December 13, 2006—The World Bank doubled funding for the fight against malaria in hard-hit Africa with the approval Tuesday of US$180 million to combat the disease in Africa’s most populated country, Nigeria.
The oil-rich nation with widespread poverty has 20 percent of the world’s malaria cases—about 110 million a year among a population of more than 130 million. The disease is responsible for nearly 29 percent of children's deaths, and for 11 percent of deaths among pregnant women.
“Malaria is perhaps the number one public health problem in Nigeria,” says Ramesh Govindaraj, World Bank Senior Health Specialist and Task Team Leader for the Malaria Control Booster Project in Nigeria.
“And the number of cases in Nigeria is huge, to the point where if one were to take the challenge of addressing malaria seriously in Africa, you would have to make sure you do a good job in Nigeria.”
The mosquito-borne disease also has “enormous” economic impacts in terms of absenteeism in the workplace, and the impact on families when the breadwinner is too sick to work. The problem affects businesses and virtually every household and individual in the country, he says.
The US$180 million in interest free loans from the International Development Association (IDA) will go to a five-year project which will support the government’s program to cut annual Nigeria’s malaria cases in half by 2010.
The Nigeria Malaria Booster Control Project is part of the Bank’s Booster Program for Malaria Control in Africa launched in 2005 to reduce malaria in about 21 of Africa's most seriously affected countries.
Prior to the Nigeria announcement, some US$177 million had been committed to 10 projects in the Democratic Republic of Congo, Eritrea, Niger, Zambia, Burkina Faso, Ethiopia, Benin, Senegal, Malawi, and the Senegal River Basin as part of a larger Senegal River Basin Infrastructure Project, covering Senegal, Mali, Mauritania and Guinea. The program is currently on track to commit US$413.5 million by the end of a three-year intensive phase ending in fiscal year 2008, out of a target of US$500 million.
The project will focus on overcoming inequities in access to health services across the Nigerian states and also “reach beyond” malaria to address a range of childhood and pregnancy related illnesses, thereby improving health outcomes for children under 5 and pregnant mothers, says Govindaraj.
“If we want to make a dent on malaria we need to very rapidly ratchet up the support that is going specifically to malaria. And this will mean a whole slew of systems-related improvements that need to be made,” he says.
About 40 percent of the $180 million will go toward purchasing commodities such as anti-malarial combination treatments that use a new drug, artemisinin, as well as prevention methods such as long-lasting insecticide treated bednets and indoor residual spraying.
The other 60 percent will support efforts by the Nigerian government's National Malaria Control Program to scale up fiduciary and health systems at the federal, state and local levels to fight malaria, along with other diseases that are deadly in childhood and pregnancy.
The Bank refers to this effort as a “malaria-plus” bundle of new and innovative interventions that includes immunization, the integrated management of childhood illnesses (IMCI), and antenatal care for pregnant mothers. Govindaraj says that for a fairly nominal extra cost the malaria-plus package is expected to almost double the impact on health outcomes for children under five and pregnant mothers compared to malaria-specific interventions alone.
The move to massively scale up health services complements the activities of other members of the Roll Back Malaria Partnership in Nigeria, including UK Department for International Development, US Agency for International Development, UNICEF, World Health Organization, Population Services International, Exxon Mobil, and Harvest Field Ltd.
The federal government’s National Malaria Control Program will coordinate the program and provide policy guidance and technical assistance, and the individual state governments will be responsible for implementing the program in their states.
The Bank is also engaging the private nonprofit and private for-profit sectors, particularly the patent medical vendors, and bringing all these groups together in a common framework “to try to make a difference on malaria,” he says.
The Bank has conducted a “very detailed” baseline survey in seven Nigerian states so results can be accurately measured as the booster project progresses.
“We’re taking the monitoring and evaluation of this program extremely seriously,” says Govindaraj.
“We’ve gone through a lot of effort to show that we’ve adequately documented the existing prevalence of malaria in Nigeria and are able to compare it as we implement the project and certainly at the end of the project,” says Govindaraj.
“Malaria is such a huge problem and touches so many lives across the various strata of society,” he adds.
“Our goal is to make sure we try to address efficiency and equity related problems so that the people that we care about—the poor and the vulnerable –get the kind of assistance they deserve.”