nigeria briefing book by j5uNBk

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									NETMARK REGIONAL AFRICA PROGRAM
         BRIEFING BOOK

      Insecticide Treated Materials
                    in

              NIGERIA
             September 2000
ABBREVIATIONS
A.arabiensis    Anopheles arabiensis
A.funestus      Anopheles funestus
AFRO            Africa Regional Office (World Health Organization)
CHESTRAD        Centre for Health Sciences Training, Research and Development
c.i.f.          Customs, insurance and freight
Culex sp.       Culex Species
DFID            Department for International Development
FMCG            Fast Moving Consumer Good
f.o.b.          Freight on board
GDP             Gross Development Product
GNP             Gross National Product
ITNs            Insecticide Treated Nets (and materials)
KAP             Knowledge Attitudes and Practices
LGA             Local Government Area
MACOA           Malaria Care Organization for Africa
MARA            Mapping Malaria Risk in Africa
MoH             Ministry of Health
MSF Holland     Medecins sans Frontieres Holland
NMCP            National Malaria Control Programme
N               Nigerian Naira
NGO             Non Governmental Organization
ODA             Overseas Development Assistance
P.falciparum    Plasmodium falciparum
P.malariae      Plasmodium malariae
P.ovale         Plasmodium ovale
RBM             Roll Back Malaria
UNICEF          United Nations Children’s Fund
USAID           United States Agency for International Development
VAT             Value Added Tax
WHO             World Health Organization




                                                                                2
SUMMARY

Nigeria had a population of 121.3 million in 1998, with about 66% of the population below the poverty
line. The GNP per capita is US $300.

Malaria is endemic throughout the country, with more than 90% of the total population at risk of stable
endemic malaria. Malaria accounts for 25% of infant mortality and 30% of childhood mortality. The
National Malaria Control Programme (NMCP) outlines Insecticide Treated Mosquito Nets (ITNs) as a
key strategy for malaria control. The 1996-2001 plan identifies the widespread promotion of treated
nets as an integral part of the programme. Net ownership is estimated at less than 5%. This figure is
lower in the rural areas. The main reason for this is probably due to the fact that importation of ready-
made nets is prohibited in Nigeria. Retail audits have demonstrated that over 70% of the population
spend money on aerosols and 17% on coils to control mosquitoes. There are currently no non-
governmental organisations (NGOs) engaged in the provision of treated nets.

The estimated total sales for nets over five years are at least 24,115,956 and for insecticide treatment
is 31,350,743 (not taking population growth into account).




                                                                                                       3
TABLE OF CONTENTS

SUMMARY                                                    3

1. BACKGROUND                                              7

1.1     Demographic Information                             7
  1.1.1    Socio-economic status                            8
  1.1.2    Ethnic groups and languages                      8

1.2      Geography and Climate                              8

1.3     Economy                                             9
  1.3.1     Basic economic indicators                       9
  1.3.2     Exports                                         9
  1.3.3     Imports                                         9
  1.3.4     Budget                                          9
  1.3.5     Industries                                      9

1.4      Political/international disputes                   9

1.5      Transportation                                     9


2. MALARIA SITUATION                                       10

2.1     Epidemiology and Entomology                        10
  2.1.1     Burden                                         10
  2.1.2     Endemicity                                     10
  2.1.3     Seasonality                                    10
  2.1.4     Vectors                                        10
  2.1.5     Local resistance to pyrethroid insecticides    10

2.2       Malaria control                                  12
  2.2.1       Government control policies and strategies   12
  2.2.2       Major actors                                 13
     2.2.2.1    Donors                                     13
     2.2.2.2    NGOs                                       13
  2.2.3       Roll Back Malaria (RBM) in Nigeria           13
  2.2.4       Past and current programs                    13
     2.2.3.1    Free and subsidised ITNs                   13
     2.2.3.2    ITNs at cost recovery                      14


3. CONSUMER MARKET FOR ITNS                                14

3.1     Policy context                                     14
  3.1.1      Policies and Political Factors                14

3.2      Current market                                    14
  3.2.1      Insect control market                         14
  3.2.2.     Nets                                          15
  3.2.3.     Insecticide                                   15

3.3     Market analysis                                    16
  3.3.1    Projected market                                16


                                                                4
3.4     Trading issues                                                                16
  3.4.1     Trade channels                                                            16
  3.4.2     Promotional methods                                                       17


4. CULTURAL AND BEHAVIOURAL ASPECTS OF ITN USE                                        17

4.1     Net ownership                                                                 17

4.2     Net use                                                                       17

4.3     Net treatment / retreatment                                                   17

4.4     Factors supportive of or obstacles to ownership, correct use, and treatment   17


5. OTHER PROMOTION INFORMATION                                                        17

5.1     Communication information                                                     17
  5.1.1    Telephone                                                                  17
  5.1.2    Television                                                                 18
  5.1.3    Radio                                                                      18
  5.1.4    The Print Media                                                            18
  5.1.5    The Outdoor media                                                          19

5.2     Advertising and promotion companies                                           19

5.3     Market research companies                                                     21


ANNEX 1                                                                               22

ANNEX 2                                                                               23

ANNEX 3                                                                               24




                                                                                           5
LIST OF TABLES
1.    Demographic indicators
2.    Basic economic indicators
3.    Value shares of aerosols, coils and mosquito products
4.    List of net manufacturers / importers / distributors
5.    List of insecticides manufacturers
6.    Number of households for targeting (market analysis).
7.    Estimated sales of nets and retreatment for 5 years
8.    Television channel coverage, ownership and cost of a 30-second spot
9.    Radio channel coverage, ownership and cost of a 30-second spot
10.   Newspaper title, frequency and circulation
11.   Magazine title, frequency/type and circulation
12.   Key players in the advertising industry
13.   Key players in the market research industry


