A new study published in Tropical Medicine and International Health (TMIH) shows that the burden of malaria falls disproportionately on poorer households. Somi et al. report that, “Poorer households bear a greater economic burden from malaria relative to their consumption than better-off households. Households are particularly vulnerable to malaria in the rainy season, when malaria prevalence is highest but liquidity is lower. Alternative strategies to assist households to cope with seasonal liquidity issues, including insurance, should be investigated. The seasonal variation in the economic burden of malaria has implications for the design and interpretation of studies.” The attached graph shows these findings for the rainy season.
In the same issue of TMIH, Deressa et al. look at the experience of rural families in an area of epidemic malaria and conclude that, “Malaria poses a significant economic burden on rural households and individuals both through out-of-pocket payment and person-days lost.” They suggest that, “The promotion and implementation of insecticide-treated nets would alleviate the economic consequences of the disease.”
Malaria Journal reported last year that, “The impacts of malaria on household economic status unfold slowly over time. Coping strategies adopted can have negative implications, influencing household ability to withstand malaria and other contingencies in future,” in a review article by Chuma et al. These negative coping strategies include borrowing money and selling assets, often because poor people have delayed seeking treatment they know they cannot afford.
As mentioned above, providing ITNs to the poor is a step in the right direction. Other pro-poor interventions that cut mortality and improve equitable access to services include “Strict monitoring of patients, removal of prescription charges for families, and small financial incentives for the staff cut hospital mortality for malaria” and “Implementation of home based practices using prepackaged antimalarial drugs.”
Ultimately, as Chuma et al., suggest, “To protect the poor and vulnerable, malaria control policies need to be integrated into development and poverty reduction programmes.” In short – the Millennium Development Goals see malaria control as part of development, not a vertical disease program. Donors and health planners need to take note.