Global Assistance and the Cascade of Malaria Prevention and Control - Sub-Saharan Africa, 2011-2022.

Abstract

Introduction: Approximately 70% of funding for malaria prevention and control (P&C) in Sub-Saharan Africa comes from global assistance, yet progress has stagnated over the past decade.

Methods: We constructed a cascade of malaria P&C services and analyzed its coverage and quality across 26 African countries from 2011-2022. Panel analysis was conducted to examine the effectiveness of four major donors [the United States of America (USA), the United Kingdom (UK), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF), and United Nations International Children's Emergency Fund (UNICEF)], which account for 90% of global funding, in implementing the cascade.

Results: Recommended practice coverage doubled during 2011-2016 but decreased by 10% by 2022. Unrecommended practices followed the same pattern. Total funding from 2011-2020 reached 7.15 billion USA Dollar (USD), with the USA and GF steadily contributing 94.65%, while the UK and UNICEF demonstrated notable funding reductions. Overall, the funding showed limited correlation with the cascade coverage and quality, promoting directly only the upstream measures.

Conclusion: Our findings highlight four key challenges: retrogression of cascade coverage since the late 2010s, persistent gaps between recommended and unrecommended practices, funding constraints, and limited direct effects of donor funding. Strengthening health system capacity at the farthest end of the cascade may provide a solution to this dilemma.