Despite a series of intervention programmes against the malaria epidemic in recent times, Nigeria is apparently not winning the war against the deadly scourge, with an estimated sum of N2.04 trillion still routinely spent on treatments yearly.
The conservative estimate of malaria cost, which is a far-cry from the $1.1 billion (N825 billion) estimated by the World Health Organisation (WHO), still excludes out-of-pocket costs of self-medication, and preventive measures by Nigerian households.
And as the globe marks the World Malaria Day (WMD) 2023, today, with the theme: “Time to deliver zero malaria: Invest, innovate, implement”, stakeholders have rallied the government and health parties to a renewed vigour and financing towards ending the scourge.
A breakdown of economic cost of malaria showed that of the estimated 51 million cases of malaria recorded yearly in Nigeria, an individual spends an average of N1,850 to treat one bout of uncomplicated malaria (totalling N94.35 billion yearly), and an average of N20,000 for one bout of complicated malaria (totalling N2.04 trillion yearly).
It also estimated that the Federal Government spends about 55 per cent of recurrent health budget yearly on malaria prevention and control – that is N319.451 billion of N580.82 billion health budget for 2023.
Chairman of the Pharmaceutical Society of Nigeria (PSN), Lagos Chapter, Gbolagade Iyiola, told The Guardian that the estimated cost for an individual to treat uncomplicated malaria in Nigeria ranges from approximately N700 to N3000, depending on the type of treatment, and the healthcare facility visited.
Iyiola added that the cost for treating complicated malaria could be significantly higher, ranging from N20,000 to N60,000, or more. On the cost to the Nigerian government, the consultant pharmacist said: “This cost includes expenditures on healthcare facilities, medication, and personnel. The exact cost is difficult to estimate, but it is estimated that the government spends approximately 50 to 60 per cent of its healthcare budget on malaria control, prevention, and treatment.”
He further said that the cost to the Nigerian economy is significant. “Malaria is a major public health challenge in Nigeria, and its impact extends beyond the healthcare sector. Costs to the economy include both direct costs such as healthcare expenditures, as well as indirect costs such as lost productivity due to illness and death. Malaria reduces productivity, increases healthcare costs, and affects tourism and foreign investment. According to the WHO, the economic burden of malaria in Nigeria is estimated to be $1.1 billion per year.
“Nigeria suffers the world’s greatest malaria burden, with approximately 51 million cases and 207,000 deaths reported yearly (approximately 30 per cent of the total malaria burden in Africa), while 97 per cent of the total population (approximately 173 million) is at risk of infection. Malaria remains a significant burden in Nigeria, particularly in children under five years of age, and pregnant women.
“It accounts for 60 per cent of outpatient visits to hospitals and led to approximately 11 per cent maternal mortality and 30 per cent child mortality, especially among children less than five years,” Iyiola said.
Deputy Director of Pharmaceutical Services, Federal Medical Centre, Asaba, Delta State, Dr Kingsley Chiedu Amibor, showed that the average amount charged per patient for treating uncomplicated malaria in private hospitals is N3,941.
The average amount spent on antimalarial drugs is about N2,443, while N1,064 is spent on laboratory investigation, and N406 for medical consultation. Amibor added that in private pharmacies, the cost of treating uncomplicated malaria as at April 2023 ranges from N2,000 to N3,000, and laboratory tests for malaria is N1,000 on the average, while the amount charged for medicines is inclusive of the Artemisinin-based Combination Therapy (ACT) and analgesics.
The consultant pharmacist said for severe malaria in private hospitals, the treatment costs range from N5,000 to N8,000, while in public hospitals, the costs range from N1,200 to N2,500, depending on the brand of antimalarial used for uncomplicated malaria. For severe malaria (complicated), it ranges from N1,500 to N4,000 – again, depending on the brand of drugs on offer.
On the cost to the government, Amibor said the Federal Government has secured credits from three multilateral banks (the World Bank, African Development Bank, and Islamic Development Bank) totalling $364 million to fund health sector interventions in 13 states of the Federation for five years (2020–2024) for malaria.
