Towards comprehensive malaria planning: The effect of government capacity, health policy, and land use variables on malaria incidence in India

We present what we believe is the first empirical research that accounts for subnational government capacity in estimating malaria incidence. After controlling for relevant extrinsic factors, we find evidence of a negative effect of state government capacity on reported malaria cases in Indian states over the period 1993–2002. Government capacity is more successful in predicting malaria incidence than potentially more direct indicators such as state public health expenditures and economic development levels. We find that high government capacity can moderate the deleterious health effects of malaria in rice producing regions. Our research also suggests that government capacity may have exacerbated the effectiveness of the World Bank Malaria Control Project in India over the period studied. We conclude by proposing the integration of government capacity measures into existing planning efforts, including vulnerability mapping tools and disease surveillance efforts.

► We offer the first systematic subnational application of government capacity to the study of malaria risk. ► Explanatory power of political capacity outperforms other risk indicators such as average state income and health spending. ► Regression analysis shows how rice production in India leads to higher malaria risk in low political capacity states. ► Quantitative evaluation of World Bank malaria control programs in India offers supportive evidence of effectiveness.