To end malaria in Nigeria, focus on health systems

Sleeping under a protective bed net

Young boy sleeps surrounded by a protective malaria bed net, Nigeria. (Photo: Arne Hoel / World Bank, source: Flickr)

The ongoing Ebola outbreak has dominated headlines for nearly a year. It is an undeniable catastrophe, with more than 10,000 lives lost and a long list of missed opportunities in the global response to the disease. However, there are a few lessons we can draw from this tragedy – particularly from the response of my country, Nigeria.

The first country in West Africa to end Ebola within its borders, Nigeria was able to halt the infection cycle before it spiralled out of control. This is partly because Nigeria’s health systems are more developed than those of other affected countries. We mobilized staff at the Emergency Operations Center established for polio eradication to rapidly identify and contain infectious patients, and engaged highly-trained medical personnel to care for them. It was an example of what we’re capable of when we deploy our health resources effectively to respond to emergencies.

The same strategic deployment of resources is key to tackling other health challenges – including ever-present threats like malaria, which causes about as many deaths every week as the thirty years of Ebola outbreaks summed together. In Nigeria, malaria is a public health crisis. The entire population lives in malaria-endemic regions, and the country reports an estimated 37 million cases per year. The toll is tremendous for individuals and also for the economy. Malaria holds back GDP growth, drains health resources and directly costs Nigerian households up to 4% of their annual income.

Fortunately, we have effective tools to address this deadly disease. Bed nets can prevent mosquito bites. Sprays can control mosquito breeding and movement. Diagnostics are available to confirm infections. Effective drugs cure millions of people each year.

Our challenge is to apply these interventions in the right ways and in the right places. In Nigeria, where more than half of the population lives outside urban centers, we won’t be able to tackle malaria with prevention tools, diagnostics and treatments unless we have trained people and infrastructure to effectively deliver them far and wide.

Nigeria is fortunate to have significant human resources for health, a reflection of our strong educational policies and committed training institutions. But we do not deploy these personnel evenly, leading to health worker shortages in rural areas and a disproportionate concentration of skilled professionals in urban cities. When drugs and diagnostics reach more remote communities, they are often delivered by people who don’t have the training to use them properly. This is wasteful, and it can also be dangerous, resulting in improper treatment and a lack of vital data on our country’s true malaria burden.

What Nigeria needs is a distribution plan: not just for drugs, but for people and information.

To defeat malaria and other diseases, we need to allocate primary care doctors and nurses to underserved areas. We can institute training programs in rural districts, helping transfer skills and human capacity. Public sector education campaigns must be designed to reach high-risk populations with information about how to prevent infection, recognize symptoms and seek treatment early from skilled professionals. Programs should focus on getting insecticide-treated nets and preventive drugs to vulnerable groups including pregnant women and young children.

We also must ensure that coordinated strategies are in place to roll out prevention and treatment at the population level. Local and national governments, donor agencies and NGOs must work together to create the infrastructure to address malaria everywhere it exists, even in the hardest-to-reach villages. If we do not have the systems to reduce the risk of malaria throughout the country, we will never be able to truly contain the disease.

Ebola showed what Nigeria is capable of when it mobilizes all its resources against a health threat. This World Malaria Day, I hope our new leaders will be inspired to apply the same focused approach to defeat malaria.

Lawal Yusuf is a Master of Public Policy student at the Blavatnik School of Government, University of Oxford. He is a 2013 graduate of Oxford’s Master of Science in Global Health program, where he was an ExxonMobil Global Health Scholar.