Malaria and Development

Africa

Extracts from World Health Organisation (WHO) World Health Report 1999:

Malaria and underdevelopment are closely intertwined. Over 40% of the world's population live where there is a risk of malaria. The disease causes widespread premature death and suffering, imposes financial hardship on poor households,and holds back economic growth and improvements in living standards.

• Almost 300 million clinical cases of malaria occur worldwide each year and over one million people die.
• Almost 90% of these deaths occur in sub-Saharan Africa, where young children are the most affected.
• Malaria is directly responsible for one in five childhood deaths in Africa and indirectly contributes to illness and deaths from respiratory infections, diarrhoeal disease and malnutrition.
• Malaria-endemic countries are some of the worlds most impoverished. Malaria causes nearly 250 times more deaths in the world's poorest countries than in the richest.

The economic burden of malaria to households can be extremely high:

• Even in the poor countries of sub-Saharan Africa, households have been found to spend between $2 and $25 on malaria treatment, and between $0.20 and $15 on prevention, each month.
• Treatment costs of malaria for small farmers have been estimated to be as high as 5% of total household expenditure in Kenya and 13% in Nigeria. Many are simply too poor to be able to pay for adequate protection.
• Government resources are also stretched in the provision of prevention and treatment services. Between 20% to 40% of outpatient visits and between 10% and 15% of hospital admissions in Africa are attributed to malaria, at an estimated cost of $1.10 per outpatient visit (Malawi) and $35 per admission (Kenya). In Rwanda nearly a fifth of the health budget was spent on malaria treatment in 1989.
• One estimate of the impact of malaria on national income in Africa put the economic burden at 0.6 % of gross domestic product (GDP); separate estimates for Kenya put the overall production loss at 26% of GDP, and at 15% for Nigeria (3). Recent research suggests that the adverse economic impact of malaria in Africa is probably even greater than 1% of GDP. This figure is mainly made up of estimated productivity losses through premature mortality and spells of sickness. Further, malaria in school-children is a major cause of absenteeism and probably reduces the effectiveness of their education.
• Malaria is also thought to drive away potential development opportunities by making certain zones unsuitable for habitation, deterring international trade and foreign investment,and jeopardizing the development of sectors such as tourism. Economic development may also be retarded by reduced access to international flows of knowledge and technology because companies may be reluctant to send representatives to malarious countries. Malaria may thus be a cause, and not just a consequence, of underdevelopment.

The economic effects of malaria have been summarised by the WHO(1997) as:

• accounting for a large part of the disease burden, and thus health service expenditure of poor countries, Mozambique being one of the poorest countries in the region;
• a major cause of poverty and inequity in the world, affecting primarily the poor;
• costing African countries more than 1% of their GDP. Malaria cost Africa (directly and indirectly) about US$1.8bn in 1995, and $US 2 billion by the end of 1997;
• being one of the biggest impediments to progress in Africa (1997 World Health Report)

Statement at the Summit on Roll Back Malaria in Africa, Abuja, Nigeria, 25 April 2000 by Dr. Gro Harlem Brundtland, Director-General, World Health Organization

Malaria, Climate and Poverty by JL Gallup and JD Sachs (1999) In their investigation into the economic burden of malaria, Gallup and Sachs (1999) concluded that malaria and poverty are intimately connected. Controlling for factors such as tropical location, colonial history, and geographical isolation, they found that countries with severe malaria had income levels that, in 1995, were only 33% of those of countries without malaria. During the period 1965 - 1990, countries with severe malaria had lower economic growth, even after taking into account other factors such as initial poverty, economic policy and tropical location.

South Africa

  Historically malaria had a pronounced and detrimental effect on the agricultural and economic development of certain parts of KwaZulu-Natal Province. In 1932 all the districts of KwaZulu-Natal Province, bar one, reported cases of malaria. Huletts representatives had visited hundreds of planters, whose average workforce was 80, but typically only three were reporting for work. The Amatikulu sugar mill was only receiving one truck load of sugar-cane per day (5 tons) instead of the expected 1 500 tons, due to the workforce being down from malaria. Control measures were instituted in the Province in 1948 and their success has rendered large areas practically malaria free with resultant economic development. See Figure 1 showing the historical malaria distribution in South Africa while figure 2 reflects the distribution following longstanding control.

References

Gallup, JL and Sachs, JD (1999)                    Malaria, Climate and Poverty , discussion paper ( CAER, Harvard Institute for International Development ) For pdf file, click  here

WHO (1999)                                                 World Health Report 1999: Ch 4 Rolling Back Malaria.

WHO (1997)                                                 World Health Report 1997

Dr Gro Harlem Bruntland, Director-General, WHO   Statement at the Summit on Roll Back Malaria in Africa, Abuja, Nigeria, 25 April 2000