Volume 96, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Sri Lanka has made remarkable gains in reducing the burden of malaria, recording no locally transmitted malaria cases since November 2012 and zero deaths since 2007. The country was recently certified as malaria free by World Health Organization in September 2016. Sri Lanka, however, continues to face a risk of resurgence due to persistent receptivity and vulnerability to malaria transmission. Maintaining the gains will require continued financing to the malaria program to maintain the activities aimed at preventing reintroduction. This article presents an investment case for malaria in Sri Lanka by estimating the costs and benefits of sustaining investments to prevent the reintroduction of the disease. An ingredient-based approach was used to estimate the cost of the existing program. The cost of potential resurgence was estimated using a hypothetical scenario in which resurgence assumed to occur, if all prevention of reintroduction activities were halted. These estimates were used to compute a benefit–cost ratio and a return on investment. The total economic cost of the malaria program in 2014 was estimated at U.S. dollars (USD) 0.57 per capita per year with a financial cost of USD0.37 per capita. The cost of potential malaria resurgence was, however, much higher estimated at 13 times the cost of maintaining existing activities or 21 times based on financial costs alone. This evidence suggests a substantial return on investment providing a compelling argument for advocacy for continued prioritization of funding for the prevention of reintroduction of malaria in Sri Lanka.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Ministry of Health Sri Lanka, World Health Organization, University of California, San Francisco. 2012. Eliminating Malaria: Case Study 3 Progress Towards Elimination in Sri Lanka. Available at: http://globalhealthsciences.ucsf.edu/sites/default/files/content/ghg/mei-eliminating-malaria-sri-lanka-lowres.pdf. Accessed March 1, 2016.
  2. Abeyasinghe RR, Galappaththy GNL, Smith Gueye C, Kahn JG, Feachem RGA, , 2012. Malaria control and elimination in Sri Lanka: documenting progress and success factors in a conflict setting. PLoS One 7: e43162.[Crossref]
  3. World Health Organization, 2015. World Malaria Report 2015. Geneva, Switzerland: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/200018/1/9789241565158_eng.pdf?ua=1. Accessed February 1, 2016.
  4. World Health Organization, 2016. WHO Certifies Sri Lanka Malaria-Free. Available at: http://www.searo.who.int/mediacentre/releases/2016/1631/en/. Accessed October 19, 2016.
  5. Sri Lanka Anti-Malaria Campaign, 2014. National malaria strategic plan for elimination and prevention of re-introduction—Sri Lanka 2014–2018. Sri Lanka: Ministry of Health.
  6. Zelman B, Melgar M, Larson E, Phillips A, Shretta R, , 2016. Global fund financing to the 34 malaria-eliminating countries under the new funding model 2014–2017: an analysis of national allocations and regional grants. Malar J 15: 118.[Crossref]
  7. Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, Sabot OJ, Moonen B, , 2012. Malaria resurgence: a systematic review and assessment of its causes. Malar J 11: 122.[Crossref]
  8. Karunaweera ND, Galappaththy GN, Wirth DF, , 2014. On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs. Malar J 13: 59.[Crossref]
  9. Wickramasinghe K, Premaratne RG, Peiris SL, Mosca D, , 2013. High attack rate for malaria through irregular migration routes to a country on verge of elimination. Malar J 12: 276.[Crossref]
  10. Wickramasingke K, Galappaththy GNL, Dayarathne D, Peiris SL, Basnayake RN, Mosca D, Jacobs J, , 2013. Irregular migration as a potential source of malaria reintroduction in Sri Lanka and use of malaria rapid diagnostic tests at point-of-entry screening. Case Rep Med 2013: 14.[Crossref]
  11. Shretta R, Johnson B, Smith L, Doumbia S, de Savigny D, Anupindi R, Yadav P, , 2015. Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya. Malar J 14: 57.[Crossref]
  12. Kelegama S, , 2014. “Strategic Focus”: Aligning Private Sector CSR Efforts to National Priorities for Development. Available at: www.csrsrilanka.lk/assets/docs/drr_saman_kelagama_01.pptx. Accessed September 4, 2015.
  13. Mills A, Shillcutt S, , 2004. The challenge of communicable diseases. Available at: http://www.academia.edu/download/30522485/communicable_diseases_160404.pdf. Accessed September 8, 2015.
