US malaria initiative wants to triple local funding by 2026

The U.S. President’s Malaria Initiative has set some ambitious goals for investing locally. These include providing more funding directly to local organizations and countries and increasing the volume of health commodities it procures from the African continent. The goals are set out in a vision statement published in August, where PMI said it is “deliberately working to shift more leadership, decision-making, and implementation to local partners to ensure sustainable, effective, and equitable malaria services and stronger health systems.” PMI is a United States government initiative set up in 2005 to help control and eliminate malaria, a life-threatening disease that caused the deaths of 608,000 people in 2022 — the majority of which were in Africa. PMI works with 30 countries — mainly in Africa — providing lifesaving malaria interventions, investing in research, and helping strengthen health systems. Dr. David Walton, who leads the initiative, told Devex that while they’ve been partnering with governments and local organizations on malaria programming for years, this time they want to be clear about their goals and intentions. “We have put out this vision statement largely to articulate to ourselves and to our partners in our partner countries and the community [that] look, we are committed. We will hold ourselves accountable to these clear outcomes that have been stated in the vision statement, and also want you to hold us accountable,” he said. “They’re ambitious. They’re going to cause us to stretch. But … we feel that they’re achievable,” he added. The vision is tailored to PMI, but aligns with the wider localization efforts by USAID, which plans to allocate a quarter of its funding to local organizations and put them in the driver’s seat of designing and implementing the majority of USAID’s programs by 2030. The ambition PMI has set medium- and long-term goals that they aim to achieve by 2026 and 2031, respectively. Among its more immediate goals is to triple the annual funding it directly provides to local organizations, including through bilateral agreements, by the end of 2026. At the moment, the baseline number is quite low, although it’s been growing steadily in recent years. In 2023, PMI directed roughly $24 million — 3.5% of its overall funding — to local organizations and governments, according to a USAID spokesperson. That was triple the percentage of funding that went to local groups in 2020, and they plan to increase that to at least 10% by 2026. “We acknowledge that we have an opportunity to increase our current baseline funding to local partners — that is why committing to a localization vision and specific goals was so important. It will allow us to generate the momentum necessary to make needed shifts,” the USAID spokesperson wrote. In the longer term, PMI aims for 80% of case management or service delivery activities, and 80% of warehousing and distribution to be led and performed by a partner based locally or in the region. It wants all therapeutic efficacy studies to be implemented through local or regional partners, and for operational research awardees to be local or regional institutions. It also aims to double the procurement of malaria commodities that are manufactured in Africa by the end of 2031. PMI sourced approximately $18.5 million of malaria commodities from Africa — about 10% of its total commodity procurements in 2023. That’s double the volume it sourced from Africa since 2021, according to the spokesperson. PMI is coordinating with other donors, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, to harmonize their procurement strategies, and now considers African-based manufacturing as part of all evaluations for procuring commodities, according to the spokesperson. Its efforts to procure more volumes from local manufacturers go hand in hand with efforts to increase the number of qualified suppliers of malaria commodities in the continent. They do this through facilitating partnerships and providing technical assistance to local manufacturers so they can achieve WHO prequalification, which is a key requirement for many international procurement agencies. Walton said PMI helped broker an introduction between malaria nets producer Vestergaard and the U.S. International Development Finance Corporation, who are now working together to help establish a manufacturing hub in Nigeria for a new generation of bed nets. PMI is also currently working with a local pharmaceutical manufacturer in Ghana producing antimalarial medicines to help them get the World Health Organization prequalification. The importance of local manufacturing, particularly for malaria products, could not be overstated. Africa is home to 94% of malaria cases globally, but produces only a “small fraction of commodities,” Walton said. A hitch in the road Achieving their ambitions is not without challenges. The scarcity of WHO prequalified products that are manufactured in Africa is one, which affects their ability to procure more from the continent. Another challenge is that around 40% of PMI funding is spent on the procurement of malaria commodities. This limits the amount of funding that can be used for programs implemented by local partners, according to the USAID spokesperson. There are challenges too when it comes to processes. Some countries are currently working on their first government-to-government agreements, which are an important part of PMI’s localization efforts. However, this can take time as the two parties — the U.S. government and partner country — enter into a bilateral agreement where they have to mutually agree on its terms and objectives. In addition, PMI pools demand for malaria commodities across partner countries. This has helped lower down pricing and support the introduction of new products. But as countries take ownership of procurement processes, PMI needs to find the right balance between supporting them in that endeavor while keeping the benefits associated with pooling demand, the spokesperson said. Walton said they’re working through to address these challenges. Although they won’t be solved overnight, it will be crucial to support communities to lead and make progress to defeat malaria. “I’ve witnessed the frustration that communities feel. I’ve witnessed how challenging it can be for ideas to be generated, local solutions to be discussed, and yet no ability to enact them” because it’s not a priority by funders, he said. But they’re working to understand “how we can be better partners,” he added.