LF elimination programmes are good investments in health and poverty reduction. Increases in productivity and earning potential are important outcomes realized in areas where LF is eliminated. Gains in labour productivity come directly from the prevention of acute attacks, hydrocele, and lymphoedema, conditions which severely decrease worker productivity. Savings on medical treatment from the elimination of LF represent another significant gain for individuals and health systems.
China – A Case Study of Success
In China before control strategies were implemented, 330 million people were at risk of becoming infected with LF, with over 30 million cases documented. In the early 1950s, China targeted five diseases as a means of improving agricultural and industrial productivity, one of which was LF. The Chinese government was worried about the negative impact of the chronic clinical cases of LF (lymphoedema and hydrocele) and the repeated acute attacks of inflammation, after finding that approximately 80% of these occurred in people in the labour force. In the early 1980s, they estimated that 17.28 million days of labour were lost each year.
A cost-benefit analysis on an LF control programme in Zhejiang Province, China calculated a cost-benefit ratio of 1 to 5.7, implying that one Yuan spent on filariasis control produced 5.7 Yuan in benefits.
Africa – A Positive Economic Rate of Return
For the African LF programme, the economic rate of return would be approximately 27%. LF elimination programmes in Africa are likely to produce increases in health status, quality of life, and the productive potential of workers.
Epidemiological modelling was used to estimate both the costs of implementing LF mass drug administration (MDA) activities in the context of ongoing onchocerciasis activities and outcomes associated with the MDA activities. The population at risk was assumed to be 314 million residents in areas with known active LF transmission. On average, acute attacks were assumed to reduce a worker’s labour productivity by 2% per year, hydrocele and lymphoedema by 20% per year. Productivity was measured using the marginal productivity of agricultural labour.
LF was found to cost Africa US$1.3 billion per year from LF disability: 6% (US$78 million) from acute attacks 11% (US$140 million) from lymphoedema 83% (US$1.1 billion) from hydrocele. The LF programme would cost from US$0.20 - $0.50 per person per year. By 2029, the number of men with hydrocele would fall from almost 20 million to less than 4 million, the number of people with lymphoedema from about 4 million to less than 1 million, and the incidence of acute attacks would almost disappear.
But until programmes are fully funded in Africa, the return on investment will be unrealized.