Value for Money in Malaria Programming : Issues and Opportunities

Although there have been studies of the cost-effectiveness of particular malaria interventions, there has been less analysis of broader aspects of value for money in malaria programming. In this paper, Paul Wilson and Ya'ir Aizenman examine opportunities for value for money in malaria control, extensively analyzing the effectiveness of interventions and current trends in spending. The authors conclude that on the whole resources for malaria control are well spent, but also note some areas where meaningful efficiencies might be possible, including (i) improving procurement procedures for bed nets, (ii) developing efficient ways to replace bed nets as they wear out, (iii) reducing overlap of spraying and bed net programs, (iv) expanding the use of rapid diagnostics, and (v) scaling up intermittent presumptive treatment for pregnant women and infants. In some ways, improving value requires increasing the quality of services -- for example, while changing insecticides might increase the cost of spraying campaigns in the short run, it could save much larger amounts in the long run by forestalling resistance. In addition to these recommendations, this paper offers a framework for analyzing value for money in malaria and considers a comprehensive set of factors, from spatial heterogeneity in malaria transmission to mosquito resistance to insecticides. If better results can be achieved at lower cost -- and often they can be -- donors and recipients alike should better utilize such opportunities. This paper offers not only recommendations to achieve better results in malaria, but also a platform for evaluation of global health interventions that will be useful in future analyses