Health economist Catherine Pitt has urged malaria programme managers and donors to rethink how they frame tough funding decisions, warning that maintaining the status quo in a shrinking budget environment is itself a choice with consequences.
Speaking to delegates at the joint meeting of the SMC Alliance and the Alliance for Malaria Prevention, at Speke Resort Munyonyo, Kampala, Pitt challenged the perception that economics is solely about cutting costs.
“It can feel like we’re not making a choice when we’re just maintaining a status quo,” she said. “But economists are not here to tell you what to value. We are here to make values explicit and help you maximise outcomes with scarce resources.”
With many countries grappling with tighter Global Fund envelopes and uncertain future financing, Pitt said the real question should not simply be how to trim budgets, but how to minimise harm from reduced malaria investments while protecting equity and health gains.
She encouraged national programmes to shift from focusing narrowly on financial costs to examining broader economic costs — including the opportunity cost of health worker time and community contributions. “Money matters for budgeting,” she noted, “but economic costs are about the value of resources in their next best alternative use.”
Pitt outlined how health economic evaluation systematically compares future options based on expected costs and health effects. Rather than analysing what happened last year, she said, the discipline is about using the best available evidence to model likely outcomes under different intervention scenarios.
She emphasised the importance of clarity in defining interventions. A bed net or a course of seasonal malaria chemoprevention (SMC), she argued, is not an intervention on its own. Delivery strategy — whether door-to-door or fixed-site distribution — determines costs and impact.
Economic evaluations, she added, should go beyond counting commodities delivered and instead measure outcomes such as deaths averted or disability-adjusted life years (DALYs) saved, enabling malaria investments to be compared with other health priorities.
Pitt also highlighted variation in cost-effectiveness across geographies, cautioning against blanket statements that an intervention is universally cost-effective. Subnational analysis and transparent reporting standards are critical, she said.
As fiscal pressures mount, Pitt called on donors to allow greater flexibility and on malaria programmes to strengthen the economic case for sustained investment. “It’s not just about cost-cutting,” she concluded. “It’s about doing the most we can with the resources available — and being ready to adapt.”