Economic Burden of Malaria in six Countries of Africa

Abstract

Economic burden studies are important for use in advocating with Ministries of Finance and donors for increased investments in public health problems such as malaria. In September 2001, the authors convened a workshop at which a framework for the assessment of the economic burden of malaria in the African region was presented to health economists from 10 countries of the region. The framework document proposes the use of any one of three approaches – production function, cost of illness and willingness to pay – for the assessment of the burden of malaria to the economies of African countries. Between 2002 and 2005, six countries (Chad, Ghana, Mali, Nigeria, Rwanda and Uganda) undertook studies to assess the economic burden of malaria using the framework. The objective of this article is to report on the methodology, results and policy implications of the country economic burden studies.

Of the six countries whose results are presented in this report, Ghana and Nigeria used all three approaches to estimate the economic burden of malaria. Uganda, Rwanda and Chad implemented the production function and the cost of illness approaches, while Mali used only the cost of illness approach.

All countries implementing the cost of illness and willingness to pay approaches that required household surveys employed a multi-stage sampling methodology and used a structured questionnaire as the principal instrument for the collection of primary data from the households. Districts were selected to reflect the malaria epidemiological profile of the countries and a total of 5,498 households were sampled. Relevant secondary data on the institutional cost of malaria in the countries were obtained through checklists designed for the purpose, while other secondary data on the economy like the Gross Domestic Product (GDP), labour force, stock of capital, etc. were obtained from the National Statistical Services, Penn World Tables, World Bank Tables, African Development Bank, among others.

Malaria was found to be a significant explanatory variable for national income in Chad, Ghana, Nigeria and Uganda, countries that estimated macroeconomic models to assess the impact on malaria on the economy. In these countries, the incidence of malaria had a negative impact on aggregate national output, with the loss in growth of the economy or the “malaria penalty†ranging from 0.41% in Ghana to as high as 3.8% and 8.9% in Nigeria and Chad respectively. The loss in economic growth in Rwanda is much smaller at 0.08%. The studies reveal that the impact of malaria on the growth in real gross domestic product is negative and decreases for every increase in malaria morbidity rates.

The cost of illness approach results corroborate those obtained from the production function approach, indicating that malaria causes an enormous drain on the national economies. At the household level, the studies reveal a pattern of immense burden, particularly for the poorest households. In Ghana for example, the direct costs of malaria to the household is US$ 6.87, while it is US$ 11.84 and US$ 17.5 in Nigeria and Mali respectively. When the total cost of malaria was calculated, it was found that the countries were spending huge sums of resources for the control of malaria, resources that could have been devoted to other productive sectors, had the disease not been so prevalent.

There is need for more investment in malaria endemic countries to combat the disease to at least US$ 1.5 billion to US$ 2.2 billion annually, levels advocated by the WHO Commission on Macroeconomics and Health, as these investments would lead to lives saved, enhanced productivity and improved quality of life, particularly for the most vulnerable population.

Keywords: Africa, Malaria, Economic burden, Cost of illness, Direct costs, Indirect costs