Fighting Malaria: The Key to 21st Century Development
by Anisah Rafi
Malaria and poverty are intimately connected. This parasitic disease—regarded as both a source and a result of poverty—causes more than a million global deaths yearly. The disease perpetuates vicious cycles of poverty and poor health in the poorest corners of the world, many of which are found on the African continent.
Malaria costs the continent of Africa about $12 billion a year in lost gross domestic product—although the disease could be controlled for a fraction of that sum. In sub-Saharan Africa, malaria affects mostly young children under the age of five, with a mortality rate of almost 3,000 child deaths every day. This accounts for almost 20 percent of all child deaths. Still, children who escape death are not untouched by the disease. In sub-Saharan Africa, malaria is responsible for approximately 50 percent of all hospital admissions and outpatient visits to clinics.
Poor, rural communities tend to suffer the greatest malarial effects because of higher infective mosquito epidemics, lower access to healthcare centers, inadequate malaria prevention education, and limited funds for prevention methods, namely insecticide-treated mosquito nets (ITNs). The direct costs of malaria include maintaining health facilities and infrastructure, managing effective malaria control campaigns and providing public education. Historically, countries with high malaria transmission have had lower rates of annual economic expansion than countries with fewer malaria cases. Studies show that malaria endemic countries in Africa have economic growth rates of up to 1.3 percent less than the non-endemic. For many African countries, this can mean negative growth rates—what economists would describe as a growth penalty. For countries with a high malaria burden, the disease may cost as much as 40 percent of public health expenditure. In Tanzania, for instance, malaria accounts for about 30 percent of the national disease burden.
Malaria’s impact on African human resources has suffered more than simple lost earnings. While it’s difficult to express in terms of dollars and cents, a significant indirect cost of malaria is the human pain and suffering it causes. The human suffering and loss of life caused by the disease is often matched by the economic burden placed on families who bear the direct financial costs. Personal expenditure includes spending on ITNs, doctors’ fees, anti-malarial drugs, transport to health facilities, patient support and, in many cases, funeral costs.
In Ghana, for example, this unbearable strain on household resources can cost up to 34 percent of a poor household’s income. Worker productivity lowers with increased sick leave, absenteeism and premature mortality in the workforce. For many rural farming communities, the transmission period of malaria coincides with the planting season, further slowing agricultural productivity. Malaria also hampers children’s schooling and social development because of absenteeism and immutable neurological damage associated with severe episodes of the disease.
Due to its constraint on social and economic decisions, the simple presence of malaria in a community curtails individual and national prosperity. In malaria-endemic regions, the risk of contracting can dissuade investment, upsetting household and individual decision-making and economic productivity. In particular, households and farms prefer to plant subsistence crops rather than more labor-intensive cash crops due to malaria’s impact on labor during harvest season. Malaria also engenders undeveloped markets and meager tourist industries since traders and travelers are hesitant to invest in endemic areas.
Counting its costs, a severe lack of funding is a taxing obstacle to controlling malaria across the African continent. Public health agencies estimate that $2-3 billion is required per year to scale up malaria control programs across endemic nations in sub-Saharan Africa. Yet, under $200 million is allocated every year on malaria control by African governments, donor governments and United Nations agencies. Extricating reserves from other essentials, malaria cripples Africa’s economic advancements and maintains vicious cycles of poverty. For instance, the Northern region of Ghana, malaria treatments cost up to a quarter of household incomes for poorer families. Across the continent, malaria treatments and lost trade productivity cost African economies about $12 billion a year.
A range of partnerships between public and private sectors are working on improving access to anti-malarial drugs and developing new tools to tackle the disease. These efforts are committed to supporting national governments in scaling up malaria prevention and control programs by identifying resource gaps—both human and financial—and helping to ensure these gaps are addressed. The proper use of a $10 mosquito bed net has been shown to reduce mortality in children under five by up to 25 percent. Confronting costly challenges, UNICEF’s initiative sponsors Malawi’s rapid expansion of the use of ITNs by pregnant women and young children through distribution of subsidized nets at antenatal and maternal health clinics. During antenatal healthcare visits, pregnant women receive intermittent preventive treatments to protect them against malaria and protect their unborn children against premature birth and low birth-weight. The initiatives’ aims are to provide the most critical and affordable interventions to maximize health benefits for women and young children, and serve as a basis for improving access to other essential medicines.
During the 1980s, ITNs were expensive—about $10 to $15 per net—resulting in low net usage for the majority of rural village residents. Tanzania was the first African country to remove taxes and tariffs on mosquito-netting materials, a major factor contributing to the expansion of the net-production industry. By 2002, the cost of a net in Tanzania had dropped to $3.50 and net coverage rose to 37 percent of households—71 percent in urban regions and 57 percent in rural communities. Currently, three Tanzanian manufacturing companies produce more than 4 million ITNs, enough to supply the local market and create a thriving export trade. In Tanzania’s rural population of 60,000, the use of these nets has been linked to a 27 percent reduction in child deaths for children ages one-month to four-years old.
In 2000, the United Nations ushered in the new millennium with a roadmap setting out eight Millennium Development Goals to achieve by the end of 2015. As the end of the course draws near, the United Nations still widely acknowledges that controlling malaria is an integral part of a comprehensive development framework with a key role in poverty reduction. Malaria alleviation in poverty-stricken countries has a positive impact on achieving other MDGs, especially improving health, education and poverty levels in those countries. The economic burden of malaria for both families and governments take a significant toll, reducing opportunities for economic growth and impacting household income. With malaria consuming nearly 25 percent of African household incomes and 40 percent of government health spending, mitigating the effects of malaria will directly help countries and communities lift themselves out of extreme, lingering poverty.