International funding for malaria control in relation to populations at risk of stable Plasmodium falciparum transmission
International funding for malaria control in relation to populations at risk of stable Plasmodium falciparum transmission
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DOI：
10.1371/journal.pmed.0050142
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发表时间：
2008-07-01
期刊：
影响因子：
15.8
通讯作者：
Hay, Simon I.
中科院分区：
文献类型：
--
作者：
Snow, Robert W.;Guerra, Carlos A.;Hay, Simon I.
在过去十年中，疟疾控制方面的国际供资显著增加，同时呼吁到2015年将疟疾负担减半。向各国分配的资金应反映出面临感染、疾病和死亡风险的人口规模。为了检验这种关系，我们比较了对国际承诺的审计与对国家需求的客观评估：2007年面临稳定恶性疟原虫疟疾传播风险的人口。方法和结果预测了87个恶性疟原虫流行国家到2007年恶性疟原虫稳定传播危险人群的分布情况。进行了系统的在线和基于文献的搜索，以审计2002年至2007年期间主要捐助者为疟疾控制作出的国际资助承诺。这些数字用于计算2007年面临稳定恶性疟原虫风险的人均疟疾年度资金拨款（以美元计）。每年向面临稳定恶性疟原虫疟疾风险的14亿人分发近10亿美元。这相当于每个有风险的人每年不到1美元。其中40%来自全球抗击艾滋病、结核病和疟疾基金。在支付方面存在着很大的区域和国家差异。虽然发现资金分配大致适当，但某些人口密度高的国家在扩大疟疾控制方面得到的支助却不成比例地少。此外，发现国际社会目前的财政承诺不足：资金不足的情况可能从50%到450%不等，这取决于采用哪种方式对扩大疟疾控制所需费用进行全球评估。结论：如果不进一步增加供资并适当确定全球疟疾控制投资的目标，到2015年将疾病负担减半的国际目标就不太可能实现。此外，科学界或国际社会尚未考虑到从疟疾控制转向消除疟疾所需的额外资金。
BackgroundThe international financing of malaria control has increased significantly in the last ten years in parallel with calls to halve the malaria burden by the year 2015. The allocation of funds to countries should reflect the size of the populations at risk of infection, disease, and death. To examine this relationship, we compare an audit of international commitments with an objective assessment of national need: the population at risk of stable Plasmodium falciparum malaria transmission in 2007.Methods and FindingsThe national distributions of populations at risk of stable P. falciparum transmission were projected to the year 2007 for each of 87 P. falciparum - endemic countries. Systematic onlineand literature- based searches were conducted to audit the international funding commitments made for malaria control by major donors between 2002 and 2007. These figures were used to generate annual malaria funding allocation (in US dollars) per capita population at risk of stable P. falciparum in 2007. Almost US$ 1 billion are distributed each year to the 1.4 billion people exposed to stable P. falciparum malaria risk. This is less than US$ 1 per person at risk per year. Forty percent of this total comes from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Substantial regional and national variations in disbursements exist. While the distribution of funds is found to be broadly appropriate, specific high population density countries receive disproportionately less support to scale up malaria control. Additionally, an inadequacy of current financial commitments by the international community was found: under-funding could be from 50% to 450%, depending on which global assessment of the cost required to scale up malaria control is adopted.ConclusionsWithout further increases in funding and appropriate targeting of global malaria control investment it is unlikely that international goals to halve disease burdens by 2015 will be achieved. Moreover, the additional financing requirements to move from malaria control to malaria elimination have not yet been considered by the scientific or international community.