Economic Impact of Malaria in Peru
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1. THE ECONOMIC IMPACT OF MALARIA IN PERU 3. Original Title: This work was carried out with the participation of: El impacto económico de la malaria en el Perú. Design and Supervision Dr. César Bueno-Cuadra (MOH) © MINSA-Perú, 1999. Dr. César Cabezas-Sanchez (MOH) Dr. Jaime Chang-Neyra (USAID) Dr. Walter Mendoza-De Souza (MOH) Dr. Salomón Durand-Velasco (MOH) Dr. Luis Seminario-Carrasco (USAID) Dr. Víctor Zamora-Mesía (MOH) The reference terms for the study were made by: María Antonia Remenyi-Díaz (Economist) Translation: Roxana Lescano Translation reviewer: Dr. Fernando Llanos-Zavalaga Research Team: APOYO Institute: Lorena Alcázar-Valdivia, Ph.D. in Economy (Project Director) Rosa Ana Balcázar-Suárez (economist) (Project Director) Pedro Francke-Ballve (economist) (Technical specialist in charge) Dr. Manuel Quimper-Herrera (epidemiologist) Augusto Portocarrero-Grados (economist) Javier Paulini-Sanchez (economist) Claudia Barrios-Paucar (sociologist) This publication was made with financial support from the Vigia Project “Addressing the Threats of Emerging and Re-Emerging Diseases ” (Cooperative Agreement between the Ministry of Health of Peru and the U.S. Agency for International Development (USAID). © Ministry of Health, 2000 Av. Salaverry cuadra 8 s/n, Jesus María, Lima, Peru Correspondence: Proyecto Vigia (MINSA-USAID) Camilo Carrillo 402, Jesus María, Lima Telephones: 51 (1) 332-3482, 51 (1) 332-3458 http: //www.minsa.gob.pe/pvigia [email protected] This document can be freely used and reproduced, as a whole or in part, as long as its procedence is mentioned and there is no commercial use. ISBN: 9972-820-15-7 Depósito Legal N° 1501012000-4490 DEDICATION To the families in rural areas of the northern coast and jungle of our country who suffer the effects of malaria and fight collectively against the disease. To the health workers. THE ECONOMIC IMPACT OF MALARIA IN PERU MINISTRY OF HEALTH Dr. Alejandro Aguinaga-Recuenco Minister of Health Dr. Víctor Zamora-Mesía National Director of the Vigia Project ACKNOWLEDGEMENTS To the families of those sick with malaria who opened their doors to us for the survey. To the Ministry of Health workers who work in health facilities and in the Regional Health Offices of Loreto, Piura and Tumbes for their valuable and speedy collaboration in the collection and correction of regional data. To the Director’s Offices from the ESSALUD Hospitals of Piura and Iquitos. To the organizations that provided information: Proyecto Vichayal III, Bosque del Norte, ADEC, Villa Nazaret, Ideas, CIPCA, Médicos del Mundo and the Red Cross Loreto. To the Transitory Council Boards of Regional Administration in Piura, Tumbes and Loreto. To the Provincial Municipalities of Piura, Tumbes and Maynas To the Basic Health and Nutrition Project, coordination headworkers of Piura. To Dr. Marie-Andree Diouf-Romisch, representative of the Pan American Health Organization Mission in Peru INDEX INDEX p. 11 PROLOGUE p. 13 EXECUTIVE SUMMARY p. 15 INTRODUCTION p. 17 1. Malaria in Peru and in the world p. 21 1.1. General aspects p. 21 1.2 Malaria in the world p. 21 1.3 Malaria in Peru p. 22 1.3.1 Historical evolution p. 23 1.3.2 Current status p. 25 1.3.3 Characteristics of the main malaria transmission areas in Peru p. 28 1.4 Prevention and control strategies p. 29 2. Cost estimation in the health reform framework p. 33 2.1 A global view of the health sector in the reform process p. 33 2.2 The economic theory, costs and health economics p. 34 2.3 The study of the economic costs of malaria and its implications in the health reform p. 35 3. Aspects considered in cost estimation p. 39 3.1 Economic costs and effects of the health status p. 39 3.2 Concepts of the economic costs p. 40 3.2.1 Direct costs p. 40 3.2.2 Indirect costs p. 41 3.2.3 Other indirect costs produced by the effects on the behavior of economic agents p. 42 4. Methodology used in the economic costs estimation of malaria p. 43 4.1 Methodological techniques and tools considered p. 43 4.1.1 Calculation of the MOH direct institutional costs p. 44 4.1.2 Costs of other institutions: ESSALUD, NGOs, and others p. 47 4.1.3 Direct and indirect costs borne by patients and their families p. 47 a) Contents of the house survey p. 48 b) Sampling for the house survey p. 49 c) Application of the survey p. 52 d) Value of time p. 53 e) Value of life p. 55 f) Value of suffering p. 55 4.1.4 Calculation of the costs by loss of tourism p. 56 4.2 Possible bias and deficiencies of the methodology used p. 56 5. The economic cost of malaria in Peru p. 59 5.1 The cost of malaria in Peru in 1998 p. 59 5.1.1 The total cost of malaria in Peru p. 59 5.1.2 The Ministry of Health costs p. 60 5.1.3 Costs of other institutions p. 68 5.1.4 Total costs for families in prevention