DESPITE multi billion naira funding from foreign donors and National strategic plans to reduce the spread, communities, particularly in the FCT, are still battling malaria cases while also complaining that they have not been receiving help from the Government to combat this disease. Misappropriation of funds, lack of state ownerships, and poor budget releases are the reasons identified as The ICIR’s Mustapha Usman reports.

Nigeria has been grappling with the burden of malaria, continuously reporting the highest rates of cases and fatalities globally for several years. Despite the implementation of a national malaria strategic plan in 2015, aimed at reducing the disease to pre-elimination levels and achieving zero malaria-related deaths by 2020, the country has persistently maintained its position as the nation with the highest prevalence of the disease.

The plan was to also provide 80 per cent of the targeted population with appropriate preventive measures by 2020.

Three years after the target year, Nigeria remains top of the countries with the highest recorded cases of malaria.

The ICIR visited three suburbs in the FCT to inquire about government interventions and the availability of vaccines for malaria, the common answer among the residents in these communities was that they had never received intermittent treated nets (ITNs), intermittent preventive treatment for malaria during pregnancy, or access proper healthcare.

The National Malaria Elimination Programme (NMEP) defined ITN as a factory-treated net that does not require any additional treatment and can, in most cases, can only be obtained from mass distribution by government agencies or concerned non-governmental organisations (NGOs). The ITNs repel and kill mosquitoes, thus providing protection against mosquito bites and reducing the transmission of malaria parasites.

Umaru Hassana, 40 years lives in Sumakpa community, a suburb of the Katampe area in FCT, with her husband and three children. The family sleep in a room with an old, defective door, and has never slept under a mosquito net.

Early this month, April, Hassana’s daughter, Helen, fell ill with malaria. She experienced high fever, and her body temperature soared, prompting the family to rush her to Dr. Bello Hospital in Mpape, a journey of approximately 30 minutes by bike.

Upon getting to the hospital, Hassana discovered that her daughter was suffering from yet another Malaria case and had to spend up to N10,000 from her hard-earned profit for hospital bills.

She explained to The ICIR that it was the second time that she would be taking Helen to the hospital despite the long distance and bad road. Before getting to the hospital, one has to cross through several bodies of running water amidst other road difficulties.

“We they get problem for sickness o, we no get hospital for here, we dey carry ourselves go Mpape, a private hospital called Dr Bello hospital. Even this month, this one (pointing towards her daughter, Helen) we carry go hospital,” Hassana said.

Sumakpa Community Secretary Amos Jerry confirmed that the community in the past 15 years has not received any government intervention to combat the ravaging malaria in the community. According to him, the community lacks a public health centre; most times, rely on a makeshift pharmacy and ‘God’s intervention.’

The situation of this community mirrors Tuda Gani a community, in Dei -ei-about 42 kilometres away from Sumakpa-as few residents who spoke to The ICIR confirmed that they have not been sleeping under ITNs because they have never been provided one.

Muhammad Aishatu, 27, recovered from Malaria a week ago as at the time of the interview, her eyes were still red, her face pale, and her voice hoarse as she narrated her ordeal. 

“Malaria is a normal thing here, there’s hardly a week where any of my family won’t have fever or feel cold. And before now, when the heat was still much, all of us used to sleep outside. I can’t really remember the last time they brought the mosquito nets around here, but I know that it has been long because I was still a teen then,” she said.

Caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes, malaria is a preventable and curable major public health issue affecting millions of Nigerians.

While individuals of all ages are susceptible to the disease, children and pregnant women are particularly vulnerable and prone to experiencing complications. This heightened susceptibility puts them at a higher risk of severe illness and increases the likelihood of mortality, especially among children under the age of five.

Aside from the National malaria strategic plan (NMSPs), in the last decade, Malaria control in Nigeria has witnessed a mass campaign for the replacement of insecticide-treated nets (ITNs), intermittent preventive treatment of malaria during pregnancy and continued funding from foreign donors. This is, of course, expected to improve the prevention of Malaria in the state; however, misappropriation of funds, poor releases and marginalisation of some communities are major factors contributing to this burden.

Trends of Malaria in Nigeria

Malaria transmission rates vary across regions in Nigeria, with higher prevalence generally observed in the northern states compared to the southern states, according to the 2021 National Malaria Indicator Survey (NMIS).

