Malaria is frequently cited as one of the biggest killers of young children in Africa. Yet rarely, do we hear about its impact on working-age adults and the economic impact of the disease.
While malaria-related deaths among adults have fallen substantially since 2000, people with malaria find their ability to go to work and support themselves and their families severely affected. People who work in agriculture may be particularly at risk of disease, as irrigation can be fertile ground for mosquito breeding. The cost of work days lost as well as lower productivity among those who continue to work while ill is also significant, both for individuals and their employers.
Early treatment can provide an effective check to lost productivity – so how do we make sure more people have access to it? We have been working in Nigeria on a programme that offers affordable, private malaria testing and treatment for sugar cane cutters at a large sugar cane plantation in Adamawe State.
We found that the programme increased workers’ income by on average 10% over a three-week period by increasing on-the-job productivity and labour supply. As well as allowing people who tested positive for malaria to get treated and return to work sooner, the project also increased information available to workers and helped them to avoid falling ill in the first place.
Since the symptoms of malaria are very general, it may be hard to self-diagnose – and a formal test provides them with hard information. Workers who were surprised to find out that they did not have malaria were more likely to then choose higher-return tasks (such as cutting) in the period following the news, moving out of tasks with lower effort and remuneration (such as scrabbling/collecting).
Despite these benefits, the use of private malaria healthcare by workers is low. So why aren’t workers who can afford it treating themselves?
Paying for health
To answer this question a study, funded by the DFID-ESRC Growth Research Programme, measured the willingness of agricultural workers to pay for malaria services at their workplace. Sugar cane cutters were approached in random order and offered the option to be tested and treated for malaria twice during a six-week period, using treatment recommended by the World Health Organisation.
Each worker was asked about their how much they were willing to pay for this service, then was invited to draw a price from a bag: they got access to the service at the price drawn if the worker’s willingness to pay exceeded or was equal to the price drawn. If the worker won access, he then paid for the service, knowing there was no refund, even if he did not fall ill or if he chose not to use the service.
In general workers’ willingness to pay is modest, at ₦350 Naira on average, slightly more than US$2. However, the study showed that an important section of workers were willing to pay more, typically because they had higher than average levels of information about malaria – how you get infected, how to avoid it and what to do when you have it – or because they had suffered from malaria in the past month. Workers who showed more trust in the service were also willing to pay more.
While many workers are initially willing to pay a modest price, as they accumulate information about the service and its benefits, and build trust, they become more likely to buy the service in the future. Information, as well as cost and trust, are key factors in helping people protect themselves from malaria.
Malaria eradication is now a major global effort and in the absence of affordable universal healthcare in many African countries, healthcare that can be accessed at work can make important contributions to the system. By improving access to care, it renders direct benefits for workers in the short run.
Subsidising this type of care to bring the price low enough to appeal to workers (below ₦500 in this case) can also yield long-term benefits, as it may prompt increased take-up in the future as workers gain trust in the reliability and cost-effectiveness of the treatment for their own livelihoods.
While agriculture is often touted as a critical source of growth for Africa, the link between health and agricultural productivity is frequently overlooked; yet it is a crucial one.
A recent workshop with malaria experts and policy makers in Abuja demonstrated enthusiasm for this workplace-based approach from employers and national policymakers, as well as employees. It also emphasised the promise of mixed funding – where government, employers and workers each contribute towards covering the cost of malaria care.
This may prove a more attractive prospect for governments and donors, especially as increased take-up by workers would gradually reduce the need for subsidies over time. Ultimately, minimising the impact of malaria on people’s livelihoods and productivity stands to benefit everyone, not just those who are spared the sore symptoms.