By Aliyu Baba Mohammed
Nigeria’s national malaria strategy is struggling because what works in Kano doesn’t work in Lagos and/or Abia, and what saves lives in Rivers State might waste lives and resources in Niger State or other parts of the country. The Nigerian government and NGOs spend billions of naira every year fighting malaria through centralized programmes that distribute bed nets, provide free treatment, and spray insecticides. But health experts now say this uniform approach ignores a crucial reality: malaria looks completely different across Nigeria’s 36 states and FCT.
The Sun Newspaper reported Former coordinator of the National Malaria Elimination Programme, Dr. Audu Mohammed, acknowledged this challenge during a Legislative Health Summit. He said;
we cannot use the same strategy in Lagos that we use in Sokoto. The transmission patterns are different, the health infrastructure is different, and even the mosquito species vary
The tale of three states, others
In Lagos State, malaria transmission happens mostly in informal settlements and construction sites where standing water collects, and breeds mosquitoes. According to a report by THIS DAY, the state has a strong health infrastructure with over 300 primary health centers and several teaching hospitals. Residents can easily access antimalarial drugs from the thousands of registered pharmacies across the metropolis of Lagos state.
But travel north to Kano State and the picture changes dramatically. Here, malaria peaks during the rainy season from June to September/October. The state has fewer health facilities per capita, and many rural communities live more than 10 kilometers away from the nearest clinic. Cultural practices also matter; many families prefer traditional healers as their first point of contact when children fall sick.
In Rivers State, the situation is different again. The creeks and waterways create year-round breeding grounds for mosquitoes. Oil industry activities have created artificial water bodies that multiply mosquito populations. Unlike Lagos, where most people buy their own bed nets, Rivers State, Niger State, Kano State, and residents of some other states depend heavily on free government distribution.
When national programmes miss the mark
Nigeria’s most recent mass bed net distribution in 2021 revealed these gaps. The programme delivered 28 million nets nationwide using the same distribution model everywhere. In urban Lagos, many nets possibly ended up unused because families already owned nets or lived in screened or fortified apartments. A report indicates that in rural Kano, distribution happened during harvest season when families were in their farms, so many households missed the exercise entirely. In Rivers State, it’s reported that the nets arrived during a fuel scarcity crisis, making it impossible for health workers to reach riverine communities.
According to a report by Daily Trust, which includes eyewitness quotes from farmers in Nigeria saying they sometimes use nets to protect seedlings or nursery beds; i.e., repurposing the nets for crops. The article by Daily Trust reported farmers in Bauchi and Jigawa states who cover their farms with netsto protect crops from birds and insects. For example, one farmer was quoted to have said the net helps to reduce the effect of the destruction drastically.This is the same scenario in other states across the north and the south.
Personally, I can testify that I have been seeing the same thing play out in some parts of rural Kaduna State communities. In some rural local government areas I have visited the state, such as Giwa, Kudan, Makarfi, Ikara, Kubau, Kauru, Lere, among others. In these rural areas, there is a possibility that only a little percentage of treated mosquito nets are being used correctly for their purpose. Because there are reported cases where some families didn’t know how to hang them properly. Therefore, the waste is worrisome.
The money problem
A report by Nairametrics showed that Nigeria’s National Malaria Strategic Plan 2021-2025 (through the National Malaria Elimination Programme) requires billions of naira to implement. The government provides roughly 30 per cent of this funding, while international donors cover the rest through organizations like the Global Fund and President’s Malaria Initiative (PMI). But this money is often spent inefficiently because programmes don’t match local needs. For example, Borno State reportedly receives antimalarial drugs based on population estimates from 2006. While the reality is that conflict has displaced millions, and current population figures are unreliable. This means some areas get too many drugs while others face shortages.
Meanwhile, Lagos State is buoyant and could afford to fund or co-fund its malaria programmes but remains locked into a national system that treats all states equally regardless of their economic capacity. From a report available, if the state could afford to adopt drone technology for traffic management and security purposes, it has the capacity to try and innovate; introducing drone technology to map mosquito breeding sites and partnering with private companies to subsidize bed nets, but these initiatives should be in line with the Federal Government’s guidelines.
Different markets need different medicines
Public health researchers increasingly talk about “malaria markets”rather than just malaria control. A market includes everything from how people perceive malaria to where they seek treatment and who profits from selling antimalarials.
