Ethiopian Ex-minister: Nigeria Faces Largest Financial Gap to Tackle Malaria

Nigeria constitutes about 27 per cent of the global malaria burden, hence eliminating it is key to defeating the public health issue globally. In an exclusive interview with Martins Ifijeh, the former Minister of Health, Ethiopia, Dr. Kesete Admasu, who is presently the Chief Executive Officer, RBM Partnership to End Malaria, said Nigeria faces the largest financial gap required to fully implement its national malaria strategic plan between 2018 and 2020, and that the country needs continued political will to address the burden

Nigeria contributes hugely to the global malaria burden, where is the country now in terms of eradication?

Nigeria has made good progress in fighting malaria, reducing the disease burden from 62 million cases in 2008 to 57 million in 2016. It has also invested in providing long lasting insecticide treated nets, accurate diagnostics and effective medicines to its citizens. For example, household ownership of insecticide treated nets (ITNs) was just two per cent in 2003. Today, 69 per cent of households have access to at least one ITN.

The World Health Organisation (WHO)’s World Malaria Report 2017 shows that progress – both globally and in Nigeria – has stalled and that malaria cases are increasing. As the most populous country in Africa and one with the highest malaria burden in the world, Nigeria must raise the profile of this threat to even greater heights in order to reverse these worrying trends and get back on track towards ending malaria.

The Nigerian Government late last year said they were making progress in eradication, but conflicting reports show Nigeria’s progress indices have come down. What does your own indices show for Nigeria?

The Nigerian Government is implementing a national malaria elimination programme with the ultimate goal of ending the disease for good — this is an important political commitment in its own right. However, given its population size, tremendous disease burden and health system weaknesses, Nigeria has a lot to do in order to meet this ambitious goal.

According to the WHO’s World Malaria Report 2017, there were an estimated 57.3 million cases of malaria in Nigeria in 2016, a one million increase from the previous year’s estimate of 56.2 million cases. Such an upsurge is not unique to Nigeria — but is an urgent reminder that, without continued political commitment and sustained funding, the gains of the past decade can be easily lost.

Some countries have made progress over the past decades. Are there case studies Nigeria can emulate?

At the turn of last century, almost all countries in the world were malaria endemic. Today, the number of malaria endemic countries stands at 91, of which 44 have less than 10,000 cases per year – meaning that malaria elimination is within reach. All this shows that ending malaria is possible for any country, even one with a high burden of the disease.

For Nigeria, there will be lessons to learn from but no exact model to copy. Perhaps the first place to start will be in scaling up the malaria surveillance system, which currently only detects 16 per cent of cases. Without adequate surveillance malaria control efforts are blind.

Finally, a strong political commitment is a prerequisite for any successful action against malaria, and needs to translate into additional resources to strengthen the health sector overall and malaria efforts in particular. Today, less than five per cent of national budget in Nigeria spent on health, of which only 0.8 per cent supports malaria, according to the estimates from the Global Fund To Fight AIDS, Tuberculosis and Malaria.

Nigeria still has high death rate from malaria, partly because cost of treatment lies on the citizens, even though about 75 per cent still live below poverty line. What do you recommend?

Tragically, malaria is still a leading cause of mortality for children under five in Nigeria, although the government’s efforts that have been credited with reducing mortality rates among children under five by 18 per cent since 2011. In Borno State, for example, malaria is currently claiming more lives than all other diseases combined.

The private healthcare system provides care for a substantial proportion of the Nigerian population. Through the Global Fund, the international community is working to increase Nigerian citizens’ access to all the needed WHO-recommended antimalarial treatments. Artemisinin Combination Therapy (ACT), the current recommended drug treatment for malaria, is officially provided free of charge in the public sector. In addition, the Global Fund’s Private Sector Co-payment Mechanism has procured 217 million life-saving antimalarial treatments at subsidised prices in 2016. The additional costs associated with battling malaria will pay off in terms of improvements to the economy. Fighting malaria is one of the most potent investments a government can make to the national economy.

Where is Africa in the global elimination of malaria. Are our collective efforts adding up?

Africa accounts for 91 per cent of the global malaria cases and 93 per cent of malaria-related deaths. In 2016, progress across the continent has been uneven and African leaders need to recommit and re-engage in the malaria elimination agenda.

Some successful examples were highlighted just two weeks ago at the annual African Leaders’ Malaria Alliance (ALMA) Excellence Awards, which this year went to the Gambia, Madagascar, Senegal and Zimbabwe for reducing malaria cases by more than 20 per cent between 2015 and 2016, as well as Algeria and Comoros for being on track to achieve more than 40 per cent reduction in cases by 2020.

Other encouraging examples from across the continent are regional initiatives such as Elimination 8 in Southern Africa, where Botswana, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe have formed a cross-border partnership to reach the bold goal of eliminating malaria by 2030.

In West Africa, eight nations — Burkina Faso, Cape Verde, Chad, the Gambia, Mali, Mauritania, Niger and Senegal — have agreed to accelerate malaria elimination in the Sahel region, and we are working with partners including WHO to roll out the programme this year. Cross-border cooperation will indeed be key to stepping up efforts against malaria in Africa.

Going by progress rate, what is the projection in the next 10 years for Africa, in terms of malaria elimination?

My hope that, in the next 10 years, we will have shrunk Africa’s malaria map. WHO has identified six African nations as having the potential to eliminate malaria transmission by 2020: Algeria, Botswana, Cape Verde, Comoros, South Africa and Swaziland. Having recorded no indigenous malaria cases in 2016, Algeria could well become the first country in the WHO-Afro region to be certified as malaria-free by WHO later this year. As part of Agenda 2063, African Union leaders have also expressed their collective political aspiration to achieve a malaria-free Africa. These targets are now at great risk but there is still hope to get on track to meeting them.

Considering that Nigeria constitutes 27 per cent of the global burden, how should the country step up commitment for its eradication?

Nigeria has a great opportunity to be a leader in the fight against malaria, for Africa and for the global community. The world cannot defeat malaria without Nigeria. I believe that, with leadership at all levels – from federal down to the local level – Nigeria can do what it takes to end one of the oldest and deadliest diseases in human history and, in doing so, unlock opportunities for its economy and its people.

Nigerian Government recently clamoured for more funding in order to tackle malaria. Is it a request you will lend your voice to?

Absolutely! Our recent analysis shows that Nigeria faces the largest financial gap required to deliver life-saving interventions to its population and fully implement its national malaria strategic plan between now and 2020. It needs US $1.4 billion over the next three years, which will need to come from a variety of sources, both international and domestic.

Many Nigerians still find it difficult using LLITNs despite wide spread campaigns. Are there alternatives to mosquito nets?

Bed nets remain the cheapest and most effective form of malaria prevention. It is noteworthy that in Nigeria alone, 128,000,000 insecticide treated nets have been distributed since 2006. Other forms of vector control recommended by WHO include indoor residual spraying and larvaecide, depending on the countries’ individual circumstances. For instance, indoor residual spraying on a six-monthly basis is a more expensive but viable option. However, there is a risk that insecticide resistant mosquitoes will continue to evolve and spread the disease. Even with resistance to the insecticide, bed nets can still be effective.