annually between 2012 and 2015, including US$5.3 billion on
average for programme costs in 109 endemic countries and US$700-800 million for global research
and development of new GMAP technologies. In this resource mobilization strategy, the GMAP country
needs have been updated based on UNSEO/ALMA estimates (2011). Also, based on input by RBM
Partners from the Research & Academia constituency, it is proposed to use the upper range of the
estimated needs for research and development. It is noted, however, that R&D financing requirements
rely on optimistic assumptions about the need for new classes of drugs, diagnostics, and other
interventions; additional research has been commissioned to determine the R&D costs associated with
the elimination/eradication agenda 1 . In order to accommodate the upper range of research and
development requirements, the estimates of the needs for the Global Plan for Artemisinin Resistance
Containment and the initial WHO estimates for the Global Plan for Insecticide Resistance Management
have also been taken into account. The annual requirements for global malaria prevention control
and elimination would therefore amount to US$26.9 billion 2 for 2012-2015. Assuming projected
ongoing funding, materialization of already made commitments and success with some easier-to-reach
funding targets, the hardest part of the funding gap (or the most difficult-to-reach fundraising target)
could be estimated at US$9.7 billion for 2012-2015 (or US$2.4 billion on average per year). Details on
these figures are provided in section 4.7 on the resource mobilization scenarios.
1 The estimate of R&D resource needs is based upon the findings of Staying the Course? Malaria Research and Development in
a Time of Economic Uncertainty, PATH, 2011, with further input provided by members of the R&A constituency, including the
Innovative Vector Control Consortium, IS Global, Medicines for Malaria Venture, PATH Malaria Vaccine Initiative, and the
University of Melbourne, and as revised based on the discussions at the Resource Mobilization Sub-Committee. A further
refinement of resource needs estimates is expected in 2013, when a project to cost the R&D needs of the eradication agenda is
expected to be completed. Among the new classes of drugs required, for example, would be those targeting the sexual stages of
the parasite and, for P. vivax malaria, hypnozoites.
2 The costs of the coordination of the global mobilization of efforts in support of the GMAP are not included in these estimates.
These costs (as budgeted in the RBM Partnership Work Plan) are approximately US$20 million in 2012, including currently
funded as well as unfunded costs.
2

Category 2012 2013 2014 2015 USD
Country needs 1 5'760'000'000 5'714'000'000 5'628'000'000 5'527'000'000
R&D (including on resistance) 1'070'000'000 1'070'000'000 1'070'000'000 1'070'000'000
Total needs 6'830'000'000 6'784'000'000 6'698'000'000 6'597'000'000 26'909'000'000
Projected as available/easier to fundraise 3'900'000'000 4'240'000'000 4'570'000'000 4'500'000'000 17'210'000'000
Projected funding gap 2'930'000'000 2'544'000'000 2'128'000'000 2'097'000'000 9'699'000'000
1 GMAP estimates except UNSEO/ALMA estimates for Africa (projecting to 2012-2015 the 2010 needs for Africa at US$2.7 billion)
There is also scope for focusing and developing in stages this challenging fundraising effort. While
financial support is needed for the whole range of malaria endemic countries and for the whole range
of interventions, a selected number of countries and regions and some sectoral needs may need
special and urgent support, because of their impact on the burden and achievement of the 2015 GMAP
objectives and targets (most importantly, the objective of achieving near zero malaria deaths) and
because of the risk that the unfolding global financing difficulties jeopardize their progress.
Since the vast majority of deaths are occurring in sub-Saharan Africa, the focus on eliminating deaths
from malaria means there has to be a greater focus on Africa and on essential commodities. The
financing gap for Africa in terms of costs for commodities and their delivery is estimated to be
approximately US$3.2 billion for the four year period 2012-2015. A concentration on raising these
funds and supporting national capacity to prevent, diagnose and treat malaria in Africa will reduce
global deaths from malaria by as much as 90%. Most of the remaining gap in financing is to develop
good strategies to delay or overcome resistance to drugs or insecticides, with the gap for Asia, Latin
America/Caribbean and the Middle East expected to largely be met from domestic resources and
ongoing programmes.
With this background, this resource mobilization strategy reviews in detail the current status and
potential from funding sources that are central in the current context of international development:
domestic investments, multilateral funders, traditional donors that are members of the Development
Assistance Committee of the Organization for Economic Cooperation and Development (OECD/DAC),
emerging economies, philanthropists and social investors, innovative financing mechanisms (chapter
4). Based on the analysis of the status and potential of the funding sources, some high-level estimates
of possible levels of fundraising efforts to fill the 2012-2015 funding gap are proposed in section 4.7.
This strategy suggests accordingly selected fundraising streams to pursue, and, for each stream, the
following menu of strategic actions (chapter 5):
A) Mobilize growing domestic public sector funding
� Encourage African and Asian endemic countries to engage to progress towards more
ambitious domestic funding targets.
� Work with robust emerging economies such as Brazil, China, India and Indonesia, to maintain
and increase domestic spending for adequately cover their own needs.
B) Maintain and expand the funding base from traditional donors
� Maintain G7 leadership in funding the next phase of the GMAP implementation: seize the
opportunity that the next two G8 Summits will be hosted by supportive governments (US, UK)
to continue to support the GMAP objectives, the Global Fund’s fundraising effort and
integration of malaria prevention, control and elimination in maternal and child health.
� Build convincingly the case for GMAP support and links to maternal and child health agenda
with a selected group of other OECD/DAC governments having the potential to become more
relevant bilateral and multilateral donors for malaria.
� Work with the European Commission to tap into the new EC/ACP resources for the
achievement of the MDGs and maternal and child health.
C) Increase aid for malaria prevention, control and elimination from emerging economies
� Establish dialogue with aid decision makers in emerging economies such as Brazil, India
and China on ongoing and potential support to countries/region of geo-political priority that are
high burden countries with funding gaps.
� Recruit at least one champion from emerging economies for profiling malaria financing in the
G20 development agenda emerging from the Seoul Development Consensus for Shared
Growth.
� Profile malaria funding in ongoing discussions of trilateral development agreements between
emerging economies, OECD-DAC/regional development banks/multilateral donors and third
countries.
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� Explore interest in malaria funding from other emerging economies that are increasing
substantially their aid packages.
� Retain funding commitment from Russia, and mobilize Russia’s political support for positioning
malaria in the G8 development discussions.
D) Frontload resources to accelerate impact of domestic investments and aid
� Take forward discussions with the World Bank and African Ministers of Finance on options for
loans from the World Bank's IDA, with a focus on the 16 th and 17 th Replenishments.
� Explore reprogramming options with the Global Fund to maximize Global Fund’s resources for
the GMAP for the 2012-2015 period, including in the context of the current reprioritization
process.
� Pursue opportunities with regional banks to support substantial scaling up of funding for
regional GMAP needs and synergistic results with other health objectives, e.g. through
matching mechanisms and incentives for regional cooperation.
E) Apply innovative financing solutions
� Create a dedicated innovative financing mechanism in support of the 2012-2015 needs, e.g. in
the form of a malaria bond.
� Support UNITAID in ongoing fundraising efforts to bring in new countries adopting air taxes
and voluntary air-travel related contribution schemes, while maximizing the opportunities for
malaria that are being offered by the 2011-2012 UNITAID calls for proposals on diagnostics
and drug procurement and, potentially, a challenge grant for new technology for LLINs.
� Further explore use of remittances and Diaspora bonds to increase domestic resources for
malaria prevention, control and elimination.
� Explore options for additional debt conversion deals (within and outside the Global Fund Debt
to Health mechanism) in support of the GMAP.
� Expand use of the UN Foundation Pledge Guarantee for Health.
F) Encourage sustained private sector and philanthropic support
� Outreach to private sector actors in endemic countries in Africa to identify opportunities for
corporate engagement in support of domestic malaria prevention, control and elimination
needs.
� Engage the private sector in emerging economies to contribute to filling domestic and
international needs, including through innovative financing mechanisms.
� Develop ideas to solicit additional support from foundations, e.g. in the form of challenge grant
or matching gift mechanisms, in collaboration with the Gates Foundation or other major partner
foundations.
G) Explore cost efficiencies and better integrated services to decrease resource needs 3
� Identify more effective ways of procuring LLINs.
� Reduce overlap of LLIN and IRS programs, at least until more is known about the possible
benefits of providing them together.
� Rotate insecticides used for IRS to delay resistance.
� Accelerate the availability and appropriate use of RDTs.
� Better understand the efficiencies of integrated health packages including systematically
malaria prevention, control and elimination components.
Special Focus on Africa. The vast majority of deaths are occurring in sub-Saharan Africa. The financing
gap for commodities and their delivery is US$3.2 billion from now until the end of 2015. Based on
current discussions strategic action on this special focus objective would include:
� US$1 billion anticipated from the Global Fund which will be applied to 2015 targets and could
potentially fully fund 2015 needs for Africa with the exception of except Nigeria, the cost driver
in the continent 4 ;
� US$ 1 billion needed for Nigeria for 2012-15 to be addressed by a special support group,
including the federal and state governments of Nigeria and committed donors;
� US$ 0.6 billion for 2012-2014 for African countries (except Nigeria) to be mobilized through
development banks' loans and the Global Fund’s Transitional Funding Mechanism;
3 Based on findings and recommendations from CHAI, " Value for Money in Malaria Programming: Issues and Opportunities",
2011, and recent data provided by Results For Development (R4D).
4 It is hoped that the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been a leader in enabling the funding
successes of the last few years, will provide funding to meet two-thirds of the total gap, in line with the proportion it has
previously funded.
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� US$ 0.6 billion, the remaining funding gap, to be mobilized 2012-2014 through other donors,
still to be identified.
This resource mobilization strategy can only be successful if it has full ownership by the RBM Partners
and Mechanisms, which all need to be engaged, based on their capacity and comparative advantage,
in this collective effort to mobilize the resources that are needed to fully fund the global fight against
malaria. A central piece of this strategy is therefore also the assessment of the overall capacity of the
RBM Partnership to pursue the proposed resource mobilization objectives and the identification of
expected roles and responsibilities in implementing this strategy.
This strategy concludes with a set of recommendations for the Board for an effective implementation of
the strategy, to:
� endorse the funding target and the fundraising streams described in this strategy, with an
immediate focus on the GMAP target of reaching near zero malaria deaths by 2015 and with a
view to getting as close as possible to filling the funding gap of the GMAP for 2012-2015.
� commit to proactively support this resource mobilization strategy and invite Board Members to
volunteer to mobilize their political leverage, expertise and contacts to serve this strategy.
� encourage further bilateral and multilateral support in support of the 2012-2015 needs, with a
view to making additional funding available to high-burden countries.
� encourage Board Members to urge high-burden endemic countries to engage their Ministers of
Finance in supporting increased domestic investments for malaria prevention, control and
elimination and, in consideration of the urgency of scaling up funding, looking at ways to
frontload resources, including by applying for loans from the 16 th and/or 17 th IDA
Replenishments.
� invite Board Members from emerging economies to contribute to scale up their bilateral and
multilateral support to malaria endemic countries to achieve the MDGs by 2015, both through
increased investments for domestic needs and by positioning malaria prevention, control and
elimination high in their aid agendas and budgets.
� request the RBM Executive Director to support the follow-up to these recommendations and
help develop a harmonized tracking system for resource needs, commitments, funding flows
and funding gaps, so as to develop a more robust and consistent base of data, including for
countries outside Africa, in support of an effective implementation of this strategy.
� urge each Partner to confirm commitment to make ending of malaria deaths a major
development priority for the next four years.
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1. Introduction
Funding for malaria has increased dramatically in the past decade – with commitments from less than
US$200 million in 2004 to US$1.8 billion in 2010 – and has led to an unprecedented record of
achievements and impact. As highlighted in the 2011 UN Report on the Millennium Development Goals,
this substantially increased investment in malaria is having a remarkable impact on the progress
towards the MDG 6. Deaths from malaria have been reduced by 20 per cent worldwide, from nearly
985,000 in 2000 to 781,000 in 2009, with the largest decrease having taken place in Africa, where 11
countries have reduced malaria cases and deaths by over 50 per cent. This record of achievement
provides a strong argument for this resource mobilization strategy and for a reinvigorated call for
support to close the funding gap for the 2012-2015 phase of the GMAP implementation.
There are clear indications that the international community is maintaining commitment, and including
funding commitment, to the goals that first prompted the creation of the RBM Partnership and the
launch of the Global Malaria Action Plan (GMAP) 2008-2015. Among them, it is important to note the
G8 commitments to continued funding for GMAP as re-stated in the 2011 Deauville Accountability
Report on Health and Food Security, and including significant funding increases by the UK and the US,
the 2011 Resolution of the UN General Assembly on "Consolidating gains and accelerating efforts to
control and eliminate malaria in developing countries, particularly in Africa, by 2015", the ongoing
World Bank's Booster Program in Africa and the Bill and Melinda Gates Foundation's Malaria Strategy,
as well as the remarkable increase in the success rate of funding proposals to the Global Fund over
the last four rounds.
At the same time, it is also recognized that maintaining the current annual income level, or even
increasing it only marginally, is challenging and not adequate to meet the funding 2012-2015
requirements for the GMAP. To achieve the objectives set in the GMAP, financial support must
continue and grow, and must allow for substantial scaling up and sustainable maintenance of
achievements at country level.
It is important in this context to emphasize the close link between funding and the life saving value of
malaria control. The Progress and Impact Series Report on saving lives 5 has eloquently highlighted this
point:
700
600
500
400
300
200
100
0
5 Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals, RBM Progress and Impact Series n.3,
September 2010
Children saved by vector control based on 2011–2015 scale-up scenarios
With rapid scale-up to universal prevention by 2010 and maintained until 2015 ( Line A), an estimated
2.95 millionchildren would besaved;with scale-up to universal prevention bytheend of 2015( LineB),about
2.15million children would besaved;with current countryscale-up trendscontinued on thesameslopeuntil
2015(LineC),about 1.14 million children would besaved;with current country coveragetrendsstabilized at
2010levels(LineD),about 906000children would besaved;but if funding ceased and nonew vector-control
serviceswereavailable(LineE),about 476000children would die(compared with thescenario of LineD).
Yearly 1–59 month child malariadeathsprevented(thousands)
2000 2005 2010 2015
Year
100%coverage in 2010
100%coverage in 2015
Continuing current trend
Maintaining current coverage
A
E
B
C
D
Ceased funding
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The urgent need for more resources has been further highlighted, over the last few months, by the
evolving information about the level of Global Fund's funding that is expected to be available over the
next few years. This is expected to impact on its capacity to continue supporting the 2012-2015 phase
of the GMAP as significantly as previously.
With this background, the aim of this Resource Mobilization Strategy is to allow the RBM Partners to
agree on approaches towards sufficient, predictable and sustainable resources to meet the 2015
GMAP Objectives and Targets.
While the timeframe of this strategy is 2012-2015, a post-MDG reflection is ongoing within the
development community, to explore how to take forwards key development objectives, including in
health, beyond 2015. The overall directions and opportunities identified in this resource mobilization
strategy for the RBM Partnership are likely to continue to be relevant, in the longer term, subject to
adjustments over time.
This document is organized as follows. After the introduction (chapter 1):
Chapter 2 outlines the global context in which the GMAP and this resource mobilization strategy
operate, highlights key areas where malaria can influence outcomes in other health and
developments areas and explains the comparative advantage of malaria prevention, control and
elimination as an investment with high return.
Chapter 3 describes the resource needs for 2012-2015, as estimated in the GMAP and
revisited/validated in subsequent analysis.
Chapter 4 explores sources of current and potential funding at both international and domestic
levels, makes assumptions regarding the size of potential inflow and proposes steps forwards to
tap into those sources.
Chapter 5 provides the strategy overview, suggesting fundraising streams to pursue, and, for each
stream, a menu of strategic actions.
Chapter 6 reviews the capacity of the Partnership to contribute to the implementation of this
strategy and summarizes accordingly key responsibilities and accountabilities.
Chapter 7 draws conclusions and recommendations.
The annexes provide references to the background and preparatory work that has supported the
content of this strategy.
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2. Context
2.1 GMAP environment
There have been significant changes in the recent years in the environment in which the GMAP
operates. These environmental variables may have an important impact on resource mobilization
outcomes and need to be taken into account and kept under close monitoring in developing and
implementing this resource mobilization strategy.
As part of the development of this strategy, the RBM Resource Mobilization Sub-Committee has
decided to carry out with its members a review of these macro-determinants with a focus on Political,
Economic, Social, Technological, Environmental and Legal variables (PESTEL analysis). The full
analysis gridline is shown in annex 2.
This analysis has identified in particular, among the key drivers:
� on the positive side, the still strong drive represented by the effort to achieve the Millennium
Development Goals by 2015, with an increased emphasis on maternal and child health;
� the current financial and economic vulnerability of traditional donors, with connected debt burden,
recession and currency fluctuations, which has prompted a period of uncertainty around the
perspectives for funding development from traditional official development assistance (ODA);
� the change in the culture of aid (due to both the financial crisis faced by traditional donors and the
emergence of new development donors and processes, such as the emerging economies in the G20,
the influence of powerful philanthropists and the development of innovative financing mechanisms),
with much more emphasis on principles such as value for money, cost effectiveness, performance
based funding and economic return.
These aspects will be looked at more in detail in the sections and chapters that follow. The range of
opportunities and threats that these and other determinants represent for the RBM Partnership in
implementing this resource mobilization strategy will be reviewed in section 6.1.
2.3 Malaria in the global health and development context
As highlighted in the section above, fundraising for malaria prevention, control and elimination does not
take place in isolation from the broader context of global health and development financing. In the
current resource-constrained environment, it is important for the RBM Partnership to map out
systematically competitive challenges and opportunities for synergies with other health and
development areas that are receiving attention, and funding commitments, from the development
community. Some of the most prominent health and development areas where strengthened synergies
could support fundraising for the GMAP for 2012-2015 are summarized below.
2.3.1 Maternal and child health. MDGs 4 and 5 on child and maternal health are among those at
most risk of remaining unmet without strong support. Malaria impacts more severely on pregnant
women and children, and funding for malaria prevention, control and elimination has a crucial role in
addressing effectively maternal and child health, since well funded malaria interventions can be used
as vehicles for other maternal and child health interventions. It has also been shown convincingly that
addressing malaria leads to a decline in all causes of mortality in children over and above malaria
mortality. At the same time, funding for maternal and child interventions could support integrated
packages including systematically malaria prevention, control and elimination components. For
example, bed nets and preventive treatments can be distributed mainly through antenatal and child
health clinics or through campaigns that include other interventions such as immunizations or
nutritional activities.
The most relevant funding envelope for maternal and child health is the Muskoka Initiative on Maternal,
Neonatal and Child Health, which engaged G8 governments in mobilizing US$5 billion by 2015 above
the 2008 baseline to reduce the number of maternal, new born and under-five child deaths in
developing countries. The Governments of the Netherlands, New Zealand, Norway, the Republic of
Korea, Spain and Switzerland, the Bill and Melinda Gates Foundation and the UN Foundation joined
the Initiative with an additional funding of US$2.3 billion to be disbursed over the same period. Based
on the Accountability Report from the Deauville Summit, prepared under the 2011 French Presidency
of the G8, it is anticipated that, over the period 2010-2015, the Muskoka Initiative will have mobilized
more than US$10 billion. It should be noted that the G8 count 46% of pledges to the Global Fund since
2010 as a contribution to the Initiative. More recently it has been reported that close to US$45 billion
has been committed to the UN-led "Every Woman Every Child" initiative, including about US$11 billion
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from the poorest countries and US$14 billion from high-income governments. While several of these
figures may overlap, it is clear that there is a momentum around maternal and child health in which the
fight against malaria could have the opportunity to retain a high profile.
2.3.2 Health system strengthening. Evidence shows that investment in malaria has an important
impact not only on reducing mortality and bed occupancy in hospitals and health centres due to the
success of preventive interventions, improved diagnosis and early treatment, but also on reinforcing
directly the capacity of health systems (e.g. by supporting delivery capacity, epidemiological
surveillance, accountability mechanisms, monitoring and evaluation). Like for maternal and child health,
there is potential for cost efficiencies and more impact if malaria interventions are part of integrated
services providing a comprehensive primary health care package allowing shared capacity for services.
This includes a close attention to human resources and recruitment and deployment of community
health workers, who are particularly important in this effort for a more integrated approach. With
appropriate supervision and reliable supplies of medicines and health commodities, extension workers
are crucial resources to provide packages of essential preventive and treatment services.
The G8 made a commitment at the 2007 Heiligendamm Summit to mobilize US$60 billion for the fight
against the three pandemics and for health system strengthening over the period 2008-2012. The main
channels for health system funding from external aid are currently general or sectoral budget support
and support to sector wide-approaches by major donors, as well as the Health Systems Funding
Platform of the GAVI Alliance, the Global Fund, the World Bank and the World Health Organization.
2.3.3 There are other development areas that have an existing or potential link to malaria investments,
such as nutrition (under the global food security and nutrition agenda), water and sanitation and,
potentially, climate change adaptation, as climate change will most certainly affect GMAP needs,
though with variable patterns that are still difficult to predict and map.
So far, funding commitments have been less concrete on these development areas: the US/Ireland-led
1000 Days Initiative on Nutrition and the Scaling Up Nutrition Platform are more focused on political
rather than funding commitments; the G8 made a pledge both in 2003 and 2005 to increase funding for
the water sector, but without clear targets; the UN Framework Convention on Climate Change has
called for the establishment of a global Green Climate Fund that is expected to allocate US$100 billion
a year by 2030 to finance, among others, climate change adaptation initiatives in developing countries,
but this funding mechanism is still in the planning phase.
These areas are nevertheless likely to become more profiled in the global development agenda in the
future and synergistic programmatic and funding opportunities should be explored and monitored
closely, seized as soon as they become relevant and conveyed in advocacy and communication
products.
2.4 Economic return of investment in malaria
Malaria, even when it does not kill, is a debilitating disease with a heavy burden on health costs and
lost productivity. High prevalence of malaria is associated with persistent and large reductions of
economic growth rates, estimated by the Commission on Macroeconomics and Health in 2001 at the
level of at least 1 percent per year. Increased, predictable and sustainable investment in malaria
prevention, control and elimination is therefore a wise investment in periods of financial constraints,
with a high return for investment. A 2008 study by Malaria No More and Mc Kinsey on the business
case for rapid scale up of malaria control in Africa has argued that a rapid acceleration of investments
in malaria control at the level of 10% annual growth over five years, including through frontloading
mechanisms, could increase the annual gross domestic product in Africa by more than US$20-30
billion, thanks to increased productivity of a healthier workforce, growth of foreign direct investment and
other economic externalities, such as revenue from more tourism.
Additional data have been collected and evidence developed by RBM Partners on the economic impact,
among others, of sustaining malaria control and elimination in five countries (Ethiopia, Rwanda,
Senegal, Tanzania Mainland and Zanzibar, Zambia). A few examples are highlighted in the below box
1:
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Box 1 - Return on investment in malaria - Examples from three African countries
In the Tigray Region in Ethiopia malaria costs households between 4% and 13% of their annual
income. Over the next five years, if Ethiopia can sustain its malaria control program, it is estimated
that it could avert about $427million in household costs: $76 million in direct costs and $351 million
in indirect costs. This is the equivalent of about 8% of household income, a very large savings for a
typical household.
In Rwanda, prior to scale-up of malaria control, treating malaria cases was costly to the public health
system—an estimated 19% of the recurrent budget of the Ministry of Health was directed to malaria.
By preventing resurgence, sustained control over the next five years (2011–2015) could save the
public health system an estimated $267 million in the costs of diagnosing and treating out-patient
and in-patient malaria. Most of these cost savings would allow health sector resources (e.g., health
workers’ time, hospital beds) to be devoted to other diseases. At the same time, some resources
could be invested into strengthening and expanding prevention and surveillance activities to
maintain a reduced burden of malaria.
In Tanzania, Said Salim Bakhresa & Co. (SSB) is an African-owned flour mill company based in Dar
es Salaam. After a study found that one in five of its employees contracted malaria each month,
SSB launched a malaria control program in 2008. It distributed ITNs to its 6,000 employees and
their families and offered free testing and treatment at its three onsite clinics. It also established a
diagnostics and training center at the company’s headquarters. After implementing the program,
employee absenteeism related to malaria fell by 80%. The company now spends a third of what it
used to spend on malaria medication at its clinics—monthly drug costs fell from US$10,000 to
$3,400.
From: "Maintaining the Gains in Global Malaria Control", Clinton Health Access Initiative (in
partnership with the Evidence to Policy Initiative of the Global Health Group at the University of
California San Francisco, and the African Leaders Malaria Alliance), October 2011
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3: Resource needs and funding patterns
3.1 Overview of needs and funding
Resource requirements for global malaria prevention, control and elimination were estimated in the
2008 GMAP to amount to some US$5.3 billion annually between 2012 and 2015 for programme costs
in 109 endemic countries and US$700-800 million annually, over the same period, for global research
and development of new technologies. The GMAP shows the following breakdown of global financing
sources in 2007: external assistance: 47%; national government spending: 34%; private sector
spending: 19% 6 . The principal sources of external aid have been so far the Global Fund (approximately
76% for the period 2002-2009), the US President's Malaria Initiative (PMI) (15%), the World Bank (8%)
and other OECD/DAC (7%). In 2009, all these donors together committed approximately US$1.6 billion
and disbursed US$1.5 billion.
3.2 Needs and funding from a regional point of view
The two regions with the largest funding requirements are Africa (US$2.7 billion annually 7 on average
for the period 2012-2015) and Asia and the Pacific (US$2.6 billion annually on average for the period
2012-2015).
In Africa, the main cost driver is Nigeria (more than US$450 million annually) with Ethiopia, DRC,
Uganda, and Tanzania all exceeding US$100 million. These countries account for a large percentage
of the population at risk and deaths in the continent. The other highest-death burden countries in Africa
are Burkina Faso, Chad, Côte d'Ivoire, Mozambique and Niger. Domestic public sector spending for
malaria prevention and control in these high-cost countries ranges between close to 0 to 30-40% of
their GMAP estimated annual needs.
Based on the OECD/DAC International Development Statistics Database, OECD/DAC donors for
malaria prevention and control in the countries that drive the costs in the continent and bear the highest
burden have been, over the last five years 8 :
- Burkina Faso: Austria, France, Italy, Japan, Spain;
- Côte d’Ivoire: Japan;
- DRC: Australia, Belgium, Japan, South Korea, US;
- Ethiopia: Australia, Canada, Greece, Italy, the Netherlands, Spain, UK, US;
- Mozambique: Canada, France, the Netherlands, Portugal, Spain, UK, US;
- Niger: Canada, Italy, Japan;
- Nigeria: Canada, Italy, Spain, UK, US;
- Tanzania: Australia, Canada, Italy, Japan, the Netherlands, Spain, UK, US;
- Uganda: Australia, Belgium, Canada, Germany, UK, US.
In Asia, six out of the ten countries with the largest share of population at risk worldwide are located in
this region (India, China, Indonesia, Bangladesh, Vietnam, Philippines). India bears a share of 45% of
all malaria cases in the region. Three cost drivers in the continent are emerging economies: India
needs US$7.6 billion for the period 2012-2015 Indonesia needs US$652 million and China needs
US$397 million. The Global Fund has invested substantially in all three countries (in Indonesia
including through a debt conversion scheme with Australia and Germany which so far has brought
some USD 60 million to be used for Global Fund's grants - potentially including malaria grants). Overall,
aid to India has decreased substantially, while aid to China was still increasing in 2009. The other
major foreign aid source in 2009 was the World Bank for India, and multilaterals (UNICEF and WHO)
as well as OECD/DAC governments for Indonesia and Myanmar (the other high-burden country in
Asia) 9 . The data from the 2010 World Malaria Report (WMR) are not sufficiently detailed to understand
the proportion of domestic investment in malaria in these three countries. However, these countries are
6 The proportion of private sector spending is difficult to track consistently. For example, looking at the ten GMAP cost-driving
countries, the WHO Statistical Information System estimates that private expenditures represent only 11% of health spending in
Angola, but more than 50% in Ethiopia, Kenya, India, Indonesia and Nigeria, and around 80-90% in DRC, Myanmar, Sudan and
Uganda. In Angola, Myanmar, Nigeria and Sudan, virtually all these private expenditures are out-of pocket contributions. Out-of
pocket expenditures should be taken cautiously in prospecting health financing approaches because, as widely reported, they
affect disproportionally the poorest. To ensure equity in access to health care, the 2010 World Health Report recommended that
funding from out-of-pocket expenditures should not exceed 15-20% of total health expenditures and that it should rather be
converted into pooled funding and prepayment schemes, including community financing programs supported by public funding
where feasible.
7 The needs for Africa are based on a recent analysis led by UNSEO and ALMA which reviewed the GMAP cost estimates and
projected to 2012-2015 the 2010 needs for Africa at US$2.7 billion.
8 The OECD/DAC database does not record any donor for malaria activities in Chad.
9 Respectively, New Zealand and Spain for Indonesia and Japan and Norway for Myanmar.
11

