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How not to roll-back malaria in Nigeria
http://www.nigeriansinamerica.com/articles/4342/1/How-not-to-roll-back-malaria-in-Nigeria/Page1.html
Joel Nwokeoma
I am a researcher, journalist, budget and public policy analyst, working with one of the most widely circulated newspapers in Nigeria. A Masters degree holder in Political Science from University, I was the immediate past executive director, Concerned Professionals Ltd/Gte, an NGO based in Lagos. My articles, comments and opinions are widely published in newspapers, online journals, magazines both within and outside Nigeria.
 
By Joel Nwokeoma
Published on 07/22/2010
 
While Nigeria was signing up to an international MOU of some sort to “support local production of malaria drugs and products” on the one hand, it is, on another, taking actions that may undermine the same local pharmaceutical firms...

In view of the huge human and financial costs of the malaria scourge on the country, whatever concerted efforts and measured steps taken, to combat it should ordinarily be a most commendable and welcome one.

During the commemoration of the 2010 World Malaria Day on April 25, UNICEF affirmed in a press release that malaria remained “a major public health problem in Nigeria” accounting for 60 per cent of out-patient visits and 30 per cent of hospitalisations in the country while an estimated 300,000 children die of the disease annually, and up to 11 per cent of maternal mortality is caused by it. This, it explains, represents one in every four deaths of children and one in every ten deaths of pregnant women.

More precisely, as one health expert, Mrs. Taiwo Olarinde, of the Global Fund Malaria Programmes, Society for Family Health, Ibadan, claimed, “a child in Nigeria dies every 30 minutes” from malaria!

The international body stressed, in particular, that malaria is the “number one killer of children under five in Nigeria” and that in addition to its direct health impact, the disease “imposes a heavy social and economic burden” as about N132 billion ($900 million) is lost annually in prevention and treatment costs as well as productivity loss in the country.

Against this disturbing backdrop, UNICEF believes, however, that along with its Government and Roll-Back Malaria partners, the deaths of thousands of children under five years old could be prevented by simple cost-effective measures, including consistent use of long-lasting insecticide-treated mosquito nets by families and anti-malaria treatment for pregnant women.

It is, perhaps, in pursuit of this objective that the West African Health Organisation, a specialized agency of the ECOWAS Commission, in 2008, developed a strategic 2009-2013 action plan to fight malaria in the sub-region, whose climatic conditions in the tropics, experts say, further favour the breeding of “culprit” mosquitoes that act as vectors for the disease.

At the 2009 Assembly of Health Ministers of ECOWAS countries held in Yamoussoukro, Cote d’Ivoire, the meeting agreed that “countries in the sub-region are not likely to achieve the Millennium Development Goals unless the fight against malaria is fought with all seriousness.”

They also accepted to undertake to, among other things, keeping malaria high on the world development agenda; develop a harmonised operational plan within ECOWAS to scale up efforts during the remaining days until December 31, 2010 as well as support local production of malaria drugs and products to fight malaria and sustain advocacy efforts to achieving 15 per cent allocation to health in national budgets.

Curiously, while Nigeria was signing up to an international MOU of some sort to “support local production of malaria drugs and products” on the one hand, it is, on another, taking actions that may undermine the same local pharmaceutical firms it pledged to “support” while it is not also failed to comply with the agreed “15 per cent” budgetary allocations for the health sector since then.

Recent media reports had it that a new campaign championed by The Global Fund, the worldwide institution established in 2002 to fight tuberculosis, HIV and malaria which are endemic in the developing world, to drastically reduce the prices of Artmisinin Combined Therapies (ACTs), the first line drug for the treatment of malaria, may in the long run cause “severe problems” for the Nigerian pharmaceutical industry. This is because none of the six pharmaceutical manufacturing firms whose ACT products will be subsidized by as much as 95 per cent by TGF is based in West Africa! Instead, the beneficiary firms are based in Asia (Guilin, China; Ipea, Ajanta, Cipla, India) and Europe (Novartis, France; and Sanofi-aventis, Switzerland)

It is reported that TGF is scheduled to inaugurate the Affordable Medicines Facilities-malaria (AMFm), a monitored price regime which will see the prices of ACT from the aforementioned six companies sell at between N60 and N70 per dose from the prevailing market price of about N300 per dose. It is said that the decision to bring the prices of ACTs  to those of traditional anti-malarials like Chloroquine and Sulphur Doxine and Pyremethamine, which have become less efficacious, is informed by the difficulty of many sufferers to pay the prevailing high prices.

This would not be, it must be stressed, the first time that TGF would be engaged in an effort targeted at combating malaria in Nigeria. Last year, it launched the all-embracing and multi-stakeholder public sector campaign against malaria through the National Malaria Control Programme in partnership with the Yakubu Gowon Centre for National Unity and International Cooperation as well as the Society for Family Health in Nigeria.

 The major difference between the public sector campaign and the proposed AMFm initiative is that local content, wittingly, as it appears to many, is being left out of its implementation. That this is even happening at a time the Nigerian Local Content Law has been mainstreamed and institutionalized is most unfortunate and incomprehensive.

How could the Federal Government have acquiesced to an initiative whereby Nigerian stakeholders are being asked to register with TGF merely as first line buyers on strict conditions? Even indigenous pharmaceutical firms, whose ACTs have been effective over the years, will only become sales agents of the six foreign manufacturing firms because, as TGF claimed, they are not pre-WHO qualified.

 Besides, what will be the fate of these local pharmaceutical firms, already constrained by poor infrastructure, inadequate power supply and myriad other socio-economic challenges, when the Nigerian market is flooded soon with highly subsidised anti-malarials from overseas at a time when they have not been provided the enabling environment and favourable legal framework by the government to boost their competitiveness? Obviously, it will be a replication of what is happening in the textile industry where the remaining manufacturing firms are struggling with imported fabrics from Asia sold at cheap prices. The likely effects of this would be huge job losses and closure of the firm, leading ti increased de-industrialisation.

For an economy whose industrial capacity utilisation is said to be below 40 per cent, any initiative that will subject encumbered Nigerian firms to further undue competition with dire consequences for the country should be reviewed. The government should at all times, factor the overall economic interests of its citizens and businesses in its international undertakings and engagements. The onus is on the Federal Government to provide the enabling environment that will help the local pharmaceutical firms to attain the standards that will pre-qualify them for such initiatives and not to look away while foreign firms stride the market like a colossus. At the end of the day, this AMFm initiative will most likely roll back Nigerian pharmaceutical firms and the manufacturing sector in general, in the name of rolling back malaria!