may be direct financial linkages between donors and suppliers. Large international NGOs often receive funds directly from bilateral donors, especially USAID, and have semiautonomous programs in individual countries, especially those in the LICUS (Low Income Countries Under Stress Initiative) category. Financial terms, too, vary greatly. Bilateral donors and the European Union largely provide grants to African countries. The World Bank and the African Development Bank provide long-term concessional loans through affiliates created for this purpose, the International Development Association (IDA), and the African Development Fund.
Over the past several years, IDA has begun to introduce grants in five categories: 1) HIV/AIDS, 2) natural disaster reconstruction, 3) poorest countries, 4) poorest and debt-vulnerable countries, and 5) post-conflict countries. These grants represent about 20 percent of IDA funds, and more than half of the grants are in the social sectors, including 3-4 percent for HIV/ AIDS projects (International Development Association, 2003b).
The introduction of a pilot program of US$450 million per year in FY04-FY05 for regional integration projects to be supported by IDA, and a set-aside of up to 10 percent in the African Development Bank, represents a strong recognition of the positive externalities of regional projects (International Development Association, 2003a). In this connection it should be noted that, to assist countries in nonaccrual status (where the Bank does not extend new financing as a matter of policy), IDA management plans to make IDA grant financing available for regional HIV/AIDS projects through a regional organization, or another country participating in the project (International Development Association, 2003b). These arrangements suggest a certain flexibility that might be exploited for antimalarial drugs.
Beyond the international financial institutions, bilateral donors—including Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Japan, the Netherlands, Norway, Sweden, Switzerland, the United Kingdom, and the United States—could conceivably support a global subsidy for antimalarial drugs. Finally, there are the agencies of the United Nations (such as WHO, UNICEF, and the Office of the UN High Commissioner for Refugees), the Global Fund, and the larger foundations, such as the Gates Foundation.
Estimating the amount of funding currently being provided for malaria control (or specifically, antimalarial drugs), much less what might be available for subsidies, poses formidable challenges. Systematic tracking of donor expenditures on malaria programs is incomplete. Where data are available, accounting definitions vary, so comparisons are difficult. One recent effort estimated the international aid for malaria control at US$100 million annually, and argued that the sums dedicated to malaria had remained essentially unchanged since the advent of Roll Back Malaria (Narasimhan and Attaran, 2003). The external evaluation of the Roll Back Malaria