Findings available from malaria market studies and health surveys (such as the ACTwatch Lite Nigeria, Demographic and Health Surveys, and reports by Nigerias National Malaria Elimination Programme) consistently showed that the malaria market in Lagos State is dominated by private pharmacies and patent medicine stores. This is due to the fact that people prefer to self-medicate because they can’t afford to miss work or daily hustlings for a hospital visit. This creates a market for fast-acting treatments, even if they are more expensive. Counterfeit drugs thrive here because consumers value convenience and speed over verified quality.
In Kano, malaria care-seeking is significantly shaped by trust in local providers, community networks and informal systems (including religious and traditional influences), alongside formal government health services; community leaders and faith-based leaders/preachers help mobilise uptake of prevention/treatment, though government campaigns and health services still play an important role. Nevertheless, the malaria market revolves around trust, where community leaders and religious authorities influence health-seeking behaviour of the people (possibly more than that of government campaigns). A successful programme here requires engaging traditional birth attendants and Islamic scholars who can explain why modern medicine works alongside prayer, using local language (Hausa) as a communication tool for effectiveness.
In 2024, a survey published by International Organization of Scientific Research – Journal of Pharmacy and Biological Sciences (IOSR-JPBS) titled: Economics Of Health Care In The Treatment Of Malaria Infection In Port Harcourt, Nigeriacites transport fee among the costs for treatment in Port Harcourt. As such, the Rivers State market situation is shaped by geography, as transportation costs to health facilities can significantly add to the malaria treatment costs. Therefore, mobile clinics and community health workers matter more than building new hospitals in the state capital for effective malaria treatment.
What success actually looks like
Some states are already breaking away from the one-size-fits-all model or approach with impressive results. Their action is commendable and should be emulated and/or adapted by others.
According to the CrossRiverWatch (online news platform), the State government has adapted several unique approaches to tackle malaria. These include: Innovative Diagnostic Methods, where in 2016 the state government partnered with Fyodor Biotechnologies Corporation to introduce a new urine malaria test kit that requires no blood, reagents, or equipment. This test kit can be effectively used by individuals with minimal skills, making it suitable for community health workers and schools. In addition, the state has trained Traditional Birth Attendants, health workers and community caregivers in various intervention areas, including malaria awareness, diagnosis and treatment. It has also initiated School-Based Programmes through the Mediatrix Development Foundation to educate school children about malaria prevention and treatment, aiming to enroll young ambassadors who can spread awareness about malaria in their communities. Then, Legislation Against Misuse of Mosquito Nets to prosecute individuals who misuse mosquito nets for purposes other than their intended use, such as fishing or gardening.
In Ogun State, THIS DAY newspaper reported that the government in partnership with the Global Fund Malaria (GFM) and the Society for Family Health (SFH), distributed over 3.1 million Insecticide Treated Nets (ITNs) to households across the state as part of efforts to curb malaria transmission. The Project Manager of Global Fund Malaria, SFH, Mr. John Ocholi, expressed concern over the states low ITN usage rate of 30 per cent, emphasizing the importance of increasing coverage to protect residents, particularly pregnant women and children under five. The campaign, carried out in collaboration with the National Malaria Elimination Programme (NMEP), Catholic Relief Services (CRS), and other malaria partners, aims to strengthen Nigerias fight against malaria from the grassroots and support the goal of making the country the third malaria-free nation in Africa.
For Kebbi State, where vast stretches of irrigated rice paddies form the backbone of local agriculture, these same waters have also become fertile breeding grounds for malaria-carrying mosquitoes. Recognizing this dual challenge, the state government in collaboration with the U.S. Presidents Malaria Initiative (PMI) Nigeria and the National Malaria Elimination Programme (NMEP) have turned their attention to the states farmlands, identifying the paddies as major mosquito larval habitats. Their collaboration is now driving the development of innovative vector-control strategies designed to protect farming communities without compromising food production. By focusing on the intersection between agriculture and public health, the initiative seeks to create sustainable solutions that not only reduce malaria transmission but also improve the wellbeing and productivity of rural households across Kebbi state. This is based on the information available on the PMI website.
The federal system’s malaria dilemma
Nigeria’s constitution grants states and even local governments significant autonomy over health matters, yet malaria control remains heavily centralized, maybe because of the nonchalant attitude of the states and LGAs towards the fight against malaria. The National Malaria Elimination Programme sets targets and distributes resources, but it cannot account for the massive variations between states in the country. Independent analyses of malaria programmes in Nigeria have suggested strong recommendations for stronger state-level malaria programmes. They cautioned against the centralized or business as usualnational approaches and called for stronger state-level capacity.
Nevertheless, the challenge is that donors prefer centralized programmes because they are easier to monitor their activities and report on accordingly. International organizations want to show concrete numbers; millions of nets distributed, millions of children treated. They worry that decentralized programmes might be less efficient or more vulnerable to corruption; a syndrome hindering not only the fight against malaria, but systems in Nigeria and Africa as a whole.
