World Health Day draws attention to the fight against vector-borne diseases – diseases that are transmitted by blood-sucking insects, ticks and mites. These creatures typically flourish in environments that are both tropical and unhealthy, so the diseases they transmit disproportionately affect the global poor.
Vector-borne diseases range from Dengue fever to Chagas disease to Japanese encephalitis, though the most high-profile is malaria. Although the death rate caused by malaria has halved since 2000, it still killed 627,000 people in 2012 – 90% of them in sub-Saharan Africa.
As the senior adviser to Nigeria’s Minister of Health, I know we can’t afford to be complacent about progress. There are worrying trends, notably among the already-evident impacts of climate change. In Africa, some insects, ticks and mites are becoming able to survive for longer in a wider range of habitats, making more populations vulnerable to the diseases their bites can pass on.
Also, because malaria is so endemic, there is a tendency to treat any fever as malaria rather than testing before prescribing medication – even assuming accurate testing apparatus is available. As a result, many people are treated for malaria who don’t actually have it, or are treated with ineffective medication. As is also happening globally now with bacteria and antibiotics, inappropriate prescription of anti-malarial drugs may be giving the parasite more opportunity to develop resistance.
Our efforts to tackle malaria and other vector-borne diseases in Nigeria are part of a wider vision for health which the government launched in 2012, called the Saving One Million Lives initiative. Why one million? Because we know that’s about how many Nigerian mothers and children died, every year, from preventable diseases.
The framing of “saving lives” is also important, because ultimately that’s what the healthcare system should be about. It may sound like an obvious point, but it’s actually quite a paradigm shift to measure the sector’s performance in this way. Historically, the focus had been more on measuring inputs – how many hospitals built, training programs held, health workers recruited or drugs prescribed. Though these are important, our belief is that it is more important to focus on how these inputs collectively result in outcomes.
Saving One Million Lives is a platform to motivate the public and private sectors to work together more effectively. There has traditionally been very little and ineffective communication between the two, and opportunities for coordination go beyond unstructured public-private partnerships to effective collaborations that serve to improve health outcomes.
For example, new lines of engagement helped reviews of the “Common External Tariffs” as they apply to life-saving health equipment and commodities. Improving access to affordable finance is another priority, as the private health sector in Nigeria is fragmented and small providers find it difficult to get the financing they need to grow. There is little history of collaboration among these small providers, so we are experimenting with ways to bring them together. The first step is to build trust, with the ultimate aspiration of sharing data and even services: where no single doctor can afford a CT scanner, 25 doctors pooling their resources just might.
There are many opportunities, too, for sectors other than healthcare to save lives. Mobile phone networks are one example: last month we held Nigeria’s first ever Healthcare Hackathon, an innovation marketplace. Among the ideas that participants contributed was overlaying a map of primary health care centres with a map of mobile phone masts which have uninterrupted power supplies. This identified potential opportunities to use those masts’ electricity to keep vaccines refrigerated.
The fight against malaria, too, needs the support of many industries. Everyone knows about efforts to distribute bed nets, but this is no magic bullet; we need to have an integrated approach that includes integrated “vector management” through the judicious use of insecticides, educating people to eliminate potential breeding sites, dispose of garbage far from human settlements, and so on. In fact, the Federal Government has recently changed the name of its program from the National Malarial Control Program to the National Malaria Elimination Program, reflecting renewed commitment, higher ambition and a more comprehensive approach towards fighting malaria.
Finding innovative ways for the health sector to collaborate with other sectors (public and private) will be vital to the fight against vector-borne diseases, to which the WHO is rightly drawing attention today and for which Nigeria’s efforts are positioned through the Saving One Million Lives initiative.
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Kelechi Ohiri is Senior Advisor to the Minister of Health of Nigeria.
Image: A boy suffering from malaria receives treatment at a hospital. REUTERS/Zohra Bensemra