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The economic burden of acute diarrhoeal illness in children under three years of age in the Andean and Amazonian regions of Peru

José Carlos ARCA VERA student laureate

°1976 Peru
Master’s in Health Economics, Universidad Nacional Mayor de San Marcos, Lima, Peru, 2006

La carga económica de la enfermedad diarréica aguda en niños menores de 3 años en localidades de la sierra y selva del Perú

In this thesis, the author develops a model of the economic burden of acute diarrhoeal illness based not only on the direct costs but also on the indirect costs for the family and for Peruvian civil society as a whole. Direct costs are the costs of preventative medicine initiatives or initiatives aimed at improving health, like the cost of consultations at the local health centre, the price of laboratory tests, the price of medicines or special diets a child will need to keep to, all of which are generally easy to evaluate. The indirect costs, however, are far more difficult to identify and calculate. On the basis of structured surveys carried out on 77 Peruvian families in the Andean and Amazonian regions, the author has sought to identify the costs and loss of revenue to which the illness gives rise: trips for regular visits to the health centre, stopping work or reduced hours of work for the close relatives of the child, expected loss of physical and intellectual capacities in the sick child in the future and loss of future human capital for the country.
By subsequently evaluating the economic model in two mountainous regions and in two plateau regions in Peru, the author calculates the economic burden of acute diarrhoeal illness in children under three years of age at one million American dollars for the Peruvian society, in 2002.
In relation to health care, some will claim that it is not realistic to make one single economic evaluation of the indirect costs of an illness. The model formulated in this thesis has its limitations – and these are in fact highlighted by the author – which is why researchers are generally forced to consider several different ways of expressing indirect costs. The choices made by the author are nevertheless worthwhile. This thesis, which is very structured and methodical and is written in a fluid style, can serve as a starting point for a new approach in the definition of a public health policy in a country like Peru.
Even though this study was carried out in Peru, the thesis is relevant to the development of many poor countries. Acute diarrhoeal illness remains a major public-health problem in areas that are not highly urbanized, where, besides the fact that food is not always available, there are clear shortages in health services and problems with access to drinking water. For both the families and the state, calculating the real cost, particularly the indirect cost of tackling the illness, constitutes a very powerful argument for encouraging a state to develop a more efficient policy for prevention and treatment.
At a time when international co-operation policies are aimed at the sectoral financing of health rather than financing per project, this work is also a plea to encourage those providing the capital to dare to exceed the boundaries of the health sector and take a more global approach to the financing of developing countries. As such they would allow the states to put in place a policy for indirect support to the health sector.

Report: Prof. A. Robert, Head of the unit for Epidemiology, Biostatistics and Operational Methods in Public Health, Université catholoque de Louvain, Louvain-la-Neuve, Belgium