Burden of malaria and other infectious diseases in the Asia-Pacific

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Burden of malaria and other infectious diseases in the Asia-Pacific. Ravi P. Rannan- Eliya Institute for Health Policy Sri Lanka. Disease Burden. Disease burden in DALYs – Developed vs. d eveloping regions (2010). Composition of disease burden – Developed vs. d eveloping regions (2010). - PowerPoint PPT Presentation

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Burden of malaria and other infectious diseases in the Asia-PacificRavi P. Rannan-EliyaInstitute for Health PolicySri Lanka0Disease Burden1Disease burden in DALYs Developed vs. developing regions (2010)

2Composition of disease burden Developed vs. developing regions (2010)3

Distribution of disease burden in South-East Asia (2010)4

Distribution of disease burden in South-East Asia (2010)5

Malaria burden in Asia-Pacific6Status of malaria control and elimination, Asia-Pacific 2013

7Malaria cases and deaths, Asia-Pacific 2012

82.2 billion at risk, 32 million cases, 48,000 deaths (2012)8% of global deaths, but 67% of global population at riskIncluding most of the largest country burdens India, China, Bangladesh, Viet NamArtemisinin resistance, Greater Mekong

Global hotspot for artemisinin in SE AsiaLinked to weak health systems, high degree of reliance on private/informal provision, high levels of prevalenceContinued production of artemisinin monotherapies, esp. in IndiaMajor risk to global malaria eradication9Economic impact of malaria and other diseases10Impact of malaria on households and nationsPrior to HIV/AIDS, malaria had the largest economic and social impact of any infectious disease in Asia-Pacific.

Effects include:FamiliesDirect impact on ability to work and functionDirect costs of medical treatment frequently impoverishedIndirect costs of looking after sick patientsNationsPrevented settlement and use of affected agricultural land, e.g, Cambodia, Sri LankaBarrier to foreign investment and tourism

Best estimates of net impact:Reduces GDP growth by 1-2% in affected countries11Health financing and expenditures on malaria and infectious diseases12Sources of financing in health systems, Asia-Pacific countries 2010

13Financing levels by source of funding, by income level within Asia-Pacific 201214

Poorest countries with highest malaria burden have least capacity to finance healthcare, in particular to raise public fundsPrivate financing (% GDP) does not grow with GDP per capitaExternal financing significant in poor countries, but fungibility is substantial

Distribution of out-of-pocket/private spending by income levels in high burden countries

15How much is spent on specific diseases?Short answer = We usually dont know

WHO, GFATM and others collect data on specific diseases, but data only reliable for external financingEfforts uncoordinated, duplicative, inconsistentTypically fails to cover spending by government and private sources for treatment within general health servicesSignificant burden created for countries from multiple, uncoordinated expenditure reporting requirements, with little benefitDomestic 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 significantPotential to use increased awareness of current spending levels to increase domestic financing16Progress towards disease expenditure tracking2011-14Agreement by international agencies to use health accounts as basis for tracking disease expendituresDecision by GFATM to support countries to use health accounts (disease accounts) to track and report spending

Asia-PacificSignificant national capacities to produce health accounts, but only few have disease accounts currently Bangladesh, Sri Lanka, ThailandEfforts by OECD and regional networks to share expertise, but underfundedPotential new initiative by GFATM to give partial support to some countries17Bangladesh Disease AccountsMOHFW Facility Expenditure Per Capita by Age and Condition (Tk)18

Conclusions19Prospects for increasing financing for target diseases in high burden countriesHigh burden countries = Poorest countriesLeast able to mobilize new fundingCase for regional and global solidarity

Private financing dominant, but difficult to capture and mostly serves non-poorHigh burden countries have weak capacity to organize financing or to regulate private providersGeneral 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 fundingBut governments generally underestimate their actual financial costs

20ConclusionsDisease 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 levelHighest 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 financingIssue 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