Eliminating again, for the last time: A case study of donor support for malaria in Solomon Islands.

Malaria elimination has been a recurring policy goal in Solomon Islands and has historically succeeded in attracting substantial donor support. Drawing on literature review and key informant interviews, we examine the influence of foreign aid on malaria control and elimination efforts in Solomon Islands between 2002 and 2016, as a unique case study of an Asia-Pacific country with high malaria burden and high donor funding. While aid appears to have contributed to reduced malaria prevalence, the ways in which aid was delivered in the short term had health systems impacts with implications for the elimination agenda. Key areas that will be critical to the future pursuit of malaria elimination in Solomon Islands include: integration of the vertical malaria program, while strengthening provincial-level service delivery; maximising incentives of performance-based financing modalities; and policy alignment between donors and domestic actors. We conclude by discussing principles exemplified in the case study of broader relevance to malaria-endemic countries.