Challenges in the Management of Malaria in Nigeria: A Healthcare System Preview

Malaria remains a huge global health burden with more than 90% of fatalities occurs in Africa and about half a million infant mortality each year. Malarial infection is of particular concern as it is a disease that can be both treated and prevented. Nigeria, biggest country by population in Africa, is responsible for about 25% of global health burden. While all local and international efforts aim to implement Nigeria’s current National Strategic Malaria Plan [NMSP 2014-2020] to have Nigeria free of Malaria by 2020, the current healthcare system in Nigeria remains a major system bottleneck to achieving such challenging objective but yet still achievable.

This report on Nigeria’s current malaria situation aims to highlight healthcare system challenges that face Nigeria as a country, and possible plans that integrate both local and international initiatives to reach 2020 with a malaria-free country.

The studies used in this review were retrieved from CINAHL Plus, MEDLINE, ProQuest and PUBMED databases focusing on Malaria and healthcare challenges in Nigeria. Google scholar was used on one occasion to obtain one full-text article

Malaria is a life-threatening disease that can be both prevented and treated which can dramatically reduce the burden of disease in the globe. There are about 3.2 billion people around the world at risk of infection, approximately half of the total world population, and about half a million people died in 2015 worldwide due to malaria infection [1].

A comparison of incomes in a malarial versus non-malarial countries shows that income is five times higher in non-malarial countries. Where malaria infection flourishes, poverty and poor health outcome exist. Malaria-endemic countries have an impeding economic growth and development by both direct and indirect way such as productivity, healthcare cost, and infant mortality [2].

There have been many international initiatives and efforts to reduce malaria mortality substantially in the last decade with a huge focus on the poorest countries.

Nowadays, in 2015, Global Malaria Action Plan (GMAP), Millennium Development Goals (MDG) and Roll Back Malaria (RBM), that are supported by both UNICEF and WHO, have managed to reduce morbidity and mortality by 75%.

Malaria situation in Nigeria

More than one-third of global malaria deaths are occurring only in Nigeria and the Democratic Republic of Congo and second leading cause of children mortality under the age of 5 years is malaria after HIV/AIDS (WHO, 2015). Nigeria’s national expenditure on health is very low with about only 5% allocated to health sector which highly affecting the impact of socio-economic level on people according to the poorly expected health outcome [3].

Another example of the direct economic impact on people of Nigeria has shown that economic growth penalty, between 1980 and 1995, regarding adjusted purchasing power parity (PPP), to be 156 US dollars loss per person [2].

Malaria health management status in Nigeria

Nigeria is composed of 6 geopolitical zones, 36 states, and 774 local government authorities (LGAs), where LGA are responsible for providing primary care and considered the main system bottleneck of the national healthcare system [4]. In addition to the public healthcare system, there is an active private healthcare system that accounts for about one-third of all primary care facilities and more than two third of the secondary care facilities, and more than 60% of fever cases seek medical attention at the private health sector [4].

Nigeria’s current malaria control situation has improved, with the aid of both international and local initiatives, and focusing mainly on transmission and diagnosis via an integrated vector control program, rapid diagnosis, and proper treatment; which were the main goals of Nigeria’s National Malaria Strategic Plan NMSP from 2009 to 2013 [5].

Nigeria faces numerous challenges, nowadays, to combat malaria [1,3,4] such as:

• Brain drain of qualified healthcare personnel and workforce.

• Poor and unintegrated healthcare system with no necessary referral links between healthcare facilities.

• Poor access to health care centres due to rurality and road conditions that affect rapid diagnosis and reliable treatment.

• Unequipped healthcare facilities with inadequate healthcare technology and quality.

• Drug-resistant malaria.

• Insufficient budget and efforts for research in the field of malaria treatment and prevention.

• Lack of ongoing training and education for medical and healthcare personnel.

While there were huge achievements occurred to reduce Malaria overall morbidity and mortality by 75% in 2015, with the aid of WHO, UNICEF, and USAID, who have funded several projects and initiatives such as, Roll Back Malaria and President’s Malaria Initiative [6]. There is more work to be done for a disease that can be easily treated and prevented.

Nigeria initiated its latest National Malaria Strategic Plan 2014-2020 with a promising goal to bring malaria in Nigeria to pre-elimination phase and a promising vision to have a malaria free Nigeria [5].

Areas of opportunity and need in Nigeria

Guided by Nigeria’s current situation, Ottawa charter for health promotion activities [7] and multinational initiatives there are few recommendations and plans to focus on in the short, medium and long-term in Tables 1,2 and 3.

Table 1: Short term plan.

Table 2: Medium term plan.

Table 3: Long term plan.