How has the influx of donor funds changed the burden of malaria financing in Rwanda?

The recent surge of malaria funds in Rwanda (the leading cause of morbidity) is a welcome development. Perhaps more important than the increase however, is how those funds are spent. This paper compares malaria expenditures (public, private, and donor spending) before (2003) and after (2006) the donor surge (e.g. from President's Malaria Initiative and Global Fund); the purpose is to examine changes in the financing burden and to monitor the use of malaria resources.

Both the 2003 and 2006 estimates use primary and secondary data from households, providers, government, donors, and NGOs. Since 2003 national malaria resources have doubled (from $142 to $305 million in 2006) and donors now account for 50% of all spending (2-fold increase from 2003). Despite this, household financing has increased 3-fold (44% of 2006 malaria expenditures) — predominantly for drugs at private pharmacies. With respect to bed nets however, HH are paying for only 3% of net expenditures (the rest paid by donors and gov) compared to 73% in 2003. Following the 2003 estimate that showed NGOs managing most donor funds (58% of expenditures), the government called for greater public coordination. By 2006 the government managed over half of all donor funds (with NGOs controlling 40%).

While these findings show the positive effects of national policies, such as the focus on bed nets and donor coordination, increased malaria funds have not reduced overall household financial burden. The Government and its partners intend to use such findings to inform future resource allocation decisions.