Policies hampering Nigeria from eradicating malaria
By Odimegwu Onwumere
Little did many Nigerians know about the country’s malaria policies till Sunday, May 26 2012, when the Environmental Health Officers Registration Council of Nigeria (EHORECON), called for an increase in policies that would see to the eradication of the deadly-disease known as malaria, across the country.
Debatably, 70 percent of Nigerians live lower than the world’s poverty index and this number, invariably, patronises the Patent Medicine Vendors (PMV), for the treatment of the pandemic, whereas the government policies are modified only to soothe hospitals.
The country had signed the funding-conformity, which brought about $1.5 billion since 2004, when $971 million grant was approved, the total Global Fund assistance to Nigeria. The Global Fund had given the country a grant of $225 million (about N36 billion) to assist in the fight against malaria, as was contained in the financial periodicals in the country of September 13, 2012. A statement in that national broadsheet, said that the Minister of Health believed the grant was a harbinger to forming a new approach of tackling the fight against malaria. Purportedly, he said how the money would be utilised, adding that about N27 billion of the first grant would be expended on the 36 states and Abuja, through what was called “public and private sector agencies.”
The second approach was for the provision of imported insecticide treated nets, an initiative which the minister said would cost N8 billion. A N1.6 billion counterpart funding for the implementation, the Minister said it would be provided by the federal government.
From the speech of the EHORECON’s Registrar in Benin, Edo State, it was disturbing that the government policies were tailored towards curative measures instead of preventive, unlike the early 1960's and 1970's, when governments at that time operated on preventive measures rather than curative measures.
There were sanitary inspectors in the 70s and 80s and early 90s. But from the middle of 90s to date, things went awry. Substandard drugs replaced the sanitary inspectors. The registrar frowned at government’s approach in spreading drugs it believed were anti-malaria to all the communities in the 774 local government areas across the country, hoping that this move would help redeem the ‘Bubonic-plague’, but to no advantage.
Malaria is a major cause of mortality and ill-health in Nigeria and has huge consequences for the productivity of the country. There has been proliferation of health providers in Nigeria of recent and this seems to put the rural poor in greater confusion of which one to believe given the old barriers between private and public, modern and traditional and formal and informal health providers.
In its efforts on the fight against malaria, the country has recorded little or nothing in its eradication. Rather, the authorities have blamed PMV, as providing a stand for patients not to go for proper medical care at government-owned hospitals, in the anti-malarial bazaar in the country. In a research funded by the Center for Health Market Innovations, Nigeria was no longer a core country beaming her light towards eradication of the epidemic in the country. In another countrywide commentary of 26 April 2013, the data is disturbing that over 300,000 Nigerians die from malaria each year; more than in any other country on the surface of the earth and out of this number, 250,000 is said to be children under five.
It is generally believed that given the not-too-serious approach of the various governments in Nigeria in the fight against malaria, it has resulted in Nigerians taking to consulting quacks, especially Patent Medicine Vendors to buy sensitive drugs, which they erroneously believe is cheaper.
When government banned chloroquine, probably the most accessible drug for the rural dwellers, the government cited malaria parasites resistance to the drug as the reason; however, it seems that independent investigations have more to say to this.
According to the Country Director of JHPIEGO, a non-profit affiliate of Johns Hopkins University in Baltimore, Maryland, USA, even the ACTs they replaced chloroquine with, have been found to be not too effective in parts of South East Asia.
As a country that is still having issues with electricity to enable fan and air conditioners boost the air within an enclosure or possibly drive away mosquitoes, the treated mosquito nets that the authorities provide have equally not helped matters much. There are complaints that the uneasy penetration of air through the very tiny holes in the nets has made many people to prefer to sleep without them to avoid excessive heat.
Professionals in the health sector are arguing that the language of communication has reduced the impact to the target audience thereby blocking off the primary targets for many of the malaria programmes. They argue that most of the communications are not done in the local language of the many rural dwellers who are the primary targets of the communication in the first place. Consequently, many people do not understand the causes of malaria and how it could be treated. It is also said that the Nigerian Malaria Control Programme (NMCP), an arm of the Public Health department of the Federal Ministry of Health, is not doing well in this direction, not minding the insecticidal nets which it boasts of distributing in the 36 states across the country.
But investigation reveals that majority of the people at the local level do not receive the nets. It is also said that the nets end in the cities and most time at market places after the announcement of distributing them have been made. And this is the major reasons many Nigerians patronise PMV for the treatment of malaria.
Many Nigerians have decried how this single virulent disease has brought the country to public ridicule. A commentator who wouldn’t want his name in print said that Nigeria with many universities, numerous doctors, cannot investigate into the cause of, and the cure for malaria. The commentator was of the view that third world countries should stop relying on the assistance of the West in eradicating malaria, because they should also do whatever the West did to eradicate malaria in their domains.
There was a school of thought that said the preventive concept of malaria could have been found if not for the recklessness of those in authorities with money provided to fight the threat. Others said that except help comes from the African Union (AU), the malaria control strategy and policies that the country was using are but a farce. The clarion calls are that the entire continent should join hand in the fight against the peril. Notwithstanding, the same school of thought said that a part of the continent – East Africa – DDT applications had become a success in the fight against the disease and Nigeria should borrow a leaf from there.
On the other hand, some other analysts are of the view that the international community and the donor agencies are not happy with Nigeria, owing to the fact that all their efforts in helping the country in the fight against malaria, have hit the rocks. They argue that many of the foreign donations find their way into the personal pockets of government officials in Nigeria. Health experts contributed that the toll in malaria-related deaths has increased across the country following the shoddy deals with foreign donations by the authorities.
It was recallable when in 2008, the World Health Organization (WHO) cried out that Nigeria and the war-torn Republic of Congo constituted 30 to 40 percent of malaria-related deaths worldwide. The government policies on malaria however do not reflect the prediction of the WHO that Nigeria is going to experience murkiness for the Millennium Development Goals (MDGs). Not even the Roll-Back Malaria launch, which was observed by the world 10years ago in Abuja, has helped the matter. In view of this, WHO had in 2008, voted $1.2 billion to combat malaria in Nigeria and Congo.
The Director of JHPIEGO pointed out that to treat malaria with ACTs, WHO recommends a four-point strategy to combat malaria, which include among others education. The director was of the belief that everyone should know how malaria is transmitted – by mosquitoes – and how it breeds in torpid water. He equally advised that sleeping under an insecticide-treated bed net is helpful, because when a mosquito touches it, it dies.
An expert advised that it has become imperative for the federal, state, and local governments to devise an all-inclusive policy for the eradication of malaria in the country. The sources of mosquito should be eradicated, through awareness to the people. Local and herbal therapies that are well researched should be tried and improved upon as a substitute for imported malaria therapies.
Another specialist also posited that about 80 percent of anti-malaria drugs in Nigeria are not effective, while imported insecticide-treated mosquito nets hardly achieve the desired results as they are sold in urban markets at exorbitant prices instead of being distributed free to rural communities as intended by the government.