Malaria Obstacles and Opportunities (1991) / Chapter Skim
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Pages 237-256
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From page 237... ...
11 Economics of Malaria Control WHERE WE WANT TO BE IN THE YEAR 2010 There will be a great change in the way economic reasoning and analysis are applied to malaria. Health priorities no longer will be set according to the absolute burden of disease, but will be based on what can actually be done about a given disease problem.
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and those that examine the cost-effectiveness of interventions aimed at preventing or controlling the disease. The Economic Costs of Malaria The primary cost of malaria is its contribution to mortality and morbidity.
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of physical ability, for example, at least one study demonstrated that malaria had no effect at all on productivity (Brohult et al., 1981)
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(Kaewsonthi, 1989) estimated, among other things, patient costs associated with seeking local treatment for malaria prior to receiving care at a governmentsupported health center.
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TABLE 11-1 Cost-Effectiveness of Malaria Control Cost (1987$) Author(s)
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utmost economic importance, while the lower figures make malaria control appear no more urgent than a number of other government programs Unfortunately, there are no simple methodological explanations for this variability that could guide future cost-benefit calculations. Differences in data quality, the assumptions used in the analyses, the definition of relevant costs, the length of the study period, the discount rate applied, and the coverage and purpose of the original intervention all contribute to, but do not account for, the variation.
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value, taking into a account the distribution at different times. This is particularly important if costs include a fixed component, such as the administrative costs for control organizations, that does not depend on the disease prevalence in any one year.
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and institutional conditions. Such exercises can greatly improve resource allocation and Program decisions by local level managers.
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different perspectives. The top levels government, for example, must weigh the value of resources put into the health sector as opposed to other sectors, such as education or agriculture.
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outcomes thus are quite context specific. Malaria policy in situations in which health care is provided within the family or by private-sector traditional healers, physicians, nurses, or pharmacists will be different than in cases in which the bulk of services are provided by public primary health facilities or malaria clinics.
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is to describe how people make choices and prescribe how governments should make them. The fact that malaria affects hundreds of million of people does not, in and of itself, make the disease a priority of policymakers.
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should have the first priority, not the one that is more prevalent. Interventions should be ranked in order of the marginal effect of each additional unit of input, whether in dollars, hours, or number of patients seen.
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Figure 11-1 Example 1 and 2: visual representation. Example 3: More Decreasing Returns There is only one disease, disease A, but there are two possible interventions.
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policy saves 355 lives (200 from focal spraying, costing $10 per person, 30 from spraying at a cost of $100 per person, and 125 ($5,000/$40) from spending on drug therapy)
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compared with 60 lives saved from drugs. The return on the third round of spraying is even worse.
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As a rule, vector operations should be expanded as long as the slope of the kinked line is steeper than the line representing drug therapy. The appropriate stopping points are marked A, B, and C, for urban, forest and high-land fringe areas, respectively.
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termination of how the latter are affected by changes in the level of program effort. RESEARCH FOCUS: Comparison of the level of effort devoted to malaria control with changes in disease incidence, deaths averted, or cases detected, with the goal of linking specific policy instruments (e.g., houses sprayed and hours worked)
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Audibert, M
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in Thailand: a retrospective study based on apportionment of expenditure under budget headings. Social and Economic Research Project Reports No.
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Van Dine, D
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