ABOUT WORLD MALARIA DAY
The genesis of the World Malaria Day (WMD) celebrations started with the Roll Back Malaria Partnership set up by the United Nations. In April 2000, Nigeria hosted an assembly of all African Heads of State which culminated in the popular ABUJA DECLARATION with the following targets for Malaria:
- 50% of all Children <5 years to be sleeping under ITN
- 50% of Pregnant women to use ITN and get IPT during ANC
(ITN= Insecticide-treated Nets; IPT –Intermittent Prophylaxis Therapy; ANC – Ante-Natal Care)
Then they unanimously agreed on the commemoration of an African Malaria Day on April 25TH to access progress made. It started in 2001 and was renamed World Malaria Day in 2008 as they felt the issue is really a matter of Global Health concern.
CELEBRATING WORLD MALARIA DAY IN NIGERIA
I have been involved in this from its inception as I was among the founding members, and have been the Chairman of the WMD Committee in the past 7years so I have thankfully watched us grow in both partnership and sensitization. Unfortunately, our hope was that by now, Nigeria’s record should probably be 1 child death from Malaria every 5 or even 10mins but sadly, it is currently 1 child death in 2mins –which is of course better than every minute that it originally was at our inception. Essentially, consider how many minutes you have just spent reading this and do the maths of how many children that have just died of Malaria somewhere here in Nigeria! So the situation is very sad indeed.
Some more unpleasant Stats: Only 52 million nets (initially ITN- Insecticide Treated Nets; but now Long Lasting ILLIN since 2009) have been distributed so far over the past 5-6 years. Bearing in mind that each has a lifespan of 4 years, we can safely estimate that barely 30 million of them are functional. Surveys show that only about 31% of children currently sleep under LLIN.
ACHIEVEMENT/IMPACT OF WORLD MALARIA DAY
Honestly touting any significant achievement right now is quite difficult because for obvious reasons- Nigeria is still lagging far behind on our target. However, we have been quite successful in the annual commemorations so far especially in the area of People Mobilization and Raising General Awareness.
THE CHALLENGES OF TACKLING MALARIA IN NIGERIA
- Finance: The cost for Prevention, treatment and man-hours lost to Malaria in Nigeria is put at #480 billion. Combating Malaria will almost require a matching fund and unfortunately, 90 -95% of Malaria funding is still given by Donor Agencies. The Nigerian Government has still not shown enough concern for the issue –that is the plain truth. Compared to the agreed Abuja Declaration of 15% allocation to health from the National Budget, it is currently 6.4%, and was 1.7% in 2000.
- Logistics: Donor Agency funding is not always received as scheduled so this causes delays and lags. Same applies to receiving the commodities (such as Drugs, LLINS, & Lavicidals) mostly due to our importation process so this further limits access.
- Poor Integration: Truth be told, we are YET to really move into proper Vector Control; we have largely majored in Case Management. Our meager attempt at our current vector control is still on a personal house-hold level with the LLIN. Until we take the required steps to manage the environmental habitat for proper breeding control, we will still keep going in cycles.
- Human Resource: We are highly short of well trained health care personnel. For instance, the WHO statndard recommends 1 Doctor: 1000 People, we have about 1 Doctor: 3000 People; and in fact, 1 Pharmacist: 8000 People.
- Corruption: Leakage of commodities like the ACTs for Government institutions is a very big problem because we often see these free drugs littered in the streets and markets. This also incapacitates private businesses who now have to compete with these highly subsidized products.
- Behavioural Attitudes: This issue is so pervasive so it contributes another major bulk to our problem today. Typical instances are:
- Naija people like free things; Nobody wants to buy what others are getting for FREE!
- The issue of actual usage of even these FREE mosquito nets for whatever minor inconveniencing reasons
- The issue of Poverty as some individuals sells their nets for like #500
- The general impression that Malaria is ‘Normal’ so people are by far more afraid of our common Nigerian Laboratory Typhoid.
- Causes poor compliance with drugs. Statistics show that 25-30% of Nigerians DO NOT complete their prescribed Anti-Malaria Drugs; failing to realize that that will eventually build resistance to the new ACTs just like it happened with Chloroquinne. Frankly, all this will cause in the end is a recurrent trend of newer drugs, new regimens, and more waste of funds.
COMBATING MALARIA IN NIGERIA: WAY-FORWARD
Until we get into position to tackle our Health scourge as a National priority, we may not get very far and this case with Malaria is a typical example. ALL our Malaria control efforts so far have been outside-driven (anchored by the World Bank, Global Fund, WHO, Carter Foundation, etc) rather than being Home-driven. The Implication is that our actions are Top-down and every decision made her has to be aligned with their goals. For example, in the past 12-13 years, NO Nigerian Pharmaceutical Company has been pre-qualified by the WHO to produce ACTs here in Nigeria. This does not change the fact that a few Nigerian Pharmaceuticals have been producing their usable ACTs here in Nigeria. However, they cannot participate in the Global Fund allocations so miss out on the opportunity of being the recipients of the available funds hence, most of the commodities we use still have to be imported from China & India. The economic implication for us is that our own industries here are not thriving and there is no sustainability. If the current donor fund dries up, there is bound to be a massive crash. This is largely why the National WMD activities have tilted more towards Advocacy because these critical issues are a matter of National Policy so we absolutely have to step up.