Sustaining Gains in Health Programs: Technical Efficiency and its Determinants in Malaria Programs in Sub-Saharan Africa.

BACKGROUND: Since the year 2000, Africa has made significant progress in the fight against malaria. Between 2000 and 2015, the incidence and death from malaria fell by 42 and 66%, respectively. However, the African region still accounts for most global cases of malaria. In 2015, the region was home to 89% of malaria cases and 91% of malaria death.

OBJECTIVE: This study aimed to evaluate efficiency of policies against malaria in 30 malaria-endemic Sub-Saharan African (SSA) countries, from the perspective of sustaining gains.

METHODS: The data came from World Malaria Report 2013. Data were analyzed using the double bootstrap method. We first estimated bootstrapped efficiency scores. Then, bootstrapped truncated regression was used to determine factors associated with malaria program efficiency.

RESULTS: This study showed that most malaria programs in SSA are technically inefficient. We also found that aid from international institutions and public expenditures on malaria programs do not significantly affect the efficiency of malaria programs. However, in an enhanced governance context, international aid and public expenditure impact positively on the efficiency of malaria programs. Moreover, intermittent preventive treatment for pregnant women is associated with a positive effect on the efficiency. Surprisingly, the free care policies-artemisinin-based combinations for under five-year-old children in the public facilities, rapid diagnostic tests, and distribution of insecticide-treated bed nets and long-lasting insecticide-impregnated nets-does not significantly affect the efficiency of malaria programs.

CONCLUSION: Financing alone does not ensure efficiency of malaria programs. Good governance and the targeting of the most vulnerable segments of the population are necessary to reduce malaria deaths and improve efficiency of malaria programs in SSA.