Post EBOLA – Exploring a National Disease Surveillance System for Nigeria Part 2

Filed under: National Issues |

DALYs and Major Economic Advantages for Nigeria


This article is a continuation of my previous article on the need to implement a National eSurveillance System for diseases like Ebola, HIV, Tuberculosis and a host of others, where I touched on the subject of DALYs (Disability-Adjusted Life Years) which is a concept reviewed in considerable detail in the UN WHO 2001 report ‘Macroeconomics and Health: Investing in Health for Economic Development’, led by Dr. Jeffrey Sachs, the world’s pre-eminent health economist.

As noted in the last article “The Report presents empirical evidence that longer healthy lives in a country is the driver behind massive economic benefits calculated on the basis of each DALY – being valued at ‘one year of per capita income x the population x the number of life years increased’.

It was also shown in the last article that it is critical to start to have in place health systems (eHealth) such as the Heron PAS/Surveillance System to be able to make ‘informed’ decisions about both a patient’s health and at the same time to gather data in e-format. The gathered data, amongst other things, enables national ‘informed’ decisions on the allocation of health resources to strengthen overall the health of the population of the country, and to be able to measure the progress in health outcomes year-to-year at all levels of society.

This article demonstrates that the World Health Organization (WHO) takes the DALYs concept very seriously, and has developed formulas enabling the WHO to measure this matter on a national, and worldwide basis, since comparisons between nations are important in enabling world progress in health.


The World Health Organization (WHO) defines this subject as follows:
Metrics: Disability-Adjusted Life Year (DALY) – Quantifying the Burden of Disease from mortality and morbidity


One DALY can be thought of as one lost year of “healthy” life. The sum of these DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.

DALYs for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences:



The YLL basically correspond to the number of deaths multiplied by the standard life expectancy at the age at which death occurs. The basic formula for YLL (without yet including other social preferences discussed below), is the following for a given cause, age and sex:

YLL = N x L


N = number of deaths

L = standard life expectancy at age of death in years

Because YLL measure the incident stream of lost years of life due to deaths, an incidence perspective has also been taken for the calculation of YLD in the original Global Burden of Disease Study for year 1990 and in subsequent WHO updates for years 2000 to 2004.

To estimate YLD for a particular cause in a particular time period, the number of incident cases in that period is multiplied by the average duration of the disease and a weight factor that reflects the severity of the disease on a scale from 0 (perfect health) to 1 (dead). The basic formula for YLD is the following (again, without applying social preferences):

YLD = I x DW x L


I = number of incident cases

DW = disability weight

L = average duration of the case until remission or death (years)

Prevalence YLD

The recent GBD 2010 study published by IHME in December 2012 used an updated life expectancy standard for the calculation of YLL and based the YLD calculation on prevalence rather than incidence:

YLD = P x DW


P = number of prevalent cases

DW = disability weight

DALYs – Massive Economic Benefit for Nigeria

The concept of DALYs, as developed by the WHO, clearly demonstrates the economic benefit to any country that improves its health system, and Nigeria, with the world’s 7th largest population, stands to achieve an unequaled economic benefit by improving its health outcomes using eHealth approaches.

Accordingly to the WHO statistics the life expectancy for all Nigerians (M/F) is at 54 years (2012), and is increasing each year, which is good, however, this level of life expectancy for Nigeria is lower than most other countries (Nigeria is ranked 182nd of 193 countries) – the average in the world (2012) being 71.0 years – as can be seen at an indicator that Nigeria can achieve very significant economic benefits by taking the required steps now to improve health through eHealth initiatives, as described in my last article, and in my next article.

Comparing Health Costs to DALYs Benefits

One way to measure this DALYs benefit for Nigeria is to compare the annual public health expenditure which is about US$1.7 billion, which on a per capita (170 million population) basis equates to about US$ 10 per capita, according to Nigeria Health Watch: The WHO figure for public health spending in Nigeria is $25. There is a big discrepancy here in the different reported per capita annual public health expenditures. Let’s compare the DALYs benefits to the larger public health budget of US$4.25 billion (based on US$ 25. per capita.)

Using the WHO DALYs formula to measure the economic benefit shows that an increase of 0.5 year of healthy life for the overall population of Nigeria (170 million) times the GDP per capita US$3,000 equates to an economic benefit of US$ 255 billion (170,000,000 x 3,000 x 0.5). When compared to the current annual public health budget of about US$4.25 billion (above) the benefit to society massively exceeds the government annual public health expenditure – by a very large factor.


Increased government spending on public health is not only very good for the population of the country, but it leads to a very significant economic benefit for Nigeria overall. One of the most important aspects of government investment in the public health sector is to now move ahead immediately to START to implement Health Information Systems (HIS or eHealth) that all of the developed countries started to implement in 1972, which have continued to be enhanced in each and every developed country ever since.

It can be concluded, that because the developed countries started to invest in their Health Information Systems (eHealth) over 40 years ago, that all of these 40 developed countries have now achieved the massive economic benefits that are shown by the WHO to result from such investments. It can also be concluded that Nigeria will correspondingly also achieve such economic benefits through eHealth over the coming years, by starting now, and by funding continuous enhancements year-by-year.

In my next article we will look at how to get STARTED, and to then continuously
expand the eHealth system in Nigeria, on an integrated national basis, over
the next 20 to 30 years, to achieve the health outcomes of the developed countries,
resulting in a healthier population, a wealthier population, and in a much enhanced
economic position overall for the Government of Nigeria.


About the Author:

Kenneth Nwosu is an eHealth Professional based in Toronto ON Canada and can be reached at [email protected]