In villages of southeastern Nigeria, Uguru and colleagues found that mosquitoes do not discriminate by socio-economic status (SES), but SES does influence where people go for treatment once those bites result in malaria. “In one of the villages the most poor, very poor and poor significantly used the services of patent medicine vendors and the least poor visited hospitals.”
Expenditure to treat malaria did not vary by SES group and ranged between US$ 1 – 3, with transport costs being less than a dollar.Â The difference therefore, was that the poor paid proportionately more for their treatment than co-villagers who were least poor.Â Treatment options sought by each group also introduced possible differences in quality of care, too.
As the World Malaria Report of 2005 observed, “Patterns of malaria transmission and disease vary markedly between regions and even within individual countries. This diversity results from variations (in) … conditions that affect malaria transmission and socioeconomic factors, such as poverty and access to effective health care and prevention services.” Because of this, “Malaria control is increasingly recognized as playing a key role in poverty reduction in high burden countries.”
Clearly, people in the villages studied do not have access to cheap or free appropriate malaria medicines, although Enugu State, where the study occurred, has been included in the Global Fund Round 4 Malaria grant in Nigeria. Initially GFATM malaria medicines covered only children less than five years of age who attended government health facilities.
Nigeria has recognized the weakness of a strictly public sector approach and is now making malaria medicines available through both public and private sector sources, particularly the medicine shops frequented by the poor as described in Uguru’s study.
The Society for Family Health (SFH) in Nigeria, with USAID support, has spearheaded an effort to make quality prepackaged antimalarial drugs available cheaply through private sources, such as medicine shops.Â Now that SFH is involved with the Global Fund grant in Nigeria, there is hope that this distribution network can be strengthened to reach more people – especially the poor who find it difficult to access formal health services in either the government or the private sector.
There is still a long way to go to achieve universal treatment coverage among the 140 million plus people in Nigeria, but a mixed sector strategy seems to be a good way to start.