Malaria Crisis Amidst Constituency Project Allocations: A Tale of Misplaced Priorities

 

The Stark Reality of Malaria in Nigeria

Despite malaria causing nearly 200,000 deaths in Nigeria annually, lawmakers are allocated nearly N740 billion (approximately $500 million) for constituency projects in 2024. This is juxtaposed against the $1.1 billion (over N1.7 trillion) that Nigerians spend out-of-pocket to combat malaria, as reported by the World Health Organization (WHO). Experts argue that this discrepancy highlights a misapplication of funds, as vital health needs remain unmet.

 Health Challenges Versus Constituency Projects

The WHO estimates that 68 million Nigerians suffer from malaria each year, with nearly 200,000 fatalities. This ongoing health crisis requires substantial political commitment and effective malaria control programs. Alamin Usman, a research assistant at Our Future Health UK, asserts that strong political will and determined leadership are crucial for malaria elimination, pointing to Cabo Verde's recent malaria-free status as an example.

 Ineffective Use of Constituency Funds

A report by Order Paper, in partnership with Budgit, MacArthur Foundation, and Tracka, revealed that over 100 constituency projects in 22 states were abandoned despite 2022 budgetary allocations. As of November 2023, 533 projects had not commenced, underscoring the inefficacy in the use of allocated funds. This inefficiency contrasts sharply with the heavy reliance on external support for malaria control, with only 21% of the $3.84 billion invested in malaria control since 2000 coming from domestic sources, excluding household expenditures.

Funding Discrepancies and Global Initiatives

Key international support for Nigeria's malaria program comes from the Global Fund, which aids 13 states, and the US President's Malaria Initiative (PMI), supporting 11 states. Until recently, 13 Nigerian states lacked external support, now supplemented by agreements with the World Bank and the Islamic Development Bank. Despite the over N63 billion allocated to malaria interventions in the 2024 budget, this amount is insignificant compared to the funds directed to constituency projects.

 Expert Opinions on Malaria Funding

David Walton, global coordinator of the PMI, highlighted a significant funding gap in global malaria control efforts during a recent address at the Harvard Global Health Institute. Walton noted that while malaria cases have increased, funding has not kept pace, resulting in a $3.7 billion deficit. He stressed the misalignment between international priorities and the needs of malaria-affected countries, complicating efforts to manage and eliminate the disease.

 Impact on Children and Regional Disparities

Malaria remains a leading cause of death among children under five, accounting for 22% of fatalities in this age group. Basic health services, such as the use of insecticide-treated nets and intermittent preventive treatment, are inadequately covered. The 2021 Multiple Indicator Cluster Survey (MICS) indicates high under-five mortality rates in states like Sokoto, Kebbi, Jigawa, Bauchi, and Kano. The 2018 Nigeria Demographic and Health Survey (NDHS) reported a 23% malaria prevalence in children under five, with the northwest zone having the highest rate at 34%.

Public Health Expenditure and Its Consequences

A 2024 World Bank Group analysis of financing and governance constraints in Nigeria's basic education and primary health care delivery reveals that government health expenditure has remained below 10% of GDP over the past five years. This insufficient funding has strained the public health system, forcing many Nigerians to cover 77% of total health spending out-of-pocket, significantly higher than the African average of 37% and the world average of 18%.

Economic Impact and Poverty

High health-related expenses push over one million Nigerians into poverty annually, according to the World Bank. Those not below the poverty threshold still face severe financial strains due to high healthcare costs. Public health expenditure in Nigeria averages $15 per capita, with state governments contributing $8.5 of this amount, which pales in comparison to other countries.

 Budget Allocation and Its Implications

In 2021, health allocations comprised only 6.6% of federal and state government spending. The majority of the budget was directed towards general public services (24.2%), economic affairs (18.4%), and debt charges (17.6%). Social sectors, including education, health, and social protection, received less than a quarter of the national budget. The limited public funds allocated to health are primarily directed towards secondary and tertiary care facilities, neglecting cost-effective preventive and primary health care services.

Conclusion: A Call for Strategic Reallocation

The current allocation strategy overlooks essential preventive health services that could significantly improve health outcomes. This results in scarce resources being unavailable for critical public health initiatives and high out-of-pocket expenses, deterring service utilization. Addressing these challenges requires a strategic reallocation of funds towards primary health care and preventive measures, ensuring that the fight against malaria and other public health issues receives the necessary support.