Accelerating Nigeria towards malaria elimination requires moving away from business as usual: insights from a political economy analysis.

Abstract

Background: Despite global efforts to eliminate malaria, progress in Nigeria has been slow. Political economy analysis (PEA) is increasingly being used to identify how political economy influences effective program implementation. Here we apply PEA to the malaria program in Nigeria to understand the contextual factors that have hindered progress.

Methods: A desk review and stakeholder mapping were carried out to identify the relevant actors in the malaria sector. Semi-structured, open-ended interviews were conducted with key influencers and high-level managers. Data were analysed and grouped thematically into factors affecting resource allocation and factors affecting the use of allocated resources.

Results: Factors affecting resource allocation included malaria receiving limited attention and resources due to low prioritisation by federal, state and local governments; weak advocacy from citizens, which means malaria elimination is not an electable issue for politicians; and no direct communication channels between the malaria program and key decision-makers. Factors affecting the use of allocated resources included poor coordination between multiple partners working on malaria.

Conclusions: Achieving meaningful progress in malaria elimination in Nigeria requires predictable financing from sustained political will. Demand from citizens is essential to encourage political prioritisation. Programs and partners must also be better coordinated to maximise impact with limited resources. Establishing high-level malaria advocacy groups and integrating malaria priorities into the national development plan would support these efforts.