He said in response to the malaria epidemic and to guide implementation, the National Malaria Elimination Program (NMEP) initiated the High Burden High Impact (HBHI) approach with technical support from the WHO and technical partners to address the malaria situation in Nigeria.
Amibor said the current 2021–2025 National Malaria Strategic Plan (NMSP) is based on the vision of achieving a malaria-free Nigeria with a goal of reducing malaria morbidity to less than 10 per cent parasite prevalence and mortality attributable to malaria to less than 50 deaths per 1,000 by 2025.
On the cost of malaria to the economy, the consultant pharmacist said: “The impact of this devastating disease on the Nigerian economy leaves much to be desired. It affects the country’s economic productivity, resulting in an estimated monetary loss of approximately N132 billion in treatment costs, prevention, and other indirect costs.
“The average direct cost per episode of uncomplicated malaria is estimated at N3,000/$ 4.3 (at N700 per dollar), while the indirect average money equivalence of the time lost due to the ailment is estimated at N2,800, giving an average cost of treating uncomplicated malaria borne by patients in Nigeria per episode to be N5,800/$8.3. The projected yearly cost of the disease is not less than N128, 921,671,307.22). About 25 per cent of household income is expended on malaria control and treatment. In Nigeria, substantial financial costs for treating malaria are borne by patients.
“The yearly costs of preparing the health system for managing severe malaria with rectal artesunate in Nigeria per child, has been put at $219, (N153, 300). Rectal artesunate has been touted as a cost-effective pre-referral treatment for severe malaria in children.”
According to WHO Fact Sheet on Malaria, the disease is transmitted throughout Nigeria, with 97 per cent of the population at risk of the mosquito-borne ailment.
The duration of the transmission season ranges from year-round transmission in the south to three months or less in the north. According to the 2021 World Malaria Report, Nigeria had the highest number of global malaria cases (27 per cent of global malaria cases) and the highest number of deaths (32 per cent of global malaria deaths) in 2020.The country accounted for an estimated 55.2 per cent of malaria cases in West Africa in 2020.
Malaria is one of the most important public health concerns in the world and, according to the latest WHO World Malaria Report; there were 247 million cases of malaria in 2021 compared to 245 million cases in 2020. The estimated number of malaria deaths stood at 619,000 in 2021 compared to 625,000 in 2020.
Over the two peak years of the pandemic (2020–2021), COVID-related disruptions led to about 13 million more malaria cases and 63 000 more malaria deaths.
It noted: “The WHO African Region continues to carry a disproportionately high share of the global malaria burden. “In 2021 the Region was home to about 95 per cent of all malaria cases and 96 per cent of deaths. Children under five years of age accounted for about 80 per cent of all malaria deaths in the Region. Four African countries accounted for just over half of all malaria deaths worldwide: Nigeria (31.3 per cent), the Democratic Republic of the Congo (12.6 per cent), United Republic of Tanzania (4.1 per cent) and Niger (3.9 per cent).”
A study published in World Journal of Public Health and titled “Economic Impact of Malaria Treatment on Resource-constrained Households in Akwa Ibom: A Case Study on Selected Local Government Areas” concluded that “low-income households spend 36 per cent of monthly household income on treating malaria compared to high-income households with spending of only 1.2 per cent.
“The cost of malaria treatment is well beyond the means of the households and given the reality of repeated bouts of malaria and its contribution to the impoverishment of households necessitating increased investment in treatment and preventive intervention.”
According to the researchers, the burden of malaria on human and economic resources cannot be underestimated. In the Nigerian communities where malaria is endemic, the impact on households results in the loss of resources, time, and health of the household members.
The researchers noted: “Up to 97 per cent of the population in Nigeria live under the risk of malaria and 76 per cent in high transmission areas; 50 per cent of the population estimated to have at least one episode of malaria yearly, with the incidence of about two to four episodes among children every year. The expenditure on malaria represents over 40 per cent of curative healthcare costs with catastrophic impact on the microeconomic level where households are represented.
