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The Global Fund is a partnership designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics. As an international organization, the Global Fund mobilizes and invests more than US$4 billion a year to support programs run by local experts in more than 100 countries. In partnership with governments, civil society, technical agencies, the private sector and people affected by the diseases, we are challenging barriers and embracing innovation.

Image by Annie Spratt

OBJECTIVES

  1. To help the Global health funder decision on prioritizing funding programs among 10 countries in African Continent.

  2. To recommend a priority list of 4 programs (diseases) to invest in 1-2 countries.

  3. To reduce the disease burden

  4. To propose a plan for a smart investment

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METHODOLOGY

DISEASE BURDEN

The first step of the analysis was to identify the most widespread epidemics. The decision criteria to select countries were truly based on prioritizing disease burden which was achieved by comparing the disability-adjusted life year (DALY). In other words, the search for the largest combination of country/diseases was taken place. Using a Pivot Table and conditional formatting, four countries that were particularly suffering from diseases in 2017 have been discovered. Furthermore, the same examination has been conducted for the three indicators, DALY, deaths, and incidence which were available in the Dataset. The results were similar for all three of the categories that were examined.

“DALY:  Sum of the years of life lost (YLL) due to premature mortality in the population and the years lost due to disability (YLD) for people living with the health condition or its consequences:  DALY = YLL + YLD” (World Health Organisation, 2019).

The 10 highest values convey four different countries: Zambia, Burkina Faso, Cote D’Ivoire, and Niger. According to this result, these countries were targeted and further ahead supported by the fact that these countries are historically more impacted by epidemics. A further observation in the trends over the 17 years available in the database were taken into account to make sure that these results are not one-time occurrences.

OUT-OF-POCKET EXPENDITURE

The second step of the analysis was based on the second dataset which is from the World Health Organization (WHO) and provides us with financial information for each country. The two OOPe indicators were used: Percentage of CHE and per Capita. These two indicators were used in combination with findings from the Global Burden Disease dataset in order to create the priority list.

Further ahead, focused on the analysis of four countries that had identified from the first dataset, Burkina Faso, Côte d’Ivoire, Niger and Zambia over the last three years had been endorsed. Out of these four countries, Niger has the highest out of pocket as a % of current health expenditure rate with 58.51% in 2016 and the second highest in 2014 and 2015. Among the four shortlisted countries, Côte D’Ivoire comes with the second-highest rate of out of pocket as a % of current health expenditure rate with 40.15% increasing from 2015 to 2016.

The out-of-pocket % of CHE indicator is lower in Côte D’Ivoire because the country has the highest external funding from all the countries in the sample, but simultaneously, the external funding as a % of the CHE is declining by 12% over the last year and it is one of the lowest among the 10 countries. Subsequently, there is an important need for higher health expenditure in Côte D’Ivoire. Meanwhile, Niger has the lowest external funding for health care despite the heavy disease burden. Furthermore, our two target countries were identified as being Niger and Cote D’Ivoire.

Fig1.  External Funding as a % of the CHE over the last 3 years

KEY DECISIONS

Based on the analysis, the priority list and reasoning behind our decision is as follows:

  1. Malaria - Niger: 2.301.556 DALY in 2017As per the observation in Fig 1., Malaria is the most widespread diseases in Niger. Additionally, since 2015, the threat of Malaria seems to be increasing in the country, with 78% of the DALY index for Malaria in the country referring to children under 5. We expect progressive positive impacts in the neighboring countries too, such as Burkina Faso from a health investment in Cote D’Ivoire.

  2. Diarrheal Diseases - Niger: 1.701.454 DALY in 2017For this reason we have suggested to fund a program combating diarrheal diseases due to it having the second highest DALY index in Niger in 2017. This figure is very high, especially if we consider that it is twice as high as Cote D’Ivoire’s who is second, and 87% of the population harmed by the disease are children under 5.

  3.  Neonatal Disorders - Cote D’Ivoire: 1.812.266 DALY in 2017Neonatal disorders cause the highest levels of death and disability combined in Cote D’Ivoire. Moreover, the data detailed in 2017’s DALY provides evidence that Neonatal Disorder was having the highest figure as stated above.

  4. Malaria - Cote D’Ivoire: 1.112.318 DALY in 2017Malaria is the second most widespread disease in Cote D’Ivoire and has the highest external funding. Despite this, there was a decline of the disease over the past decade but despite the efforts, the results show that since 2016 the disease is still widespread. 65% of the children under 5 population of the country is harmed from Malaria.

CONCLUSION

​In conclusion, Niger and Cote d’Ivoire are the most populated countries of the sample, therefore, funding programmes in these countries will impact the most people. Furthermore, the priority list deduced to effectively runs in correlation to the analysis undertaken and provides the most suitable options for potential investment. Moreover, it is expected positive side effects of the project combination in Niger and Cote D’Ivoire for Malaria, hoping that it will fight the disease efficiently in the whole region since these are the two largest countries in it.

© 2023 by Ruchi Acharya. All rights reserved.

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