  14. The World Bank, 2015. World Development Indicators. Available at: http://databank.worldbank.org/data//reports.aspx?source=2&country=THA&series=&period=#. Accessed January 1, 2016.
  15. Global Malaria Programme, 2012. World Malaria Report 2012. Available at: http://www.who.int/malaria/publications/world_malaria_report_2012/en/. Accessed January 1, 2016.
  16. Attanayake N, Fox-Rushby J, Mills A, , 2000. Household costs of “malaria” morbidity: a study in Matale district, Sri Lanka. Trop Med Int Health 5: 595606.[Crossref]
  17. Department of Census and Statistics, Sri Lanka, 2015. Available at: http://www.statistics.gov.lk/. Accessed September 4, 2015.
  18. United Nations Department of Economic and Social Affairs Population Division, 2015. World Population Prospects, the 2015 Revision. Available at: http://esa.un.org/unpd/wpp/DVD/. Accessed September 4, 2015.
  19. Kurunegala Teaching Hospital. Monthly cost accounting report. 2015.
  20. World Health Organization, 2015. Global Technical Strategy for Malaria 2016–2030. Geneva, Switzerland: World Health Organization.
  21. Kumar K, Pigazzini A, Stenson B, , 2013. Financing for Malaria Elimination. Available at: http://globalhealthsciences.ucsf.edu/sites/default/files/content/ghg/mei-financing-malaria-elimination.pdf. Accessed September 8, 2015.
  22. Population Division, United Nations, 2015. World Population Prospects. Available at: http://esa.un.org/unpd/wpp/Download/Standard/Population/. Accessed December 17, 2015.
  23. Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, Bustreo F, Evans D, Feachem RG, Frenk J, , 2013. Global health 2035: a world converging within a generation. Lancet 382: 18981955.[Crossref]
  24. Feachem RG, Phillips AA, Hwang J, Cotter C, Wielgosz B, Greenwood BM, Sabot O, Rodriguez MH, Abeyasinghe RR, Ghebreyesus TA, Snow RW, , 2010. Shrinking the malaria map: progress and prospects. Lancet 376: 15661578.[Crossref]
  25. Lucas AM, , 2010. Malaria eradication and educational attainment: evidence from Paraguay and Sri Lanka. Am Econ J Appl Econ 2: 4671.[Crossref]
  26. Fernando SD, Rodrigo C, Rajapakse S, , 2010. The “hidden” burden of malaria: cognitive impairment following infection. Malar J 9: 366.[Crossref]
  27. Bleakeley H, , 2010. Malaria eradication in the Americas: a retrospective analysis of childhood exposure. Am Econ J Appl Econ 2: 145.[Crossref]
  28. Modrek S, Liu J, Gosling R, Feachem RG, , 2012. The economic benefits of malaria elimination: do they include increases in tourism? Malar J 11: 244.[Crossref]
  29. Maartens F, Sharp B, Curtis B, Mthembu J, Hatting I, , 2007. The impact of malaria control on perceptions of tourists and tourism operators concerning malaria prevalence in KwaZulu-Natal, 1999/2000 versus 2002/2003. J Travel Med 14: 96104.[Crossref]
  30. Jha P, McLeod R, Moser P, , 2014. Priorities in Financing the Control of Malaria in the Asia-Pacific. Available at: http://aplma.org/upload/resource/Papers/PrioritiesinFinancingMalaria.pdf. Accessed September 8, 2015.
  31. Central Bank of Sri Lanka, 2014. Annual Report 2014. Available at: http://www.cbsl.gov.lk/pics_n_docs/10_pub/_docs/efr/annual_report/AR2014/English/content.htm. Accessed September 4, 2015.
  32. EYGM Limited, 2015. Sri Lanka Announces 2016 Tax Proposals. Available at: http://www.ey.com/Publication/vwLUAssets/Sri_Lanka_announces_2016_tax_proposals/$FILE/2015G_CM6044_Sri%20Lanka%20announces%202016%20tax%20proposals.pdf. Accessed January 20, 2016.
  33. United Nations General Assembly, 2015. Addis Ababa Action Agenda of the Third International Conference on Financing for Development (Addis Ababa Action Agenda). New York, NY: United Nations.

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  • Received : 15 Mar 2016
  • Accepted : 19 Nov 2016

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