also members of the G20, which suggests that their funding gap could be substantially supported
through increased domestic investments.
The Greater Mekong sub-region is experiencing increased resistance to artemisinin and insecticides.
Investment in malaria prevention and control in this sub-region has therefore a clear global public good
value, as it would contribute to addressing the threat of spreading resistance within the continent and
globally. The cost of addressing resistance on the border areas between Cambodia, Myanmar,
Thailand and Vietnam and preventing global spread of resistance has been calculated in the GPARC
at around US$175 million annually until 2015 and is additional to the GMAP resource needs.
The resource needs for the 22 malaria endemic countries in the Americas (which include three major
emerging economies, namely Brazil, Mexico and Venezuela) amount to US$233 million annually on
average for 2012-2015. 40% of malaria deaths in the continent occur in Brazil, which is the cost driver
in the continent (US$100 million needed annually on average for 2012-2015). Brazil’s domestic
investments, as reported in the WMR, are fully adequate to meet these domestic needs, though since
2007 Brazil has also received support from the Global Fund, the US and the World Bank.
The most acute needs in the Americas are for the countries of the Amazon Basin (Bolivia, Brazil,
Colombia, Ecuador, Guyana, Peru, Suriname and Venezuela), which bear the highest burden of
mortality and where the malaria epidemic is concentrated among isolated, indigenous populations
(US$300 million excluding Brazil). The Global Fund has invested so far US$12.7 million for the
countries of the Amazon Basin (which adds to a US$25 million grant, in the closure phase, for a subregional
project on the cross-border areas of the Andean Region), the World Bank US$350,000 and
OECD/DAC donors some US$2.6 million (Spain and the US). The modest and relatively concentrated
funding gap for this region could be expected to be appropriately covered through national and regional
investments.
In the Middle East and Eurasia, needs are for US$164 million annually for 2012-2015. Three
countries (Pakistan, Afghanistan and Yemen) account for more of 99% of the 56,000 regional deaths.
In Eurasia, the objective is elimination. Resources from domestic spending amount to 89% of total
funding. However, Pakistan, Afghanistan and Yemen still need support by international funders. The
Global Fund has invested so far US$52 million in the three countries (in Pakistan including through a
debt conversion scheme with Germany), the World Bank US$2.8 million. Other funders are mainly
Arab donors and Russia (the latter for elimination in Eurasian countries particularly). Continuation of
the current efforts of these regional donors could help these countries to manage their relatively limited
funding shortfall.
3.3 Needs and funding from a sectoral point of view
Prevention represents the highest cost in the GMAP, at around US$3.7-3.9 billion annually from 2010
up to 2020, or 70% of the total costs. Most of these costs are almost equally distributed between indoor
residual spraying (IRS, 55%) and bednets (long lasting insecticidal nets – LLINs, at almost 45%), with a
relatively negligible need for intermittent preventive treatments (for children, infants, pregnant women –
IPT, less than 1%). Because of the significant proportion of the GMAP resource needs in this category,
cost efficiencies in the area of prevention would have a major impact in reducing the GMAP cost tag.
Case management (rapid diagnostic testing, artemisinin-based combination therapy, drugs to address
other malaria strains and management of severe malaria) represents some 20% of needs in the initial
scale up phase (which was estimated in the GMAP to reach a pick in 2011). The GMAP projected that
the success in prevention and reduction of over-treatment of fevers with antimalarials would prompt a
drastic decrease in the cost of case management (to less than 10%), which would be particularly
significant between 2012 and 2015.
Programme support, in the form of infrastructure, monitoring and evaluation, operational research at
country level, training, salaries and other costs for the deployment of community health workers, is
estimated to require 14-19% of resources and remain relatively stable between 2012 and 2015. This is
described in the GMAP as a cost component that is particularly prone to compression through better
health system synergies.
A separate analysis of costs is devoted in the GMAP to global research and development, for which
the estimates are for US$750-800 million annually between 2010 and 2015 for development of drugs,
vaccines and diagnostics, vector control and analysis of effectiveness and impact. The importance of
research and development cannot be overestimated. Over the last ten years, innovations in long-
12

lasting insecticidal nets, artemisinin combination treatments and rapid diagnostic testing have
transformed the malaria landscape. Research and development is part of a continuum towards
implementation of effective measures that can lead to the elimination of malaria. The immediate focus
for research and development is on finding transmission blocking interventions that can radically
reduce the numbers of new cases as well as new molecules that address resistance. In the meantime,
a scaling up of diagnostics and appropriate treatment to complement successful vector control can
bring the malaria community closer to eliminating deaths from malaria. More recent estimates by RBM
Partners have identified needs as at least some US$800 million annually over the four-year period
2012–2015, including support for the R&D components of the GPARC and GPIRM. A further
refinement of resource needs estimates is expected in 2013, when a project to cost the R&D needs of
the eradication agenda is expected to be completed. Research and development seems to have been
relatively well supported by a mix of public and private donors over the past five years, though with
relatively few donors and an uneven distribution of funding among the various areas that need support.
3.4 Are the GMAP data on resource needs still valid?
Before looking at how to mobilize existing and potential funding sources to address the funding gap for
2012-2015, the legitimate question is whether the GMAP costing estimates are still valid, three years
after having been developed, also considering that the environment around malaria is changing. As
part of its work for the development of this resource mobilization strategy, the Resource Mobilization
Sub-Committee has reviewed secondary data from six high-burden and high-cost countries (DRC,
Ethiopia, India, Nigeria, Tanzania and Uganda) to ascertain if new data could validate the costing
estimates made in 2007. While this analysis was of limited scope due to its reliance on secondary data,
country information seems to confirm that the GMAP, overall, did not overestimate the projected
resource needs. Rather, it may be argued that some costs may have increased in the meanwhile, due
to different factors:
• As several of the 2010 targets have not been achieved and most countries have accumulated
delays in the GMAP implementation (including because of insufficient funding and funding
delays), the costs of the scaling up phase are still substantial for most countries and some of
the resource needs that have not been met since 2008 will need to be added to the costs
originally estimated for the years to come.
• A more compelling set of milestones has been set in 2011 for achieving the 2015 GMAP
Objectives and Targets as compared to the original GMAP framework, requiring an
accelerated scaling up of efforts.
• The GMAP estimates did not factor in all costs, notably the needs for the Global Plan for
Artemisinin Resistance Containment (GPARC), launched at end 2010 and those for a plan for
insecticide resistance management (GPIRM), which is in the pipeline. The GPARC and GPIRM
costs have been estimated respectively at US$175 million and US$195 million annually
between 2012 and 2015 (for the GPIRM these are very preliminary WHO estimates).
• The impact of the ongoing currency fluctuations (e.g. devaluation of the US$ over the past year)
is not yet fully known, but it is likely to have an effect on current and future costs.
3.5 Funding target of this resource mobilization strategy
Resource requirements for global malaria prevention, control and elimination were originally estimated
in the GMAP to amount to some US$6.1 billion annually between 2012 and 2015, including US$5.3
billion on average for programme costs in 109 endemic countries and US$700-800 million for global
research and development of new GMAP technologies. In this resource mobilization strategy, the
GMAP country needs have been updated based on UNSEO/ALMA estimates (2011). Also, based on
the above mentioned estimates by PATH 10 and input from the R&A constituency, it is proposed to use
the upper range of the estimated needs for research and development, while noting that these
requirements rely on optimistic assumptions about the need for new classes of drugs, diagnostics, and
other interventions. In this document, the Research and Development requirements also include the
requirements for the Global Plan for Artemisinin Resistance Containment and the initial WHO
estimates for the Global Plan for Insecticide Resistance Management. The annual requirements for
global malaria prevention control and elimination would therefore amount to US$26.9 billion 11 for 2012-
10 Staying the Course? Malaria Research and Development in a Time of Economic Uncertainty, PATH, 2011, with further input
provided by members of the R&A constituency, including the Innovative Vector Control Consortium, IS Global, Medicines for
Malaria Venture, PATH Malaria Vaccine Initiative, and the University of Melbourne.
11 The costs of the coordination of the global mobilization of efforts in support of the GMAP are not included in these estimates.
These costs (as budgeted in the RBM Partnership Work Plan) are approximately US$20 million in 2012, including currently
funded as well as unfunded costs.
13

