Malaria, the world’s deadliest mosquito-borne illness, is a longstanding health problem that leads to over half a million deaths annually. Africa had 95 percent of all malaria cases and 96 percent of deaths in 2022.
The USAID-led U.S. President’s Malaria Initiative (PMI) has been a key player in the fight against malaria. USAID has invested over $9 billion since PMI’s inception in 2005 to help partner countries fight the disease. In fiscal year (FY) 2024 alone, Congress appropriated $795 million to USAID for malaria control and elimination.
As PMI’s lead agency, USAID develops a comprehensive malaria strategy every 5 years. The most recent version identified six “strategic shifts” from its previous strategy. Our audit focused on the Agency’s shift to prioritizing countries with the highest burden of malaria and death.
The objective for this audit was to determine the extent to which USAID implemented the PMI Strategy to prioritize high-burden malaria countries in Africa. Specifically, we sought to determine whether the Agency’s resource allocation process resulted in changes in funding for the 14 high-burden countries identified in the Strategy and whether existing budget and planning processes prioritized high-burden countries
What OIG Found
USAID’s allocation of funding for the 14 high-burden countries in Africa remained flat under its 2021–2026 Strategy. These countries accounted for about 81 percent of the total deaths and malaria cases that occurred within the 27 countries included in PMI. However, the 14 countries received only about 50 percent of USAID’s malaria funds in FY 2023—the same percentage they received in FYs 2020 and 2021 under the previous PMI Strategy that did not include a shift to prioritize high-burden countries.
The U.S. Global Malaria Coordinator did not use his authority to adjust funding allocations to the high-burden countries. The Coordinator can adjust final budget levels for individual country programs to ensure that strategic priorities are met. In FY 2023, USAID received a $20 million budget increase from the previous year for malaria control and elimination activities, yet none of the 14 high-burden countries received a year-over-year increase in funding. Rather, the Agency used the funds for other PMI priorities, such as expansion to additional countries.
USAID failed to document budget and resource priorities during strategy development. As a general principle, strategic planning and budget plans should work closely together to ensure stated objectives are achieved, and strategic plans should document that alignment. According to USAID officials, documenting how changes to strategic objectives impact resource allocations across countries within PMI was not part of their strategy development or implementation processes.
What OIG Recommend
We made three recommendations to ensure that USAID documents a strategic budgetary process that supports its malaria strategy. The Agency agreed with two recommendations and partially agreed with one. MORE