“The results showed that 55.7 per cent of households preferred visiting drug stores for malaria treatment. Total cost was made up of 44.7 per cent of direct cost and 55.3 per cent of indirect cost, with average direct cost of malaria treatment per household estimated at N8,563.77, and the average indirect cost of treatment per household estimated at N10,437.09. Average total cost for each episode (888) of malaria was estimated at N9,305.51, while at the household level, the average total cost was estimated at N18,868.10.”
MEANWHILE, on the occasion of World Malaria Day, Speak Up Africa and its partners reiterate the urgency to mobilise communities, political leaders and private businesses to develop and support innovative funding initiatives to end malaria.
They said the rising cost of fuel due to COVID-19, and the conflict in Ukraine, are impacting the supply chain, as well as the cost of transport to roll out prevention tools to populations exposed to malaria. Without sustained investment in malaria control, there is a risk that the progress made in recent decades will be reversed.
Interim CEO of the RBM Partnership to End Malaria, Dr. Corine Karema, said: “Without sustained investment in malaria control, the progress made in recent decades may continue to be reversed. Our challenge today is to develop innovative approaches not only in the implementation of intervention strategies targeting the most exposed populations, in the development of innovative tools for malaria elimination, but also in the search for funding to fill the financial gaps and to invest sustainably in ending malaria.”
To address this challenge, the Ecobank Group, the RBM Partnership to End Malaria and Speak Up Africa launched the “Zero Malaria Businesses Leadership Initiative” to engage businesses of all sizes to contribute financially to the efforts of national malaria control programs. The initiative, which is being deployed in five African countries (Benin, Burkina Faso, Senegal, Ghana, and Uganda), has mobilized 60 companies to date and their financial and in-kind contributions amount to more than $1.3 million between 2020 and 2023.
Chief Operating Officer of Ecobank Foundation, Elisa Desbordes-Cissé, said: “The estimated economic losses due to malaria are $12 billion each year. This is a huge loss to the development of African countries and the growth of our businesses. We believe that the private sector can and should play a key role in financing the fight against malaria. Moreover, businesses have a vested interest in participating in national malaria control efforts because a healthy population helps the country’s economy develop and allows the private sector to grow efficiently.”
Executive Director of Speak Up Africa, Yacine Djibo, said: “It is time to take innovative and concrete measures to achieve zero malaria in African countries. Through the mobilisation of resources, businesses are contributing to the achievement of national targets and can inspire other partners to join efforts to eliminate the disease on the continent once and for all.”
ALSO, Francis Nwapa, convener of #EndMalariaInNigeria, has urged the government to put more effort to fight mosquito if it is serious in delivering its zero malaria mandate.
#EndMalariaInNigeria commends efforts and interventions being made by various groups, individuals and government agencies over the years towards malaria elimination in Nigeria and it is in recognition of this that we have in the last one year advocated a redirection in the methods of intervention from curative to preventive.
“Although, the use of IPT, prophylaxis and distribution of ITNs to pregnant women has helped in reducing malaria mortality among pregnant women in some regions of the country when compared to previous records, however, certain factors has limited the effectiveness of this methods.
“Most rural Nigeria women due to lack of education are still attached to some cultural and religious beliefs that dissuade them from taking this treatments.
“Also, the poor housing system with no ventilation compounded with epileptic power supply is a discouraging factor for not using distributed insecticide treated nets (ITNs).
“Nigeria can attain a malaria-free status. A country is granted malaria-free certification by WHO when the country proves that it has interrupted indigenous transmission of the disease for at least three consecutive years.
“If African countries like Lesotho, mauritius, Algeria Libya, Egypt, LA Reunion, Seychelles, Tunisia have been declared malaria free, then Nigeria can put an end to the over 200, 000 malaria mortality annually,” he said.
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