An Inquiry into Economic Consequences of Malaria Elimination in Sri Lanka

Abstract

After bearing a huge social cost at the time of malaria endemics in the recent past, Sri Lanka has now reached the level of its elimination with the absence of any indigenous case reported to the Anti-Malaria Champaign during the last three years. However, there is no assurance that there will be no resurgence of malaria in the near future. The sustainability of malaria elimination is a huge task with several constraints such as a) limited demand for malaria prevention and treatment due to lack of information from the providers' end b) lack of community engagement in malaria control c) inadequate supply of consumables including malaria drugs, diagnostic tests and insecticides d) poor-quality diagnosis and treatment practices at many health facilities e) reducing flexibility and ownership due to reliance on external funding (as in the case of Sri Lanka with the Global Fund) and f) overloading country management capacity by donor practices. Some projections were made on the possible social cost of a resurgence of malaria on the basis of a study undertaken in Matale district at a time of a malaria epidemic. The social cost of a resurgence of malaria consists of both public and private costs of treatment and prevention. In this context, private cost contains household cost of treatment, including cost of time loss due to illness and self-preventive measures. Thus, the social cost of a resurgence of malaria in the near future could stand at around Rs. 680 per person per year, making the total social cost equal to least Rs. 14 billion, of which the public provider's cost stands at around 4% of the total public health budget. Therefore, it is essential to strengthen the existing surveillance system of malaria substantially to avoid any resurgence of malaria for the prevention of this social cost.