Nigeria spent just $1 per person on a malaria patient in 2023 despite carrying the largest burden of the disease in the world, new data from the World Health Malaria report has revealed.
Despite accounting for about 26 percent of global cases, with 68.1 million infections and 5,704 deaths, Nigeria recorded one of the lowest levels of spending among endemic countries to combat the disease.
About 95 percent of the $1 spent was generated from international donations while domestic public spending covered the rest. This does not include out‐of‐pocket expenditure or patient service delivery costs.
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According to the World Health Organization (WHO), the Global Fund donated more than $92.1 million to Nigeria’s malaria control and elimination in 2023.
The President’s Malaria Initiative and the United States Agency for International Development (USAID) donated $73 million, with the World Bank donating over $29.2 million and the United Kingdom handing $8,054 to Nigeria.
The data indicate that these international donations are declining gradually while Nigeria makes little effort to measure up or put its money where its mouth is.
Between 2021 and 2023, donations from Global Fund increased by 19 percent but later decreased by 41 percent. Funds from PMI/USAID dropped by 11 percent, the World Bank’s reduced by 32 percent while that of the United Kingdom fell by 99.8 percent.
Generally, the WHO itself is struggling to attract funding for this purpose. It set out to gather $8.3 billion for malaria control in 2023 but ended the year with less than half its target – $4 billion.
The organisation said the funding gap has widened over the past five years, increasing from $2.6 billion in 2019 to $4.3 billion in 2023.
But there seems to be a silver lining. Malaria-endemic countries have increased their share of domestic funding to 37 percent in 2023, up from 33 percent in 2021, while international funders contributed 63 percent.
Additionally, malaria-related research and development funding saw a nine percent increase in 2023, (an increase of $60 million compared with 2022), primarily driven by contributions towards the clinical development of P. falciparum vaccines.
Nigeria is unfortunately not one of the countries demonstrating this positive trend.
While some contend that spending alone is not the sole determinant of malaria eradication success, the data suggest a strong correlation.
Cabo Verde, the only African country certified malaria-free by the WHO in 2023, allocated an average of $6.2 per person at risk of malaria that year, with 100 percent of the funding generated domestically without external aid.
The small island nation became the third country to be certified as malaria free in Africa following Mauritius in 1973 and Algeria in 2019.
Liberia spent about $10, the highest amount per person at risk, with about half of it generated from domestic sources.
Ghana spent almost $7, with more than half of it from domestic sources.
Senegal spent almost $5 and over 60 percent sourced domestically.
According to WHO, countries that have been certified as malaria free demonstrated sustained commitment and investment.
They met the 2023 Global Technical Strategy (GTS) morbidity milestone by achieving a 63 percent or greater reduction in malaria case incidence or reporting zero cases.
This 63 percent reduction represents the estimated target for 2023, falling between the GTS targets of 40 percent in 2020 and 75 percent in 2025.
The top five countries carrying the heaviest estimated burden of malaria cases in 2023 were Nigeria (26 percent), the Democratic Republic of the Congo (13 percent), Uganda (5 percent), Ethiopia (4 percent) and Mozambique (4 percent).
However, beyond funding, malaria-endemic countries grapple with fragile health systems, weak surveillance, and rising biological threats, such as drug and insecticide resistance, WHO says.
Akin Osinbogun, a professor of Public Health at the University of Lagos, said the government must improve the use of resources and invest more in health.
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He noted that some countries can be more efficient in the use of resources, spending less to achieve more results.
“The second point is that you can only spend what you have. While our GDP per capita is about $2,000, the GDP per capita for the United States is about $50,000. So, we have less money than those countries. Even with the less money we have, we allocate a low percentage to health. And we know that the more a country spends on health, the better its health outcomes,” the professor said.
Mohammad Alli Pate, health minister, had revealed that his leadership had set up an advisory group on malaria elimination in Nigeria and integrated it as a critical part of the Nigeria Health Sector Renewal Initiative.
“Malaria elimination is a critical component of this comprehensive framework, as it directly impacts population health and contributes to unlocking the potential of the health sector value chain. Through strengthened collaboration, and efficient resource mobilisation, we are ensuring that no one is left behind,” Pate stated.
