Five years ago, in February, the country outlined its ambitious roadmap to eradicate malaria mortality by 2020. Today, not only are we miles off target, but the COVID-19 pandemic further derailed implementation.
- Nigeria misses the 2020 target for a malaria free society, with children under age 5 and pregnant women as the worst hit;
- Nigeria’s health financing is low, with more than ₦350 billion (about $927 million) in funding gaps for malaria intervention programmes.
- Ahead of the 2030 SDG deadline, Nigeria’s malaria woes, more of a funding gap than COVID-19 pandemic.
Nigeria scored some wins, or rather a mention, a noteworthy one from the World Health Organisation no less. Through its 2019 World Malaria Report 2019, the agency noted a significant global reduction in malaria deaths. Chief amongst them was Africa’s most populous nation, featuring a decline from 153,000 deaths in 2010 to 95,000 deaths in 2018.
Appraisals end there, however, as things go south. Still, in 2018, Nigeria had absolute increases in cases of malaria when compared with the previous year. Not to mention, Nigeria has a larger share of Sub-Saharan Africa’s 155 million malaria cases in Hugh Burden to High Impact (HBHI) countries in 2018. Of the figure, the Democratic Republic of the Congo and Nigeria accounted for 84 million (representing 54% of total cases).
Children under five and pregnant women, worst hit from malaria
Worse, though, children under age 5 and pregnant women have it worse. And despite a 19% reduction in child prevalence since 2010, UNICEF notes an inadequacy in Nigeria’s testing and treatment in that regard.
Exacerbating things further is Nigeria’s climatic conditions, which make it suitable for perennial malaria transmission.
Malaria’s death burden still high in Nigeria
Data from UNICEF show that every two minutes, a child under five dies of malaria; the highest prevalence being in Sub-Saharan Africa. But within the dark continent, one country stands apart, with one-quarter of the death burden from the disease.
| Sub-Saharan Africa Countries | Malaria Burden (Percentage) |
| Nigeria | 25% |
| DRC | 12% |
| Uganda | 5% |
| Côte d’Ivoire | 4% |
| Mozambique | 4% |
| Niger | 4% |
| Total | 58% |
Dataphyte analysis/World Malaria Report
Further, findings from the WHO Report showed that the prevalence of exposure to malaria infection in pregnancy is still high in Nigeria. Pregnancy-associated-malaria (PAM) is life-threatening to both mother and offspring, which may explain Nigeria’s depressing statistics.
The 2018 Nigeria Demographic and Health Survey has similar concerns as the WHO report. One of such was an insufficiency in the distribution and ownership of insecticide-treated nets (ITNs) in the country. ITN is one of the most widely adopted preventive measures against malaria. It is useful because the female mosquito that transmits plasmodium only bites at night. Per the survey, about 30% of Nigerian households have at least one insecticide-treated net (ITN) for every two people. Likewise, 31 percent also had one ITN, but it was not enough for all household members; the remainder 39% had none.
What went wrong, funding?
Nigeria’s annual budget commitment towards eliminating malaria averages almost $1 billion (₦380 billion). And per ex-President Goodluck Jonathan, out-of-pocket treatments and prevention expenditures comprised the allocation. However, the financial issues and funding gap in the health sector raise doubts towards this figure. As of 2017, the sector had over ₦350 billion (about $927 million) in deficit funds. Regardless, the country is crawling to meet Goal 3, Target 3.3 of the Sustainable Development Goals (SDGs).
Also noteworthy were the COVID-19 related disruptions. Not only did the pandemic shift the government’s attention away from perennial health challenges, it hindered policy implementation and fund allocation across the health sector.
Lagging Ahead SDG 2030
Ahead of 2030 deadline for the Sustainable Development Goals (SDG), Nigeria needs to work in line with global recommendations towards malaria control and elimination. And the target, a 90% reduction in both malaria prevalence and mortality rates. This is per the WHO Global Technical Strategy for Malaria 2016–2030 (GTS). But with the current statistics, Nigeria may be far from achieving these ambitious goals by 2030.
Covid Disruptions, but were we on track?…
The Technical Director for the National Malaria Elimination Programme (NMEP), highlighted the COVID-19-disruption mentioned earlier. According to Mr Olugbenga Mokuolu, delays in seeking care because of the fear of the stigma of COVID-19 hampered their elimination strategy.
Aggravating the situation was hospital workers testing positive with the novel virus. Speaking at a presentation on the impact of COVID-19 on Malaria in September 2020, Mr Mokuolu noted how these interruptions hindered NMEP from implementing the malaria programme. He added how patients sought care in the wrong places.
“At the government level, we have the diversion of resources, diversion of attention, economic consequences because of the lockdown, disruption in the supply chain, and a threat to a planned intervention. The aggregate impact was the threat of reversal in malaria gains. For Nigeria, we had a threat of doubling annual mortality of 80,000. So that means we stood at the risk of having 120,000 to 150,000 due to disruption.”
During the lockdown, NMEP used a rolling mass campaign to ensure the government deployed services and equipment such as nets throughout the country.
However, the Biomedical Researcher admitted that the NMEP required more resources, as it was now more expensive to implement a malaria programme. “At the national level, we have started advocacy to increase funding allocation by the government to malaria intervention programmes,” he added.
… funds allocated say otherwise
Olugbenga’s comment also confirmed that Nigeria’s health financing is low. The annual budget for health falls short of the African Union’s recommendations of at least 15% in the country. For instance, in the 2021 budget, the country proposes ₦380.21 billion for recurrent expenditure and ₦132 billion for capital projects in the health sector.
One can observe similar tones from UNICEF, who noted that Nigeria’s health sector’s challenge was not one of policy frameworks, but implementation. The UN agency had urged the Federal Government to play its part by giving grants to states to revitalise primary health centres (PHCs) just as the Universal Basic Education system.
Juxtaposing the impact of COVID-19 and level of preparedness showed that Nigeria was still far behind prior to the pandemic. Even without a coronavirus pandemic, it is uncertain Nigeria would have met the 2020 target of the NMEP. More so, the 2030 target of SDG would also be far from reach if the country cannot match words with actions on the eradication of malaria endemic in the country.
UPDATE: Changed the sentence: “Speaking with the Malaria Technical Director for the National Malaria Elimination Programme (NMEP), Dataphyte got a sense of the COVID-19-disruption mentioned earlier.” And replaced it with: “The Technical Director for the National Malaria Elimination Programme (NMEP), highlighted the COVID-19-disruption mentioned earlier.”
Update: Turn inward, expert urges
“Adequate funding by Government will gradually reduce the reliance of external donors which has not always, and will not be sustainable in the long term. It will also require effective collaboration with the private sector for meaningful and result oriented public-private-partnership (PPP) to compliment domestic funds for malaria programmes.”
Echoing UNICEF’s recommendation, Maxwell Kolawole, Programme Director for West and Central Africa’s Malaria Consortium, affirmed that Nigeria had a policy implementation problem. To that effect, he emphasised the need for policymakers to focus on enforcing guidelines on preventing and treating the disease. Close to this was the significance of prompt funds disbursed.
“This effort requires adequate budget and timely release of funds by the government to buy malaria prevention and treatment commodities and training service providers.”
UPDATE: changed exchange rate from $480 to ₦1 to $380 to ₦1, corresponding to the CBN values.
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