Monday, 24 July 2017

Economic Impact Of Roll Back Malaria Program in Nigeria


In recent, several roll-back malaria programme has been organized to bring the menace of malaria under immediate control. Therefore, the main objective of this research work was to examine and analyze the economic impact of the programme in Anambra State. The relevant theories to this study are Demographic translation theory and Health belief model. Population for the study consists of 1050 selected individuals from the twenty one local government areas in Anambra State. A total of two hundred and ninety (290) participants were selected randomly as sample for the questionnaire. Data for the study were collected using structured questionnaire then analyzed with chi-square (x2) statistical method. The study found out that the programme has made a positive economic impact on the lives of people. It is therefore, recommended that the central government should extend their web by reaching out to the entire populace to reduce the hazard of malaria in the society.



1.1. Background of Study

Roll back malaria, simply put is a malaria control programme. A programme which involves coordinated action against malaria; an action that harmonizes key actions like W.H.O, UNICEF, ministries of health amongst others in malaria control and mobilizes resources to fight malaria in its endemic countries, Nigeria inclusive.   

Between 1955 and 1968, pre-eradication pilot epidemiological studies were conducted in Kankiya District, under the World Health Organization (WHO)

Global Malaria Eradication Programme. Results of the pilot studies were not encouraging, and malaria control—rather than eradication—was recommended for Nigeria. It was also during that time that a Division of Malaria and Vector Control was established within the Medical Department, now named the Federal Ministry of Health.

Further studies were conducted from 1970 to 1975 in Garki District and from 1975 to 1980 in Bendel State (currently Edo and Delta States).

 In 1975, the National Malaria Control Committee was established, with membership drawn from the Federal and State Ministries of Health, universities and other relevant sectors. The committee produced a five-year plan of action (1975–1980) with the key objective to reduce the malaria burden by 25% nationwide by 1980. This plan was dormant for years but was re-activated at the start of the RBM initiative in 1998.

In the early 1980s, malaria control became a joint venture between federal, states and local governments, while the committee was expanded to ensure a multi-sectorial approach to malaria control. The objective was to reduce malaria morbidity and mortality by 50% by 1985, mainly through distribution of antimalarial drugs, both as chemoprophylaxis for vulnerable groups and as treatment of primary school children’s fever.

In 1988, a wide health systems reform was conducted and both National Health Policy and the Malaria Control Programme were revised and based on the concept of Primary Health Care.

In 1989, National Guidelines on Malaria Control were prepared by the Federal Ministry of Health (FMOH) for the first time.

In 1992, the Nsukka project investigated the efficacy of permethrin used in ITNs.

In 1996, a National Malaria Control Plan of Action (1996–2001) was written by the Malaria and Vector Control Division of the FMOH.

With the birth of the RBM initiative in 1998, a new approach was brought to malaria control that emphasized evidence-based planning and decision-making, and public and private partnerships. The first strategic plan for rolling back malaria in Nigeria (2001–2005) was released at the end of 2000. It involved a comprehensive needs assessment using adapted RBM tools, situation analyses conducted in four rural communities of six LGAs drawn from the six geopolitical zones of the country, and a tentative programmatic plan and budget.

However, an evaluation carried out in 2005 to assess progress in implementation of that plan found only minimal advances towards its targets. The main challenges to implementation identified during the assessment were limited resources to scale up proven prevention and treatment interventions, non-availability of ACTs and ITNs in most areas of the country, and increased resistance of malaria parasites to the drugs commonly used.

At about the same time, a massive increase in external funding, most notably from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the World Bank, and bilateral donors such as the United States and United Kingdom governments, started to turn the situation around dramatically. Later, the third national strategic plan, covering the period 2009–2013, was implemented with demonstrable results.

In building a large-scale malaria prevention and control programme; the government of Nigeria has initiated the plan that the NMCP, within the Division of Malaria and Vector Control in the Department of Public Health of the FMOH located in Abuja, assumes responsibility for coordinating Nigeria’s malaria control activities.

The NMCP provides technical support to, and coordination of, a wide range of domestic and international partners in the public and private sectors. It comprises six units representing the programme’s core tasks: programme development and administration; integrated vector management; case management and drug policy; procurement and supply management; monitoring and evaluation; and advocacy, communication, and social mobilization.

At national, state, and local government levels, programme management is supported by multiple partners through various mechanisms, including direct secondment of staff, capacity building, and organizational or technical support.

All partners involved in malaria control form the country RBM Partnership. Coordination of the partnership is ensured through a National Malaria Coordination Committee, which is supported by five technical working groups: integrated vector management, case management, procurement and supply management, monitoring and evaluation, and behaviour change communication (BCC).

In the last ten years, a clear and focused commitment has emerged with well-defined organizational plans. Hence, under consistent leadership from the FMOH and the NMCP, clear and focused policy documents with defined targets and goals (see the figure below) were drafted. 

