Malaria budget advocacy

Since 2015, the MEI has supported countries across southern Africa and Asia Pacific in domestic resource mobilization and malaria budget advocacy. As of 2023, the MEI and its country partners have successfully mobilized over USD 2.5 million in additional domestic malaria funding and strengthened the capacity of nearly 3,000 health and administrative officials at the national and sub-national levels to pursue their budget advocacy objectives.

The MEI’s catalytic support has significantly contributed to the sustainability and scale-up of budget advocacy efforts led by country programs, as well as regional and international partners including the WHO, the Global Fund, the Faith Leader Advocacy for Malaria Elimination (FLAME), and the Asia Pacific Malaria Leaders Alliance (APLMA).

Our team of health financing, policy and budget advocacy, and program management specialists support ministries of health and partners to effectively and sustainably secure resources and political commitment to achieve a malaria-free world within a generation.

Challenging Context

Leaders in Africa, Asia Pacific, and Latin America are making ambitious commitments to eliminate malaria by 2030 or earlier. The global fight against malaria has achieved significant gains since 2000 yet the progress has stalled in recent years with many countries experiencing an increase in malaria incidence.¹ Ministries of health and development assistance partners must ramp up their efforts to protect the hard-earned attainments and get back on track.

Malaria donors are placing growing emphasis on the importance of domestic financing in sustainably resourcing malaria control and elimination efforts. Despite record-breaking fundraising results, the Global Fund noted a 22% resource gap in the 2024-2026 period for countries to continue as planned.^2,3 The COVID-19 pandemic and evolving health threats pose additional hurdles, leading major donors to reduce or divert investments toward other pressing health concerns.

Within malaria-endemic countries, national malaria programs are facing budget shortfalls in constrained resource environments and as policymakers' and public attention to malaria wavers. In countries with decentralized governance and health systems – and where decentralization is ongoing – gaps in subnational leadership on malaria may contribute to under-prioritization and underfunding of malaria efforts. In elimination settings, community and policy-maker awareness declines even further yet domestic financing is even more critical as ministries of health work to sustain the gains, prevent reestablishment of malaria, and prepare for the transition from donor funding.

In these contexts, enhancing financial management and budget advocacy strategies and capabilities at all levels is critical to increasing domestic financing for malaria, augmenting local ownership and governance over malaria control and elimination efforts.

¹ World Health Organization. (2023). World malaria report 2023

² The Global Fund. (n.d.). Seventh Replenishment - The Global Fund to Fight AIDS, Tuberculosis and Malaria. Retrieved November 7, 2023, from https://www.theglobalfund.org/en/seventh-replenishment/

³ The Global Fund. (2022). Global Fund Partners Pledge Record Level of Support to End Deadly Diseases, Prevent Future Pandemics. https://www.theglobalfund.org/en/news/2022/2022-09-21-global-fund-partners-pledge-support-to-end-deadly-diseases-prevent-future-pandemics/

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Our Approach

The Malaria Budget Advocacy (MBA) Framework

The MEI, in close collaboration with global partners and national stakeholders, developed the MBA Framework in response to countries' rising needs for sustainable financing and domestic resource mobilization. Culminating from our years of experience working with partners across southern Africa and the Asia Pacific on budget advocacy and domestic resource mobilization, this Framework serves to guide national malaria programs, their subnational counterparts, and partners to advocate for prioritization of malaria targets in political agendas, identify sustainable financing mechanisms, and secure domestic investments in the malaria response.

The MBA Framework encompasses five modules: situational analysis, advocacy strategy development, capacity strengthening, strategy implementation, and monitoring and evaluation. Each module contains a comprehensive set of tailored theories, ready-to-apply tools, practical recommendations, guiding questions, and real-life examples. The MBA Framework can also be applied to other disease elimination programs (eg., neglected tropical diseases), programs transitioning from donor funding, and other health programs seeking to strengthen domestic financing.

