55 million cases of malaria are reported yearly at health facilities across the country, according to a World Health Organisation (WHO) 2018 Malaria Report. By implication, more than one in every four Nigerians seeks treatment for Malaria in a hospital every year. Malaria is Nigeria’s deadliest disease and it causes about 300,000 deaths annually in the country, the Nigeria Centre for Disease Control revealed. Malaria also accounts for 60% of outpatient visits to health facilities, 30% childhood death, and 11% of maternal deaths in Nigeria estimated at 4,500 cases.
Annually, significant investment is channelled towards eradicating malaria in Nigeria. Asides for the intervention of the Federal Government to reduce the highly endemic disease in the country, the country has benefited from support from various partners to address its problem of malaria.
A DATAPHYTE analysis shows at least $1.355 billion have already been cumulatively spent directly on malaria control in Nigeria in the last 10 years. Nigeria also benefited from $67 million spent from 2014 to 2016 on malaria control in the Sahel region. Besides, a new $200 million is proposed to be spent on malaria control in Nigeria between 2019 and 2029.
A Cocktail of Development Grants for Malaria Eradication
Currently, the Global Fund, the U.S. Government, United Kingdom Department for International Development (DfID), UNICEF, and WHO are the largest funding partners for malaria control in Nigeria. These organizations support the National Malaria Elimination Programme (a programmed initiated by the Federal Government) to achieve its outlook of a malaria-free Nigeria.
Although the total value of monetary support to malaria reduction in Nigeria cannot be readily assessed, USAID documented that in March 2015, the Federal Government of Nigeria and the Global Fund signed the New Funding Model Grant totalling over $400 million for two years. In this arrangement, Nigeria was to provide a counterpart fund of $22.5 million which was made available by the government in late 2018.
Between 2008 and March 2016, DfID invested £89 million (about $140 million) in the Support to National Malaria Programme (SuNMaP). SuNMaP worked with the Nigerian government’s National Malaria Elimination Programme (NMEP) to harmonize donor efforts and funding agencies around agreed national policies and plans for malaria control and elimination. Similarly, UNITAID made a $67 million investment to malaria control in the Sahel region through the Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention in the Sahel Programme.
Other documented monetary support for malaria control in Nigeria include the Saving One Million Lives (SOML) Program-for-Results Project ($500 million), Nigeria State Health Investment Project Phase 1 ($170 million), and Nigeria State Health Investment Project Phase 2 ($145 million).
Moreso, in 2019, a Multi-Phased Programmatic Approach Project was anticipated to reduce under-5 mortality in Nigeria. The project which is to last for 10 years proposed to commit $200 million to the Innovative Malaria Control Project through a partnership between the World Bank, Islamic Development Bank, and the Federal Government of Nigeria.
NMEP through the support it receives ensures the provision of long-lasting insecticide-treated nets, targeted indoor residual spraying, intermittent preventive treatment in pregnancy, and effective case management to control malaria in the country. Also, since 2011, the U.S. President’s Malaria Initiative (PMI) has supported malaria control efforts in Nigeria. Despite all these interventions, Nigeria accounts for more than 25% of the global malaria burden, more than any other country in the world, according to the World Health Organisation (WHO) 2018 Report.
Tales of Unrelenting Malaria Epidemic
Different factors frustrate malaria treatment in Nigeria. Antimalarial drug resistance is one of the causes of treatment failure. Most cases of antimalarial resistance result from incorrect drug dosage and compliance. The dearth of quality control of drugs is another factor. Reportedly, the sale of adulterated drugs is rampant across the country. This challenge is compounded by the widespread presumptive treatment and self-medication that is very common across the country. Incorrect diagnosis, obsolete and inadequate diagnostic equipment, inadequate malaria epidemiological data, and the dearth of effective rural drug distribution mechanism are other factors that limit the treatment and management of malaria in Nigeria.
Malaria control efforts in the country are also impeded by the inadequacy of health facilities across the country. For instance, in the northeast of Nigeria, more than 60% of the health facilities are only partially functioning. The ratio of health facility to the population is also significantly low.
There are only 28,642 hospitals to serve Nigeria’s population of 200 million people. In addition to the inadequacy of health facilities, many Nigerians do not have access to regular health services even in the existing health care centres. Access of poor people to quality anti-malarial services is low especially in the rural areas of the country. Patent and proprietary medicine vendors (PPMVs) provide the majority of malaria treatment in the rural areas yet little is known about their knowledge of malaria testing and treatment.
Terms for change
To reduce malaria prevalence across the country, there is a need to address the existing challenges of frustrating malaria control efforts in the country. In this regard, the government needs to genuinely focus on improving the efficiency of existing health facilities in the country. In addition, more health facilities should be established to address the growing health needs in the country.
Measures should also be developed to ensure that only wholesome drugs are circulated across the country. Besides, regulations should be developed and/or implemented to ensure that health care providers in the urban and rural areas of Nigeria are adequately knowledgeable and competent to deliver health care services.
Public health awareness campaigns should also be conducted regularly to emphasize the need for citizens to maintain proper hygienic conditions and ensure other malaria prevention measures. This sensitization should also discourage self-medication while promoting strict compliance with prescribed medications.
The government will do well to increase the availability of malaria prevention materials across the country. Long-lasting insecticide-treated nets and indoor residual sprays should be made more easily available for citizens. Ultimately, a more inclusive health policy that fosters extensive universal coverage should be developed to address the teeming health challenges in the country.