Transcript Burden of Malaria and other Infectious Diseases in the

Burden of malaria and other infectious
diseases in the Asia-Pacific
Ravi P. Rannan-Eliya
Institute for Health Policy
Sri Lanka
Disease Burden
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Disease burden in DALYs – Developed vs.
developing regions (2010)
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Composition of disease burden – Developed
vs. developing regions (2010)
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Distribution of disease burden in South-East
Asia (2010)
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Distribution of disease burden in South-East
Asia (2010)
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Malaria burden in Asia-Pacific
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Status of malaria control and elimination,
Asia-Pacific 2013
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Malaria cases and deaths, Asia-Pacific 2012
• 2.2 billion at risk, 32 million cases, 48,000 deaths (2012)
– 8% of global deaths, but 67% of global population at risk
– Including most of the largest country burdens – India, China,
Bangladesh, Viet Nam
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Artemisinin resistance, Greater Mekong
Global hotspot for
artemisinin in SE Asia
• Linked to weak health
systems, high degree of
reliance on private/informal
provision, high levels of
prevalence
• Continued production of
artemisinin monotherapies,
esp. in India
• Major risk to global malaria
eradication
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Economic impact of malaria and other
diseases
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Impact of malaria on households and
nations
Prior to HIV/AIDS, malaria had the largest economic and social
impact of any infectious disease in Asia-Pacific.
Effects include:
• Families
– Direct impact on ability to work and function
– Direct costs of medical treatment frequently impoverished
– Indirect costs of looking after sick patients
• Nations
– Prevented settlement and use of affected agricultural land, e.g,
Cambodia, Sri Lanka
– Barrier to foreign investment and tourism
• Best estimates of net impact:
– Reduces GDP growth by 1-2% in affected countries
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Health financing and expenditures on
malaria and infectious diseases
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Sources of financing in health systems,
Asia-Pacific countries 2010
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Financing levels by source of funding, by
income level within Asia-Pacific 2012
Grouping
Per capita
health
expenditure
(USD)
Public health
expenditure
(% of GDP)
Private health
expenditure
(% of GDP)
Total health
expenditure
(% of GDP)
External
financing (%
of total health
expenditure)
71
1.6
3.6
5.0
14.1
Lower middleincome
countries
166
2.3
2.2
4.5
11.5
Upper middleincome
countries
514
2.7
1.7
4.4
0.6
3,228
5.8
2.9
8.3
0.0
Asia-Pacific
Low-income
countries
High income
countries
•
•
•
Poorest countries with highest malaria burden have least capacity to finance
healthcare, in particular to raise public funds
Private financing (% GDP) does not grow with GDP per capita
External financing significant in poor countries, but fungibility is substantial
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Distribution of out-of-pocket/private spending
by income levels in high burden countries
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How much is spent on specific diseases?
• Short answer = We usually don’t know
• WHO, GFATM and others collect data on specific diseases, but
data only reliable for external financing
– Efforts uncoordinated, duplicative, inconsistent
– Typically fails to cover spending by government and private
sources for treatment within general health services
– Significant burden created for countries from multiple,
uncoordinated expenditure reporting requirements, with little benefit
– Domestic financing may be 100-300% more than reported for many
countries, e.g., malaria in Bangladesh, Solomon Islands
• For malaria and many other diseases, unreported domestic
spending is likely to be significant
– Potential to use increased awareness of current spending levels to
increase domestic financing
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Progress towards disease expenditure
tracking
2011-14
• Agreement by international agencies to use health accounts as
basis for tracking disease expenditures
• Decision by GFATM to support countries to use health accounts
(disease accounts) to track and report spending
Asia-Pacific
• Significant national capacities to produce health accounts, but
only few have disease accounts currently – Bangladesh, Sri
Lanka, Thailand
• Efforts by OECD and regional networks to share expertise, but
underfunded
• Potential new initiative by GFATM to give partial support to
some countries
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Bangladesh Disease Accounts
MOHFW Facility Expenditure Per Capita by Age and Condition (Tk)
25
20
15
10
5
0
0
1-4
5-9
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95+
Acute respiratory infections
Benign neoplasms
Cardiovascular disease
Chronic respiratory diseases
Diseases of the digestive system
Congenital anomalies
Endocrine & metabolic disorders
Diabetes mellitus
Genitourinary diseases
III-defined conditions & other contacts
Infectious & parasitic diseases
Injuries
Malignant neoplasms
Maternal conditions
Mental disorders
Musculoskeletal disorders
Neonatal causes
Nervous system and sense organ disorders
Nutritional deficiencies
Oral health
Other anaemias and blood/immune disorders
Skin diseases
Unspecified abnormal clinical & laboratory
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Conclusions
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Prospects for increasing financing for target
diseases in high burden countries
• High burden countries = Poorest countries
– Least able to mobilize new funding
– Case for regional and global solidarity
• Private financing dominant, but difficult to capture and mostly
serves non-poor
– High burden countries have weak capacity to organize financing or
to regulate private providers
– General global consensus that out-of-pocket spending must be
reduced because of link to impoverishment and barriers to access
• External financing important for many countries, but additionality
is not 100%
– Some crowding out today of domestic funding
– But governments generally underestimate their actual financial
costs
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Conclusions
• Disease and economic burden justify attention to malaria in
Asia-Pacific after HIV/AIDS, TB.
• Cost-effectiveness of available interventions, economic impacts
and potential losses from malaria resurgence justify prioritization
of spending today at regional level
• Highest burden countries least able to finance efforts, but
growing incomes in Asia-Pacific and large size of countries
points to increasing domestic mobilization in those that can
afford, and increased reliance on domestic public financing
• Issue of fungibility of aid and challenge of maintaining domestic
financing commitments in elimination countries suggests
potential for using external and new funding to incentivize
greater domestic government spending efforts
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