Malaria No More and the Health Finance Coalition (HFC) today launched the Outcomes Fund for Fevers (OFF) in partnership with the Global Fund, Global Citizen, NPX, and the Clinton Health Access Initiative (CHAI). OFF is a new performance-based financing initiative aimed at scaling fever testing, treatment, and digital reporting through the private sector in sub-Saharan Africa.
The initiative was announced by Dr. Chelsea Clinton at the Clinton Global Initiative meeting today during the Community Health session. The OFF will use performance-based payments and product subsidies to expand rapid malaria testing and access to quality treatments through innovative private sector delivery and care models.
While OFF will initially focus on increasing malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACT) treatments, once established, OFF can be expanded to include additional fever diagnostic products such as COVID-19 tests, and other quality-assured drugs.
The Challenge: Private Sector Health Care & Undiagnosed Fever Cases
The private sector is the primary source of care for many children under five across sub-Saharan Africa. Up to 60% of patients in countries like Nigeria, where 1 in 3 global malaria deaths occur, first seek care from private providers. Yet 87% of fever cases go undiagnosed in the private sector, delaying treatment and contributing to high rates of illness and mortality from treatable diseases and conditions, including malaria.
The Opportunity: Private Capital for Incentivizing Healthcare Investments
Enormous health gains can be made quickly and cost-effectively to address malaria and other febrile illnesses, and prepare for future pandemics by scaling rapid diagnosis, quality-assured treatments, and data reporting in the private sector. Critical to achieving this goal is aligning financial incentives for patients and providers with the public health objective of providing quality products and care, even in informal private sector settings.
The OFF is an outcomes fund, designed to scale quality testing, treatment, and digital reporting in the private sector using product subsidies and performance payments, thereby enabling greater impact and a faster path to scale compared to traditional grants or government funding. In this structure, impact investors provide upfront capital to implement the programs, and then are repaid – with the opportunity for a small return – when outcomes are achieved. Outcomes funders provide grant capital that is only released when results are achieved and independently verified.
The OFF aims to raise an initial $25m to demonstrate this approach, with the opportunity to scale in Nigeria, Kenya, Uganda, and beyond. The OFF is hosted by the Global Fund and administered by Malaria No More and the Health Finance Coalition, with technical assistance provided by CHAI. The OFF is a part of Global Citizen’s Impact Funds, powered by NPX.
Getting Started: Demonstrating the Potential in Nigeria
In conjunction with the launch of the OFF, the Gates Foundation announced a $9M direct commitment to Maisha Meds to partner with Ministries of Health and women’s savings groups across Nigeria, Uganda, and Kenya. In time, the hope is to grow Maisha Meds’ technology-enabled network to 5,000 pharmacies and drug shops to support delivery of healthcare reimbursements for malaria for 550,000 patients. This project is expected to be one of the first to benefit from OFF outcome payments. Results of a randomized control trial of this approach showed a 330% improvement in appropriate malaria care with a 310% return on investment for pharmacies and drug shops. This technology system also has the potential to save global health funders 50% versus the status quo and serve as more transparent, inclusive, and cost-effective way of delivering healthcare in the private sector that can support many millions of patients in the coming years.
“Private sector testing and treatment of fevers is a vital but overlooked element of the fight against malaria, COVID, and future pandemics,” said Peter Sands, Executive Director of the Global Fund. “Innovative solutions, like the Outcomes Fund for Fevers, are required to accelerate the end of malaria, AIDS and tuberculosis.”
“For far too long, fevers have gone underdiagnosed in the private sector – resulting in delays of appropriate treatments, a waste of resources and an increase in antimicrobial resistance,” said Philip Welkhoff, Bill & Melinda Gates Foundation Malaria Director. “Through the work of Maisha Meds, other innovators, and the Outcomes Fund for Fevers, we now have the opportunity to close this gap by scaling proven interventions in the private sector.”
“Subsidizing private healthcare providers in Africa to test, treat, and track fever cases offers a quick and cost-effective strategy that will start saving lives immediately.” said Martin Edlund, CEO of Malaria No More and Executive Director of the Health Finance Coalition. “Through OFF, funders get the added protection of only paying once the outcomes are achieved and independently verified. It’s a great example of innovating financing generating new solutions that can go to scale.”
“The impact funding model offers a bold, innovative approach for accelerating our world toward ending malaria and indeed global poverty,” said Michael Sheldrick, Co-Founder and Chief Policy, Impact, and Government Relations Officer, Global Citizen. “Our hope is that over time, evidence-based, data-driven outcomes will lead to an upsurge in the amount of philanthropic capital flowing to SDG-related programs.”
“There are few opportunities to save lives that are as cost-effective as investing in a $0.35 rapid test and a $1 course of malaria treatments,” said Dr. Neil Buddy Shah, CHAI Chief Executive Officer. “Through innovative delivery models and digital technology, we now have the opportunity to bring these tools to the huge proportion of African families that seek care in the private sector.
“Frontline pharmacies provide the bulk of malaria care across many parts of Africa outside of the formal health system, and digital systems can play an important role in improving the quality of care that they provide,” said Jessica Vernon, Maisha Meds Founder & Chief Executive Officer. “Financing approaches like the OFF are essential for enabling and scaling this type of innovation, and we are excited to see these efforts come to life.”