2015. Assuming projected ongoing funding, materialization of already made commitments and success
with some easier-to-reach funding targets, the hardest part of the funding gap (or the most difficult-toreach
fundraising target) could be estimated at US$9.7 billion for 2012-2015 (or US$2.4 billion on
average per year). Details on these figures are provided in section 4.7 on the resource mobilization
scenarios.
Category 2012 2013 2014 2015 USD
Country needs 1 5'760'000'000 5'714'000'000 5'628'000'000 5'527'000'000
R&D (including on resistance) 1'070'000'000 1'070'000'000 1'070'000'000 1'070'000'000
Total needs 6'830'000'000 6'784'000'000 6'698'000'000 6'597'000'000 26'909'000'000
Projected as available/easier to fundraise 3'900'000'000 4'240'000'000 4'570'000'000 4'500'000'000 17'210'000'000
Projected funding gap 2'930'000'000 2'544'000'000 2'128'000'000 2'097'000'000 9'699'000'000
1 GMAP estimates except UNSEO/ALMA estimates for Africa (projecting to 2012-2015 the 2010 needs for Africa at US$2.7 billion)
Since the vast majority of deaths are occurring in sub-Saharan Africa, the focus on eliminating deaths
from malaria means there has to be a greater focus on Africa and on essential commodities. The
financing gap for Africa in terms of costs for commodities and their delivery is estimated to be
approximately US$3.2 billion for the four year period 2012-2015. A concentration on raising these
funds and supporting national capacity to prevent, diagnose and treat malaria in Africa will reduce
global deaths from malaria by as much as 90%. Most of the remaining gap in financing is to develop
good strategies to delay or overcome resistance to drugs or insecticides, with the gap for Asia, Latin
America/Caribbean and the Middle East expected to largely be met from domestic resources and
ongoing programmes.
14

4. Funding sources and resource mobilization scenarios
The following chapters will review more in detail current funding patterns from a comprehensive range
of funding sources and will identify a menu of action streams for potential for increased/new funding. In
considering the funding options of all existing and potential avenues, close attention has been paid to
some key criteria to decide on their suitability, with a focus on potential for:
� Prioritizing quick wins and frontloading options that can maximize acceleration of results;
� Identifying sources of funding so far under-explored that show a potential to make funding
impact over 2012-2015;
� Building up medium to long-term sustainability and predictability of resource inflows;
� Ensuring the additionality of resources raised – e.g. by making sure to use at best the
comparative advantages of different RBM Partners in fundraising from different sources and
avoid duplication of efforts;
� Optimizing the efficiency of resource mobilization efforts, in terms of cost and effort invested in
comparison to financial and political benefits gained.
4.1 Domestic investments
The Abuja Declaration, adopted at a 2001 summit of the Organization of African Unity, was a
commitment of African States to allocate at least 15% of their annual budgets to the health sector.
Analysis undertaken in 2009 for the Global Fund’s Replenishment showed that, since the Abuja
Summit, many African countries had increased the proportion of their national budget allocated to
health between 2001 and 2007. The WHO Statistical Information System reports that seven countries
had achieved or exceeded the Abuja target in 2009, including, among the countries with the highest
burden of malaria, Burkina Faso and Tanzania. Three additional countries are close to the target (Chad,
Mozambique and Niger, at some 13-14%), and Uganda is at two-thirds of the path. The lowest health
investments among the top high burden countries are recorded in DRC, Côte d'Ivoire and Nigeria (2 to
6%).
If we look at malaria commitments, extrapolation of data from the 2010 WMR shows that the proportion
of GMAP annual estimated needs that are covered through domestic investments in the public sector
range from close to 0 (in five of them) to some 30% (Sudan and Uganda). The potential for higher
domestic investments from the public and private sector, should be considered also in the context of
the economic growth of these countries. The IMF World Economic Outlook database shows that the
highest GDP growth 2009/2008 among the African countries with the highest malaria burden has been
recorded, in order of size, in Uganda, Nigeria, Tanzania and Mozambique (more than 6% growth
annually on average between 2008 and 2010, based on constant prices and local currency) and the
lowest in Chad, Cameron and DRC (between 0 and less than 3%). If we consider the high impact that
malaria prevention, control and elimination has on economic growth (Malaria No More and McKinsey &
Company estimated in 2008 that an investment in malaria prevention and treatment of approximately
US$2.2 billion a year for five years would increase annual GDP in Africa by US$30 billion), there is a
strong case, particularly for the countries experiencing significant growth, to re-invest part of their GDP
increase in malaria prevention, control and elimination, so as to prompt a multiplier effect for their
economic growth.
The highest burden countries in Asia are India, Myanmar and Indonesia. The 2010 WMR data are not
sufficiently detailed to understand the proportion of domestic malaria investment currently being made
in these countries. However, for India and, to a lesser extent, Indonesia, based on their potential as
emerging economies, it could be argued that these needs could be more substantially resourced
domestically.
In the Americas and in the Middle East/Eurasia needs are currently covered at 91% and 89%
respectively by domestic investments, and this pattern could continue to be the most appropriate,
possibly with additional support from regional donors to the least resourced countries in these regions.
Potential for increase
A positive emulation effort between the endemic African countries experiencing economic growth
towards the Abuja commitments, while at the same time prioritizing malaria prevention, control and
elimination, could potentially bring substantial new resources for the GMAP in 2012-2015. An
illustrative simulation, based on investment of a proportion of GDP growth, is proposed in annex IIb.
This domestic investment effort could be facilitated, as illustrated in sections 4.2 and 4.6, by the World
15

Bank and other development banks' loans and innovative financing initiatives. The above mentioned
analysis of CHAI of five endemic African countries 12 identified a broad range of options for domestic
innovative financing mechanisms for malaria prevention, control and elimination, from airport taxes,
taxes on harmful products, incentives to private donations, prize-linked savings, community health
insurance schemes, health trust funds, pooled commodity procurement, "net purchase sweepstakes"
and other mechanisms to ensure sustainable financing of malaria interventions.
For Asia, in the context of its participation in the work of the RBM Resource Mobilization Sub-
Committee, China has asserted that it is gradually shifting to a position to be able to finance the
malaria response domestically. For India and Indonesia, a similar approach could lead to significantly
decreasing the 2012-2015 GMAP funding gap. This would require a commitment from the three
countries for average annual investments in the order of US$1.9 billion for India, US$163 million for
Indonesia and US$100 million for China.
4.2 Multilateral funding mechanisms: Global Fund, World Bank and Regional Banks
Global Fund to fight AIDS, Tuberculosis and Malaria
The Global Fund has been so far a major external financier for the GMAP, having contributed 76% of
total aid for malaria since 2002, and 65% in 2009 13 . Around 28% of the resources raised by the Global
Fund during its history has gone to malaria prevention, control and elimination, a proportion that has
consolidated over the years (it is now at around 34%), thanks to an increasing success of malaria
proposals reviewed by the Technical Review Panel.
At the Global Fund Replenishment Conference in New York in October 2010, US$11.7 billion were
recorded as pledges and projections for the period 2011-2013. The projections amounted to US$2.5
billion relative to discussions that were ongoing with traditional donors not in a position to pledge at the
time, as well as new private sector donors and potential income from innovative financing initiatives.
Following reports about some implementing countries’ mismanagement of the resources received, the
Global Fund is now making efforts to reinvigorate the confidence of its donors, and some of them have
already confirmed their support. It is nevertheless still unclear at this point in time if all the pledges
made in New York, not to mention the projections, will fully materialize. The outcomes of the 2010
pledging conference and the subsequent estimates and discussions seem to suggest that the Global
Fund may have in the future to rely on a more limited range of core donors. In part to counteract the
constrained ability to contribute among some of its traditional donors, the Global Fund has embarked
on an expanded effort to increase fundraising from both public and private sources in emerging
economies, with success in Russia already during the Replenishment and potential opportunities
among corporations in Latin America and India.
When the Global Fund Board decided to launch Round 11 only in August 2011, proposals would have
been considered for approval at the earliest at the Global Fund Board Meeting in May 2012. However,
in light of funding uncertainties, the Global Fund’s 24 th Board Meeting in September 2011 decided to
delay the closing date for Round 11 proposals until at least 1 st March 2012, thus further pushing back
the approval date until end 2012. Based on analysis by the Global Fund of the status of pledges and
contributions, and even assuming pledges would be contributed in full, projections as of 8 November
2011 indicate that by the end of 2013 there may not be any uncommitted assets against which to sign
new grants (i.e. under Round 11) or even a slight shortfall. A Board Working Group on Round 11 has
been established to look at measures to ensure that sufficient funds can be made available to approve
Round 11 albeit of smaller size. In the uncertain environment and the severe fiscal strain, most, if not
all, public sector donors that are operating under the Working Group felt that it would be prudent to
provide the Board with a risk-adjusted projection of uncommitted assets available for grant signing by
the end of 2013. This number that will be shared with the Global Fund’s Board shortly is likely to project
a substantial shortfall. The Working Group will provide recommendations to the Global Fund’s 25 th
Board Meeting in November 2011 on sufficient measures to cover this potential shortfall and still fund a
Round 11 possibly of US$500 million or more. The projections are not fixed and will become clearer
after the Global Fund’s 25 th Board Meeting. Nonetheless, they remain projections and subject to
possible revisions both up and down.
12 Maintaining the Gains in Global Malaria Control, Clinton Health Access Initiative (in partnership with the Evidence to Policy
Initiative of the Global Health Group at the University of California San Francisco, and the African Leaders Malaria Alliance),
2011
13 Global Fund to Fight AIDS, Tuberculosis and Malaria, “Making a Difference. Global Fund Results Report 2011”.
16

As far as the timeframe is concerned, Round 12 approvals are likely to be pushed back, probably to
2014. Disbursements would therefore be expected to materialize at the end of 2013 for Round 11 at
the earliest and only in 2015 for Round 12. The change in the architecture of Global Fund’s financing,
which is part of the ongoing development of the new Global Fund Strategy, may change the way in
which resources are provided to countries (with an expected decrease in importance of annual rounds
and increased reliance on single stream funding, based on national planning cycles). The Global
Fund’s Board at its 24 th Meeting instructed the Secretariat to bring forward some of the foreseen
measures in the new strategy and to apply them already in Round 11, such as a more interactive
proposal development and greater strategic focus in the types of interventions and expenditure
supported by grants.
World Bank
In 2005, the World Bank launched the Booster Program for Malaria in Africa, a 10-year program
designed to help African nations meet the malaria control targets to which they agreed in Abuja in 2000.
During its first three years (2005–2008), the Malaria Booster Program committed over US$465 million
to the continent. In 2008, the World Bank launched Phase II (2008–2011) of its Booster Program and
committed to an expansion of US$1.1 billion. US$300 million have so far been already engaged, thus
leaving a substantial balance still due from the 2008 commitments.
In addition to the Booster Program, countries can access resources from the World Bank’s
International Development Association, which provides both grants and concessional loans at 0
interest, 40 year maturity and 10 year grace period for payback. The 16 th IDA Replenishment can count
on just under US$50 billion, all needs included, for July 2011-June 2014. The 17 th IDA Replenishment
can also impact on the final stage of this resource mobilization strategy, as it will apply from July 2014.
Borrowing governments have shown over the past years an increasing preference for infrastructure, in
the context of the IDA Replenishments. However, the return on investment in malaria is significant
enough for this to be reconsidered.
Regional Banks
Due to the regional configuration of the GMAP resource needs, as illustrated in the chapter 3, the role
of the regional development banks is potentially important in contributing to filling the funding gap
2012-2015. However, the information on the regional development banks' investments is scattered.
Among the most relevant initiatives:
� African Development Bank: the main reference is still the 2002 Malaria Strategy, which,
aiming at the 2010 RBM targets, committed the Bank to co-financing national and regional
malaria programmes directly or as part of an integrated approach for communicable disease
control. The most relevant funding commitment from the Bank was, in 2006, a five-year
project with the Southern African Development Community (SADC) for the control of
communicable diseases, including malaria, for 20 million Units of Accounts (equivalent to
US$29 million). The project was funded through grant resources from the Bank’s allocation of
financing for multinational operations, and is being implemented within the framework of the
Cooperation Agreement with SADC.
� The Asian Development Bank launched in 2005 a project of US$30 million over 4 years as
part of the Greater Mekong Subregion Program, to contain the spread of epidemic diseases at
local level and reduce the burden of common endemic diseases, including malaria, in
Cambodia, the Lao People's Democratic Republic and Viet Nam. The project was matched
with funding from WHO and with domestic funding from the three countries. In 2010, the
project was extended for 5 more years with additional US$10 million from the Bank and
funding for technical assistance from the Poverty Reduction Cooperation Fund.
� Inter-American Development Bank: a regional protocol for technical cooperation was
established in 2010 with the Ibero-American Organization for Social Security for regional
epidemiological surveillance in border areas, also including malaria, mobilizing US$1 million
from the IDB Ordinary Capital for four years. Most recently, the Bank has joined forces with
the Mexican Carlos Slim Foundation, the Bill and Melinda Gates Foundation and the
Government of Spain, which donated US$150 million for a Mesoamerica Health Initiative,
including a well profiled malaria component, administered by the Bank.
17

