Vertical and horizontal equity of funding for malaria control: a global multisource funding analysis for 2006–2010

International and domestic funding for <br/>malaria is critically important to achieve the Sustainable <br/>Development Goals. Its equitable distribution is key in <br/>ensuring that the available, scarce, resources are deployed <br/>efficiently for improved progress and a sustained response <br/>that enables eradication. <br/>We used concentration curves and <br/>concentration indices to assess inequalities in malaria <br/>funding by different donors across countries, measuring <br/>both horizontal and vertical equity. Horizontal equity <br/>assesses whether funding is distributed in proportion to <br/>health needs, whereas vertical equity examines whether <br/>unequal economic needs are addressed by appropriately <br/>unequal funding. We computed the Health Inequity Index <br/>and the Kakwani Index to assess the former and the latter, <br/>respectively. We used data from the World Bank, Global <br/>Fund, Unicef, President’s Malaria Initiative and the Malaria <br/>Atlas Project to assess the distribution of funding against <br/>need for 94 countries. National gross domestic product <br/>per capita was used as a proxy for economic need and <br/>‘population-at-risk’ for health need. <br/>The level and direction of inequity varies across <br/>funding sources. Unicef and the President’s Malaria Initiative <br/>were the most horizontally inequitable (pro-poor). Inequity <br/>as shown by the Health Inequity Index for Unicef decreased <br/>from −0.40 (P<0.05) in 2006 to −0.25 (P<0.10) in 2008, and <br/>increased again to −0.58 (P<0.01) in 2009. For President’s <br/>Malaria Initiative, it increased from −0.19 (P>0.10) in 2006 <br/>to −0.38 (P<0.05) in 2008, and decreased to −0.36 (P<0.10) <br/>in 2010. Domestic funding was inequitable (pro-rich) with <br/>inequity increasing from 0.28 (P<0.01) in 2006 to 0.39 <br/>(P<0.01) in 2009, and then decreasing to 0.22 (P<0.10) in <br/>2010. Funding from the World Bank and the Global Fund <br/>was distributed proportionally according to need.