p. 69 5.1.5 Total cost for families for treatment p. 70 5.1.6 Mortality costs p. 73 5.1.7 Costs for loss of tourism p. 73 5.1.8 The fiscal costs of malaria p. 74 5.1.9 Malaria costs in regard to the GDP and by economic activity. p. 75 5.2 The cost of malaria for families p. 77 6. Final comments p. 83 BIBLIOGRAPHY P. 87 ANNEX 1 The economic impact of malaria in Peru Socio-economic Profile of the areas in the study p. 93 ANNEX 2 Profile of for health services user p. 117 INDEX OF ANNEXES NOT INCLUDED p. 127 12. PROLOGUE Malaria has re-emerged alarmingly in the epidemiological maps of the world and has turned into a serious threat, not only for individual and collective health but for the sustainable economic development of the societies struck by it. Social, economic, biological and environmental phenomena explain its re-emergence. The dramatic change suffered by the environment –which determines earth warming and thus, the modification of climatic patterns–; the expansion of agricultural borders; overpopulation and uninterrupted migration; constant changes in the biology and behavior of the vector and parasite involved in the transmission of the disease; increased resistance to medications and insecticides used to fight it; as well as the limited interest in developing new technologies and procedures for its control (since it is a disease centered around countries of limited economic development, therefore, not very attractive for the commercialization of new drugs and vaccines) are the underlying factors of this threat, which pose an enormous challenge for the health systems. The threat this problem poses to the whole world, as well as its extreme complexity, has lead the World Health Organization to develop a special program to fight it. This is the “Roll Back Malaria Initiative” whose main development scene is the African continent where this disease has reached unusual levels of morbidity and mortality. The last World Assembly of the World Health Organization, after extensive discussion on the magnitude and implications of malaria, was able to persuade the main international cooperation agencies of the need to carry out an additional effort to fight it, assigning special funds for malaria research, prevention and control. In our country, upon the boundless advance of malaria, the Ministry of Health has made huge efforts to try to control the phenomenon. However, the multiple factors conditioning the disease and the complexity of the control measures that overflow the health borders, have stopped the malaria prevention and control results from being optimum. The study entitled “Economic Impact of Malaria in Peru” is a Ministry of Health initiative, its purpose is to contribute to improve the knowledge of some elements that make up the complex malaria problem and its repercussions in the health and economy of the Peru- vian population. This effort has been accompanied and financed by the U.S. Agency for International Development (USAID) through the Vigia Project. 13. The results obtained in this study evidence the loss the country has and continues to have due to the persistent factors conditioning the magnitude of the disease, as well as the need for a multisectorial approach that guarantees the necessary resources to control a problem that seriously threatens the sustainable development and national security. We hope this study becomes a powerful management and awareness tool that commits institutions and society as a whole in the prevention and control of malaria in Peru. Dr. Alejandro Aguinaga-Recuenco Minister of Health The economic impact of malaria in Peru 14. Executive summary EXECUTIVE SUMMARY The Ministry of Health and USAID, through the Vigia Project, contracted for the performance of this study. The objective was to estimate the cost of malaria, not only for the government, but also for the familes affected by the disease, and to find out about the other effects the disease has on the economic activity in an indirect manner. The study is framed within the sector reform context because the control of malaria implies prioritizing collective health and reducing the inequities in health. The study has considered the estimation of direct costs which are the economic re- sources directly spent because of the disease; and the indirect costs that do not imply a cash disbursement of money but represent a loss of opportunities to produce or to work. The methodology used involved: a survey of 364 houses of the areas affected by malaria (Loreto, Piura, Tumbes) to determine the time lost and other costs faced by families affected by the disease; a survey of health services to identify the total costs of the health centers, including personnel costs and general services; and the data collection from the Ministry of Health units and others that assign resources to the fight against malaria.