As global financial support for malaria and other disease control efforts has faltered, there is a greater need for national malaria programs to pick up the slack. A look at Nigeria’s national health accounts does show that ‘foreign’ aid does play a relatively small role in health financing and expenditure in this oil-rich country, but ironically it is the common citizen who picks up the bulk of health financing through out-of-pocket expenditures.
The question of local initiative in the move toward elimination of malaria received a severe blow when the Nigerian Senate Committee on Health questioned the need for continued purchases of long lasting insecticide-treated nets (LLINS). The Guardian newspaper reported that the, “Chairman of the committee, Dr. Ifeanyi Okowa, wondered why Nigeria would still continue to cling to the strategy, which he said was not working, when country like Senegal that has manufacturing plants for LLINs was using other effective means to tackle malaria.”
The Senator’s views contrast with those of national experts and the WHO: “While the Minister of State for Health, Dr.Muhammad Ali Pate, said in January that the ministry proposed N1.8 billion for the procurement of LLINs for additional three states, a World Health Organisation (WHO)â€™s report shows that Nigeria would need one billion dollars (N158 billion) to stave off backsliding and resurgences of malaria in 2013 and 2014.”
It would seem that the Senator was reacting to perceived pressure from the international community to maintain a malaria control strategy that he thought was less effective than indoor residual spraying (IRS).Â Of course one of the biggest challenges in disease control advocacy efforts is to educate policy makers. The Director-General of the Nigerian Institute for Medical Research, Prof. Innocent Ujah, tried to do this. He pointed out cultural factors that inhibit net use – and in fact lack of serious community follow-up efforts after massive net distribution over the past 2-3 years, can be traced as one reason why LLINs may have been wasted.
The Senator did not realize that malaria control leading toward elimination needs a multifaceted strategy. IRS can be part, but has its own limitations of which one is expense.Â In highly endemic, stable and year-round transmission environments like Nigeria, spraying would be needed twice a year.Â We forget that Nigeria has already once tried IRS a few decades ago and abandoned the effort in part due to the huge logistical challenges required.
Nigeria has tried selling LLINs/ITNs through the private sector, but coverage was low since not all Nigerians could or would buy them despite paying disproportionately out-of-pocket for treatment. If the government refuses to fund massive LLIN distribution, then we can expect the burden to fall on the common people who may die from malaria before they purchase a more costly net on the commercial market.