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Malaria, more than any other disease of major public health importance in developing countries, disproportionately affects poor people, with 58% of malaria cases occurring in the poorest 20% of the world’s population. If malaria control interventions are to achieve their desired impact, they must reach the poorest segments of the populations of developing countries. Unfortunately, a growing body of evidence from benefit-incidence analyses has demonstrated that many public health interventions that were designed to aid the poor are not reaching their intended target. For example, the poorest 20% of people in selected developing countries were as much as 2.5 times less likely to receive basic public health services as the least-poor 20%. In the field of malaria control, a small number of studies have begun to shed light on differences by wealth status of malaria burden and of access to treatment and prevention services. These early studies found no clear difference in fever incidence based on wealth status, but did show significant disparities in both the consequences of malaria and in the use of malaria prevention and treatment services. Further study is needed to elucidate the underlying factors that contribute to these disparities, and to examine possible inequities related to gender, social class, or other factors. To achieve impact and overcome such inequities, malaria control efforts must begin to incorporate approaches relevant to equity in program design, implementation, and monitoring and evaluation.
Received August 21, 2003. Accepted for publication January 6, 2004.
Acknowledgements: This paper is based on a review and analysis of the literature and a report on a meeting on Malaria and Equity carried out by the Health Economics and Financing Program, London School of Financing and Tropical Medicine, in collaboration with the World Bank, and funded by the World Bank.
Financial support: Natasha Palmer, Eve Worrall, Kara Hanson, and Anne Mills are members of the Health Economics and Financing Programme, which receives a research grant from the United Kingdom Department for International Development.
Authors’ addresses: Lawrence M. Barat, Academy for Education Development, 1825 Connecticut Avenue, Washington, DC 20009 and Suprotik Basu, Natasha Palmer, Eve Worrall, Kara Hanson, and Anne Mills, Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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