An Investment Case for Eliminating Malaria in Bangladesh

Executive Summary

Bangladesh—having committed to a malaria-free Asia Pacific by 2030—has declared a national elimination goal of 2027. The country has made impressive progress towards this goal, reducing cases by 50% and deaths by 54% in just six years. The malaria program has renamed itself as the National Malaria Elimination Program (NMEP) due to its recent successes and transition from control to elimination activities.

Nevertheless, the NMEP faces key challenges ahead. Malaria is endemic in 13 out of 64 districts in Bangladesh with roughly 17.5 million people living at risk. These endemic districts are typically located in hard-to-reach areas, resulting in inadequate surveillance and limited access to healthcare services. In addition, external financing for malaria from the Global Fund to Fight AIDS, Tuberculosis and Malaria is declining, particularly for low transmission settings. The malaria program will need to ensure continued financial and political commitment from the Government of Bangladesh. Donor assistance for malaria has declined by almost 60% in Bangladesh between 2013-2015, and current domestic financing contributions are not sufficient to meet the need, threatening Bangladesh’s momentum towards elimination.

To provide evidence of the economic rationale for malaria elimination in Bangladesh, the UCSF Global Health Group’s Malaria Elimination Initiative, Mahidol-Oxford Tropical Medicine Research Unit (MORU), the International Centre for Diarrhoeal Diseases Research, Bangladesh, and the NMEP, with support from the Asian Development Bank and the Bill & Melinda Gates Foundation, developed an investment case for malaria elimination. Leveraging several approaches, the investment case estimates the costs of malaria elimination through 2030, estimates the economic and financial returns of malaria elimination, and explores feasible and sustainable financing options for Bangladesh.

Using data from five sample districts of varying endemicity levels, we estimated the median cost of the malaria program from fiscal year 2015-16 to be USD 20.4 million or USD 1.54 per person at risk. The costs and benefits of elimination were generated using outputs of a transmission model that projected rates of decline to elimination by at least 2030. The economic benefits of elimination were calculated using estimates of the mortality and morbidity averted and the return on investment.

The model predicts that it will cost approximately USD 76.9 million (range USD 68.8 million to USD 92.2 million) to achieve elimination in 2025 and USD 14.64 million (range USD 10.5 million to USD 19.9 million) for prevention of reintroduction until 2030; a total of USD 91.5 million. Elimination was predicted to prevent 829,605 clinical cases, save over 1,577 lives (range: 697 to 17,277), and generate economic benefits of USD 343.5 million (range: USD 153.4 million ot USD 3.6 billion) through reductions in deaths, cases, household and healthcare system spending, and increases in productivity over a fifteen year time period. By investing in malaria elimination, Bangladesh can expect to see a return of nearly 7 to 1 on every additional dollar spent on elimination.