� The Islamic Development Bank is among the most active regional banks on malaria. Its Vision
1440H (2020, in the Hijri calendar) identified in 2006, as a key strategic thrust, the need to
address “the most severe and debilitating threats to health in the Muslim world. These are
child mortality, maternal health, diseases including HIV/AIDS and malaria, and environmental
sustainability (access to safe drinking water and sanitation)”. A special fund for reducing
poverty in member countries was established, with the objective of, inter alia, eradicating
major communicable diseases including malaria. In 2005 the Bank established a Quick-Win
Malaria Program aiming at combating malaria in 10 highly endemic member countries
(Burkina Faso, Chad, the Gambia, Guinea-Bissau, Indonesia, Mali, Mauritania, Niger, Senegal
and Sudan), which is still in operation. The program was launched with an approval of US$50
million for the initial phase (which was intended to last two years).
Potential for increase
The Global Fund's financing capacity over the next few years is of concern and will require the full
attention of the RBM Partners. As of today, Global Fund's resources are likely to be in the near future
far less than in prior rounds and also, importantly for the GMAP targets, these funds may not be
available until very late into the timeframe of implementation of this strategy. The Global Fund
projections are by their nature subject to uncertainty and the change from a twelve-month to the threeyear
timeframe of the replenishment cycle adds to the potential volatility. This strategy tries to mitigate
this uncertainty by focusing on additional funding options.
There is however a great deal of potential in exploring with the Global Fund options for reallocating and
re-programming existing funding based on prioritization of needs. Frontloading options were already
proposed and acknowledged by the Global Fund Board at its 17 th Meeting in 2008, when a paper was
presented on the Global Fund’s role as a "strategic and responsible investor in malaria" to promote
accelerated support for the 2010 RBM targets. In fact, resources for approved Global Fund's grants
can be “frontloaded,” and such possibility seems to have been used with successful outcomes in
Ethiopia and have prevented waste of resources, e.g. for multiple tenders for procurements resulting in
delays in implementation. Frontloading Global Fund resources would contribute to support the
fundraising effort for the 2012-2015 funding gap.
Another supportive action for this resource mobilization strategy would be for the Global Fund to take
measures to speed up the process for signature and disbursement, when guarantees of good
management by principal recipients can be provided. A key pre-requisite in the fundraising effort with
the Global Fund for the years ahead is obviously, at the same time, to continue to strive for cost
efficiency and effectiveness in proposal preparation and in grant implementation.
It is most likely that in the future World Bank funding for malaria will increasingly materialize by closely
integrating malaria activities in health system strengthening and maternal and child health interventions.
This may open new funding avenues. In the meanwhile, the World Bank IDA and its preferential credit
facility can represent a key, synergistic funding source for the health MDGs and the GMAP. The option
is under discussion to encourage Ministers of Finance in high-burden countries in Africa to submit to
the World Bank requests for IDA loans from the 16 th and 17 th Replenishments for health investments
under which to prioritize malaria. Ministers of Health should support and help argument this request.
This “frontloading” process through loans could contribute substantially to filling the 2012-2015 funding
needs. In this option, it could be also envisaged that other major donors propose matching deals with
high-burden countries around co-financing with IDA, including additional frontloading mechanisms.
As far as the regional development banks are concerned, there seem to be a significant unmet
potential, particularly taking into account that malaria appears as one of the regional banks’ priority
areas of intervention in health, that the resources invested so far are well below the potential and that
the possibility of frontloading grants and loans could also be pursued with regional banks. Synergies
with the World Bank and other co-investors could usefully be promoted.
4.3 OECD/DAC donor governments
The context
The Development Assistance Committee (DAC) of the Organization for Economic Cooperation and
Development (OECD), which gathers the 25 traditional donor governments and the European
Commission, has reported official development assistance (ODA) flows for US$128.7 billion in 2010,
still representing an increase of 6.5 % over 2009. Net ODA as a share of gross national income (GNI)
18

was on average 0.32% (thus with additional room for reaching the 0.7% by 2015 to which the
OECD/DAC governments committed through the Monterrey Consensus in 2002). The forms of aid that
increased more substantially over the last year were bilateral aid, debt relief and bilateral lending.
Bilateral aid, including debt relief, rose by 5.9% over 2009. Bilateral ODA to Africa and to sub-Saharan
Africa increased of 3.6% and 6.4% respectively.
The largest aid providers by volume were the United States, the United Kingdom, France, Germany
and Japan. The largest increases in real terms were recorded by Australia, Belgium, Canada, Japan,
South Korea, Portugal and the United Kingdom. Decrease in aid was recorded for Greece, Ireland, Italy,
New Zealand, Spain and Sweden. Denmark, Luxembourg, the Netherlands, Norway and Sweden
continued to exceed the ODA/GNI target of 0.7%.
The OECD-DAC Secretariat predicted in 2011 a slower but continued aid growth ahead.
Programmable aid is forecasted to grow at a rate of 2% per year from 2011 to 2013. For bilateral aid
only, the projected increase is 1.3% per year. The slowing down is forecasted to be more marked for
support to low income countries and for Africa, where aid is projected to increase at about 1% per year
in real terms, compared to a 13% annual growth rate in the past three years. The likely scenario is for
an increase of aid at a pace that would be too slow to follow the pace of population growth in
developing countries, particularly in Africa.
Malaria Funding
The G8 (G7 + Russia) committed in 2005 to contribute an additional US$1.5 billion per year to malaria,
but this has yet to materialize. However, some members have substantially increased their political and
financial commitment to the fight against malaria. Combining funding provided bilaterally and
multilaterally (limited for this analysis to the malaria proportion of contributions to the Global Fund), and
including for research and development, in 2009 the G7 donors committed to malaria prevention,
control and elimination a proportion of their ODA ranging from some 0.7% to the outstanding 2.8% of
the United States. Spain is the non-G7 OECD/DAC donor that over the years has invested resources
at a level that is comparable to that of the core G7 donors, including with budgets dedicated to funding
research and development.
Among the most interesting, current commitments to the fight against malaria from OECD/DAC
Member States:
United States: The 2008 Lantos/Hyde Act authorized up to US$5 billion funding for malaria prevention
and control for the period 2009-2013. The Act, which forms an integral part of the 2009 US
Government’s Global Health Initiative (a six-year, US$63 billion commitment to global health), has
inspired a comprehensive 2009-2014 Malaria Strategy that builds up on the President’s Malaria
Initiative 2005-2010 and also includes substantial funding for research.
United Kingdom: In December 2010, the British Prime Minister confirmed that tackling malaria was a
top priority for the UK Government, and the Secretary of State for International Development has
recently promised an investment of up to £500 million annually by 2014/2015 in the UK Framework for
Results (equivalent to some US$800 million at the time of the pledge). The UK geographical priorities
in aid for malaria include all the endemic countries with the highest disease burden. The UK is also
committed to increasing the proportion of its budget for research.
The European Commission has launched a new MDG Initiative amounting to US$1.32 billion to support
national plans in African, Caribbean and Pacific (ACP) countries and help them make progress on the
MDGs, with a focus on MDGs 4 and 5. The Commission has also pledged US$1.42 billion for 2011-
2013 for maternal and child health under the Muskoka Initiative. So far, the most relevant funding area
in malaria, in addition to the contribution to the Global Fund, has been research and development.
At the 2010 G20 Summit in Seoul, Japan reiterated its commitment to provide US$5 billion in support
of the health MDGs over five years from 2011. Malaria initiatives in endemic countries are supported
through grant aid and technical cooperation projects with integrated services for health system
strengthening and maternal and child health.
South Korea has decided to more then double its ODA/GNI ratio, from 0.1% in 2009 to 0.25% by 2015.
The Korean International Cooperation Agency has identified health as a priority sector, with a focus on
MDGs 4, 5 and 6. South Korea has a number of ongoing projects in the health area, especially in the
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context of the Association of Southeast Asian Nations (ASEAN), but it is also increasingly investing in
Africa, including in the prevention of malaria and in water and sanitation projects.
Potential for increase
An analysis of the proportion of aid that the different OECD/DAC donors devote to malaria, either
bilaterally or multilaterally, shows considerable differences between members, despite the fact that the
fight against malaria is a key, common UN and OECD/DAC development goal. In fact, if all the
OECD/DAC members allocated to malaria prevention, control and elimination some 2% of their aid
budgets, bringing their investments closer to the proportional investment of the US, this would generate
an annual revenue of some US$2.6 billion for malaria, against current investments of some US$1.5
billion (see annex IIa). While this simulation is merely illustrative, it gives an indication of the monetary
value that a strong political commitment from OECD/DAC members can bring in and the type of burden
sharing/peer emulation that could be advocated for, particularly but not exclusively, among the G7.
The outstanding effort of the UK will bring significant new resources over the next few years and will
position the UK as the European OECD/DAC champion in the global fight against malaria. To identify
strategically additional donors, the following parameters could be proposed: a) donor financial capacity
and relatively healthy financial record, b) commitment to ODA targets, and c) expressed interest in
malaria over the last five years. Based on these criteria, a rapid review points to at least three
OECD/DAC members that it may be advisable to work with in the short term: Australia, Norway and
South Korea. These three donors have already contributed bilaterally and multilaterally to malaria
prevention, control and elimination (Australia has been a major funder for malaria research over the
past few years), are still vocal in their effort to continue to aim to the 0.7% ODA target (Norway has in
fact been exceeding it for years), and they also have the distinctive advantage of having recorded in
2010 a relatively lower central government debt as a proportion of their GDP (less than 35%).
Most of the EU Member States seem to be less well positioned, within the current context of their
economic and financial vulnerability, to be able to provide any short term increase in their contribution
to filling the GMAP funding gap 2012-2015. However, the European Union, as mentioned above, has
pledged through the European Commission considerable new resources to be deployed for the
achievement of the MDGs, in consultation with the ACP countries, which could contribute significantly
to supporting the GMAP fundraising agenda for 2012-2015.
4.4 Aid from emerging economies
Some governments in non OECD/DAC countries are already funding the GMAP, but with significant
potential to become more important, if not leading, actors in the fight against malaria, due to their
economic growth and positioning in the global development agenda. This could be done, in some
cases synergistically, through domestic commitments (for those of these countries that are also malaria
endemic) as well as public sector and private sector aid. This section will address their role as public
sector aid investors, while section 4.1 has reviewed their public sector’s domestic investments and
section 4.5 will examine the potential role of their private sector.
The G20 committed in the 2010 Seoul Development Consensus on Shared Growth to assist
developing countries, particularly low-income countries, in achieving the MDGs, including through
south-south and triangular cooperation. According to the World Malaria Report, the G20 countries that
are not members of OECD/DAC (Argentina, Brazil, China, India, Indonesia, Mexico, Russia, Saudi
Arabia, South Africa and Turkey) all had populations at risk of malaria in 2009. India, Indonesia and
Brazil in particular are among the 50 countries with the highest number of cases (India is number 2).
An analysis commissioned by the Resource Mobilization Sub-Committee shows that, among the new
emerging economies, Brazil, Russia, India and China (BRIC) are probably the foreign aid providers of
most relevant potential for supporting the GMAP. The level of aid provided by the BRIC is difficult to
assess in detail but it is undoubtedly on the rise and, at least for China, India and Russia, it seem
already now quite substantial. These countries have clearly expressed geopolitical interest in a number
of malaria endemic countries with funding gaps. Brazil, China, India and Russia have already
contributed resources to international GMAP efforts (regionally and/or in Africa). Based on the analysis
performed by the RBM Resource Mobilization Sub-Committee, it seems that China and Russia
contribute a significant 1.3-1.6% of their estimated aid budget to malaria. BRIC countries (with the
exception of Russia) clearly prefer bilateral south-south cooperation approaches, or, in some cases,
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trilateral deals with multilateral organizations, regional development banks or traditional OECD/DAC
donors (some of them, such as the UK and the US, are committed RBM Partners) 14 .
Brazil has demonstrated a growing interest in technical cooperation around malaria, having supported
in recent years small projects, mainly in Portuguese speaking African countries. In addition to leading
the malaria agenda in the IBSA (India-Brazil-South Africa) Forum, Brazil is an active member of the
Community of Portuguese Speaking Countries, headquartered in Lisbon, which also include two highcost
endemic countries in Africa: Angola and Mozambique. Brazil is the 7 th largest governmental donor
for the global research and development agenda.
The Russian Federation has so far prioritized multilateral funding and less tied forms of aid. Russia has
provided contributions to WHO and co-financed IDA operations on malaria, including US$15 million in
2008-2010 under the World Bank Malaria Booster Program in Zambia and Mozambique and US$4
million to WHO to support malaria interventions in Africa and the Middle East. For 2011-2014 Russia
has launched a capacity building project (with over US$4.5 million funding) to be implemented in
collaboration with WHO and with a main focus on malaria elimination in Africa and in the
Commonwealth of Independent States.
India is interested in increasing its development assistance to Africa. The first India-Africa Forum
Summit, in 2008, led to a Declaration, a Framework for Cooperation and a Plan of Action that entailed
a commitment by India to provide US$500 million in development assistance to Africa and included
health as an area for cooperation, mentioning malaria. In 2011, India declared that it would offer US$5
billion in credit to African countries for the next three years to help them meet their development targets.
India is currently the 6 th largest governmental donors for malaria research and development.
China has singled out malaria as one of the priority areas of its foreign aid effort in the health sector,
particularly in the “Beijing Action Plan (2007-2009)” and in the subsequent “Sharm El Sheikh Action
Plan (2010-2012) of the Forum on China-Africa Cooperation. The Sharm El Sheikh Action Plan,
following up on a previous commitment for some US$38 million, included a new pledge to “provide
RMB500 million Yuan [US$73.3 million] worth of medical equipment and malaria-fighting materials to
30 hospitals and 30 malaria prevention and treatment centers built by China for Africa in the coming
three years”, as well as a exchange programs in the area of malaria. News accounts have highlighted
China’s efforts on malaria in high-burden countries in Africa, such as in Tanzania and Uganda.
Potential for increase
There is undoubtedly potential for increase in the BRIC contribution to the 2012-2015 needs, as in
terms of economic growth all these countries continue to have a high GDP growth, ranging between 3-
4% (Russia) to more than 10% (China and India). In terms of foreign aid, if all the BRICS governments
contributed to a level of funding amounting to some 4% of their aid budgets), this effort could bring to
some US$130 million per year, as opposed to the current US$50 million (using aid budget estimates on
the higher side this amount could be as high as US$180 million) (see annex IIIa).
In addition:
Turkey, without having shown so far a marked interested in malaria, is nevertheless worth following
closely because of its dramatic increase in foreign aid over the past few years, and because it is an
influential member of the Organization of the Islamic Cooperation (which includes high-burden
countries such as Bangladesh, Indonesia, Nigeria, Sudan and Uganda).
For the same reason, Saudi Arabia and other oil-rich Middle East countries are also of major interest
(the RBM Partnership already receives support from the Abu Dhabi Government). However, as the
main potential in these countries is from foundations, it will be addressed in section 4.5 on foundations
and private philanthropy.
14 Both multilateral organizations and bilateral donors such as the European Commission, Japan, the UK and the US have
recently engaged in discussions and negotiations, in particular with China, about reaching trilateral cooperation agreements with
African countries. With some exceptions (e.g. a widely quoted DFID-funded malaria project in Angola that would have benefitted
by Chinese expertise), these agreements have so far been quite complex, politically sensitive and of limited success However,
US aid programs on malaria have been considered as a potential area for US-China cooperation. The potential benefit of
trilateral cooperation in supporting regional approaches of broader development scope has been acknowledged by US
diplomats, with the recommendation to focus this approach on projects that “have broad support within the African community,
preferably African-initiated and led” (Wikileaks: “US-China development cooperation in Africa”, 07 December 2010)
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Venezuela, though not a G20 country, is an oil exporting country affected by malaria, and its active role
in the context of the cooperation framework of the Amazon Countries Community could position it well
to support with Brazil the funding effort to meet the GMAP needs in the region.
4.5 Philanthropy and private sector’s social investment
Philanthropy and social investments in traditional donor countries
Philanthropic funding for the global fight against malaria is led by the Bill and Melinda Gates
Foundation, which committed US$1.7 billion in grants between 2004 and 2010, with a major focus on
advocacy and research and development.
Other important RBM Partners in the philanthropic area have been the UN Foundation and the Clinton
Foundation. The UN Foundation’s flagship initiatives have been the Nothing But Nets campaign
(having raised more than US$35 million) and the UN Foundation - United Methodist Church and
Lutheran World Relief campaign aimed to raise US$200 million for the malaria cause (to be channeled
through the Global Fund and faith-based organizations). The Clinton Foundation directs financial
resources to the implementation of its own programs on the ground, notably, on malaria, through the
Clinton Health Access Initiative, currently focusing on negotiating prices of malaria drugs and analyzing
and designing resource mobilization approaches for malaria elimination.
Among the top 15 US foundations providing resources for global development, a few have committed
funding to malaria projects, such as the Ford Foundation, mainly to assist organizations supporting
Global Fund’s grants, and the Rockefeller Foundation, which has contributed significantly to support
the malaria research agenda.
Outside the US, the major foundations involved in malaria support have been, as a funder/implementer,
the Geneva-based Aga Khan Foundation, as well as, as funders, the UK Welcome Trust, which has
substantially funded research on tropical diseases, including malaria, and the Portuguese Calouste
Gulbenkian Foundation, which has supported the fight against major epidemics and health system
strengthening in Lusophone Africa and East Timor 15 .
The corporate sector plays an important role in supporting the GMAP through direct cash contributions
to research and developments and, to a lesser extent, projects, co-investments in affected
communities, price reduction of commodities, in-kind donations and pro-bono services to organizations
involved in the fight against malaria. Among the corporate actors involved in the fight against malaria in
social responsibility and social investment activities, the Private Sector Constituency on the RBM
Board counts some 20 companies. Major contributors to the malaria agenda have been made by
companies, or corporate foundations, from the extractive and pharmaceutical industries as well as from
producers of malaria commodities.
Philanthropy and social investments in emerging economies
In emerging economies, philanthropy is growing, but it is still mainly focused on domestic causes. A
notable exception is the Carlos Slim Foundation in Mexico, which has a broad regional focus and has
recently launched, together with the Gates Foundation, the Government of Spain and the Inter-
American Development Bank, the Mesoamerica Health 2015 Initiative, funded with US$150 million,
aiming to reduce the gap in access to health faced by the poorest 20% of the population living in
Central America and Southern Mexico, and also including activities for the control of malaria.
In other countries:
Brazil has a long history of private philanthropy, in some cases linked to the Catholic Church.
Estimates of the amounts donated each year range from US$3.9 to US$4.7 billion. The bulk of this
comes from local and multinational corporations. A specific interest in funding the fight against
communicable diseases has been expressed by the Fundação Vale, which is the philanthropic arm of
the Vale Group (Brazilian mining company that is a member of the Global Business Coalition on
HIV/AIDS, Tuberculosis and Malaria). Over the last three years, Vale invested US$725 million in social
projects.
15 Malaria has also been a recurrent theme for the work of fraternal organizations, such as the Rotary, Kiwanis and Lions Clubs.
In addition, some relatively small foundations have also provided significant support, such as the UK Comic Relief, which has
granted £6.3 million to the Global Fund and the Malaria Consortium for the distribution of bed nets, health services and malaria
education programs in Africa.
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Brazil has also a large number of wealthy individuals: with nearly 150,000 high net-worth individuals
(HNWIs), it ranks second to China among the BRICS group of emerging economies (Brazil, Russia,
India, China, South Africa). “Ultra-high net-worth individuals” (those with financial assets in excess of
US$30 million) account for 87% of the total HNWI wealth. Among the 100 richest people in the world,
Forbes lists some Brazilian philanthropists who have been engaged in child development activities,
such as Joseph Safra or the family Moreira Salles.
Philanthropic giving in China has been reported as growing, but with a focus on domestic needs. This
has been linked to the Chinese system of guanxi, or personal connections, which emphasizes
personalized networks of influence in social relations and philanthropy. Some organizations already
gather Chinese business around charity causes. However, the overall weight of private philanthropy in
China is still modest, and many donations seem to come from the Chinese units of large multinational
companies.
An important development is obviously the emergence of private wealth in the country, as China
records the highest number of HNWIs among the BRICS (480,000 HNWIs), and the fourth largest
worldwide. A regularly published source of data on philanthropy among Chinese HNWIs is the Hurun
Philanthropy Report. According to the 2011 Report, the top 100 Chinese philanthropists have donated
individually some US$18.5 million annually on average. At least ten of them have expressed publicly
an interest in philanthropic giving to social welfare and health causes. About half of them have now
their own personal foundation, and some of them fund child welfare projects (e.g. the BYD Charity
Foundation, the Yu Pengnian Foundation). The Li Ka Shing Foundation in Hong Kong has also funded
projects on malaria. In addition, it seems that Diaspora philanthropy is also on the rise, so far providing
support mainly to Chinese organizations for the development, social welfare and education of the
people in connected clans and counties.
Private philanthropy in India has traditionally been guided by religion and caste, clan, family and
community demand, but, more recently, also by the development of a more modern corporate social
responsibility culture. Reliable estimates of the amounts donated each year are not available for recent
years, with figures as high as US$5 billion mentioned (2006). Philanthropy in India has been
characterized as typically inward-looking, focused on domestic needs (mainly education, but also
health) and not much prone to be reported publicly.
India has a relatively large number of wealthy citizens: 130,000 are HNWI, with a considerable
proportional increase in their number (+51%) between 2008 and 2009. Forbes currently lists 7 persons
among the 100 richest people in the world. Among them, there are personalities such as Mukesh
Ambani (who supports with his wife two Indian foundations linked to his corporate group, the Reliance
Foundation and the Dhirubhai Ambani Foundation, focusing on occupational health as well as
community health care, and including malaria), or the industrialist Gautam Adani, whose wife leads the
Adani Foundation, which implements, inter alia, activities against malaria in India.
Another significant potential could be found in the Indian corporate sector, although, at first glance,
malaria does not seem to have featured prominently in Indian corporate social responsibility activities,
certainly much less than HIV/AIDS. However, there are examples of interest, such as Tata Iron and
Steel, one of India's largest conglomerates, has sponsored numerous community health programmes
in India in the areas of direct relevance to malaria, such as human capital, mother and child health,
water and sanitation.
Other philanthropic sources with known potential are the international oriented foundations from oil
exporting countries in the Middle East. The most advanced philanthropic markets for this type of
foundations, virtually all supported by royal families and their networks, are in Jordan, Kuwait, Qatar,
Saudi Arabia and the United Arab Emirates. In addition to regional support, these foundations could be
targeted for their potential to be interested in supporting, more broadly, cost-driving malaria endemic
countries that are members of the Organization of Islamic Cooperation.
Last but not least, there are developments in philanthropic giving in Africa. The Gift from Africa
Campaign, which was announced at the MDG Summit in September 2010 and launched in Africa, with
initial pledges of US$3 million, was supported by the TY Danjuma Foundation, together with the United
Nations Global Compact, Friends of the Global Fund Africa, and the Global Business Coalition on
HIV/AIDS, Tuberculosis and Malaria. This initiative has been able not only to gather support for the
Global Fund from the private sector in Africa, but also to engage a new champion from the business
sector, the South African philanthropist Precious Moloi-Motsepe.
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Potential for increase
There are ad-hoc examples of many foundations supporting the fight against malaria in traditional
donor countries, but their financial commitment cannot at any rate compare with the financial support
that has been provided over the years by the Gates Foundation. In perspective, however, it is important
to note that at least four out of the 15 major US foundations have as a main thematic priority maternal
and child health, and they could therefore be the target of ad hoc fundraising effort aimed to support
the scaling up of support to malaria prevention, control and elimination as an effective step to
accelerate impact on maternal and child health.
All in all, the highest potential for new substantial money from philanthropy in western countries could
come from social investment and innovative financing deals, including with venture philanthropy. Some
of these organizations, such as the Children's Investment Fund Foundation (CIFF) or the Acumen
Fund, have an international portfolio with a direct link to child survival and health, thus with a significant
potential to include malaria, and they can become interested in matching their investments with the
contributions of other major donors (including the Gates Foundation, as it has been the case for CIFF
in supporting the fight against malnutrition). The UNF Pledge Guarantee for Health can offer additional
opportunities (see following section).
Opportunities for increase seem also to be found in business in endemic countries, particularly in
emerging economies from Asia and in Africa, and, more traditionally, in oil exporting countries.
If increasing contributions from foundations and other philanthropists in the various regions are
pursued, and as funding decisions in the philanthropic area are mainly made based on the influence of
networks and connections, a preliminary strategic mapping of the leverage that can be obtained from
RBM Partners would be needed to fully exploit the fundraising potential of philanthropy.
4.6 Innovative financing
The Resource Mobilization Sub-Committee established an Innovative Financing Task Force, led by the
Private Sector constituency, to review a comprehensive list of mechanisms within health, energy,
agriculture and development and propose potential new mechanisms that could help fill the funding
gap for 2012-2015, develop selection criteria and shortlist the most promising mechanisms.
This work was presented to the RBM Board at its 20 th Meeting in May 2011. The Board asked the Task
Force to develop a business plan for the possible implementation of a Malaria Bond, prioritize other
proposals and develop business plans for one or maximum two additional proposals between rounding
up credit/debit card spending and donations via ATM (possibly merged in one initiative), Diaspora
bonds and remittances.
Based on further analysis, the Task Force decided to pursue the possibility to include the Diaspora
bond within the Malaria Bond concept. It was decided that this would be looked at once the malaria
bond was implemented to capitalize on lessons learnt. However, while developing the Business Plan
for the Malaria Bond, the Task Force decided to develop concept notes for Diaspora bonds for malaria
as well as a bond aimed at implementing malaria activities within the private sector in malaria endemic
countries. These two concept papers will be presented to the Board at the 21 st Board Meeting in
November 2011.
The Malaria Bond business plan looks at setting up a pilot bond for approximately US$50 million to be
implemented before 2015 and gives further thought to how this can be scaled up. However it is clear
that the pilot will give extensive learning and proof of concept which will be used to develop this further.
UNITAID
Brazil, Chile, France, Norway, the United Kingdom and the Bill and Melinda Gates Foundation
established UNITAID in 2006 to contribute to scaling up access to treatment for HIV/AIDS, malaria and
tuberculosis by leveraging price reductions and accelerating access to drugs and diagnostics. UNITAID
derives most of its funding from an air solidarity levy which ranges from US$1 for economy class to a
maximum of US$40 for business and first class. Currently, eight countries contribute to UNITAID
through the airline tax system and some more through regular ODA contributions or other funding
mechanisms.
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Since its creation, UNITAID has committed US$350 million for provision of malaria drugs and supplies.
Malaria projects have represented so far some 26% of the total UNITAID portfolio. As part of the
UNITAID Strategy 2010-2012, an ongoing project for forecasting artemisinin and ACT demand and
supply will contribute to a decision by the UNITAID Board in 2012 regarding a new call for proposals for
innovative approaches to the provision of drugs, including for malaria (and will define future support to
the Affordable Medicines Facility for malaria). In the meanwhile, a call for proposals was launched this
year to promote the uptake of diagnostic technologies, which should allow opening this channel of
funding in mid-2012.
UNITAID, which is currently relying on a relatively restricted donor basis, is working on a resource
mobilization strategy for the years to come, which, if successful, would provide additional opportunities
to finance the 2012-2015 needs for the GMAP as part of the UNITAID support to the fight against the
three diseases. Based on an initial landscaping, UNITAID currently sees its most relevant fundraising
opportunities in consolidating the engagement of current donors, both through air taxes and ODA
contributions, increasing the number of governments implementing the air solidarity levy, with a
particular focus on emerging economies, exploring the possibility of involving the business sector in
voluntary solidarity contributions linked to air travel (e.g. in China) and possibly accessing funding
through other innovative financing mechanisms currently being discussed by the development
community, such as a solidarity tobacco levy or the financial transaction/currency transaction taxes.
Another area with potential impact on this resource mobilization strategy could come from UNITAID
supporting challenge grants for promoting new or improved technologies that can shape the market for
malaria products.
Debt to Health
The Global Fund's Debt to Health mechanism allows creditors and debtors to collaborate through debt
conversions to increase funding for Global Fund approved grants. Under a Debt to Health agreement,
creditors cancel a portion of their claims on the condition that the beneficiary country invests an agreed
counterpart amount in its national health programs through an approved Global Fund grant. The
revenue is reported as Global Fund's income.
To date, four Debt to Health agreements have been signed. They involve Australia and Germany as
creditor countries and Indonesia, Pakistan and Côte d’Ivoire as debtors/beneficiaries. Deals have been
concluded for some total US$105 million since 2007, of which some US$32 million could be attributed
to malaria grants in the three beneficiary countries.
UNF Pledge Guarantee for Health
The UN Foundation has established the Pledge Guarantee for Health (PGH), an innovative financing
mechanism backed by the Bill and Melinda Gates Foundation. This mechanism provides bridge
financing by organizing guarantees through Letters of Credit, so that health supplies can be shipped
while the normal processes of transferring donor funding for a particular commodity are worked out. In
late 2010, PGH helped the Government of Zambia, the World Bank and UNICEF accelerate delivery of
800,000 malaria bed nets ahead of the rainy season, potentially saving thousands of lives and millions
of dollars in the local health system. PGH has therefore added an important frontloading capacity,
which broadened the solutions that existed before to increase access for LLINs, namely: (1) for donors,
to provide more funding to secure additional supplies and commodities to reach underserved
populations; (2) for manufacturers, to lower their prices so that more supplies and commodities could
be secured with existing funding.
Potential for increase
Additional funding could be generated from new ideas and deals with innovative financing mechanisms
that have already supported malaria prevention and control targets.
The UNF/PGF is a case in point. The PGF is structuring a framework to amortize payments of
contraceptive implants across multiple years. There is a potential to do the same for LLINs, by
leveraging both Letters of Credit and Supplier Credit through bank guarantees so that donors and
endemic countries can provide bridge financing to accelerate delivery of LLINs. Without needing to
increase funding for LLINs, PGH enables donors and endemic countries to frontload the delivery of
LLINs in order to benefit from more years of protection. Countries are able to avert more deaths for the
same funding envelope, sidestepping funding constraints and ultimately enhancing value for donor
funding.
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The establishment of an ad-hoc innovative financing mechanism, such as the malaria bond, fully
dedicated to increasing resources for the GMAP 2012-2015 is another promising option, which would
challenge the RBM Partnership to strengthen its capacity to manage a relatively complex process
which requires investment and sustainable support. A separate analysis is provided to the RBM Board
by the RBM Task Force on Innovative Financing.
Innovative financing solutions adapted to specific country conditions can also be envisaged to be
proposed for adoption to foster domestic investments in emerging economies and other endemic
countries with a high malaria burden. For example a proposal to establish some innovative financing
options is being considered in Nigeria, with the support of the Friends of the Fund Africa. Other options
have been reviewed and presented in a piece of research by CHAI, already mentioned under 4.1.
4.7 Resource mobilization scenarios
Based on the analysis of the status and potential of the funding sources described in the preceding
sections as well as taking into account the inputs provided by the major donors to the section on
financing of the GMAP Implementation Overview, some high-level estimates are presented here of
possible levels of fundraising efforts to fill the 2012-2015 funding gap. These estimates are illustrated
through scenarios:
1. "Conservative” scenario: the main assumption of this scenario is that the major, current donors will
continue to contribute to malaria prevention, control and elimination at current levels or as committed or
estimated as of 8 November 2011 (notably the US, the UK, the World Bank and other regional banks,
the Global Fund, the Gates Foundation). This scenario assumes that the risk that these donors may
decide to reduce contributions from now on is low, but it takes into account the recent uncertainties
regarding the Global Fund's potential for providing resources (updated as of 8 November 2011 and
subject to further adjustments based on forthcoming discussions at the Global Fund's Board).
2. "Moderate growth” scenario: the assumption underpinning this scenario is for limited additional
funding flows that should be possible to mobilize with a relatively modest fundraising effort. These are,
namely, materialization of additional commitments of US and UK, current level of malaria aid of other
OECD/DAC members, the European Commission and major emerging economies (with a slight
increase from them), projected revenue from Global Fund rounds 11 and 12 (as of 8 November 2011),
available funding from the World Bank’s Booster Phase II, continuation of current UNITAID support as
well as continuation of domestic spending for malaria in endemic countries at the same level as
reported in the 2010 WMR. This moderate growth path (which may stop and stabilize at around 2014,
if no new sources are added) would not allow meeting the needs by 2015, or even later.
If maintained at these levels, funding would be still insufficient to address the needs for the next four
years, and the funding gap would remain extremely challenging. Based on the analysis of the current
and potential funding sources described in the previous chapters, it is possible to project a more
ambitious "accelerated growth" scenario, based on the assumption that a robust and creative
fundraising effort by all RBM Partners could result in much more significant increases in domestic
investments in emerging economies and in Africa, additional aid from the G7 and other selected
OECD/DAC members, more international investment from emerging economies, more funding from
philanthropic sources. There is also a larger scope for a range of frontloading options in this model,
notably through loans from the World Bank's IDA (thus supporting domestic investments, particularly
from Africa) and regional banks, reprogramming opportunities with the Global Fund and the
development of bonds dedicated to/including funding for malaria. The figures in this scenario would be
at this stage more theoretical than those in the other scenarios and they are therefore not presented
here in detail since they are not corroborated with donors and endemic countries. However, the growth
path that could characterize this more ambitious scenario is factored in in the graph which follows.
26