The five modules of the MBA Framework

1. Assess

   Situational Analysis

   • Understand the epidemiological, program, political, and financial context
   • Identify opportunities for policy advocacy, improved budget process/management, and domestic resource mobilization
   • Identity key stakeholders to engage

2. Strategize

   Advocacy Strategy Development

   • Convene key stakeholders in advocacy stralegy development
   • Prioritize malaria policy/budget advocacy problem(s)
   • Develop and validate SMART advocacy objective(s) and Theory of Change
   • Develop advocacy strategy and action plan

3. Strengthen

   Capacity Strengthening

   • Engage capacity strengthening implementers
   • Strengthen capacity to implement the strategy and action plan

4. Act

   Advocacy Implementation

   • Implement according to the strategy and action plan
   • Engage advocacy targets, influencers, and allies
   • Engage and influence processes
   • Integrate efforts within existing platforms and scale up

5. Evaluate

   Monitoring and Evaluation

   • Adjust the strategy and implementation to reflect new developments, priorities
   • Monitor the strategy and implementation, including capacity strengthening
   • Evaluate the MBA efforts for improvement, impact evidence and success sharing

Read the two-page overview.

Download the MBA Framework.

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Our Support

The MEI offers catalytic support to country and regional partners to adopt and implement any or all of the five modules of the MBA Framework to strengthen domestic resource mobilization, enabling an effective and sustainable country-led response. Specifically, the MEI facilitates a process to:

• Assess opportunities to:
  • Align domestic financing and political engagement with national and local malaria strategies.
  • Empower malaria programs and health teams to steward well-resourced malaria programs, ensuring funds are allocated and used effectively, equitably, and efficiently.
  • Harness other sustainable funding channels such as UHC-related funding sources or Sin Taxes for malaria.
• Develop an advocacy strategy and theory of change to articulate advocacy priorities and plans.
• Bolster advocacy, financial management, and leadership capacities of malaria/health teams to ensure advocacy objectives are within reach.
• Provide technical assistance or co-lead the implementation of the advocacy plans to achieve the set objectives.
• Monitor and evaluate the success of advocacy implementation and identify opportunities to scale up and sustain political engagement and budget support through existing mechanisms.

Support can be in the form of technical consultation, institutional capacity transfer, and/or hand-in-hand implementation. Depending on specific needs, the timeline of support can range from six months (eg., for situational analysis and advocacy strategy development) to multi-years (eg., for a full MBA cycle and preparation for integration/scale-up).

By the end of our support, we expect the following outcomes to be attained:

MBA's expected outcomes

• Sub-national capacities strengthened
• Budgest and policies match program strategies
• Collaboration between and across administrative levels strengthened
• Leaders prioritize malaria
• Budget bottlenecks solved

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Our Impact

Global and regional levels

The MEI and the Centre of Economic Governance and Accountability in Africa (CEGAA) collaborated to develop the Budget Monitoring and Expenditure Tracking training series, an online training course for malaria leaders to strengthen budget management and advocacy skills. This 14-module series includes video instruction and supplementary activities providing foundational health financing and economics knowledge, practical skills to analyze and develop budgets, and tactics to influence decision-makers.

Between 2021 and 2024, the MEI successfully transferred its Sustainability Model, including MBA approach, to the Asia Pacific Malaria Leaders Alliance (APLMA), equipping a regional entity to provide sustainability support to the Asia Pacific region moving forward.

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Country level

Since 2015, MEI has partnered with the ministries of health and national malaria programs in eight countries - Cambodia, Indonesia, Lao PDR, Namibia, the Philippines, Sri Lanka, Thailand, and Vietnam- to implement the MBA approach with an average engagement period of three years. In three of these countries, the MEI and its partners mobilized US$2.5 million in additional domestic malaria funding.

Click on each country for more details of our impact:

Maps by Vemap.com

Read our country case studies for what we did.

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Success Factors

We recognize the following success factors in our work to strengthen and sustain domestic financing and subnational ownership. The MBA process should be:

• Country-led and country-driven.
• Highly collaborative, multi-sectoral, and inclusive of subnational and community leadership.
• Opportunistic to take advantage of local and global budget advocacy expertise to strengthen budget advocacy capacity of malaria and health teams.
• Designed and implemented with sustainability in mind.

Contact Us

Connect with us via mei@ucsf.edu to learn more about how we can work together to employ the MBA approach in your setting.

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