Malaria: Substantial costs to individuals, governments

12 January 2021 | Gesondheid
Malaria is one of the most severe public health problems worldwide and a leading cause of death in many developing countries with young children and pregnant women being the most affected. The illness imposes substantial costs to both individuals and governments, with individual costs including purchase of drugs treating malaria at home, expenses to travel to and treatment at, dispensaries and clinics, lost days at work, absence from school, expenses for preventative measures as well as for burials in cases of deaths.

Costs to governments include maintenance, supply and staffing of health facilities; purchase of drugs and supplies; public health interventions against malaria, such as insecticide spraying or distribution of insecticide-treated bed nets; lost days of work with resulting loss of income; and lost opportunities for joint economic ventures and tourism.

Direct costs (for example, illness, treatment, premature death) have been estimated to be at least US$ 12 billion per year. The cost in lost economic growth is many times more than that.

Tracking global malaria spending provides insight into how far the world is from reaching the malaria funding target of US$6·6 billion annually by 2020. Because most countries with a high burden of malaria are low income or lower-middle income, mobilising additional government resources for malaria might be challenging.

Globally, malaria incidence fell by nearly 1% annually or 1,9 million cases per year and malaria death rates dropped 3,1% each year, averting an additional 14?000 deaths annually on average. Relative to 2000, 24,2 million fewer malaria cases and 226?000 fewer deaths occurred in 2016. These declines were underpinned by a 30,2% increase in development assistance for malaria between 2000 and 2010. More than US$10·3 billion in development assistance for health (DAH) was disbursed to control and eliminate malaria between 2000 and 2010.

Despite this progress, a large malaria health burden persists in many low-income and lower-middle-income countries and particularly in sub-Saharan Africa. In 2017, 208,8 million cases of malaria occurred globally and 620?000 people died, including 328?000 children under the age of 5 years in sub-Saharan Africa. Evidence suggests progress in the fight against malaria has stalled in some settings. Moreover, between 2010 and 2018, development assistance for malaria decreased 1,9% annually on average.

Sustaining achievements in malaria control and making progress towards global malaria elimination goals requires funding above present levels of DAH. The Global Technical Strategy for Malaria, 2016 – 30, aims to reduce case incidence and mortality by 40% by 2020, eliminate malaria from at least ten countries, and prevent re-introduction of malaria in all malaria-free settings. Achieving these aims requires an estimated US$6,6 billion in malaria investments annually by 2020.

With little growth in future DAH expected, it is crucial to better understand present health spending on malaria, including how much is financed by governments, households, and prepaid private sources in malaria-endemic countries. To date, no comprehensive and comparable estimates of global spending on malaria exist. Country-specific information has increased, with malaria spending estimates for 149 years of data for numerous countries published in National Health Account (NHA) sub-accounts and System of National Health Accounts 2011 reports. However, just 55 of these country-years accounted for malaria out-of-pocket (OOP) payments, which comprise spending by households at the point of care and other household spending to prevent and treat malaria. Estimates of government health spending on malaria have been published for all malaria-endemic countries and 35 malaria elimination countries. However, these estimates omitted government spending on inpatient and outpatient care for malaria. Overall, incomplete estimates of government malaria spending and few credible studies on malaria OOP expenditure limit knowledge about the full malaria spending envelope—information which is important for tracking progress towards malaria reduction and elimination targets.

In 2018, an estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally by governments of malaria endemic countries and international partners – a reduction from the US$ 3.2 billion that was invested in 2017. The amount invested in 2018 fell short of the US$ 5.0 billion estimated to be required globally to stay on track towards the GTS milestones.

Nearly three quarters of investments in 2018 were spent in the WHO African Region, followed by the WHO Region of the Americas (7%), the WHO South-East Asia Region (6%), and the WHO Eastern Mediterranean Region and the WHO Western Pacific Region (5% each).

In 2018, 47% of total funding for malaria was invested in low-income countries, 43% in lower- middle-income countries and 11% in upper-middle-income countries. International funding represented the major source of funding in low-income and lower-middle-income countries, at 85% and 61%, respectively. Domestic funding has remained stable since 2010.

Of the US$ 2.7 billion invested in 2018, US$ 1,8 billion came from international funders. Governments of malaria endemic countries contributed 30% of total funding (US$900 million) in 2018, a figure unchanged from 2017. Two thirds of domestically sourced funds were invested in malaria control activities carried out by national malaria programmes (NMPs), with the remaining share estimated as the cost of patient care.

As in previous years, the United States of America (USA) was the largest international source of malaria financing, providing US$ 1.0 billion (37%) in 2018. Country members of the Development Assistance Committee together accounted for US$ 300 million (11%). The United Kingdom of Great Britain and Northern Ireland contributed around US$ 200 million (7%).

Of the US$ 2.7 billion invested in 2018, US$ 1.0 billion was channeled through the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Although funding for malaria has remained relatively stable since 2010, the level of investment in 2018 is far from what is required to reach the first two milestones of the GTS; that is, a reduction of at least 40% in malaria case incidence and mortality rates globally by 2020, compared with 2015 levels.

US$ 663 million was invested in basic research and product development for malaria in 2018, an increase of US$ 18 million compared with 2017.

Funding for drug research and development (R&D) increased to the highest level ever recorded, from US$ 228 million in 2017 to US$ 252 million in 2018. This increase was a result of private sector industry investment in several Phase II trials of new chemical entities with the potential for single- exposure radical cure. Sources: cdc.gov; thelancet; who; unicef

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