The Fight against Malaria: A New Index for Quantifying and Assessing Policy Implementation Actions to Reduce Mortality in Sub-Saharan Africa

More than 90% of people suffering from Malaria live in Sub-Saharan Africa (SSA). We construct, for the first time, a Malaria Policy Index (MaPI) for 44 SSA countries to quantify and compare each country’s antimalarial policy actions between 1990 and 2017. The MaPI compiles information on intervention strategies such as prevention, diagnosis and treatment (Pillar 1) and the use of antimalarial therapies and tests (Pillar 2). We find that: antimalarial policy implementation is a widespread phenomenon in the region from the mid-2000s on; initial differences in per capita GDP, quality of institutions and malaria burden are not associated with the current levels of policy implementation and; there exists a first stage of policy divergence (before mid-2000s), followed by a strong convergence period. The convergence period is associated with an unprecedented increase in international malaria fight funding, which was unevenly distributed across countries according to their necessities to eradicate the disease. Using a difference-in-difference events study design and a distributed lag model approach, we estimate the effect of antimalarial policy implementation increases on subsequent changes in malaria mortality within SSA countries. We find that policies included in Pillar 1 are key to reduce within-country malaria mortality: an increase of 10 p.p. in policies implemented in this pillar generates a cumulative malaria mortality decrease of about 6 p.p. after five years.