Mills Anne, Lubell Yoel, Hanson Kara
Health Economics and Financing Programme, Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Malar J. 2008 Dec 11;7 Suppl 1(Suppl 1):S11. doi: 10.1186/1475-2875-7-S1-S11.
Malaria eradication raises many economic, financial and institutional challenges. This paper reviews these challenges, drawing on evidence from previous efforts to eradicate malaria, with a special focus on resource-poor settings; summarizes more recent evidence on the challenges, drawing on the literature on the difficulties of scaling-up malaria control and strengthening health systems more broadly; and explores the implications of these bodies of evidence for the current call for elimination and intensified control. Economic analyses dating from the eradication era, and more recent analyses, suggest that, in general, the benefits of malaria control outweigh the costs, though few studies have looked at the relative returns to eradication versus long-term control. Estimates of financial costs are scanty and difficult to compare. In the 1960s, the consolidation phase appeared to cost less than $1 per capita and, in 1988, was estimated to be $2.31 per capita (both in 2006 prices). More recent estimates for high coverage of control measures suggest a per capita cost of several dollars. Institutional challenges faced by malaria eradication included limits to the rule of law (a major problem where malaria was concentrated in border areas with movement of people associated with illegal activities), the existence and performance of local implementing structures, and political sustainability at national and global levels. Recent analyses of the constraints to scaling-up malaria control, together with the historical evidence, are used to discuss the economic, financial and institutional challenges that face the renewed call for eradication and intensified control. The paper concludes by identifying a research agenda covering: issues of the allocative efficiency of malaria eradication, especially using macro-economic modelling to estimate the benefits and costs of malaria eradication and intensified control, and studies of the links between malaria control and economic development, the costs and consequences of the various tools and mixes of tools employed in control and eradication, issues concerning the extension of coverage of interventions and service delivery approaches, especially those that can reach the poorest, research on the processes of formulating and implementing malaria control and eradication policies, at both international and national levels, research on financing issues, at global and national levels.
疟疾根除面临诸多经济、财政和体制方面的挑战。本文回顾了这些挑战，借鉴以往疟疾根除工作的证据，特别关注资源匮乏地区；总结了关于这些挑战的最新证据，借鉴了关于扩大疟疾控制规模及更广泛加强卫生系统困难的文献；并探讨了这些证据对当前消除疟疾及强化控制呼吁的影响。可追溯至根除疟疾时代的经济分析以及近期分析表明，总体而言，疟疾控制的益处超过成本，不过很少有研究考察根除疟疾与长期控制的相对回报。财政成本的估计数据稀少且难以比较。在20世纪60年代，巩固阶段的人均成本似乎低于1美元，1988年估计为人均2.31美元（均按2006年价格计算）。近期对高覆盖率控制措施的估计表明人均成本为几美元。疟疾根除面临的体制挑战包括法治的局限性（在疟疾集中于与非法活动相关人员流动的边境地区时是一个主要问题）、地方实施机构的存在及绩效，以及国家和全球层面的政治可持续性。近期对扩大疟疾控制规模制约因素的分析以及历史证据，被用于讨论重新呼吁根除疟疾及强化控制所面临的经济、财政和体制挑战。本文最后确定了一个研究议程，涵盖：疟疾根除的配置效率问题，特别是利用宏观经济模型估计疟疾根除和强化控制的益处与成本，以及疟疾控制与经济发展之间联系的研究，控制和根除中使用的各种工具及工具组合的成本与后果，干预措施覆盖范围扩大及服务提供方式的问题，特别是那些能够惠及最贫困人口的方式，关于在国际和国家层面制定和实施疟疾控制与根除政策过程的研究，关于全球和国家层面融资问题的研究。