The 2021 Nigeria Malaria Indicator Survey (NMIS) revealed that malaria prevalence fell from 42 per cent in 2010 to 27 per cent in 2015, then to 23 per cent in 2018 and finally to 22 per cent in 2021.

However, the 2022 World Malaria Report – the latest report on the disease – shows that the country contributes about 27 per cent (26.6) of the global burden of the disease. The report also shows that Nigeria accounts for about 31.3 per cent of deaths from malaria, the largest globally.

According to the United States government, malaria is a major public health problem in Nigeria, accounting for more cases and deaths than any other country in the world. The US report stressed that malaria is a risk for 97 per cent of Nigeria’s population.

”The remaining three per cent of the population live in the malaria-free highlands. There are an estimated 100 million malaria cases, with over 300,000 deaths per year in Nigeria. This compares with 215,000 deaths per year in Nigeria from HIV/AIDS. Malaria contributes to an estimated 11 per cent of maternal mortality,” the US add.

The Nigeria Malaria Elimination Program Coordinator, Perpetua Uhomoibi also said that the endemic disease accounts for 60 per cent of outpatient visits to health facilities, 11 per cent of maternal deaths (4,500 per year), and 25 per cent of infant deaths (children under a year old).

Budgets, foreign donation for malaria

The allocation of the budget for health by federal government, as a proportion of total investments, has consistently remained low (averaging between 5-7 per cent). This percentage is consistently below the recommended 15 per cent set by African Heads of State during the Abuja Declaration of 2001. 

Checks by The ICIR revealed that the Malaria related allocations in the National Health budget had increased from 0.019 per cent in 2016 to 6.327 per cent in 2023.

However, NMEP, the body solely responsible for the elimination of malaria, saw a decline in the portion of the budget allocated to them from the Federal Ministry of Health budget between 2016 to 2019, according to the 2019 Malaria Programme Review.

The budget decreased from 0.003% in 2016 to 0.0003% in 2019, representing a ten-fold decrease.  This reduction, according to the review, has widened the funding gap for the Malaria Strategic Plan.

Also, the Federal Government has consistently failed to earmark a significant amount to epidemiology and disease control-related projects as the highest amount the country has ever allocated for epidemics was in 2019 when it approved N625, 860,454 million, translating to 0.09 per cent of the health budget and that was in 2019.

Meanwhile, apart from the National and state budgets for epidemic responses, Nigeria has benefitted from other sources of funding for Malaria, which include the Global Fund, US President’s Malaria Initiative, UK Department for International Develop, The World Bank, World Health Organization and UNITAID. 

For instance, the World Bank, between 2006 and 2019, committed a total of $180 million to a Malaria Booster Programme for seven states in Nigeria – Gombe, Kano, Jigawa, Adamawa, Anambra, Rivers and Akwa Ibom. Although the money was given primarily to the states, part of it was to go into some activities on the national level.

Also, Nigeria was also allocated over US$1.5 billion for the 2017-2019 and 2020- 2022 funding cycles, meaning that it is one of the single biggest recipient of Global Fund grants.

In February 2023, Global Fund approved nearly $1 billion for Nigeria to continue its fight against tuberculosis (TB), malaria, and HIV/AIDS for the next three years. Out of approximately 110 countries, Nigeria got the highest grant of $933,156,931, covering 2023 to 2025.

The fund adds to almost $3 billion that the country has received since 2003. The Global Fund boasts of providing 63 per cent of all international financing for malaria programmes and has invested more than US$16.4 billion in malaria control programs as of June 2022.

Since the start of the COVID-19 pandemic in 2020, it stated that it awarded over US$4.2 billion to 108 low- and middle-income countries and 21 multi-country programmes to fight COVID-19 and protect lifesaving malaria, HIV and TB interventions.

Similarly, USAID PMI, DFiD, Unicef, WHO, UNITAID were also part of the foreign donors that funded Nigeria in its fight against Malaria. 

The ICIR gathered that USAID PMI donated N73,230,000 in 2014 and N75,000,000 in both 2015, 2016, and 2017 for the malaria intervention project. Also, DFiD funded the Malaria treatment and intervention project in Nigeria in 2014 with N89,272,524 and while Nigeria got N2,967,421 in 2015.

