Oladimeji Solomon Yemi (Lead writer)
Editor’s Note: The insights in this article draw heavily from the discussions, data, and presentations shared during Nigeria’s hosting of the ‘Big Push’ Against Malaria meeting. These insights represent a synthesis of key messages, with particular focus on what they mean for Nigeria’s malaria elimination journey.
Malaria is still the first illness every Nigerian parent fears, accounting for more than a quarter of the world’s malaria cases and one in three global deaths from the disease. Children are most at risk and bear the greatest burden, facing the highest risk of illness and death.
No other country in the world carries a malaria burden as heavy as Nigeria’s. Despite decades of investment and countless campaigns, malaria continues to expose critical weaknesses in the health system.
In the past two years Nigeria has convened the global community twice. First at the Roundtable Meeting on Rethinking Malaria Elimination in Nigeria in May 2024, and again at the Harnessing Africa’s Central Role for the Big Push Against Malaria 2024–2030 in September 2025.
session at the Big Push Against Malaria meeting in Abuja, 2025. Image Credit: Nigeria Health Watch
Both moments brought together global leaders, experts, and financiers, resulting in bold declarations. However, discussions alone do not save children’s lives, actions do. What Nigeria needs now is courage, the courage to change how we fight malaria.
Why business as usual will not work
At the 2024 roundtable, WHO Director-General Dr. Tedros Adhanom Ghebreyesus, in his remarks, commended Nigeria’s commitment but stressed the urgency of data-driven resource allocation and stronger partnerships. He reminded leaders in attendance that Nigeria carries the world’s largest malaria burden and called for translating political commitments into tangible resources and actions.
Building on this call to action, at the Big Push Against Malaria, Nigeria’s official presentation revealed a bleak reality, the country requires $1.2 billion annually for malaria control but has only $514 million available, leaving a $696 million financing gap. The funding shortfall highlights the dangers of donor dependency and the urgent need to mobilise sustainable domestic financing solutions.
Four shifts Nigeria Must Make
- From Donor Dependency to Domestic Ownership: Nigeria cannot continue outsourcing its survival. Today, many malaria programmes rely heavily on external partners, a model that is neither sustainable nor strategic. That must change. Nigeria needs ring-fenced malaria budget lines at both federal and state levels, mandatory Corporate Social Responsibility (CSR) allocations from the private sector, and bipartisan parliamentary caucuses to hold the line beyond electoral cycles. Domestic financing is not just an option, it is a clear signal of greater country ownership in health.
- From Siloed Programs to Integrated Primary Care: In Lagos, over 94% of fevers are no longer malaria. This striking insight reveals that many Nigerian children treated for malaria may, in fact, be battling other illnesses. Continuing to pour malaria medicines into every fever is both wasteful and dangerous, eventually leading to resistance. Malaria must be treated as part of an integrated primary healthcare (PHC) approach to febrile illness management, where testing leads to answers, not just negative results.
- From Political Will to National Will: For too long, malaria has been viewed as the Ministry of Health’s problem alone. Yet, malaria is a national problem requiring whole-of-government action. Agriculture ministries must address stagnant water in irrigation schemes; housing authorities must improve slum drainage; climate and environment ministries must address mosquito breeding grounds, and legislators must recognise that every citizen lost to malaria is also a voter lost. Malaria deaths are not just health statistics; they weaken constituencies and erode democratic foundations. Ending malaria is as much a political survival strategy as it is a health imperative.
- From Treatment-Heavy to Prevention-First: Nigeria cannot medicate its way out of malaria. Prevention, from vector control to environmental sanitation must take centre stage. The R21 vaccine and dual-insecticide nets are promising innovations, but only if deployed at scale and equitably. Nigeria must invest in prevention as aggressively as it has in treatment, shifting the balance from crisis response to long-term control and elimination.
Lagos as proof of possibility
Image Credit: Lagos State Ministry of Health
Lagos offers a glimpse of what the future could look like. In 2023, the state reported a malaria prevalence of 2.6%, its lowest ever, and current data suggests it has now fallen below 1%, crossing the World Health Organization (WHO)’s pre-elimination threshold.
The strategy was simple but uncompromising. Test–Treat–Track. Every suspected case is tested, every confirmed case treated early, and every case tracked.
Image Credit: Lagos State Ministry of Health
As part of the Preliminary Review of the Pathway to Malaria Pre-Elimination Project in Lagos State, more than 40,000 patients were tested across 414 health facilities and nearly 400 Patent and Proprietary Medicine Vendors (PPMVs) and community pharmacies over a six-month period. The findings were striking, only 5.6% of those tests came back positive, confirming that malaria is no longer the dominant cause of fever cases in the state. This does not mean malaria has disappeared, but it signals that Lagos is entering a new phase, where the bigger challenge is effectively managing non-malaria fevers.
Image Credit: Lagos State Ministry of Health
This evidence strengthens the case for shifting from a malaria-centric model to a broader, integrated febrile illness management approach, while maintaining donor confidence and aligning with national elimination goals.
underscoring the need for integrated fever case management. Image Credit: Lagos State Ministry of Health
Governor Babajide Sanwo-Olu went a step further, declaring himself “Malaria Elimination Situation Commander”, transforming malaria from a technical programme into a political priority. The state has shown that with strong leadership, accountability and sustained investment malaria elimination is within reach.
Why Nigeria must lead now
According to Prof Olugbenga Mokuolu, Strategic Adviser to the Coordinating Minister of Health and Social Welfare, on Malaria, every $1 invested in malaria control yields $40 in economic returns. This return comes through four main pathways:
- Lives saved and productivity gained: Malaria disproportionately affects children and pregnant women. Preventing these deaths means more Nigerians surviving, learning, and contributing to the economy.
- Reduced healthcare costs: Families spend less on drugs, transport, and hospital visits, while the health system is freed up to focus on other health priorities.
- Boosted economic growth: Malaria-free countries in Africa grow, on average, 1.3% faster annually. For Nigeria, even a 1% increase in GDP would translate into billions of dollars in additional economic value.
- Long-term development dividends: Eliminating malaria makes Nigeria more attractive for investment, while resources once spent on malaria can be redirected to infrastructure, education, and innovation, supporting sustainable national development.
Eliminating malaria is not just a health target; it is an act of nation-building. Malaria drains our workforce, robs our classrooms, and deepens poverty. With a population of 230 million, Nigeria is Africa’s tipping point. If Nigeria fails, Africa fails. If Nigeria succeeds, the continent moves closer to zero malaria deaths.
A Call to Courage
Nigeria does not lack proven tools, from insecticide-treated nets and malaria medicines to rapid diagnostic tests, seasonal chemoprevention, and now a vaccine. Yet tools alone cannot defeat malaria. The real test lies in how effectively they are deployed, whether states have the capacity to sustain supply chains, generate and use reliable data, and secure the financing and community engagement needed to sustain progress.
What Nigeria truly lacks is not knowledge, but the systems and courage to act on it: the financing mechanisms to fund our own response, the data systems to guide local action, the advocacy to sustain political attention, and the human capacity at state and community levels to translate policies into impact.
Only by integrating these layers, tools, data, people, and accountability, can Nigeria treat malaria not as inevitable, but as intolerable.