US$
8'000'000'000
7'000'000'000
6'000'000'000
5'000'000'000
4'000'000'000
3'000'000'000
2'000'000'000
1'000'000'000
0
Conservative scenario 2'795'000'000 2'775'000'000 2'775'000'000 2'725'000'000
Moderate growth scenario 3'900'000'000 4'240'000'000 4'570'000'000 4'500'000'000
Projected achievement path 3'900'000'000 4'700'000'000 5'600'000'000 6'597'000'000
Projected achievement path
with frontloading
2012 2013 2014 2015
4'500'000'000 4'700'000'000 5'600'000'000 6'597'000'000
Resource needs 6'830'000'000 6'784'000'000 6'698'000'000 6'597'000'000
Projected funding flow by funding source (as of 8 November 2011, in US$)
2012 2013 2014 2015 Comments
Resource
needs
Conservative scenario
Moderate growth scenario
Projected achievement path
Projected achievement path with
frontloading
US ongoing (multi-bilateral) 1 585'000'000 585'000'000 585'000'000 585'000'000
UK ongoing ((multi-bilateral
projection) 1
130'000'000 130'000'000 150'000'000 150'000'000
UK potential (additional multibilateral)
1
Continuation of expected 2012 funding
GMAP IO
120'000'000 320'000'000 650'000'000 650'000'000 GMAP IO + Framework for Results
Other OECD/DAC ongoing
(bilateral projection)
110'000'000 110'000'000 110'000'000 110'000'000 Based on bilateral aid 2009 (OECD/DAC) + R&D 2009 (Path)
EC ongoing (projection - R&D) 30'000'000 30'000'000 30'000'000 30'000'000 2009 contribution to R&D
Emerging economies ongoing
(multi-bilateral projection) 1
50'000'000 50'000'000 50'000'000 50'000'000
Emerging economies potential
(additional multi-bilateral) 1
Estimated continuation 2009 support incl. research
10'000'000 20'000'000 20'000'000 50'000'000 Assuming BRIC increase to reach burden sharing - average estimate of aid
levels
GFATM ongoing (projection) 430'000'000 410'000'000 390'000'000 340'000'000 GMAP IO
GFATM potential (additional,
lower)
100'000'000 100'000'000 100'000'000 40% of round 11 and 12 (at 0.5 billion) - only phases 1 expected by 2015
WB ongoing (projection) 50'000'000 50'000'000 50'000'000 50'000'000 GMAP IO
WB committed 200'000'000 250'000'000 250'000'000 200'000'000 GMAP IO: Booster Phase II
Regional Banks ongoing
(projection)
30'000'000 30'000'000 30'000'000 30'000'000
BMGF ongoing (projection) 1 Past programmes
170'000'000 170'000'000 170'000'000 170'000'000 GMAP IO
IF ongoing (projection) 50'000'000 50'000'000 50'000'000 50'000'000 26% of UNITAID tax component (2010 budget)
Domestic ongoing (projection) 1'350'000'000 1'350'000'000 1'350'000'000 1'350'000'000 WMR 2010 based on 2009 expenditures
1 Excluding commitments to Global Fund for 2011-2013
A 2'795'000'000 2'775'000'000 2'775'000'000 2'725'000'000 Conservative=expected
B 1'105'000'000 1'465'000'000 1'795'000'000 1'775'000'000 Easier to reach funding level
C 3'900'000'000 4'240'000'000 4'570'000'000 4'500'000'000 Moderate growth (A+B)
27

