Logistics, irregularities mar distribution of treated nets in Nigeria

With 52 countries on track to reduce malaria case incidence rates by 75 percent, in line with World Health Assembly and Roll Back Malaria targets for 2015, and international disbursements for malaria control rising from $100 million in 2000 to $ 1.97bn in 2013, distribution of Long Lasting Insecticide treated Nets (LLIN), as well as logistic obstacles in transportation and delivery to cover the vast population has remained a major challenge in combating malaria in Nigeria.

While malaria remains a major public health issue as Nigeria and Democratic Republic of Congo (DRC) accounts for 40 percent of malaria deaths globally, according to the World Health Organisation (WHO), 97 percent of Nigeria’s 160 million population are at risk of having an episode of malaria as massive distribution of LLIN costing $10 is among the most cost-effective ways to save lives.

A 2014 report by Support to Nigeria Malaria Programme (SuNMaP), an initiative of United Kingdom Department for International Development (DFID), revealed that delivered nets are often neglected due to the lack of a ‘net culture’, and that population access to LLINs remains too low.

“Finding the most effective distribution methods has become a priority for public health organisations and ministries of health, and is a matter of intense debate among experts. The discussions over distribution have raised several questions regarding the effectiveness of the private and public sectors in getting ITNs to those who need them. Does distribution through the commercial sector exclude the poorest groups?” SuNMaP report asked.

In 2009, the Federal Government through the National Malaria Control Programme (NMCP) supported by international bodies, including the World Bank and Global Fund embarked on a very ambitious programme to freely distribute 63m insecticide treated nets.

With malaria interventions by international bodies in Nigeria running to billions of dollars and the distribution process still ongoing, the distribution of the insecticide-treated nets has been marred by irregularities with uncertainty surrounding officials in charge of distributing mosquito nets to households in the country.

The 2011 Multiple Indicator Cluster Survey (MICS) conducted by the National Bureau of Statistics revealed that only 40 percent of households have at least one insecticide treated net. This leaves 60 percent of Nigerians without at least one insecticide treated nets. The survey revealed a dismal proportion of people, particularly the high risk group, including pregnant women and children who do not use ITNs.

BusinessDay investigations show that malaria accounts for 60 percent of outpatient visits and 30 percent of hospitalisations among children under five years of age in Nigeria. Statistically, about N132bn is lost to malaria annually in form of treatment cost, prevention and loss of man hours.

A peep into malaria funding in Nigeria reveals that the World Bank provided $180 million for the Malaria Booster Programme that supports seven states and some national-level activities. It also provided an additional $100m for this programme in 2009.

The UK DFID initiated SuNMaP, a $100m, five-year programme to control malaria in 2008. The Global Fund provided a $500m Round 8 Malaria grant that began in 2009 and will last until 2014.

Also, the United States President’s Malaria Initiative (PMI) was launched in June 2005 as a five-year, $1.2bn initiative to scale up malaria prevention and treatment interventions, and has been extended through 2015.

With the goal of PMI, working closely with host governments, aimed at reducing malaria-related mortality by 70 percent in the original 15 countries by the end of 2015, Nigeria became the 17th PMI country in 2010 as pre-PMI malaria funding in Nigeria was $18 million.

Malaria Action Programme for States (MAPS) is a PMI-funded integrated malaria project. The MAPS project, which spans from 2010 to 2015, is implemented in Benue, Cross River, Ebonyi, Nasarawa, Oyo, and, Zamfara states.

For Folake Olayinka, director, SuNMaP, “Provision of nets alone will not bring about high coverage in Nigeria. We need to create the demand for insecticide treated nets and for malaria control services, and that has to be done by raising awareness of malaria and community knowledge about the most effective means of preventing and treating it.”

Alexander Chiejina