Malaria interventions

In 2021, the NMEP implemented its Nigeria Malaria Indicator Survey (NMIS) across the country, including the FCT. The survey asked questions about the intermittent preventive treatment of malaria during pregnancy, fever management in children and the usage of intermittent treated nets, popularly known as mosquito nets.

The NMEP, is a division of the Department of Public Health of the Federal Ministry of Health which is responsible for policy formulation, coordination and regulatory roles on all matters that concern Malaria control and elimination in Nigeria. Its pursuit of universal access to prompt malaria diagnosis, effective treatment and universal coverage with preventive interventions made it to develop a very ambitious plan in 2014 targeting Elimination.

The result shows that 56 per cent of the households own at least one insecticide-treated net (ITN), translating to half of the examined population, while 25 per cent of households own enough ITNs to cover all households’ members.

According to the report, 50 per cent of the sampled pregnant women aged 15-49 slept under an ITN, while 31 per cent of women within that age bracket said they received three or more doses of Intermittent preventive treatment. 

This figure revealed that there is still a significant problem in preventing malaria in the country, particularly in FCT, where only 29 per cent of the household population sleep under an ITN.

The low  percentage could be traced to many residents not having access to the nets, as it was noted that the last time an ITNs were distributed in FCT by the government was in 2011.

Households that own at least one ITN increased from 8 per cent in 2008 to 69 per cent in 2015 before decreasing to 56 per cent in 2021.

Another key finding by NMEP was that only 41 per cent of children under age five nationwide sleep under an ITN.

On May 7, Ramatu Bolanle, a resident of Gida fulani community of Dei-Dei, was in a PHC to complain about the sickness of her five-year-old son when this reporter approached her. The attending doctor had directed her to do a malaria test, which came out positive. 

Bolanle explained to The ICIR that she suspected that the cause of the malaria was mosquito as she has been sleeping outside of her house without nets because of the heat.

This situation represents one of the numerous unreported instances in which children experience preventable illnesses, despite the government’s claims of significant investments and interventions in addressing such issues.

Some other factors contributing posing as challenges for intervention is the widespread extortion of citizens through the sale of free anti-malaria drugs to patients at primary health centres (PHCs) across the country.

Corruption in Malaria intervention project 

While there has been a slight reduction in the number of people affected with malaria and deaths recorded over the past few years, there are projections that Nigeria could have achieved even a lower number of cases if the 2015 strategic plan had been successful and adequate funding were allocated for the project. 

The 2019 Malaria Programme Review (MPR), stated that the country was unable to accomplish the objectives outlined in the National Malaria Strategic Plan and attributed the failure to the government’s inadequate allocation of funds for combating the disease.

In 2022, the Global Fund, in its audit, accused the National Agency for Control of AIDS (NACA) and the Lagos State Government of misappropriating $19.6 million worth of COVID-19 procurement grants through shady contract awards.

That was also not the first time the Global Fund would accuse Nigeria of misusing its grants. In 2016, the Fund accused NACA and NMEP of misappropriating the grants they got. The Global Fund consequently suspended them as its grant recipients, and as of 2021, NACA was yet to clear itself of the 2016 indictment before the Nigerian government.

Need to tackle malaria

Tackling malaria in Nigeria requires a comprehensive approach from all levels of government, according to a public health physician and CEO of TalkHealth9ja, Laz Ude Eze.

He noted that although there has been some progress recorded in the past few years, he said the progress is not proportionate to the investment made by the government.

“Malaria cases in Nigeria are too high. Though some progress has been made towards malaria control, but they’re not proportionate to the humongous investments made so far. All hands must be on deck if we must end malaria.”

Speaking on whether Nigeria needs to improve its strategic plan to attain zero cases of malaria, Eze explained that Nigeria has a challenge of poor implementation. 

“Nigeria has always developed a good strategic plan but has a challenge of poor implementation. Many of the subnational governments don’t do their jobs efficiently,” he said.

This report is supported by The Nigeria Health Watch.

Mustapha USMAN

Usman Mustapha is a solution journalist with International Centre for Investigative Reporting. You can easily reach him via: umustapha@icirnigeria.com. He tweets @UsmanMustapha_M