5. Resource mobilization strategy overview
The GMAP needs overall funding support to meet its needs for 2012-2015. A summary of strategic
fundraising streams (with some of them interacting and/or overlapping) is proposed below, together
with a range of related strategic actions that derive from the analysis of the current and potential
funding sources performed in the previous chapters.
A. Mobilize growing domestic public sector funding
There is ample justification for high-burden African and Asian countries to continue to make investment
in malaria prevention and control, in view of the high economic return and, for the African countries,
also to incrementally align their investments to the commitments they made in Abuja on increasing
health investments. This resource mobilization strategy recommends that:
A.1 Encourage African and Asian endemic countries to engage to progress towards more ambitious
domestic funding targets. Options would include accessing loans from the IDA (see sections 4.1 and
4.2) as well as increased private sector investment in malaria, in particular for those countries that are
experiencing an economic growth. Inter-governmental processes, such as in the context of the Africa
Union, ASEAN and regional economic communities in Africa and Asia would be essential to advocate
for the need for strong political leadership to drive this process.
A.2 Work with robust emerging economies such as Brazil, China, India and Indonesia, to maintain and
increase domestic spending for adequately cover their own needs. If these countries cover as much as
possible of their cost share in the GMAP, this would allow the fundraising effort of the RBM Partnership
to concentrate on poor countries with the greatest needs. In this context, it should be noted that the
Ministers of Health of the BRICS group of countries issued the Beijing Declaration in July 2011, which
institutionalizes the dialogue among the Ministries and the Geneva Permanent Missions around health
priorities. Challenges and opportunities for domestic engagement in malaria prevention, control and
elimination as well as synergies with other health areas, such as health system strengthening, could be
promoted as a core part of this agenda.
B. Maintain and expand the funding basis from traditional donors
Even if development assistance from OECD/DAC governments was not to increase significantly in the
next few years, they need to remain a key funding source for the GMAP. Resource mobilization
activities aiming at maximizing contributions from these traditional donors will therefore continue to
remain central to the 2012-2015 GMAP fundraising effort. This strategy will need to be adjusted
regularly to take into account the evolving challenges and opportunities with them.
B.1 Maintain G7 leadership in funding the next phase of the GMAP implementation: seize the
opportunity that the next two G8 Summits will be hosted by supportive governments (US, UK) to
continue to support the Global Fund’s fundraising effort and profile malaria prevention, control and
elimination and its value for money in the development financing agenda of the G7 and the urgency of
scaling up investments as the last opportunity to impact on the 2015 targets, including on maternal and
child health.
B.2 Build convincingly the case for GMAP support and links to the maternal and child health agenda
with a selected group of other OECD/DAC governments having the potential to become more relevant
bilateral and multilateral donors for malaria. This should be done through tailor-made strategies for
each donor including high-level consultations led by the best positioned RBM Partners with decision
makers of these governments in both capitals and embassies in endemic countries, as well as through
advocacy and communication activities aiming at creating conducive environments with the media, the
parliaments and the public. Section 4.3 has highlighted possible immediate targets and approaches.
B.3 Work with the European Commission to tap into the new EC/ACP resources for the achievement of
the MDGs and maternal and child health, while preparing dialogue with the Commission on the
Multiannual Financial Framework 2014-2020. This would include particularly establishing a timely
dialogue with the EC Directorate General for Development and Cooperation/Europeaid and the
Directorate General for Research.
C. Increase aid from emerging economies
28

This resource mobilization strategy proposes an increase in the emerging economies’ support to the
GMAP for 2012-2015 through a variety of means, including, for emerging economies that are also highcost
countries in the GMAP, domestic funding from the public and private sector (see strategic streams
A.2 and F.2). In addition, emerging economies can become leading international donors for malaria
prevention, control and elimination. This strategy suggests focusing on a few strategic emerging
donors:
C.1 Establish dialogue with aid decision makers in emerging economies such as Brazil, India and
China on ongoing and potential support to countries/regions of geo-political priority that are high
burden countries with funding gaps (including increased investments in malaria in the agendas of the
ASEAN, China/Africa and India/Africa cooperation fora, the Amazon Cooperation Treaty Organization,
the Community of Portuguese Language Countries).
C.2 Recruit at least one champion from emerging economies for profiling malaria financing in the G20
development agenda emerging from the Seoul Development Consensus for Shared Growth.
C.3 Profile malaria funding in ongoing discussions of trilateral development agreements between
emerging economies, OECD-DAC/regional development banks/multilateral donors and third countries.
C.4 Explore interest in malaria funding from other emerging donors that are increasing substantially
their aid package, such as Turkey (e.g. in support to needs in endemic countries that are members of
the Organization of Islamic Cooperation).
C.5 Retain funding commitment from Russia, and mobilize Russia’s political support for positioning
malaria in the G8 development discussions.
D. Frontload resources to accelerate impact of domestic investments and aid
Frontloading has the potential to be an extremely important tool to fundraise for the 2012-2015 needs,
since it would allow accelerated investment, which would show results by 2015 (see section 4.2). At the
same time, frontloading through loans (e.g. by the World Bank or regional banks) would encourage
domestic investments and contribute to fulfilling the international commitments on health spending.
Finally, in the hope that the financial vulnerability of the OECD/DAC members is a relatively short term
liquidity crisis, frontloading resources would help bridge the urgent financial shortfall of the GMAP and
allow the aid budgets of traditional donor countries to recover and resume their support for malaria
prevention, control and elimination.
A few proposals are put forwards in this strategy focusing on the possibility to frontload funding that
would otherwise only become available after 2015 (in addition to the establishment of a "malaria bond",
which is reviewed in the section E. below):
D.1 Take forward discussions with the World Bank and African Ministers of Finance on options for IDA
loans, with a focus on the 16 th and 17 th Replenishments.
D.2 Explore reprogramming options with the Global Fund to maximize Global Fund’s resources for the
GMAP for the 2012-2015 period, including in the context of the current reprioritization process.
D.3 Pursue opportunities with regional banks, along with the discussion with the World Bank, to
support substantial scaling up of funding for regional GMAP needs and synergistic results with other
health objectives, e.g. through matching mechanisms and incentives for regional cooperation.
E. Apply innovative financing solutions
Innovative financing is playing an important role in funding health and development, including malaria
prevention, control and elimination. It is recommended to continue exploring innovative mechanisms
such as those undertaken by UNITAID and also identify other possible avenues for funding, based on
criteria of comparative advantage, additionality, predictability and sustainability. Innovative financing
options have been described in various parts of this strategy and have already been mentioned in the
previous sections. The most relevant proposals are grouped as follows:
E.1 Create a dedicated innovative financing mechanism in support of the 2012-2015 needs, e.g. in the
form of a malaria bond.
29

E.2 Support UNITAID in ongoing fundraising efforts to bring in new countries adopting air taxes and
voluntary air-travel related contribution schemes, while maximizing the opportunities for malaria that
are being offered by the 2011-2012 UNITAID calls for proposals on diagnostics and drug procurement
and, potentially, a challenge grant for new LLIN technology.
E.3 Further explore use of remittances and Diaspora bonds to increase domestic resources for malaria
prevention, control and elimination.
E.4 Explore options for additional debt conversion deals (within and outside the Global Fund Debt to
Health mechanism) in support of the GMAP.
E.5 Expand use of the UN Foundation Pledge Guarantee for Health.
F. Encourage sustained private sector and philanthropic support
Increased contributions from foundations and other philanthropists in both traditional and non
traditional donor countries as well as for domestic needs could be pursued through various means:
F.1 Outreach to private sector actors in endemic countries in Africa to identify opportunities for
corporate engagement in support of domestic malaria prevention, control and elimination needs. An
advocacy/fundraising event with the African private sector is planned on the occasion of the 2012
World Malaria Day in Tanzania. The initial fundraising target is US$10 million. Based on the success of
this event, and some landscaping analysis, a broader and more stable partnership for supporting the
2012-2015 needs could be established with leading private sector champions in Africa.
F.2 Engage the private sector in emerging economies to contribute to filling domestic and international
needs, including through the above mentioned innovative financing mechanisms (e.g. bonds, voluntary
contributions to UNITAD from business travels, remittances, in-kind provision of high quality products
and services at international standards, etc.).
F.3 Develop ideas to solicit additional support from foundations, e.g. in the form of challenge grants or
matching gift mechanisms, in collaboration with the Gates Foundation or other major partner
foundations, aiming at leveraging support to the global maternal and child health agenda with a well
profiled malaria component (and, for example, allowing foundations or HNWIs from emerging
economies to contribute to the needs of their countries or regions).
G. Explore cost efficiencies and better integrated services to decrease resource needs
Several studies have been undertaken to examine the possibility of cost efficiencies. The below
suggestions are summarized from CHAI ("Value for Money in Malaria Programming: Issues and
Opportunities", 2011) and R4D (Results for Development, 2011 - Box 2).
G.1 Identify more effective ways of procuring LLINs. Bednet programs amount for more than 80% of
spending. There could be gains of 10% or so from more efficient procurement. Gains in value for
money would be obtained by measures such as better spatial targeting, longer net life or more efficient
replacement, as well as cutting net prices. It may also important to explore further public demand for
LLINs in endemic countries by promoting a cheaper shorter-lasting insecticidal net to be uniquely
available for purchase by the public in order to test and develop the private market.
G.2 Reduce overlap of LLINs and IRS programs, at least until more is known about the possible
benefits of providing them together. Most spraying is currently done in areas that are also covered by
bednet programs. Research is underway to estimate the additional protection provided by the
combination of the two interventions, to be weighed against the additional cost.
G.3 Rotate insecticides used for IRS to delay resistance. The spread of resistance to current
insecticides is a serious threat to malaria prevention and control and value for money of malaria
interventions. Both the use of multiple insecticides in vector control programs and the development of
new ones are a high priority, as well as continuing research and bringing down the costs of existing
alternatives.
G.4 Accelerate the availability and appropriate use of RDTs. RDTs are cost effective when the benefit
of appropriate treatment of non-malarial fevers are considered.
30

G.5 Better understand the efficiencies of integrated health packages including systematically malaria
prevention, control and elimination components. Analyses have been carried out in different countries
of the costs of integrating bednets, in particular, into measles, water and sanitation, HIV/AIDS or polio
vaccination interventions. Overall, it has been argued that integration results in reduced costs,
increased coverage, early detection, reduction in stigma and delayed disease progression (e.g. for
HIV/AIDS) through prevention of malaria. However, on the negative side, a major reason for not using
an integrated approach has been the need to achieve rapid scale up in targets through large-scale,
disease-focused national campaigns. A more in-depth validation of integration costs and savings and a
review of financing models and opportunities and obstacles for integration are needed for making a
convincing case for integration approaches with national authorities and donors.
Box 2 - Cost efficiencies in LLIN procurement
R4D (Results for Development) has noted annual decreases in pricing from 2007 given increasing
volumes and a more diversified supplier base, with 3 suppliers in 2007 and 10 suppliers in 2011.These
price declines have accelerated in 2011.
R4D has identified three potential opportunities for increasing the efficiency of the LLIN marketplace:
a) focus on highest value for money products;
b) reduce the fragmentation of packaging and specifications (200+ supplier offerings, with ~25
commonly purchased variants); and
c) strengthen strategic national procurement capacity (e.g. improved forecasting/quantification, splitting
tenders).
The streamlining of packaging and specifications would not only save well over US$100 million over 5
years, but it would also lead to a reduction of over one month in lead time to delivery.
R4D will also continue to explore the following key issues in coming months to determine any potential
market dynamics interventions:
Product
innovation
Competitive
marketplace
Country
strategies
Local
production
� Price focused tenders reduce incentives for innovations on quality
� Insecticide resistance is emerging as a key concern, though next generation
‘resistance’ nets may be more expensive → need to review procurement policies,
incentives for innovation around resistance-management nets.
Market conditions (e.g. challenges in production planning, ‘winner takes all’
tenders, decreasing prices) may threaten a competitive, sustainable supplier base.
� Net usage rates are below target levels, with limited evidence on drivers of net
usage → need to develop, incorporate info into LLIN strategies
� Effective continuous replacement financing, procurement strategies are critical to
establish following universal coverage push.
R4D will explore local production as it relates to market dynamics impact (e.g.
shorter lead times, reduced delivery costs) with development benefits examined by
the School of Oriental and African Studies (SOAS) and others.
31

Special Focus on Africa
The vast majority of deaths are occurring in sub-Saharan Africa. The financing gap for commodities
and their delivery is US$3.2 billion from now until the end of 2015. Based on current discussions
strategic action on this special focus objective would include:
� US$1 billion anticipated from the Global Fund which will be applied to 2015 targets and could
potentially fully fund 2015 needs for Africa with the exception of except Nigeria, the cost driver
in the continent 16 .
� US$ 1 billion needed for Nigeria for 2012-15 to be addressed by a special support group,
including the federal and state governments of Nigeria and committed donors;
� US$ 0.6 billion for 2012-2014 for African countries (except Nigeria) to be mobilized through
development banks' loans and the Global Fund’s Transitional Funding Mechanism;
� US$ 0.6 billion, the remaining funding gap, to be mobilized 2012-2014 through other donors,
still to be identified.
ALMA and the RBM Harmonization Working Group, together with relevant Board members and
members of relevant RBM Committees and supported by the RBM Situation Room, will be primarily
tasked with the responsibility to work with countries in Africa to achieve this priority fundraising
objective.
16 It is hoped that the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been a leader in enabling the funding
successes of the last few years, will provide funding to meet two-thirds of the total gap, in line with the proportion it has
previously funded.
32

6. SWOT analysis, roles and responsibilities in the RBM Partnership and budgetary implications
6.1 Fundraising capacity of the RBM Partnership: analysis of Strengths, Weaknesses,
Opportunities and Threats (SWOT analysis)
Strengths
� Remarkable success of the Partnership in increasing funding over the last years. The
Partnership is well positioned and visible, and can learn from and build on its success.
� The public/private nature of the Partnership, including public sector donors, endemic
countries, multilaterals, foundations, the private sector, civil society and academia puts it in
a unique position to leverage maximum influence for the global malaria targets as well as
for fundraising from various funding sources.
� The creation of the RBM Resource Mobilization Sub-Committee shows the determination
of the Partnership to work together and share knowledge on fundraising for more
effectiveness.
� The record of results and impact is strong. The Partnership has developed over time
strong arguments for investing resources in malaria; these need to be updated and
adjusted to the new environment.
Weaknesses
� Not all Partners are currently directly engaged in fundraising efforts for the GMAP.
� Responsibilities on resource mobilization have been scattered, without clear coordination
and information sharing processes in place.
� Partners have still to learn from the process on how to develop a culture of common
purpose in fundraising for the GMAP.
Opportunities
� The Partnership has a relatively strong support from the philanthropic sector. Philanthropy,
including venture philanthropy, has a marked interest in maternal and child health, and
could offer important fundraising opportunities.
� The Partnership has Board members, or members of organizations represented on the
RBM Board, who are high-profile figures who can use their status, experience and
connections to advocate and significantly support fundraising for the GMAP, in view of the
2015 GMAP Objectives and Targets.
� Research and development capacity in the Partnership is well funded and progress is
under way to discover new tools that can decrease the malaria burden and future malaria
prevention, control and elimination costs.
� Social networks, if well managed by the Partnership, can be a source of support and
visibility for the resource mobilization objectives.
Threats
� The overall slowing down in ODA growth is forecast to be more marked for support to low
income countries and for Africa. The overall slowing down in ODA growth is forecast to be
more marked for support to low income countries and for Africa. The uncertainties around
the Global Fund's capacity as a main funder of the GMAP over the next few years, are a
major, immediate threat, which requires the RBM Partnership's attention and preparedness
to explore alternatives.
� Some high-burden countries are unstable, and this poses problems for both domestic and
external investments in malaria prevention, control and elimination.
� Population growth in malaria-affected countries may have significant impact on the malaria
prevention, control and elimination efforts (it is for example forecast to soon outpace ODA
growth).
� Commodity prices: vaccine and medicine prices affect the partnership mission and
attainability of fundraising objectives.
Elements that are both opportunities and threats
33

