New analysis by researchers at Imperial College London and the Malaria Atlas Project (MAP), supported by CHAI, provides the most comprehensive retrospective estimate to date of the impact of the President’s Malaria Initiative (PMI), the primary vehicle for direct bilateral US malaria assistance in sub-Saharan Africa since 2005.
The headline finding: from 2005 to 2024, PMI’s investments prevented an estimated 379 million malaria cases and 1.1 million deaths across 25 countries, at an average cost of US$18.60 per case prevented and US$6,205 per death averted. During the same period, roughly one in three people who received frontline antimalarial treatment for the first time did so because of PMI funding.
What PMI funded — and what it changed
The analysis examined PMI’s contribution to four core interventions across 25 sub-Saharan African countries: prevention via insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), and seasonal malaria chemoprevention (SMC), as well as frontline treatment via artemisinin combination therapies (ACTs). In 2024 alone, malaria incidence was 11.8% lower and malaria mortality was 15.9% lower than would have been predicted without PMI support.
Over the last two decades, notable proportions of the scale-up in bed nets (18 percent), indoor residual spraying (13.9 percent), and seasonal chemoprevention (10.2 percent) can also be attributed to PMI’s involvement.
Robust findings from two independent models
A distinctive feature of this analysis is that two independent research teams, Imperial College London and MAP, used distinctly different modeling approaches and arrived at a similar magnitude of impact. That agreement substantially increases confidence that the findings reflect what happened on the ground.
Cost-effectiveness has also proved durable. PMI’s US$18.60 per case prevented and US$6,205 per death averted compare favorably with benchmarks from GiveWell, a nonprofit that evaluates aid effectiveness. GiveWell estimates US$12–US$56 per case averted and US$3,000–US$8,000 per death averted for bed net programs. PMI’s findings fall comfortably within both ranges, despite covering four interventions rather than one.
The complete analysis, including methods, country-level data, and disaggregated model outputs, is available here. To learn more about CHAI’s work in malaria, visit our malaria program page.
CHAI is grateful to our partners at Imperial College London and MAP for this rigorous and consequential work, and our donor Coefficient Giving for their support.
