All hands on deck: Malaria control urgently needs workable public-private-philanthropic partnerships (PPPP)

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Between 2000 and 2015, great progress was made to drive down malaria, with incidence and mortality rates from the disease falling by 27% and 50% respectively [1].This was a result of effective programming and the increased global attention and funding for the disease.However, since 2015 the mortality rate has fallen by less than 2% and the funding gap has continued to widen from US$ 2.6 billion in 2019 to US$ 3.8 billion in 2021 [1].The COVID-19 pandemic further pushed back progress, especially in sub-Saharan Africa where malaria cases rose by over 7% between 2019 and 2021 while funding remained stagnant [1].For the malaria community to tip the balance back towards eradication an all hands on deck approach must be taken.We propose creating the conditions that allow public-private-philanthropic (PPP) partnerships i.e. collaborations between public, private for-profit, and private non-profit health subsectors, to help sustain the progress towards malaria eradication in Africa.The private sector for health, even for malaria services, is well developed in Sub-Saharan Africa; in countries such as Nigeria and Uganda, over half of citizens receive treatment for malaria in the private sector [2,3].A large number of citizens also purchase malaria commodities from private vendors and pharmacies [2,3].However, the private sector is largely unregulated, and the type, quality, and affordability of services vary.Because available products and services are often determined by customer demand, patients may not always have access to products such as rapid diagnostic tests (RDTs) or quality-assured (QA) medicines which are often seen as an unnecessary additional expense.In the public sector RDT coverage is on average 64% whereas in the formal private sector it is just 48% [1].A lack of testing availability can lead to the unnecessary prescription and use of antimalarials, since presumptive diagnosis of malaria can be incorrect up to 90% of the time [4], and increases the risk of antimalarial drug resistance.Attempts have been made to improve the quality and affordability of services in the private sector through public-private partnerships such as the Affordable Medicines Facility for Malaria (AMF-m) which transitioned to the Private Sector Co-payment Mechanism (PSCM) and Unitaid's Private Sector Malaria RDT project.The AMF-m significantly increased the percentage of private for-profit outlets with availability of QA Artemisinin-based combination therapies (ACTs) in five countries (Ghana from 25% to 83%, Kenya from 21% to 60%, Nigeria from 27% to 53% and Tanzania from 11% to 66%) [5].However further studies are needed to assess the long-term sustainability of the results since the partnership ended in 2017.Similarly,

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