China’s fight against malaria holds lessons for Nigeria, writes
Toluwani Oluwatola
Amid the sombre atmosphere over the global health space in the past 30 months due to the ongoing Covid-19 pandemic, one news that has generated so much optimism recently is the announcement of China’s certification as malaria-free by the World Health Organisation. This certification came after 70 years of consistent efforts against the deadliest disease known to man, reducing its prevalence from 30 million cases to zero. China applied for the certification after four years of zero malaria diagnosis and became the first country in the western pacific region to become malaria-free in 30 years. This is great news and a beacon of hope to countries in sub-Saharan Africa, with 94% of global malaria cases and deaths that the war against malaria can be won.
Nigeria started its war against malaria in 1948 with the National Malaria Service; this was about the same time the People Republic of China began its antimalarial war. Though Nigeria has made progress in its fight against malaria, while China is celebrating its malaria-free status, Nigeria still has the highest prevalence of malaria and malaria-related deaths globally, accounting for approximately 25% of cases and malaria-related deaths. Nigeria’s malaria epidemic also comes at a considerable cost; it costs $3.5 billion to treat malaria in Nigeria and an additional $1.1 billion in economic loss due to the disease annually.
Nigeria’s current efforts against malaria are coordinated through the National Malaria Elimination Program, which features initiatives like the Rollback malaria and carries out activities such as: ramping up distribution of mosquito nets, access to drug therapies and expanding the plan for vector management. This notwithstanding, much ground remains to be covered; Nigeria can learn a lot from China’s successful fight against malaria and reinvigorate its fight against the killer disease. Three of these lessons are: One, sustained political commitment: China’s attainment of a malaria-free status was not accidental; it was a product of sustained political commitment by the country’s leadership throughout the 70 years. It is near impossible for any country to make substantial progress in the public health of its citizens without political commitment by its leadership.
Sustaining commitments to health policies, programs and agendas have been a huge challenge in Nigeria; ending malaria will require more commitment from governments at all levels than what currently obtains. This support needs to go beyond policies and programs that are currently implemented. It must be consistent efforts by governments at all levels, irrespective of party affiliation. For political commitment to yield results, it must be sustained and translate to financial commitment and tangible actions, use of data and technological tools to maximize impact, coordination of country efforts, alignment of partners and engaging other sectors. Two, developing local solutions: China was at the forefront of innovation in malaria prevention and treatment; its research efforts tagged “Project 523” led to the discovery of artemisinin. It also adopted the nationwide use of insecticide-treated nets ahead of WHO recommendation. These innovative and home-grown efforts made China a step ahead of other countries in fighting against malaria.
Nigeria cannot get far ahead in its war against malaria if it remains a consumer of solutions. There is a need for national proactiveness through investments in research and development through dedicated research grants for malaria intervention. This should be complemented with investment in pharmaceutical manufacturing capacities to create a link between research outputs and industrial manufacturing at scale.
Three, a robust domestic health financing plan: China’s war was an adequately funded one; the government invested in financing the health system generally and malaria interventions specifically. The government invested sufficiently in funding public health facilities, training health workers, nationwide rollout of proven interventions and demand-side health financing.
Successive governments in Nigeria have shown a pattern of poor commitment to funding the health sector. Heavy reliance on donor funding is inadequate to wage a successful war against malaria due to dwindling donor funds. It will require adequate domestic funding and coordination of donor efforts to achieve this.
Governments at all levels must also step up efforts at ensuring health insurance coverage of the entire population. Efforts at eradicating malaria will not come to fruition if part of the population cannot afford care for malaria when they need it.
Stepping up the war against malaria holds many benefits for the country; it will strengthen its health system and fight against other diseases. Beyond the health system benefits, it also has economic gains; it will strengthen the economy by eradicating productivity losses due to malaria and boosting its GDP.
China’s fight has made it clear that the war against malaria can be fought and won with determination and consistent efforts. Nigeria can replicate this feat by becoming more resolute and stepping up its fight against malaria.
Dr Oluwatola is a Research Officer at the Lagos State Health Management Agency