� Financial control and oversight is essential for effective management and risk mitigation at
country level, however it can be detrimental if it paralyses countries in their scaling up of
efforts for impact.
� The emerging economies are showing support to development aid and the MDGs. These
commitments can increase further and be better coordinated with those of other donors.
� Other health and development areas are receiving attention from the development
community (e.g. climate change). The Partnership needs to map out systematically
competitive challenges and opportunities for synergistic resource mobilization.
� Increased resistance to artemisinin and insecticides is experienced in some regions. While
this is a major challenge in perspective, it also offers the opportunity of positioning even
more strongly on the international public health and donor agenda malaria prevention,
control and elimination as a global public good.
� Regulations. Trade laws as well as drug regulations may have a positive or negative
impact on scaling up malaria prevention, control and elimination efforts and deployment of
resources.
6.2 Roles and responsibilities in the RBM Partnership
6.2.1 The Board
This resource mobilization strategy will have limited potential to be successful on any of the
fundraising streams described in the previous chapters without active support from Board
Members. As part of its responsibility for financial accountability and oversight, the Board plays a
central role in ensuring that sufficient funds are raised to meet the needs for the 2012-2015 phase
of the GMAP implementation, in view of the 2015 GMAP Objectives and Targets, and can use the
Partnership Work Plan as an instrument to achieve this.
The responsibilities of the Board as an entity can be summarized as follows:
� Provide overall guidance to and review challenges and opportunities of this resource
mobilization strategy through discussions at Board meetings;
� Ensure appropriate donor representation in the governance processes of the Partnership,
including encouraging new donors to join the funding effort through domestic investments
as well as bilateral and/or multilateral aid;
� Help its Chair and Vice-Chair to take a leadership role in advocating for increased
resources;
� Challenge its Members to be proactive advocates for increased resources with their
respective countries and constituencies.
Board Members, individually, are responsible for:
� Acting as advocates and spokespersons when any opportunity arises, to give credibility to
the fundraising efforts;
� Using their networks and contacts to broaden the group of decision makers and
influencers in development financing that can be instrumental in addressing the funding
challenge towards the achievement of the 2015 GMAP Objectives and Targets.
Board Constituencies. Each Board Constituency has different assets in supporting the resource
mobilization effort. Some of them are more apparent, and will be reviewed below, some others may
need to be identified and mapped on a case by case basis.
Malaria Endemic Countries
The success of this resource mobilization strategy depends very much on the endemic countries
investing domestically and presenting a convincing demand for external aid to address malaria as
a priority public health problem. The constituencies from malaria endemic countries can be key
actors in involving and facilitating dialogue of the Partnership with their Ministers of Health and
Ministers of Finance around domestic investments and innovative financing opportunities (such as
Diaspora funding).
The Chair of the Board, in particular, having traditionally been in the RBM Board a high-level
representative from an endemic country, presently a Minister of Health, can play a prominent role,
together with the RBM Executive Director and ALMA, in advocating with peers for domestic funding
and providing a voice from the south in the fundraising dialogue with existing and potential donors.
34

Board Members of the Malaria Endemic Countries also play a crucial role in informing the
Partnership of opportunities for profiling malaria in consultations and events of regional, subregional
and international groupings (African Union, regional economic and development
commissions, the ACP group of states in the dialogue with the European Commission, the
Organization of the Islamic Cooperation, the Organization of American States, etc.) and therefore
spread the word and engagement of other southern constituencies about prioritizing malaria and
adopting resolutions for members to commit to financial support.
Board Members from endemic countries that are emerging economies are instrumental in helping
the Partnership to articulate a “case statement” for support of resource mobilization objectives and
to facilitate the Partnership's outreach to relevant ministries for domestic investments and malaria
aid to third countries, as well as for advocacy opportunities e.g. in the context of the G20 process.
OECD Donor Countries
The OECD Donor Members are the core actors when it comes to engaging the G7/G8 leadership
as well other OECD/DAC development agencies and the European Commission in support of
malaria prevention, control and elimination. They can make a convincing case for increased
bilateral and multilateral funding from those governments and other traditional donors, and help the
Partnership prevent and react timely to donor fatigue and ensure continued engagement in funding
for malaria.
OECD Donor Members can help identify for the RBM Partnership opportunities to position malaria
prevention and control and related requirements in relevant donor fora, such as the G8 and G20
processes, the EU agenda and OECD/DAC consultations.
Also, OECD Donor Members can support this resource mobilization strategy by advocating for
including malaria prevention, control and elimination in integrated packages of health services
within their health system strengthening/maternal and child aid budget, as well as in trilateral
cooperation agreements between their governments, emerging economies and malaria endemic
countries, debt relief deals and re-programming options that can help frontload resources to
accelerate scaling up of interventions.
Multilateral Development Partners
Multilaterals have the advantage of an extensive field presence, which is instrumental for the
dialogue with endemic governments about elevating malaria in domestic financing and with donor
delegations about aid at country level.
The UN Members help profile malaria in the MDG agenda and advocate for increased funding in
support of the impact that the 2015 GMAP Objectives and Targets can have on the achievement of
the 2015 MDGs.
The World Bank has a distinct advantage, in addition to being a major external donor for malaria
prevention and control, in bringing the GMAP financing needs to the attention of Ministers of
Finance in endemic countries. The World Bank has a primary role in fostering the use of IDA loans
in support of the 2012-2015 needs and beyond. The World Bank can also be a key actor in
supporting the RBM Partnership's dialogue with regional banks for substantial scaling up funding
for regional needs.
The Members of the Multilateral Constituency can also rely on their liaison offices in donor capitals
for intelligence building and dialogue with key potential donors (e.g. World Bank and UN offices in
Brussels to explore funding options from the European Commission's External Action budgets;
World Bank and UN offices in Moscow to maintain and increase attention on malaria elimination
from the Russian Federation; etc.).
Research and Academia
The Research and Academia Constituency has a primary role in advising on specific opportunities
to fund research as part of the overall fundraising effort (e.g. supportive arguments for outreach to
DG Research in the European Commission) as well as identifying and involving leading academics
in influencing aid decision makers (e.g. tropical research institutes in targeted donor countries can
help advocate for support from their governments for the fundraising effort in countries of geo-
35

political priority). The Members involved in operational and economic research help take forwards
the agenda on cost efficiencies and return on investment, which has a major impact on decreasing
the price tag of the 2012-2015 phase of the GMAP and on providing a key advocacy argument for
increased investments.
Non-Governmental Organizations
The role of the NGO Board Constituencies is crucial to ensure that civil society and communities
have an effective role and voice in identifying needs and in promoting supportive advocacy
activities with both the public and the private sector. This includes supporting the mobilization of
southern advocates and other partners. The NGO Board Constituency provides an important entry
point for key advocacy opportunities, to facilitate the organization of events and reinforce
messages from the grassroots, and also for increasing the demand for malaria interventions and
mobilizing the private sector and the communities in endemic countries.
Private Sector
The Private Sector Constituency guides and advises the Partnership on development of highpriority
funding opportunities with the corporate sector, including innovative financing solutions
involving the financial sector, as well as efficacy of supply chain management and measurement
tools. The Constituency is also a leading actor, together with the Special Envoy, in outreach to
major corporations and advocacy activities with the private sector.
Foundations
The Foundation Constituency and its leading Members can make influential advocacy around the
urgency of fully funding the 2012-2015 needs in view of the achievement of the 2015 GMAP
Objectives and targets and also in developing innovative ideas around leveraging increased
funding from the public and private sector (including through challenge grants, matching gifts, etc.).
The Constituency has also been so far a key actor for support to the research agenda and
monitoring and evaluation needs.
Ex Officio Board Members
African Leaders Malaria Alliance (ALMA)
Because of its top-level membership of Heads of State and Government from Africa, ALMA plays a
similar role as the endemic country constituencies (see above) in high-level advocacy for domestic
investments and presenting a convincing demand for external aid. The ALMA "Scorecard for
accountability and action" also provides and useful tool to track funding for commodities.
The Global Fund
The Global Fund has been the major external financier for malaria prevention and control, and it
has a key responsibility and challenge in attracting confidence from development donors and in
identifying with partners how its resources can provide the maximum impact. The support of the
Global Fund Board Member is important to help the Partnership identify options for flexible and
efficient use of available resources to support scaled up efforts at country level and maximize
results, including in the context of the current constraints and the Global Fund's ongoing
architecture review and strategy development.
UNITAID
UNITAID's long-term funding commitment has important implications not only for the level of
funding available for the GMAP but also for fostering market dynamics that can result in decreasing
the overall price tag and increasing value for money. The UNITAID Board Member can be an
important ally in this resource mobilization strategy by helping identify and share information about
malaria specific opportunities that may be made available through the UNITAID processes as well
as involving UNITAID in joint fundraising and advocacy opportunities.
UN Secretary General Special Envoy for Malaria
36

The UNSG Special Envoy is the key UN ambassador for political will and funding for the GMAP,
and he has a primary role in profiling malaria high on the UN Secretary-General's agenda,
including in interaction with governmental leaders on behalf of the Secretary-General, in the UN
processes and in global advocacy and political positioning of malaria in the international
development agenda. Because of the Special Envoy's leverage in the corporate and philanthropic
sector, he also has a comparative advantage in leading outreach to major corporations, together
with private sector partners.
6.2.2 Secretariat
The Executive Director ensures the bold political leverage that is needed for advocating
convincingly for the GMAP, for interacting with the decision makers at the highest level from both
donor and endemic countries. The Secretariat has the responsibility of taking forwards information
sharing for coherent approaches between Partners on fundraising targets, activities and outcomes,
ensure harmonized reporting systems and consistency of data messages around resource
mobilization across the Partnership and engage SRN and relevant Working Group Focal Points in
supporting resource mobilization objectives.
6.2.3 Sub-Regional Networks and Working Groups
The Sub-Regional Networks, as coordinating bodies of Partners, can have a supportive role in
helping fundraising at local level. Among the Working Groups, the Harmonization Working Group
has developed a role in supporting resource mobilization at country level, to facilitate a high level of
success in applications to the Global Fund and other major funding initiatives. The work of the
Malaria Advocacy Working Group would also have a link to the resource mobilization effort.
6.3 Budgetary implications
Scaling up the GMAP resource mobilization effort for 2012-2015 will have cost implications. It is
expected that Partners will help address these costs and sponsor from their budgets additional studies
or activities that may be needed as well as cover their outreach activities and meeting costs.
A few structural costs would also need to be specifically budgeted in the Partnership Work Plan. These
mainly include provisions related to a core capacity to facilitate the implementation of this strategy, with
a focus on helping the RBM Executive Director to facilitate coordinated tracking and regular information
sharing with Partners on evolving GMAP resource needs, commitments, funding flows and funding
gaps, including in the context of special focus needs that the Partnership may decide to concentrate on.
This, in collaboration with WHO and funding tracking processes carried out by other Partners, will help
develop a more robust and consistent base of data, including for countries outside Africa, to feed the
funding section of the GMAP Implementation Overview and alert Partners on needs and opportunities
to inform their action.
37

7. Conclusions and recommendations
The RBM Partnership must remain prepared for a considerable funding effort to meet the global
malaria prevention, control and elimination needs to be met by 2015. It is anticipated that most of the
RBM top donors will continue to constitute the main source of funding, but also acknowledges that they
cannot be solely responsible for the required scaling up and for sustainably maintaining the levels of
coverage achieved.
The previous chapters have outlined where to find additional funding, how to mobilize and what the
RBM partnership needs to be ready to do in order to take this resource mobilization strategy to a
different level of funding outcome.
Here a summary of the main points:
� The dramatic increase in global funding for malaria prevention, control and elimination has
led to a remarkable record of results and impact. There are clear indications that the
international community is maintaining commitment, and for some donors notably also
funding commitment.
� The RBM Partnership contributed positively to this fundraising success, and it has shown
over the past few years both strengths and weaknesses, notably in engaging proactively
and cohesively in resource mobilization. The Partnership will need to be ready to adapt
quickly and respond effectively to challenges in order to be even more successful in
resource mobilization.
� There is now a renewed urgency to meet the funding challenge represented by the global
financial crisis and a significantly reduced potential for Global Fund’s support, at least in
the near future, with much more limited resources to meet the 2015 targets.
� Raising additional financial support is a challenge, but not an insurmountable one, if the
RBM Partnership commits to contribute cohesively to the expansion of fundraising efforts.
All Partners will need to contribute, and the Board will need to play a key role in guiding the
funding efforts with even more emphasis than before.
Recommendations:
The Resource Mobilization Sub-Committee proposes the following recommendations for the Board -
and respective oversight roles:
� Endorse the funding target and the fundraising streams described in this strategy, with an
immediate focus on the GMAP target of reaching near zero malaria deaths by 2015 and with a
view to getting as close as possible to filling the funding gap of the GMAP for 2012-2015.
Oversight: Chair of Performance Work Stream.
� Commit to proactively support this resource mobilization strategy and invite Board Members to
volunteer to mobilize their political leverage, expertise and contacts to serve this strategy.
Oversight: Chair of the Board.
� Encourage further bilateral and multilateral support in support of the 2012-2015 GMAP needs,
with a view to making additional funding available to high-burden countries.
Oversight: Donor Constituency Representatives and UN Special Envoy.
� Encourage Board Members to urge high-burden endemic countries to engage their Ministers of
Finance in supporting increased domestic investments for malaria prevention, control and
elimination, in consideration of the urgency of scaling up funding, looking at ways to frontload
resources, including by applying for loans from the 16 th and/or 17 th IDA Replenishments.
Oversight: World Bank Representative, UN Special Envoy and ALMA Representative (for
Africa).
� Invite Board Members from emerging economies to contribute to scaling up their bilateral and
multilateral support to malaria endemic countries to achieve the MDGs by 2015, both through
increased investments for domestic needs and by positioning malaria prevention and control
high on their aid agendas and budgets.
Oversight: Board Members from G20, UN Special Envoy.
38

� Request the RBM Executive Director to support the follow-up to these recommendations and
implementation of the strategy, including helping develop a harmonized tracking system for
resource needs, commitments, funding flows and funding gaps, so as to develop a more robust
and consistent base of data, including for countries outside Africa, in support of an effective
implementation of this strategy.
Oversight: Chair of Performance Work Stream.
� Urge each Partner to confirm commitment to make ending of malaria deaths a major
development priority for the next four years.
Oversight: Chair of the Board and UN Special Envoy.
39

Annex I. Summary of PESTEL analysis of the GMAP resource mobilization environment
Political
Economical
Social
Technological
Key driver Opportunity Threat
Political Stability in traditional donor countries, leading to lack of leadership on
ODA and Health
- Upheaval in Euro area
- Paralysis in Japan
- Partisan approach in US and other donor countries
Right wing political shifts in major donor countries
- Uncertainty on the availability of long-term funding sources
X X
- Decreasing priority on ODA
International political power balance changing
- waning influence of traditional G8 donors
X
- unclear commitment from "rising" G20 countries, unclear legal structures
Competing development priorities
- Visibility of malaria among other areas (migration, climate change etc)
X X
- Shift of ODA towards Climate change (with potential upside for malaria)
Focus on Mother and Child Health
X X
- Potential for increased focus on malaria
Value for money
- Performance based funding
X X
- Cost effectiveness of interventions X X
Political instability in high burden countries affecting implementation
Global Economic Environment
- Recession
- Exploding debt burden in donor countries
- Stalled growth
X
- Currency fluctuation risks
Emergence of new economic powers
X X
- ODA potential
Focus on benefit of investments
- Economic return of malaria investment
- Focus on value for money & cost effectiveness
X
- Performance based funding
Donations
- Increasing philanthropic donations (through eg tax incentives)
X X
- Personal donations/collections X
Innovative Financing
- Emergence of new mechanisms to ensure sustainability and predictability in funding
- Financial Transaction Tax (devoted to Health)
- Increased Cause related marketing by partners to fundraise X
Increased focus on financial accountability - less rapid scale-up
- Focus on financial control and oversight and value for money, may prevent rapid scaleup
X
Push for MDGs leading to increase in funding towards 2015 X X
Social Networking
- Internet crowd sourcing X
Trust in traditional institutions
- More focus on niched NGOs
- RBM perception as a UN organization
- Cultural aspects to support foreign bodies such as RBM X
RBM Brand
- RBM Board Relations - opportunity for leveraging X
Focus on results through "personal stories" X
Population growth in endemic countries X
Commodity prices
- Vaccines and medicine prices affect our mission and fundraising objectives X
New Products
- Discovery of more effective cures/vaccines/insecticides
- Increase in drug and insecticide resistance
- Value for money drives product development X
Changes in research agenda (MalERA)
- Development of elimination strategy for vivax X
Climate change X X
Urbanization and land use X X
Environmental Drug and insecticide resistance
- New drugs and insecticides
Changes in animal reservoir (genotype change)
X
Legal
Trade regulations impacting on malaria commodities X
Drug regulations and licensing X
Depency on WHO for setting technical standards and product evaluation X
40

