Ghana's efforts to eliminate malaria could be in jeopardy as its improved economy results in reduced external funding for fighting malaria, a study suggests.

With Ghana experiencing a five-fold increase in gross domestic product per capita from $309 to $1,517 between 2002 and 2016 and thus becoming a lower-middle-income country, its dependence on external support for malaria has been diminishing, according to the study.

The study explains that between 2005 and 2015, malaria cases and deaths in Ghana decreased by more than 50 per cent and 65 per cent respectively, although the disease still accounts for 30 per cent of outpatient attendances and 23 per cent inpatient admissions.

However, the COVID-19 outbreak now means this progress is under threat, and the government must step up to avert a feared rise in cases.

"In the context of the current COVID-19 pandemic, where lockdowns have limited access to health facilities and preventive malaria interventions have been interrupted, there is a risk that the recent progress made by Ghana in the fight against malaria will be reversed," says Rima Shretta, lead author of the study and honorary visiting research fellow of Nuffield Department of Medicine, University of Oxford, United Kingdom.

The study, published this month in the Malaria Journal, says that Ghana needs to increase domestic funding for malaria control from the 38 per cent of the total financing of malaria recorded in 2018 as donor support dwindles.

"It is imperative that malaria services continue and additional funding is made available to counteract any unintended consequences," Shretta tells SciDev.Net. "The evidence generated by this study can be used to develop a robust and effective resource mobilisation strategy to facilitate advocacy actions to overcome the financial barriers to achieving malaria elimination in Ghana."

The study assessed the impact of partially-funded and fully-funded malaria responses in Ghana. Researchers used the country's malaria data including its economic burden in 2018 to make projections for eliminating the disease by 2030.

Shretta says that Ghana is currently dependent on external support from the global fund to fight AIDS, tuberculosis and malaria.

However, with an increase in government financing in the past decade because of its lower-middle-income status, the amount from the global fund is currently less than 25 per cent of the total sources of financing for malaria.

Funding for malaria saw a surge from less than US$25 million in 2006 to US$100 million in 2011 but with this donor support falling, the resulting financial gap will need to be met domestically, Shretta adds

"For each dollar invested in malaria elimination, Ghana can expect to see a 32-fold return on the total investment," says Shretta, comparing the outcome in 2018 and 2030. "Reducing investments and a resulting resurgence will lead to … economic losses of $14.1 billion."

"The economic gain is substantial and is estimated at US$32 billion in reduced health system expenditure, increased household prosperity and productivity gains from 1.06 billion days of averted employee and caretaker absenteeism and presentism," Street adds.

Timothy Awine, a biostatistician at the Navrongo Health Research Centre in Ghana, commends the researchers estimating the burden of malaria and its associated cost in Ghana over the next decade.

"The mathematical methods used are very valid and the estimates arrived at were supported by key managers of malaria control in Ghana as co-authors, who understand the business of malaria control better," Awine says.