The burden of malaria in Solomon Islands, a small island state of lower-middle-income status, remains among the highest of all countries outside of sub-Saharan Africa. Nevertheless, significant improvements have been made in the last 25 years. Annual national malaria incidence dropped from over 200 to 40 new cases per 1,000 between 2002 and 2015, before doubling in 2016. Donor funding for malaria control and elimination increased significantly during this period, before declining to a 10-year low in 2016.
This presentation explores the role that foreign aid played in reducing malaria in Solomon Islands between 2002 and 2015 (Burkot and Gilbert 2017). Our research used a qualitative within-case methodology, including a review of published and grey literature; and 18 in-depth, semi-structured interviews with individuals from the Ministry of Health, donor and civil society organisations, and researchers.
We find that aid contributed to reducing malaria, particularly by enabling the scale-up of key technical interventions. However, evidence for how efficiently and cost-effectively that aid was spent is limited. Aid for malaria was historically provided in a highly vertical manner, reliant upon parallel systems, with little evidence of positive spill-over to the broader health system. While the Ministry of Health previously had limited ownership over this aid, it worked with donors to increase its involvement over time.
We conclude by considering the future of aid for malaria in Solomon Islands. As aid declines, sustaining the gains that have been made will be dependent on strengthening the capacity of provincial malaria programs within the broader health system. Finally, while the political appetite for pursuing malaria elimination in Solomon Islands is resilient, history shows that achieving elimination is highly challenging. A nuanced and evidence-informed policy dialogue is required to determine how best to pursue elimination in a way that is effective and complementary to control efforts.