As countries strive to meet the rigorous criteria set by the World Health Organisation (WHO) for malaria elimination, Nigeria emerges as a focal point in the global fight against this ancient scourge.
By Abujah Racheal
Malaria, an ailment deeply entrenched in the fabric of tropical regions like sub-Saharan Africa, poses a formidable challenge to public health.
Nigeria, with its vast population, bears a significant burden of the world’s malaria cases, amplifying the urgency for decisive action.
With over 76 per cent of the population residing in high-transmission areas, malaria remains the leading cause of mortality among children under five, resulting in an estimated 95,000 annual child deaths.
In 2021, Nigeria recorded approximately 68 million cases and 194,000 deaths due to malaria, with staggering economic implications, costing the country an estimated 660 million dollars annually, says the World Health Organisation Regional Office for Africa.
The financial loss is also mind-boggling. The economic burden of malaria in Nigeria may increase to about $2.8bn by 2030, according to former Minister of Health, Dr Osagie Ehanire.
As of 2022, the figure was estimated at $1.6bn, says the ex-minister
To combat the disease, Nigeria implemented various initiatives such as the National Malaria Strategic Plan (NMSP), the Nigeria End Malaria Council (NEMC), and the National Malaria Elimination Programme (NMEP), all aimed at eradicating malaria by 2025.
However, progress has fallen short of the NMSP 2021-2025 target, which aimed to reduce malaria deaths to less than 50 per 1,000 births or achieve a parasite prevalence of less than 10 per cent by 2025.
On August 16, 2022, former President Muhammadu Buhari inaugurated the 16-member NEMC, echoing similar efforts across Africa following Zambia’s establishment of the council. Over the past decades, Nigeria has made significant strides in combating malaria.
Key investments in malaria control have been facilitated through initiatives like the National Malaria Strategic Plan (NMSP) and collaborative partnerships.
The Roll Back Malaria (RBM) initiative, established in November 1998, has played a pivotal role in mobilising resources and efforts against malaria globally.
Launched in April 2000 in Abuja, Nigeria, RBM brought together various stakeholders, including multilateral organisations, bilateral partners, NGOs, and private entities, to support interventions in Nigeria and worldwide.
RBM’s objectives included halving malaria-related deaths by 2010 and reducing transmission to pre-elimination levels by the end of 2020.
In spite of the efforts, Nigeria still grapples with multifaceted challenges in its quest to eliminate malaria.
Beyond the well-documented hurdles of limited resources and weak health systems, the journey towards malaria elimination is fraught with complexities at the grassroots level.
Bureaucratic hurdles often delay the delivery of essential interventions to rural communities exacerbating the burden of malaria on the poorest of the poor.
Logistical challenges further impede progress, with the timely distribution of bed nets and medications sometimes hindered by infrastructure gaps. This is made worse by bad roads during rainy season.
Moreover, say medical experts, deeply ingrained socio-cultural beliefs and practices pose significant barriers to effective malaria control.
For instance, misconceptions about the causes of malaria or reluctance to adopt preventive measures can undermine the impact of awareness campaigns and community outreach efforts.
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Thus, while Nigeria presses forward with its malaria elimination agenda, navigating these intricate challenges requires not only strategic planning but also a nuanced understanding of local contexts and dynamics.
Recently, the Federal Government spearheaded a sector-wide approach to eliminate malaria in Nigeria, focusing on innovative interventions and resource alignment.
This initiative involves strengthening healthcare systems, enhancing governance, and mobilising technical and financial resources through collaborations with global partners.
In spite of progress, malaria remains a leading cause of illness and death in Nigeria, particularly affecting vulnerable demographics such as children under five and pregnant women.
At the Ministerial Roundtable on Rethinking Malaria Elimination in Nigeria”, in commemoration of the 2024 World Malaria Day,’ organised by the Federal Ministry of Health (FMOH) in partnership with the NMEP, stakeholders convened to expedite malaria elimination efforts in Nigeria.
The WHO Director-General, Dr Tedros Adhanom Ghebreyesu, underscored Nigeria’s substantial malaria burden and urged the utilisation of both innovative and established tools to promote a robust community engagement.
Ghebreyesus highlighted the initiative’s bolstering by increased domestic funding and collaboration with international partners.
“Nigeria is first out of the blocks ready to implement the Yaoundé Declaration, paving the way for other high burden countries.
“By implementing the Yaoundé Declaration, Nigeria sets the stage for other HBHI countries, making the dream of a malaria-free world a reality,” he said.
Speaking on the implementation of malaria within the Sector-Wide Approach (SWAp) framework, Dr Chris Isokpunwu, Director of Health Planning, Research & Statistics, Federal Ministry of Health (FMOH) outlined said focus was on innovative interventions, resource alignment, and collaboration with global partners.
Dr Michael Adekunle, Chief Executive Officer of Roll Back Malaria, emphasised the importance of adopting a step-by-step multisectoral approach to fast-track malaria elimination.
Adekunle said there was a need for government integration, innovation, and proactive planning, as well as redefining community engagement as an ongoing dialogue.
The Co-Chair of the Roll Back Malaria (RBM) Partnership Case Management Working Group, Prof. Olugbenga Mokuolu said limited resources, population growth, resistance, weak health systems, access to quality data, and tool optimisation remain challenges.
According to Mokuolu, addressing these bottlenecks will accelerate progress against malaria in the country.
Despite longstanding efforts to eliminate malaria, Dr Matshidiso Moeti WHO Regional Office for Africa, called for collaborative efforts, data-driven interventions, and sustainable financing to accelerate malaria elimination in Nigeria.
Moeti commended Nigeria’s strong commitment and stressed the crucial role of data, technology, and investment in health systems.
The Executive Secretary of African Leaders Malaria Alliance 2030, Dr Joy Phumaphi emphasised enhancing accountability across government at all levels through the introduction of scorecards for legislators to monitor and guide malaria control efforts.
Phumaphi suggested making the scorecards accessible to the public and stressed the need for increased private sector engagement to fund local production of malaria treatments.
“The battle against malaria necessitates integration across ministries, including agriculture, along with engagement with the private sector and communities.
“Empowering communities with this vision is crucial for fostering ownership in the fight against malaria,” she said.
A Biomedical Scientist, Mr Odinaka Obeta said if Nigeria would eliminate malaria it had to expand distribution channels for essential tools, providing training for healthcare workers, enhancing vector control measures, and engaging the private sector and communities, among others.
Obeta emphasised collaboration with NGOs and faith-based organisations to support government initiatives in malaria prevention and treatment.
Partnership is key to eliminating any disease, including malaria and the authorities recognise this fact.
“We must all work together across different sectors,” said Prof. Muhammad Pate, Coordinating Minister of Health and Social Welfare, an expert in Internal Medicine and Infectious diseases.
He said that by implementing a comprehensive and multi-sector approach, Nigeria aimed at significantly reducing the burden of malaria and enhancing the health outcomes of its citizens.
“We are focused on mobilising domestic and global funding for malaria; Enhancing community and leadership involvement in malaria elimination; Strengthening data integrity and accountability”, he said.
He said the federal government was also committed to intensifying preparedness and response to climate change impacts on malaria and exploring innovative financing mechanisms to increase resources.
He stressed that government would prioritise community engagement and mobilisation efforts to raise awareness about malaria prevention and control measures, promote behaviour change, and foster community-led initiatives to combat the disease.
Public health expert say while progress has been made in eliminating malaria, much work remains to be done to achieve the ambitious goal of malaria eradication.
They urged the acceleration of concerted efforts of government officials, health experts, NGOs, and international partners underscore the collective determination to tackle malaria head-on.
