High Burden – High Challenge

This Day Newspaper reported in May 2007 that, “Unfortunately, Nigeria, according to the World Bank, carries Africa’s greatest malaria burden with 110 million cases per year out of her 140 million people. Malaria accounts for 30 per cent of infant mortality in Nigeria. According to Professor Eyitayo Lambo, Nigeria’s Health Minister and chairman of RBM, malaria costs the country an estimated US$1 billion a year.”

Likewise WHO observed that, “Malaria is the most significant public health problem in Nigeria. It accounts for 25% of under-5 mortality and 30% childhood mortality and 11% maternal mortality. At least 50% of the population will have at least one episode of malaria annually while children that are aged below 5 years (about 24 million) will have 2 to 4 attacks of malaria annually. The economic cost of malaria, arising from cost of treatment, loss of productivity and earning due to days lost from illness, may be as high as 1.3% of economic growth per annum. The disease is a major cause of poor child development.”

Nigeria has been in the forefront of the RBM partnership and hosted the 2000 Abuja Summit that launched the partnership in Africa. Nigeria is also important because as noted above, with the largest population of any single African country, Nigeria bears the greatest burden of malaria. Without progress in Nigeria, there will be little overall progress in the fight against malaria in Africa. Therefore, how far have we progressed in reducing the malaria burden in Nigeria? Unfortunately the Malaria Consortium reports that. “Previous efforts to control malaria in Nigeria have not led to a sustained reduction in the burden of mortality and morbidity.”

nigeria-malaria-indicators-2007.jpgNigeria has kept up with national strategies and planning, but 10 years after RBM was launched and 8 years after the Abuja Summit, the coverage indicators for malaria interventions remain extremely low as seen in the attached chart (UNICEF). Obviously there will be regional and state variations, but even with input from among others, GFATM, USAID, DfID, UNICEF, the World Bank and of course the oil rich national government, the overall picture is bleak. Public statements announcing the imminent demise of malaria in Nigeria had to be withdrawn, yet Nigeria still hopes to reach the 2010 RBM targets.

What can be done? Nigeria was on the verge of losing its Global Fund malaria grants in 2006. Quick work to address management and health systems bottlenecks around procurement and supply, monitoring and evaluation and coordination among the three levels of government (federal, state and local) helped save the grants, but these problems obviously have not been banished completely.

When RBM started in 1998 the founders said that malaria could never be rolled back unless these efforts were carried out in the context of health system reform and strengthening. Nigeria may be the most obvious case study for the importance of health systems. Donors who focus only on outcome statistics are missing the point – outcome cannot be achieved, let alone sustained, where systems are weak.

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