World Malaria Day: How has Nigeria fared in fighting the scourge?

The events surrounding the 2024 World Malaria Day are yet to settle as concerns have been raised over why despite the humongous amounts spent to eradicate this number one killer-disease, it still remains a herculean task. SUNNY IDACHABA writes on the possible reasons and the way forward.

Last week, Nigeria joined the rest of the world to mark this year‘s World Malaria Day. As part of the celebration, USAID/Nigeria mission director, Melissa Jones, said over 180 million Nigerians are now protected from malaria because of the procurement and distribution of over 90 million insecticide treated nets which are a welcome development considering the number.

Giving further details, the mission director said three million children under five years of age were among those protected from malaria through doses of malaria preventive treatments.

According to a poll conducted by NOI on malaria pandemic in Nigeria not too long ago, “Nigeria had the highest number of global malaria cases (27 percent of global malaria cases) and the highest number of deaths (32 percent of global malaria deaths) in 2020. In addition, Nigeria accounted for an estimated 55.2 per cent of malaria cases in West Africa in 2020.”

It, therefore, noted that given the findings from the poll, it was pertinent for the government and other donor agencies to tackle malaria disease swiftly by putting in the needed resources for combating the scourge. That is the reason what the USAID/Nigeria mission did is commendable and in line with the solutions earlier preferred in solving the problem.

Age-long disease

The problem of malaria is old as the discovery of Africa because right from when Africa was supposedly discovered by the whites, what looked like a major pandemic to them was and still remains malaria. Many expected that long before now, the World Health Organisation (WHO) and other relevant partner organisations would have come up with a remedy to eradicate the scourge way back, just the way the global body did with the various pandemics like Covid-19 that have ravaged the world in 2020.

That concern has been generating debates for a while. For instance, Prof. Olusegun Ademowo, of the University College Hospital Ibadan, while at one of NOI forums in Abuja recently wondered why it has taken the World Health Organisation (WHO) 50 years to develop a malaria vaccine.

According to him, “It has taken WHO 50 years to develop a malaria vaccine and in the research we now have two that would be effective. These are RTS; S and R21 vaccines. Our concern right now is how we can make those vaccines available for use from the level it is presently for malaria endemic countries.”

His concern is exacerbated by WHO’s estimates that Nigeria had nearly 67 million cases in 2022 which accounts for 27 percent of the global malaria burden.

Also, worrisome was the fact that in 2022, Nigeria accounted for 31 per cent of global deaths and 38 per cent of global deaths in children aged under-five years despite the government’s efforts.

Past attempts

With the theme of ‘Accelerating the Fight Against Malaria for a More Equitable World’ for 2024, countries of the world especially those with endemic cases like Nigeria need to expedite actions towards eradicating malaria out of the country.

In the last couple of years especially from 2015 to date, the government has developed a number of programmes aimed at tackling malaria. One of those is the National Malaria Elimination Programme (NMEP).

Part of the core vision of NMEP was to ensure the availability of Insecticide Treated Nets (ITN) that does not necessarily require any additional treatment. ITNs repel and kill mosquitoes by providing protection against bites that result in the ailment. However, while government spends millions of dollars to procure the nets, investigation reveals that in many homes, they are not used.

According to the National Malaria Indicator Survey (NMIS) done in 2021, malaria prevalence is common in the northern part of the country compared to the south. So far, it has crest-fallen from 42 per cent in 2010 to 27 per cent in 2015, then to 23 per cent in 2018 and finally to 22 per cent in 2021. But the 2022 World Malaria Report shows that Nigeria contributes about 27 per cent (26.6) of the global burden of the disease.

Despite the steps taken by the government towards eradicating malaria, it’s said to be like a drop of water in an ocean. For instance, the US noted in one of its latest rankings of malaria that Nigeria is a major public health problem accounting for more cases and deaths than any other country in the world, stressing that malaria is a risk for 97 per cent of Nigeria’s population.

“The remaining three per cent of the population live in the malaria-free highlands. There are an estimated 100 million malaria cases, with over 300, 000 deaths per year in Nigeria. This compares with 215, 000 deaths per year in Nigeria from HIV/AIDS. Malaria contributes to an estimated 11 per cent of maternal mortality,” the US said.

What happened to those funds?

There are several sources of funding for Malaria, which include the Global Fund, US President’s Malaria Initiative, and UK Department for International Development, the World Bank, World Health Organisation and UNITAID, different from funding from both states and federal governments.

Investigations by Blueprint Weekend revealed that between 2006 and 2019, the World Bank donated a total of $180 million to a malaria booster programme for seven states of Gombe, Kano, Jigawa, Adamawa, Anambra, Rivers and Akwa Ibom to address the scourge. Even though the money was given to the state governments, part of it was to go into some activities on the national level.

Also, from 2017-2019 and 2020- 2022, Nigeria was allocated over US$1.5 billion funding cycles as single biggest recipient of Global Fund grants. Again, in February 2023, Global Fund approved nearly $1 billion for Nigeria to continue its fight against malaria, tuberculosis and HIV/AIDS for the next three years. Out of approximately 110 countries, Nigeria got the highest grant of $933,156,931, covering 2023 to 2025.

It is also on record that international agencies like USAID PMI, DFiD, UNICEF, WHO, UNITAID were also part of the donors to Nigeria in its fight against Malaria. 

On the part of the Federal Capital Territory (FCT) administration’s effort to curb malaria, the authority donated thousands of insecticide treated nets to residents as part of the 2024 World Malaria Day celebrations last week.

The mandate secretary of FCT Health Services and Environment Secretariat (HSES), Dr. Adedolapo Fasawe, said the FCT is united with the world in a steadfast commitment to eradicate malaria which she noted has been a long-time burden to Nigeria.

According to her, “The distribution of free Insecticide Treated Nets (ITNs) is the FCT Administration’s role of ensuring the increase of usage in households within the FCT to avert malaria and save lives, especially children who are mostly susceptible to the disease.”

How graft impedes malaria intervention projects 

It is true that there has been a slight reduction in the number of fatalities from malaria over the past few years; however, that could have been lower if the 2015 strategic plan was successful with adequate counterpart funding from the government. 

It’s on record that the 2019 Malaria Programme Review (MPR) showed the country was unable to accomplish the objectives outlined in the National Malaria Strategic Plan due to inadequate allocation of funds.

Of more concern are the reported cases of corruption that trailed the grants secured towards eradicating the scourge. For instance, the Global Fund, in its 2022 audit accused the National Agency for Control of AIDS (NACA) and Lagos state government of misappropriating $19.6 million worth of Covid-19 grants under their care through shady contracts.

It could be recalled that in 2016, the fund had accused NACA and NMEP of the same offence for which Global Fund subsequently suspended them from the list of its grant recipients.

Curiously, as of 2021, NACA was yet to clear itself of the 2016 indictment before the current accusation came up.

The government may not be able to completely eradicate malaria, but, like polio, it can be reduced to a minimal proportion so that the disease would cease to contend for the number one position as the worst killer in Nigeria.