Beyond bed nets and drugs
The fixation on bed nets and antimalarial drugs has overshadowed other solutions that might work better in specific contexts or states.
In Lagos for instance, environmental management could be more cost-effective than distributing nets every three years or so. According to Lagos State Waste Management Authority (LAWMA), the state generates an estimated 13,000 metric tons of waste daily. Much of this waste blocks drainage systems and creates mosquito breeding sites. Therefore, investing in waste management might prevent more malaria cases than any number of bed nets.
In northern states like Sokoto and Zamfara, indoor residual spraying (IRS) works better than bed nets because families tend to sleep outdoors during hot months, where they cannot hang bed nets properly. As such, having trained sprayers coming to their homes to spray a special insecticide on the walls or surfaces would help reduce the mosquito population and prevent malaria transmission. But it requires different logistics, different training, and different community engagement.
In coastal states like Lagos, Ogun, Ondo, Delta, Rivers, and others, larviciding would do a great job in malaria control. This involves treating water bodies to kill mosquito larvae before they become adults. But this requires mapping water bodies, training spray teams, and monitoring results over time. It is more complex than distributing nets though but potentially more effective.
The data gap nobody talks about
One reason Nigeria keeps using uniform solutions is that most states lack reliable data about their malaria situation. DAWN HERALD recently featured the sad situation of poor data records of malaria cases, especially by private health providers in its feature article titled: Nigerias Silent Malaria Crisis: Why Most Private Sector Cases Go Unreported.The organization looked into a research study byACTwatch Lite Nigeria (2024 study) which showed that many cases of malaria in the three states covered go unreported. Meanwhile, the National Malaria Indicator Survey happens only every few years and provides state-level estimates, not the detailed information needed for targeted programmes.
In a related development, many local government health departments still record data in paper registers in this digital age. By the time this information reaches state or federal level, it is months old and often incomplete. Without real-time data, policymakers default to national averages and standard solutions. However, technology could help bridge this gap effectively. Several Nigerian startups can develop mobile apps for community health workers to report cases immediately. But these innovations could struggle to scale if they are not integrated into official health systems. The federal government’s own electronic health record system has been “under development”for over five years without any results.
What needs to change
Fixing Nigeria’s malaria crisis requires accepting that the country is too diverse for uniform solutions. But this doesn’t mean abandoning national coordination; it means rethinking what coordination looks like for better outcomes.
First, give states genuine autonomy to design and implement malaria programmes based on local evidence. The National Malaria Elimination Programme should set outcome targets but let states choose their own strategies to meet those targets.
Second, allocate resources based on need and capacity rather than population alone. Without other factors, the human population can never determine the gravity of malaria cases in a state. A state like Borno with weak health infrastructure and high malaria burden needs more support than Lagos with strong infrastructure but lower transmission rates. In this case, regional bias must be removed in the decision making progress.
Third, invest in state-level data systems so decisions are based on current evidence rather than national averages or outdated surveys. Every state should know its malaria burden in real time.
Fourth, create flexibility for innovation. When Cross River or Kebbi develops a programme that works, other states with similar contexts should be able to adopt it quickly without waiting for federal approval.
Finally, engage the private sector differently in different markets/states. In Lagos, pharmaceutical companies and health insurance schemes matter most. In Kano, there are traditional healers and patent medicine vendors. In Rivers, it is oil companies and community-based organizations.
The cost of inaction
Every year that Nigeria continues with ineffective uniform programmes, more children die unnecessarily. The economic cost is equally staggering. According to an Independent Newspaper report, in November, 2024, the Nigerian Government (through the Federal Ministry of Health) quoted a figure of over US$1.1 billionlost annually to malaria in terms of impact on GDP. This reduced productivity, and increased out-of-pocket health expenditures.
But the real tragedy is that Nigeria has all the tools needed to dramatically reduce malaria across the states and FCT. The country has skilled health workers, functional pharmaceutical manufacturing, and strong research institutions. What it lacks is a policy framework that acknowledges what health workers on the ground already know; Lagos is not Kano, Kano is not Rivers, and pretending otherwise is killing Nigerians through malaria.
As Nigeria moves toward 2030 when the government aims to eliminate malaria, the question is whether policymakers will continue defending a broken system or embrace solutions as diverse as the country itself. The answer will determine whether Nigeria finally escapes from being the world’s malaria capital or remains trapped in another decade of well-intentioned programmes that deliver disappointing results.
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