World Malaria Day: Funding key to eliminating scourge in Nigeria — Experts

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female anopheles’ mosquitoes.

Some of the symptoms are fever, headache, vomiting, diarrhea, profuse sweating and anaemia.

According to the World Health Organisation (WHO) Malaria Report 2022, Nigeria contributes 27 per cent to the malaria burden and 31 per cent to malaria deaths globally. This means about one out of every four persons having malaria, and one out of three deaths from malaria globally occur in Nigeria.

Children are the worst affected, according to the 2018 National Demographic and Health Survey (NDHS).

Nigeria has missed out on its 2014-2020 National Malaria Strategic Plan (NMSP) of reaching pre-elimination status for the disease (less five per cent, which can be interpreted as less than 5,000 cases per 100,000 people) and zero mortality from malaria.

This is happening as some countries in the region have achieved elimination of the disease or are near elimination

Despite efforts by the government and partners, prevalence of malaria in Nigeria still remains significantly high. While there has been some progress, more still needs to be done to bring down malaria prevalence in Nigeria.

Despite the high burden of malaria in the country, its treatment is still majorly donor driven and many do not have access to prevention measures.

Experts say Nigeria is not yet where it ought to be in domestic resources mobilisation in tackling malaria. They say increased domestic funding is key to tackling the burden of the disease. It will also help in “Accelerating the fight against malaria for a more equitable world”, as outlined in the theme of year’s 2024 World Malaria Day.

Olugbenga Mokuolu, a professor of paediatrics at the University of Ilorin and former national malaria technical director to the National Malaria Elimination Programme (NMEP) said that malaria requires a lot of funding.

He said Nigeria has made some significant efforts over the years but increased domestic funding is critical for fast track malaria elimination in the country.

“No, partner is going to lead you to destination. without you being on the front seat,” he said.

He said funding for malaria is not only in the purview of the Federal Ministry of Health but should also involve the sub-nationals.

He said the estimated funding requirement for the current malaria strategic plan (NMSP 2021-2025) is about $1 billion and approximately $5 billion for the five-year period of implementing the plan.

Mokolu explained that the approach the government has used over the years   is to have a robust and comprehensive gap analysis.

“What that means is to define the need, which is like stage one, and then secondly to look at the resource profile from their own end.

“So, that will be the proportion of the need that is met. And then obviously, there is something called unmet need or the outstanding need or programme need that the government will present in the malaria is a space or to its various partners and these partners contribute or take up different aspects of the need. This means that they will help to close the gap to some extent, but because they are unable to close the gap completely, there is the final gap of unmet need.

“So, over the last few years, what has changed is that the government now has the Basic Health Care Provision Fund (BHCPF). It serves to enhance treatment, diagnosis or treatment of malaria as a service item. But for that particular expenditure, it may be a bit difficult to extract fully what is committed to malaria because it is an envelop to deliver on primary health.”

He explained that the current administration, being aware of some of the challenges, is galvanising an intervention christened ‘Thinking malaria elimination in Nigeria’ and part of it provides the acute awareness that government can do more.

“Therefore, there is still the call and the need for a deliberate and traceable malaria vote, which will help in how funds are positioned within specific malaria interventions. And this should be at both the national and sub-national levels,” he added.

Dr. Gafar Alawode , the project director of Prevent Epidemics project , and who was also program director of Abt Associates on SuNMaP2 project of Malaria Consortium shared a similar view.

“We are not yet mobilising the resources needed to tackle malaria, that is the number one problem. We need more resources to start to scale up intervention for malaria. We cannot continue to depend on donors or external financing,”

A study titled ‘Malaria eradication in Nigeria: State of the nation and priorities for action’ carried out by Jeremiah Oluwamayowa Omojuyigbe of the Faculty of Pharmacy, Obafemi Awolowo university among others revealed that in many states without external support, the coverage of Long-Lasting Insecticide Nets (LLINs) has remained insufficient due to limited funding.

They also found in the study that was published in the Journal of medicine, surgery and pubic health that distribution efforts have been heavily reliant on donor contributions, leading to an uneven distribution of LLINs across different regions. “Consequently, states needing more donor support have been unable to distribute LLIN for an extended period of seven years, exacerbating the disparity in malaria prevention efforts.”

The research also found that in the aspect of vector control strategies, Indoor Residual Spraying (IRS) and Larva Source Management (LSM) have yet to receive adequate funding and have consequently been sparsely implemented.

“Also, the low proportion of suspected malaria cases undergoing diagnostic testing, specifically Rapid Diagnostic Tests (RDTs) and microscopy, is a glaring concern. With only 13.8 per cent of cases being tested against the target of 80 per cent, there is a significant gap in accurately identifying and confirming malaria cases,” it said.

‘Our experiences with malaria’

Hajara Aliyu, a community mobiliser in Kwali, Federal Capital Territory (FCT) lamented that many women and children suffer from malaria frequently but could not afford to buy net or drugs when they fell ill with the disease.

John said he could recall when he used to buy malaria drugs for as low as N200. But that the Coartem that he used to buy at N1,000 has risen to between N3,500 and N4,000. He said providing free tools to prevent malaria for Nigerians of all ages and subsidised treatment will help in reducing malaria outbreaks.

How to increase domestic funding for malaria in Nigeria

Prof. Mokuolu, said there is need to increase budget allocation at all levels of government as well as engagement with the private sector to leverage on the capacities that are present there.

He further said there is also need to adopt the concept of backward integration, and multisectoral collaboration.

“So, if we have the minister of environment, that is dealing with environmentally related issues on a broad spectrum, that action will also reduce the natural habitat for growing malaria. It will also be very important if the minister of agriculture is working and deploying pesticides and we can also key into that level of use to also reduce the vector population.”

Another expert, Dr Olanrewaju Olaiya, Senior Director, Global Health Programmes at the Africa Diseases Prevention and Research Development Initiative (ADRAP) said increased budgetary allocation could help.

He said that another way for domestic mobilisation is through Public Private Partnership (PPP) for malaria.

“We can actually achieve that by collaborating with the private sector to fund malaria control initiatives.

“We could also talk about using the resources that we have efficiently. That is ensuring accountability and transparency in the funds that have been put out for malaria.”

While saying that political commitment on malaria elimination is key for optimal funding for malaria, he said there is also need for increased public awareness on malaria.

He added that another option called international funding matching, sometimes called tripartite agreements, involves working with donor agencies while committing to a certain amount that the donor agencies will match.

The WHO Nigeria Representative, Dr Walter Kazadi Mulombo, had during a media roundtable in Abuja said it is time to rethink and revitalise strategies by investing, innovating and implementing smartly to eliminate malaria.

Reading the WHO Regional Director’s message, Dr Mulombo says “World Malaria Day allows us to renew political commitments and bolster investments in malaria prevention and control.”

“To achieve this, governments need to mobilise more resources and technical capacities at domestic and international levels and build effective partnerships and multisectoral mechanisms to help strengthen preventive measures and improve coverage of malaria case management services,’’ he said.