Nigeria accounts for over 29 per cent out of 90 per cent of the global burden of malaria in Africa. Nigeria also suffers the world’s greatest malaria burden, with approximately 51 million cases and 207,000 deaths reported annually. In this interview with AJUMA EDWINA OGIRI, the Malaria Programme Officer, World Health Organisation (WHO) Nigeria, Dr Lynda Ozor, speaks on the organisation’s malaria control efforts, elimination and funding in Nigeria.
What is WHO strategy to support Nigeria on elimination of malaria by 2030?
At policy level, Nigeria has put together a strategy to guide efforts in controlling malaria; the national strategic plan, which is aligned to global malaria technical strategy. The key strategies under this plan are, prevention through Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spraying (IRS) and chemo prevention for children and pregnant women; diagnosis with malaria microscopy and rapid diagnostic test kits and prompt treatment Artemisinin Combination Therapy (ACTs).
These interventions are proven and remain effective for the control and elimination of malaria. It is important to note that these interventions need to be implemented at scale or universal coverage to achieve optimum effect and results.
Why is funding for malaria prevention and control in Nigeria stagnated?
While there is significant funding from both external and domestic sources, it remains insufficient to meet the need for malaria control in Nigeria. This year’s World Malaria Day theme is ‘’Ready to Beat Malaria’’.
The recently concluded malaria commonwealth summit in London witnessed a positive response to the Director-General’s call to action on increasing resources for malaria control and elimination. We are hopeful that this call will trigger further responses from countries, other donors and the private sector.
It is also key to identify new sources of funding form internal communities, philanthropists and other non-traditional and emerging private sector. As WHO, we call on Nigerian government, at all levels to prioritise public sector funding for malaria control.
How much is needed to combat malaria in Nigeria?
I may not be able to reference the actual amount required for malaria control in Nigeria, however I can say that cost of delivering one LLIN is a minimum of $3.50, diagnostics and treatment staggering around $1 each.
These costs do not include cost of training of health care providers, community mobilisation, maintenance of the supply chain system and other system costs including surveillance.
If you put these in context of the at least 97% of entire population at risk, you will realise that malaria control requires funding and contribution of everyone.
Despite the increase in global warming and temperatures in Sub-Saharan Africa, how easily can malaria carrying parasite be eliminated?
A tropical climate such as ours is favourable for the malaria transmitting mosquitoes. However, it is very possible to eliminate malaria even within such a climate. What we need is known and proven. The tools are available.
What we are not doing is implementing these interventions at full universal coverage. We need the political will to mobilize adequate action to scale up for maximum impact and appeal for commitments towards universal coverage of anti-malarial interventions.
For the average Nigerian that literally survives on a dollar a day, what affordable malaria preventive measures is WHO and its partners working on?
The Director-General’s statement during the launch of the health dialogue on universal health coverage, said and I quote; ‘’No person should have to choose between poverty and healthcare, this is the simple meaning of universal health coverage’’.
WHO and partners have supported the government of Nigeria to ensure that these services are affordable and available when needed. LLINs are distributed periodically to households and are free for charge. Indeed, the payment for malaria service within the public sector is very limited.
In the private sector, WHO and partners have supported government to make the prices of anti-malaria drugs affordable through subsidies. Our call remains universal access to health care for all Nigerians irrespective of social economic status.
Would you say WHO has made gains in the fight against malaria?
The gains in the fight against malaria are enormous. First, the availability of tools for malaria control is a huge gain. Some years back, Chloroquine resistance was documented for most areas in Nigeria and around the world, WHO in collaboration with the research community quickly introduced an effective substitute, the ACTs which up till date, remains effective against malaria.
Same has been for the Nets, you will recall that previously, the nets were being treated individually, but with the improvement in research and innovation, the LLIN which provides long acting protection against malaria.
Secondly, WHO’s role in the monitoring of trend of disease has provided immense support in the targeting of interventions to areas where it is mostly needed. This has also helped in the monitoring of programme performance against its set targets.
Thirdly, WHO supports the capacity development of healthcare workers at all levels. This ensures that there is a critical mass of individuals, healthcare workers and village health workers, who are able to provide quality service.
Also, WHO provides guidelines and other tools for implementation of malaria control interventions. These guidelines reflect evidences that have been generated from areas with similar epidemiology and have proved to be efficient in malaria control.
We support the programme reviews, planning and evaluations. This helps to review the programme performance, identify critical gaps in implementation as well as provide alternate strategies to address identified bottlenecks. These processes provide inputs into development of strategic direction to the programmes.
Last but not the least, we are also a key convener and coordinator of health partnerships. This role supports individual countries to engage properly through agreed methods in order to respond timely to any changes in the disease landscape, and to mobilize resources required for adequate programme management.
WHO and partners are working on a commercially viable vaccine for malaria, how is the progress going and when do we expect it in the market?
The RTS vaccine for malaria, ‘’Mosquirix’’ is currently being piloted in a few countries; Kenya, Ghana and Malawi, with 360,000 children to be vaccinated between 2018 and 2020. The injectable vaccine could provide limited protection against malaria in children less than 5years.
The lessons from these pilots will support the feasibility of larger scale roll out and scale up, especially as we try to operationalize the vaccine structure within the existing immunization structure.
The vaccine when made commercially available will be used as a complementary control tool which will be used in addition to existing interventions. The vaccine will be used alongside other preventative measures such as bed nets, insecticides and anti-malaria drugs.
In rural areas, traditional herbal medicines are still in high use to treat malaria, is WHO carrying out any research on the viability of these herbal medicines?
WHO encourages innovations and new evidence for malaria control. There have been pieces of research on phytomedicinal use for malaria control, and the malaria evidence review team are reviewing these evidences. Until any herbal medicine is recommended for malaria treatment, there is no recommended or approved herb for malaria treatment or prevention.