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Malaria Elimination in Nigeria: A case for domestic, sustainable financing

By Hassan Zaggi

There is no doubt, malaria is a major challenge in Nigeria. That is why over the years, both the government and foreign donors have  made concerted efforts to combat the disease and if possible, eliminate it in Nigeria.  

A cursory look at the 2020 World Malaria Report, Nigeria had the highest number of global malaria cases -27 %, and in 2019, Nigeria also accounted for the highest number of global malaria induced deaths -23 % .

The report also indicated that the case numbers of malaria increased  by 3.5% between 2016 and 2019,  from 293 to 303 per 1000 of the population at risk.

Also, a close look at the 2018 Nigeria Demographic and Health Survey (NDHS), malaria prevalence in children under 5 years of age is 23 percent, although there are significant regional, rural-urban, and socioeconomic differences.

This is where Nigeria has found itself, hence, the need to mobilise resources from wherever it can be found to combat the disease and eliminate it. It is doable. Other countries have achieved it.

While one commends the efforts of donors both local and international, there is the need to call on the government to explore more ingenious ways of mobilizing domestic and sustainable resources to halt the disease.

This is important, considering that the COVID-19 pandemic has overstretched and nearly crippled many donor countries and agencies.

Recently, the case for domestic resource financing for malaria become more prominent. This was when the Support to the National Malaria Programme Phase 11 (SuNMaP2) had its end of programme dissemination meeting in Abuja. Malaria consortium organised the event.

At the meeting, it was clear to all stakeholders that domestic resource mobilization and financing for malaria is the sure way to go.

SuNMaP 2 was a UK aid-funded follow-up to SuNMaP.

The programme which was implemented by Malaria Consortium was aimed at supporting government efforts to further reduce Nigeria’s malaria burden.

The programme was integrated into malaria prevention, treatment, and other interventions at the community and service delivery levels, as well as in other settings, through public and private sector partnerships.

SuNMaP 2 was, from the onset, targeted at improving the planning, financing and delivery of sustainable malaria programmes across 165 local government areas in six states of Nigeria: Jigawa, Kaduna, Kano, Katsina, Lagos, and Yobe.

There is no doubt, the positive impact of SuNMaP 2 was felt in all the states and local governments it was working.

Sadly, however, the negative impact of the COVID-19 pandemic which affected most countries and donor agencies  globally, necessitated the funders of the project to shift their resources to more pressing COVID-19 concerns.

The consolation is that Nigeria had benefited immensely from the project and have also learnt how resources can be mobilized for projects that touch on the lives of the ordinary people.

At the event to mark the end of the project, the  SuNMaP 2 Team Lead National, Dr. Nihinlola Mabogunje, insisted on the need for governments at all levels to plan beyond donor support.

“We have created that awareness that people should start thinking beyond donors; how they can be self-reliant,“she said.

According to Dr. Mabogunje: “SuNMaP2 from day one was on the issue of sustainability, the first two years was to build capacity of National Malaria Elimination Programme

“The third year was to transit and then the fourth year was to mentor. We are supposed to be on the third year; we are not exactly where we want to be, but one thing that is clear to me is that people are asking questions that what would do if money stops coming from donors. So Nigerians are thinking inward on how to drive the programme with domestic funds.

“The whole essence of SuNMaP2 is about increasing domestic resources and reducing out of pocket expenditure for the common man. It is all about the common man will not go into financial catastrophe because of spending on malaria.

“I guess we are getting there with the Basic Health Care Provision Fund (BHCPF) that the government is building up and the National Health Insurance Scheme (NHIS).

“SuNMaP2 went further to engage philanthropists and private sector to harness their strength together and now that we cannot go further, we have passed the baton for other programmes to continue where we have stopped.”

Dr. Mabogunje, however, expressed optimism that some states where the project was implemented will mobilise domestic resource in a sustainable manner and continue with the project.

 “I have hope in my government as I stand here today. I am a Nigerian, and I believe strongly in my country that one day, we will get there.

“The states we worked; Kano in particular, has shown a sign that they want to carry some things forward; same with Lagos. 

“So, the first thing is to create awareness about sustainability in the minds of the people. When you create awareness, then people start to think on how to build their own resilience and start planning for the rainy day, so those states, will get somewhere particularly on community intervention programme”.

 On his part, the Programs Director of Abt Associates, Dr. Gafar Alawode, explained that SuNMaP2 was contracted to tackle malaria in a sustainable manner.

 ‘’I think the first thing the project had to do then was to change the endemic notion that malaria financing is  primarily on the purview of external financing or donors, so we had to change that through sensitization at the national and state levels.

 “The truth of the matter is that we cannot continue to depend on external financing, as a result of that, the Federal and the state governments were helped to develop a sort of a strategy; a roadmap for sustainable financing for malaria including how the money would be spent judiciously.

“There was a good roadmap and then,  not only a roadmap there was capacity building for actors as well, so that they build their capacity in terms of how to mobilize resources  and how to make a strong case for malaria in order to make  government  to be interested and willing to put in more money. To the best of my knowledge, that translated to a significant result,” he noted.

 Dr. Gafar reiterated that: “What the project tries to do in terms of target was that in few years’ time, out of the total amount of money needed to fight malaria, half of it should be mobilized locally, that was the target we were working on at the national and state level.

“Part of what we did was to look at where the money would come from looking at the federal and state budgets; what is the fiscal room for government to be able to spend. That was very helpful we were about to be using that information for engagements and which I know some states have started putting in money, but unfortunately, due to global meltdown occasioned by COVID-19, the tenure of the project had to be truncated , otherwise, it was a very promising endeavor.”

Speaking on the federal government’s efforts to tackle malaria, the Director, National Malaria Elimination Programmme (NMEP), at the Federal Ministry of Health, Olufunmilayo Sanni-Adeniyi, regretted that malaria remained public health issue in Nigeria.

She, however, noted that the government had put in place many intervention programmes   that will lead to the elimination in Nigeria.

 “The interventions are working; for example, the Seasonal Malaria Chemoprevention (SMC) which is targeted at under-5 children in the North and so, we are very much working at malaria elimination and we are also thinking of replicating it in the South; it may not be SMC, it might be malaria treatment for infants, so that we can strike a balance.

“At the same time, we are having insecticide treated nets mass campaign across the nation where we expect that all the households should sleep under insecticide treated nets. This will prevent malaria in adults, pregnant women and children.

“Again, we also encourage all pregnant women to visit antenatal care during pregnancy to take malaria treatment for pregnant women.”

It is important, therefore, to call on the governments at all levels, despite their lean resources, to take full ownership and provide sustainable financing for the fight against malaria.

The private sector, wealthy Nigerians, philanthropists, corporate bodies and indeed, all well-meaning Nigerians must join in this fight so that Nigeria can successfully eliminate malaria in no distant time.  

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