Mrs Taiwo Sulaiman was six months pregnant when she experienced persistent fever and cold. To save her condition, she quickly rushed to the General Hospital, Ilorin, where she consulted a doctor and was subsequently treated.

“When the symptom was becoming unbearable for me, I had to go to the clinic. I was asked to run some tests, one of which was malaria test. This test was conducted, using a Rapid Diagnostic Test (RDT) kit.

“For all these I paid, except for the malaria test which the laboratory attendant told me was free. In the end, the result showed I was positive. I took the result back to the doctor, and he prescribed ACT (Artemisinin-based Combination Therapy). The anti-malaria drug was, as well, dispensed free of charge. Here, I got the wind that malaria test and treatment at the hospital is free,” said Mrs Sulaiman.

It's a similar experience at Ero-Omo Basic Health Centre, Ilorin South Local Government Area, where Mrs Aminat Ayinla was tested and treated for malaria. Ayinla, a primary school teacher visited the centre when she felt feverish and cold.

“I developed the symptoms overnight; then I visited the centre the following morning. Though, I had a premonition that it could be malaria, but I wanted to be sure.

“When I tested positive to malaria, the test and drug given to me were at no cost. When I asked, the head of the centre told me malaria test and treatment are free at the centre,” she said.

This is the situation in over 500 public health centres, where the Kwara state government is supporting healthcare facilities with RDT kits and ACT among others materials to test, treat and track malaria for free, under its malaria free initiative.

Malaria is a life-threatening disease, caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. In 2020, World Malaria Report estimated 241 million cases of malaria worldwide.

The figure was an increase from the 227 million in 2019, with most of this increase coming from countries in the African region. The estimated number of deaths from the cases for the year stood at 627,000, with Africa still carries a disproportionately high share of the global malaria burden. The region homed 95 per cent of malaria cases this year and 96 per cent of the resultant deaths.

Only four African countries accounted for more than half of all malaria deaths worldwide, with Nigeria having the chunk with 31.9 per cent. Similarly, children under five accounted for about 80 per cent of all the death cases in the region.

In Nigeria, the disease is transmitted all over; 76 per cent of the population live in high transmission areas in the country, while 24 per cent of the population live in low transmission areas. The transmission season according to the Severe Malaria Observatory (SMO) can last all year round in the South and it's about three months or less in the Northern part of the country.

SMO notes that microscopy data from the 2018 Nigeria Demographic and Health Survey (NDHS) showed that the average national prevalence of malaria in Nigeria was 27 per cent. The data also captured 27 as the prevalent rate in Kwara.

In line with the global efforts, the Federal Government introduced National Malaria Elimination Programme (NMEP), with a broad mandate of formulating, facilitating policies and guidelines, coordinating the activities of partners and other stakeholders on malaria control activities in the country. The timeframe for this strategic plan was from 2014 – 2020.

The programme was meant to provide technical support to implementing bodies including states, local government areas and stakeholders, mobilization of resources, monitoring and evaluation of progress and outcomes in malaria control efforts.

Concurrently, this effort is replicated in most states of the country under the nomenclature of State Malaria Elimination Programme (SMEP). Alhaji Abdullahi Nageri, is the Programme Manager of SMEP in Kwara, and identified Malaria Free Kwara Initiative as a project that is helping to control, and free the citizens from the scourge.

Besides the free malaria treatment at public health centres, there is also Community Drug Distribution (CDD) with officials of the relevant ministry and department in the state and its local government councils going from house-to-house to give malaria drugs to children under the age of five at no cost.

Mrs Rukaya Lawal, a mother of three, who resides in Ilorin West Local Government Area of the state collected the drug for her daughter when the health workers visited her community.

“They have been here on three different occasions to give my children drugs. I administered it on my first child, Khadijat on these occasions and since she took the medicine, she rarely falls ill from malaria,” said Mrs Lawal.

Beke Audu is another beneficiary, whose child had benefitted from the free drug. The mother of two testified to have collected and accordingly administered the free drugs on her children.

For Hajia Suliyat AbdulSalam, officer-in-charge, Ero-Omo Basic Health Centre, the initiative has led to a reduction in the record of the disease at the centre, with a claim that over 5000 households had benefitted from the free drugs.

“We have so far covered Ero-Omo, Kilanko, Olunlade, Agbabiaka, Alagbede, Ita-Alamu and other nearby axes. We try to sensitise the public not to underrate malaria, but to embrace the opportunity, which they are doing. They receive the drug without hesitation,” AbdulSalam said.

Interestingly, the latest report indicated that the fight against malaria in the state is yielding the desired result. The World Malaria Report 2021 recently released demonstrates that the prevalent rate in Kwara has dropped to 20 per cent from the 27, even below the now improved national average of 23 per cent.

Corroborating the stance, Nageri, the SMEP manager admitted that timely release of counterparts, to complement the supports from the Global Fund, an international donor helping the state in the anti-malaria campaign, was a big great contributing factor.

“In 2019, when the governor came in, he released a counterpart fund of N83 million. This is exactly what the donor wants; states must have an input. The following year (2020), he also released N42 million; the third year (2021), about N32 million. So when you look at the money from the inception, it is about N160 million released by the state government.

“This means that the programme we are running, the state is spending money apart from the donor. This elevated us from the status of sub sub-reciepient to sub-recipient. When they say you are a sub-recipient, it means the state is ready to support the programme; we don't rely on the donor's money again.

“In malaria programming, we have partners; and in the last grant, Kwara was a sub sub-recipient, meaning we had a partner that was implementing for us. The partner we had was Management Science for Health.

“But due to the proactiveness of the government, the state was the first to be shortlisted from sub sub-recipient to sub-recipient. This means that the grants we receive from the Global Fund, Kwara now stands as an entity that can implement its programme directly without any partner,” he said.

Through this input of the government, Kwara SMEP added 180 healthcare facilities to the 339 being supported by the donor for free malaria tests and treatments, with 2.9 million pieces of Long Lasting Insecticide Nets (LLIN) distributed to the residents in 2020.

Nageri recounted as well that about N3.5 million was spent on jingles and media visits, to further enlighten the public on the malaria programme, and its procedures.

“Because of this, it makes a share that if one side is following the national guide on malaria; with the state supports, we are also able to carry out our own. Besides that, we trained health facilities across the state public service and the private in 2020 from this money.

“This means that malaria management and treatment in Kwara is more improved than those years. Capacity was built, and based on that, we are able to get the status of sub-recipient, because there is an assessor to come and assess every state,” said the programme officer for the malaria elimination project in the state.

Limitations

Dwindling allocation into the state from the federation account is one of the challenges, identified to be threatening the initiative, particularly inclusion of more facilities into the programme. For instance, in Awodi Basic Health Centre, one of the facilities visited, an official complained of shortfall in the supply of RDT kits.

Moreover, the SMEP officer bemoaned improper use of the mosquito nets that cost the state N13 million. As against sleeping under it, he regretted that many recipients exchanged the treated net with plastics; use it for fishing, as well as, to make a garden.

“That is the area we need to dwell much on, and that is why we need money. We need to dwell much on publicity and public enlightenment. We want to change the narration that if you have fever, it is not all malaria. If tested negative, some will not comply with the test, but insisting that they have malaria because they have fever.

“We are appealing to our people that if they are tested with our RDT kit and they are tested negative, then they should comply,” he said. For health centre, the matron at Ero-Omo said the facility is constrained by inadequate staff, thereby hampering its services.