Annex IIa - Aid investment in GMAP from OECD/DAC and BRIC governments and simulation of increased investments (US$)
Aid investment in malaria control from OECD/DAC and BRICS Members and simulation of increased investments
Current aid level Simulation of potential
Donor Country
2010 Net ODA 2009 Net ODA
Bilateral malaria
contributions
(commitments) -
OECD/DAC 2009
Multilateral
malaria
contributions
2009 (27% of
GFATM
contribution -
Contribution to
R&D 2009
Estimated % of
2009 ODA
Contributed to
malaria
1.5% of 2010 ODA
for malaria control
(when not yet reached)
2% of 2010 ODA
for malaria
control
(when not yet
reached)
Australia 3,849,000,000 2,762,000,000 0
Round 9)
8,861,319 11,391,587 0.7% 57,735,000 55,240,000
Austria 1,199,000,000 1,142,000,000 167,100 0 0.0% 17,985,000 22,840,000
Belgium 3,000,000,000 2,610,000,000 1,660,400 6,299,646 0.3% 45,000,000 52,200,000
Canada 5,132,000,000 4,000,000,000 35,728,000 38,201,585 1.8% 73,929,585 80,000,000
Denmark 2,867,000,000 2,810,000,000 0 8,605,774 0.3% 43,005,000 56,200,000
Finland 1,335,000,000 1,290,000,000 332,900 1,322,339 0.1% 20,025,000 25,800,000
France 12,916,000,000 12,600,000,000 515,200 111,934,657 11,027,001 1.0% 193,740,000 252,000,000
Germany 12,723,000,000 12,079,000,000 456,300 73,289,279 5,383,784 0.7% 190,845,000 241,580,000
Greece 500,000,000 607,000,000 13,900 0 0.0% 7,500,000 12,140,000
Ireland 895,000,000 1,006,000,000 1,698,900 3,770,820 0.5% 13,425,000 20,120,000
Italy 3,111,000,000 3,297,000,000 3,070,200 50,788,598 1.6% 53,858,798 65,940,000
Japan 11,045,000,000 9,457,000,000 19,297,500 52,495,040 0.8% 165,675,000 189,140,000
Korea (ROK) 1,168,000,000 816,000,000 104,800 945,000 0.1% 17,520,000 16,320,000
Luxemburg 399,000,000 415,000,000 1,069,500 896,872 0.5% 5,985,000 8,300,000
Netherlands 6,351,000,000 6,426,000,000 0 22,537,440 6,185,521 0.4% 95,265,000 128,520,000
New Zealand 353,000,000 309,000,000 0 0 0.0% 5,295,000 6,180,000
Norway 4,582,000,000 4,086,000,000 1,160,000 18,130,865 0.5% 68,730,000 81,720,000
Portugal 648,000,000 513,000,000 29,200 675,000 0.1% 9,720,000 10,260,000
Spain 5,917,000,000 6,584,000,000 5,769,900 57,510,000 6,526,248 1.1% 88,755,000 131,680,000
Sweden 4,527,000,000 4,548,000,000 0 24,230,648 0.5% 67,905,000 90,960,000
Switzerland 2,295,000,000 2,310,000,000 0 1,699,182 0.1% 34,425,000 46,200,000 Top level donors
United Kingdom 13,763,000,000 11,283,000,000 46,346,900 49,699,251 30,190,739 1.1% 206,445,000 225,660,000 Higher middle range donors
United States 30,154,000,000 28,831,000,000 373,842,700 258,939,905 164,805,181 2.8% 797,587,786 797,587,786 Lower middle range donors
Sub-total 128,729,000,000 119,781,000,000 491,263,400 790,833,218
1,517,606,679
235,510,061 0.7% 2,280,356,168 2,616,587,786 Bottom level donors
Sources: OECD, 2011: http://www.oecd.org/dataoecd/54/41/47515917.pdf; GFATM Pledges and Contributions Table (accessed June 2011)
Donor Country
Bilateral malaria
contributions
(average
estimates)
Other malaria
contributions
2009 (27% of
GFATM
contribution,
UNITAID,
WHO/WB
Booster)
Contribution to
R&D 2009
Estimated % of
aid to malaria
Simulation of
potential
4% of aid for
malaria control
Brazil 590,000,000 1,000,000 3,400,000 6,500,000 1.8% 23,600,000
China 1,500,000,000 24,400,000 540,000 1.7% 60,000,000
India 600,000,000
0 540,000 8,400,000 1.5% 24,000,000
Russian Federation 500,000,000
0 6,000,000 1.2% 20,000,000
Sub-total 3,190,000,000 25,400,000 10,480,000
50,780,000
14,900,000 1.6% 127,600,000
Donor Country
Annual aid budget (average estimate)
Annual aid budget (higher estimate)
Current aid level
Current aid level
Bilateral malaria
contributions
(average annual
estimates)
Multilateral
malaria
contributions
2009 (27% of
GFATM
contribution,
UNITAID,
WHO/WB
Booster)
Contribution to
R&D 2009
Estimated % of
aid to malaria
Simulation of
potential
4% of aid for
malaria control
Brazil 1,000,000,000 1,000,000 3,400,000 6,500,000 1.1% 40,000,000
China 2,000,000,000 24,400,000 540,000 1.2% 80,000,000
India 1,000,000,000
0 540,000 8,400,000 0.9% 40,000,000
Russian Federation 500,000,000
0 6,000,000 1.2% 20,000,000
Sub-total 4,500,000,000
25,400,000 10,480,000
50,780,000
14,900,000 1.1% 180,000,000
Sources: RMSC Paper: "Financial opportunity mapping with Brazil, Russia, India, China, South Africa, Malaysia and Mexico"; GFATM Pledges and Contributions Table (accessed June 2011)
41

Annex IIb. Domestic investment in health and malaria control from high-burden African countries and simulation of increased investments
Countries
GMAP Costs
2012-2015
(USD billion)
Death
burden
(ranking -
WHO 2011)
Disease
burden
(number of
cases: WHO,
2011*)
Annual
malaria
investments
(US$ million
2009 - WMR
2011)
Health
investments
(US$ million
2009 -
extrapolatio
n from IMF
WEO 2011
Nigeria 1.6 1 55,707,630
0.20 9,793
Uganda 0.7 6 9,075,134
0.00 1,296
DRC 0.6 2 18,168,420
2.00 222
Tanzania 0.5 3 11,374,250
NA 1,069
Sudan 0.4 7,888,891 26.27 4,073
Mozambique 0.3 4 7,538,293
0.00 573
Ghana 0.3 6,278,813
8.70 2,105
Cameron 0.3 5,146,960
8.55 1,553
Cote d'Ivoire 0.2 9 7,460,826
0.00 1,147
Burkina Faso 0.2 5 5,086,618
0.02 542
Niger 0.2 8 4,542,784
0.90 322
Chad 0.1 7 4,143,122
0.00 488
* Data not yet validated through country consultative process as of March 2011
Malaria
spending as
% of health
spending
Progress in 15%
Abuja target
(WHOSIS 2011)
GDP growth 2009/2008 (IMF,
WEO April 2011)
% growth
(constant
price, local
currency)
Monetary
growth (US$
billion)
Simulation:
Malaria
spending at
4% of
annual
growth
(USD
0.0 6.4% 6.95% 4.270 170.8
0.0 11.6% 7.24% 0.435 17.4
0.9 1.7% 2.83% 0.013 0.5
NA 18.1% 6.70% 0.597 23.9
0.6 9.8% 5.98% 0.375 15.0
0.0 12.6% 6.33% 0.296 11.8
0.4 12.8% 4.65% 0.652 26.1
0.6 8.2% 1.95% 0.362 14.5
0.0 4.4% 3.75% 0.625 25.0
0.0 16.3% 3.24% 0.206 8.2
0.3 14.5% -0.80% -0.034 0.0
0.0 13.8% 0.27% 0.013 0.5
42

Annex III. Explanatory note on the resource mobilization scenarios
Projections for US, UK, other OECD/DAC governments, European Commission, emerging
economies and the Bill and Melinda Gates Foundation exclude pledges to the Global Fund
Third Replenishment 2011-2013.
� Projection of US ongoing funding is based on the expected 2012 appropriation and
currently financed amounts at US$585m per year, which would need to be
adjusted based on year-by-year appropriations.
� Projection of UK ongoing funding is based on UNSEO analysis of resources
committed according to existing operational plans (as per GMAP Implementation
Overview).
� UK potential funding adds potential from full implementation of the funding
commitments in the DFID Framework for Results (£500 million annually by
2014/2015, or some US$800 million at the time of the announcement).
� Projection of other OECD/DAC governments' ongoing funding is based on
OECD/DAC data on 2009 bilateral aid and aid to research and development.
� Additional OECD/DAC potential could project that the G7 members and a few
selected other members will increase their funding to at least 2% of their annual
ODA (using as a comparator the US investment of 2.8% and based on OECD/DAC
estimates of 2010 ODA).
� Projection for the European Commission is based on data on 2009 aid to research
and development.
� Additional potential could project that the European Commission increases malaria
aid at the level that is expected from G7 members that are currently making
comparable investments (Germany has been used as a comparison to project this
figure in this document).
� Projection of BRIC (Brazil, Russia, India, China) ongoing funding is based on the
available 2009 data on malaria spending, notably on bilateral aid and contributions
to Global Fund, UNITAID, World Bank, and research and development.
� Additional emerging economies' potential could project aid investments for malaria
at some 2 % of BRIC aid budgets (using as a comparator the US investment of
2.8% and based on average estimates of BRIC aid budgets). Higher potential
could factor in the same proportion but based on higher aid estimates. Additionally
emerging economies other than the BRIC countries could be factored in (e.g.
Turkey and Middle East oil exporting economies).
� Projection of Global Fund's ongoing funding is based on annual projection of
resources not yet disbursed for approved grants up to Round 10 (and including
NSA and single stream funding) and assumes all these grants will continue to
completion. The Global Fund's reprioritization process in development may require
adjustments to these estimates in the months to come.
� Global Fund's potential (lower) assumes additional income from Round 11 and
Round 12, assuming (based on data as of 8 November 2011) rounds of US$0.5
billion and at level of success of malaria grants slightly higher than the proportion
of total Global Fund's funding achieved in Round 10 (40%, against 34% in Round
10). This assumption may need to be adjusted over the next months to come
based on updated estimates and decisions by the Global Fund Board.
� Global Fund's frontloading option would assume arrangements for reprogramming
part of the approved funding for 2014-2015 and make it available for accelerated
scaling up in 2012-2013.

RBM Partnership
� Projection of World Bank’s ongoing funding is based on existing resources
committed through existing projects through the Malaria Booster Program.
� Projection of World Bank’s committed is based on the pledge by the President of
the World Bank in September 2008 for the Malaria Booster Program Phase II, i.e.
US$1.1 billion for malaria, after deduction of US$300 million that have already
been committed.
� A World Bank’s frontloading option could project IDA loans to accelerate domestic
investments in Africa.
� Projection of Regional Banks ongoing funding is based on extrapolation of
information about annual budgets of ongoing and past projects.
� Additional Regional Banks potential could be factored in by projecting higher
investments in grants and loans.
� Projection of the Bill and Melinda Gates Foundation’s ongoing funding is based on
the GMAP Implementation Overview.
� Other philanthropic potential could be projected in traditional and emerging
markets, e.g. in the form of matching grant challenge with the Gates Foundation.
� Projection of ongoing funding from innovative financing is based on current malaria
share of UNITAD resources (26%) as a proportion of the part of the UNITAID
income from the tax levy.
� Potential from innovative financing could project income from new mechanisms,
such as a malaria bond.
� Projection of ongoing domestic funding is based on the data on the 2009
investments from the 2010 WMR.
� Additional domestic investment potential could be projected, e.g. that endemic
countries in Africa with economic potential invest a proportion of GDP growth (if
relevant), that Brazil and China will fully cover domestically their 2012-2015 GMAP
needs, that Indonesia cover its needs at least at 50% and India at least at 40%.
This investment could come from a mix of public and private sources and could
factor in innovative mechanisms such as remittances, bonds, etc. Part of the
domestic investments from Africa, as mentioned above, could also be frontloaded
through IDA loans.
44

RBM Partnership
Annex IVa. TOR of the Resource Mobilization Sub-Committee
Background
At the 17 th meeting of the Roll Back Malaria (RBM) Board on 3 – 5 December 2009, the
Board asked Task Force 1 to:
(1) develop new Terms of Reference for a Resource Mobilization Working Group (RMWG)
to secure resources towards full implementation of the Global Malaria Action Plan (GMAP);
and
(2) create a redefined RMWG to develop the appropriate strategy for funding the GMAP.
Task Force 1 would also look into the status of the RBM Resources Working Group that
was approved by the Board in March 2003 and determine how it could be reconfigured in
accordance with the new Board decision in December 2009.
The Board recognized the importance of establishing a coordinating mechanism to oversee
the development and implementation of the resource mobilization strategy for the GMAP.
To reach the 2015 targets, almost US$6 billion USD was projected as the annual
requirement. This level of funding has become a challenge to achieve, particularly in the
face of the ongoing economic crisis. In 2010 alone, the funding gap against the projection
to reach GMAP targets was estimated to be US$4 billion.
At the19 th Meeting of the RBM Board on 6–8 December 2010, the Board decided to
rename the Resource Mobilization Working Group as the Board Resource Mobilization
Sub-Committee and tasked it to establish a resource mobilization strategy, including
traditional and new donors and innovative financing methods.
I. Purpose/ Rationale
The overall objective of the Resource Mobilization Sub-Committee is to develop a
sustainable fundraising strategy to achieve the GMAP objectives, targets and milestones
and oversee its implementation. The Sub-Committee responds to the expressed need for
greater pro-activeness among RBM Partners, including endemic countries, to collectively
address issues relating to an appropriate fundraising strategy for the GMAP, including
appropriate investments for specific malaria control interventions or regions. The Sub-
Committee serves as an advisory body to the RBM Partnership Board to enhance the RBM
Partnership's capacity to mobilize new resources for the GMAP.
The Resource Mobilization Sub-Committee is guided by the overall commitment of RBM
Partners for:
(i) strengthening partnership and capacity building;
(ii) ensuring harmonization, accountability and transparency in scaling-up actions; and
(iii) bridging the gaps between technical and programmatic support needs at country level.
II. Functions of the Resource Mobilization Sub-Committee
The Sub-Committee will:
• Engage academia and/or other institutes and organizations to carry out an
economic analysis on return of investments for malaria control, prevention and elimination.
• Review and update the projections for resource needs and funding gaps. The Sub-
Committee will commission work towards an improved malaria costing model, harnessing
updated knowledge from national health accounts, price reporting mechanisms/databases,
procurement management systems, and new evidence on control and elimination
interventions, as well as needs for health systems and operational research. This
45

RBM Partnership
information will feed into the resource mobilization strategy and will allow the GMAP to truly
be a living and dynamic blueprint for fighting malaria. The Sub-Committee will work in close
collaboration with the RBM Harmonization Working Group and the Sub-Regional Networks
in this effort.
• Provide an analysis of different resource mobilization scenarios and their
consequences on GMAP implementation, with the objective of providing guidance to the
RBM Partnership on options for financing effective and sustainable malaria control,
prevention and elimination.
• Develop a comprehensive resource mobilization strategy. The strategy should
include innovative approaches tailored to different sectors - public, private, endemic
countries – as well as innovative financing mechanisms to expand the donor base. The
strategy will also provide options for implementation, including the need for dedicated staff
within the RBM Secretariat for harmonizing resource mobilization efforts and building
relationships with prospective donors.
• Develop effective linkages to the RBM advocacy strategy to support the
implementation of the resource mobilization strategy, in collaboration with other RBM
Working Groups, such as the Malaria Advocacy Working Group, and including advocacy
for financial commitments from endemic countries for better national ownership.
• Coordinate partner efforts to track resources mobilized for GMAP implementation
(e.g. National Health Accounts, malaria sub-accounts exercises), thus creating a
harmonized reporting system for resources available, immediate resource needs and
funding gaps.
• Monitor and evaluate resource mobilization efforts and performance on a yearly
basis with support from RBM Partners.
The recommendations of the Resource Mobilization Sub-Committee will be reviewed and
ratified by the Board. These functions will be revisited periodically to ensure continued
relevance.
III. Roles and Responsibilities and Working Procedures
Roles and responsibilities and working procedures are governed by the RBM Operating
Framework and By-Laws.
46

RBM Partnership
Annex IVb. Members of the Resource Mobilization Sub-Committee (as of April 2012)
Chair
Alan Court
Senior Adviser
Office of the UN Secretary General's Special Envoy for Malaria
Vice-Chair
Peter Potter-Lesage
Chief Financial Officer
Medicines for Malaria Venture (Research and Academia)
Secretariat
Silvia Ferazzi
Technical Officer
RBM Secretariat
Other Members
Foundations
Carol Medlin
Senior Program Officer
Bill and Melinda Gates Foundation
Kelly Willis (since August 2011)
Senior Vice President, Global Health Programs
Accordia Global Health Foundation
Malaria Endemic Countries
Nie Jiangang (since June 2011)
Director, Department of International Cooperation
Ministry of Health
People's Republic of China
Multilateral Development Partners
Maryse B. Pierre-Louis
Lead Health Nutrition and Population Specialist
The World Bank
Non-Governmental Organizations
Akudo Ikemba
Chief Executive Officer
Friends of the Global Fund Africa
Louis Da Gama
Director, Malaria Advocacy & Communications
Global Health Advocates
OECD Donor Countries
Frédéric Goyet
Head, Health Department
Ministry of Foreign and European Affairs, France
47

RBM Partnership
Timothy Ziemer
Global Malaria Coordinator, President’s Malaria Initiative
United States' Agency for International Development
Private Sector
Mikkel Vestergaard
Director and Chief Executive Officer
Vestergaard Frandsen Group
Research and Academia (in addition to the Vice-Chair)
Sally Ethelston (since January 2012)
Director, Communications and Advocacy
PATH Malaria Vaccine Initiative (MVI)
African Leaders Malaria Alliance
Joy Phumaphi (since April 2012)
Executive Secretary
Global Fund to Fight AIDS, Tuberculosis and Malaria
Stefan Emblad
Director, Resource Mobilization
RBM Secretariat
Thomas Teuscher
Executive Director a.i.
RBM Partnership
48

RBM Partnership
Annex V. List of papers produced in preparation for the Resource Mobilization
Strategy and other sources
Papers for the Resource Mobilization Sub-Committee
1. Review of resource needs, financing flows and funding gap for the Global Malaria Action
Plan, March 2011
2. Global Malaria Action Plan funding through innovative financing, March 2011
3. Revisiting the GMAP cost estimates for malaria control, March 2011
4. Financial opportunity mapping with Brazil, Russia, India, China, South Africa, Malaysia
and Mexico, June 2011
5. Analysis of GMAP costing in selected high burden countries, PowerPoint Presentation,
August 2011
6. Malaria Bond Concept Note, October 2011
7. Malaria Bond Business Plan, October 2011
Other selected sources
1. Macroeconomics and health: investing in health for economic development, WHO, 2001
2. Successful integration of insecticide-treated bed net distribution with mass drug
administration in Central Nigeria,
(B.G. Blackburn, A. Eigege, H. Gotau, G. Gerlong, E. Miri, W.A. Hawley, E. Mathieu, F.
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22. Hurun Philanthropy Report, 2011
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50