1.2. Statement of the Problem

In spite of logistic challenges, the need felt by the global community to tackle malaria in Nigeria—if the battle was to be won in Africa—encouraged partners to increase their investments in the country. The government’s own increasing contributions testified to Nigeria’s national commitment to malaria prevention and control. Between 2008 and 2010, US$ 3.5 million was spent on malaria control out of the Government of Nigeria budget and US$ 78 million was disbursed through the Debt Relief Millennium Development Goals Achievement Fund (MDG-F).

The World Bank’s Nigeria Malaria Booster Project started supporting LLIN distribution campaigns in seven states (Akwa Ibom, Anambra, Bauchi, Gombe, Jigawa, Kano, and Rivers) in 2007. Between 2007 and 2010, US$ 117 million was disbursed by the World Bank to support delivery of interventions in these seven states. Global Fund grants started being secured at the end of 2004. Between 2004 and 2010, US$ 304 million was disbursed through Round 2 (US$ 20 million), Round 4 (US$ 64 million), and, starting in 2009, Round 8 (US$ 220 million).

These funds were mostly channelled to support LLIN distribution campaigns in seven other states (Adamawa, Ekiti, Kaduna, Kebbi, Niger, Ogun, and Sokoto). DFID’s contribution, through its Support to National Malaria Programme (SuNMaP), started in 2008 and reached US$ 18 million for the year 2010. UNICEF has made yearly contributions of several million dollars, with a peak of US$ 32 million in 2008. USAID has also actively funded malaria control activities since 2004, with funding of US$ 26 million in 2010. 

(This funding is bound to increase markedly with the recent inclusion of Nigeria as one of the 19 countries supported by the US-PMI). Numerous other partners provided smaller financial contributions towards various aspects of technical assistance, advocacy or service delivery at the local level, including WHO. The amount of external funding reached a peak of US$ 325 million in 2009. Still, this represented roughly US$ 2 per person at risk for malaria when current estimates show that 2 to 2.5 times this amount is needed to tackle the disease. This is a crucial issue for Nigeria: the large number of people at risk means that a daunting quantity of resources is necessary to control the disease.

Furthermore, the following year (2010), less than US$ 100 million of external funding was disbursed for malaria control. Ups and downs in funding can make implementation difficult and will need to be evened out over time to achieve consistently functioning malaria control efforts. Nigeria has not reached the Abuja target of allocating 15% of its overall country budget to the health sector. The health-sector budget grew from 5% of the total national budget in 2004 to 6.5% in 2006. In 2009, 40 billion naira (US$ 250 million) out of the national budget was spent on health. The share of the health-sector budget devoted to malaria is difficult to estimate because the budget includes all support for health workers and structures (hospitals, health centres, and laboratories) that provide most of the care. Most (69%) of Nigeria’s health budget is still spent on tertiary care (Prof Osotimehin, 2010). Partners’ collaboration is conducted on the basis of the National Malaria Strategic Plan, which is largely funded by malaria partners. The budget for commodities (antimalarials, diagnostics, insecticides, and mosquito nets) is provided entirely by external partners.

1.3. Research Questions

(i)  What is the economic impact of the roll back malaria programme on the people?
(ii) What is the overview analysis of the programme on Nigerian citizens in general?

1.4. Objectives of the Study

The major objective of the study is to evaluate the economic impact of roll back malaria programmes.
The specific objectives are as follows:-
(i)  To evaluate the impact  of the  roll  back malaria programme using Anambra State as a case study  and
(ii) To give an overview analysis of the programme in Nigeria in general.

1.5. Research Hypotheses

The hypothesis of this research work is:
H1: Roll back malaria programme has created positive economic impact on the people.

1.6. Significance of the Study
This study would be significant for the following reasons:
The study will provide answers for the impact of the health sector on the overall economic growth of Nigeria. It will add to the existing body of related literature on the impact of fight against malaria and of health sector growth in Nigeria. And as well serve as a reference point for other health-related programmes in the country.

Furthermore the recommendations provided therein will aid both the State and the Federal Ministries of Health, and other health–related organizations in enacting policies aimed at driving simultaneous growth in rural and urban sectors.

Finally it will reveal the actual impact of the programme in Nigeria in general.

1.7. Organisation of the Study
The study is presented in five chapters. The first chapter which is the introduction covers the background of the study, statement of the problem, objectives of the study, research questions, research hypothesis, significance of the study as well as organization of the study. This is followed by chapter two which reviewed the conceptual issues, theoretical literature review, empirical literature review, summary of literature review and justification of study. 

Chapter three which is research methodology covers the research method, research design, research population and sample, sampling design and sample size determination, reliability and validity of the research instruments, method of data analysis, research variables and measurement. Chapter four discussed data presentation, data analysis, evaluation of research hypotheses and discussion of findings. The final chapter, five, contains summary of findings, conclusion and recommendations. 


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