Examining the economic costs of delivering a Pan-African Leadership, Management, and Governance Program for public sector malaria managers

Abstract

Efforts to eliminate malaria require public health systems leaders and managers to have better capacity to harness and manage resources and use them to execute priority, evidence-informed interventions. However, this has not been the case across many sub-Saharan African countries. Health systems leaders and managers, including those for disease programs like malaria and HIV, have tended to be senior healthcare workers with strong technical competencies in medical areas, but limited managerial capacity. Through funding from the Bill and Melinda Gates Foundation, Strathmore University mounted a novel Leadership, Management and Governance (LMG) program for malaria managers from National Malaria Control Programs (NMCPs) and ministries of health across six African countries, namely Kenya, Mali, Cameroon, Côte d'Ivoire, Rwanda, Ghana between 2022 and 2024. The program specifically targeted senior malaria program managers at the NMCPs, aligning with the African Union’s goal of moving the continent towards malaria elimination. The training was designed as a blended learning approach consisting on in-person and virtual sessions. Using an ingredient costing framework, both financial and economic costs were analyzed across startup and implementation phases. The total economic cost of delivering the program stood at USD 1.69 million for 206 participants, translating to a unit cost of USD 8,225 per trainee. In-person training consumed over 50% of total costs, driven by hospitality, travel, and human resource costs. Kenya had the highest per-person cost at USD 13,389, nearly 25% above the six-country average, being where coordination was centralized, while virtual delivery models halved costs in some cases. Sensitivity analysis revealed minimal volatility across discounting and useful life assumptions, reinforcing the robustness of estimates. These findings underscore a lesson that leadership training is not cheap, but it is transformative. Strategic design, localized delivery, and hybrid models can deliver cost-effective LMG training for health managers. The findings offer a roadmap for health ministries and funders to scale leadership development in malaria programs sustainably, while keeping an eye on both outcomes and efficiency.