LIST OF MAPS

1.    General position of Nigeria
2.    Meteorological profile of several sites in Nigeria
3.    MARA map of climatic suitability for the transmission of stable malaria
4.    MARA map of the length of the malaria transmission season




                                                                                6
                                                NIGERIA


                                      Map 1: General position of Nigeria




1.     BACKGROUND

1.1    Demographic Information
                                  1
Table 1: Demographic indicators

Population (mid-1998-millions)                                  121.3
Average annual growth rate (1992-1998)                            2.9
Average household size                                             7
Age distribution <15 years (%)                                    48
Male/Female Ratio                                             50.3 : 49.7
Urban population (% of total population)                          42
Life expectancy at birth (years)                                  54
Infant mortality (per 1000 live births)                           77
Total Fertility Rate                                              5.5
Illiteracy (% of population age 15+)                              40


                                                                            7
1.1.1 Socio-economic status
Household income or consumption by percentage share:
Lowest 10%:               1.3%
Highest 10%:              31.4% (1992-3)


1.1.2 Ethnic groups and languages
English is the official language although there are over twenty different languages spoken, the most
common being Hausa, Yoruba, Ibo and Fulani.


1.2    Geography and Climate
The Federal Republic of Nigeria lies on the West Coast of Africa. It borders Niger in the North, Chad
on the Northeast, Cameroon to the East and Benin to the West. The surface area of the country is
923,708 square kilometers. The southern lowlands merge into central hills and plateaus with
mountains in the Southeast and plains in the North. The capital city is Abuja. There are thirty states
and the Federal Capital Territory has 593 Local Government Areas (LGAs).

The climate varies from equatorial in the South, tropical in the central areas and arid in the North. The
rainy season is April-July (heavy rains) and September-December in the South, and July-September
in the North. Nigeria can be divided into the ecological zones of: Forest, Savannah/Forest Guinea
Savannah, Sudan Savannah and Sahelian Savannah. The yearly temperatures and rainfall levels for
several sites are shown in Map 2.

                                                                            2
               Map 2: Meteorological profile for several sites in Nigeria




                                                                                                       8
1.3       Economy 3
Despite oil revenues of around $280 billion since the early 1970s, Nigeria has debts of around $30
billion. However, since the recent election, there has been a mood of optimism. In the past, dollars
could only be purchased on the black market, recently; however, the exchange rate has been
liberalized. Although the Naira is not yet fully convertible, its rate is set daily at more or less market
levels, and oil companies are allowed to sell dollars direct to anyone who wants to buy them. Nigeria
has a better chance now for economic growth than at any other time since independence.

1.3.1     Basic economic indicators 4

Table 2: Basic economic indicators

GNP per capita (Atlas method-US$)                                        300
Poverty (%pop below poverty line)                                         66
GDP (US $ billions-1998)                                                 41.4
Average annual growth in GDP (1999-03 projection)                         2.1
Average annual growth in GNP per capita (1999-03 projection)             -1.6
Inflation (% 1998 est.)                                                   15
Net ODA from all donors (US$ millions-1996)                              192
                        *
Exchange Rate: Naira per US$1 (March 2000)                                99


1.3.2 Exports
Commodities:             petroleum, and petroleum products, cocoa and rubber.
Total value (1998):      US$9.7 billion (f.o.b., 1998)

1.3.3 Imports
Total value:             US$9.8 billion (f.o.b., 1998)

1.3.4 Budget
Revenues:                US$13.9 billion (1998 est.)
Expenditure:             US$13.9 billion (1998 est.)

1.3.5 Industries
Crude oil, coal, tin, palm oil, peanuts, cotton, rubber, wood, hides and skins, textiles, cement and other
construction materials, food products, footwear, chemicals, fertiliser, printing, ceramics and steel.


1.4       Political/international disputes
Delimitation of international boundaries awaiting ratification by Cameroon, Chad, Niger and Nigeria.

1.5       Transportation
Railways:                       3,557 km
Highways:                       51,000 km
Ports and Harbors:              Calabar, Lagos, Onne, Port Harcourt, Sapele, Warri.
                                There is a network of main roads and a few railway lines although
                                because of poor maintenance and years of heavy freight traffic, much of
                                the road system is barely useable and only 56.5% of the health facilities
                                are accessible by good roads.
Airports:                       36

*
    1 Naira (N) = 100 Kobo

                                                                                                        9
2.     MALARIA SITUATION

2.1    Epidemiology and Entomology

2.1.1 Burden
Malaria is a major cause of mortality and morbidity in Nigeria. It accounts for 25% of infant mortality
and 30% of childhood mortality 5. Malaria is a notifiable disease and is one of the tracer diseases for
the monitoring and evaluation of Primary Health Care in the Country. It is the most common cause of
hospital outpatient attendances in all age groups. It is estimated that 50% of the population has at
least one episode of malaria each year. Malaria is the major cause of socio-economic deprivation with
up to 200,000 child deaths per year being attributed to the infection 6.

Total population at risk of stable endemic malaria: 111,705,248 7.

2.1.2 Endemicity
Malaria is generally endemic in Nigeria. It is holoendemic in the rural areas and mostly hyperendemic
in the urban areas. Transmission is high and stable in all parts of the country (Map 3) with high
intensities in the forest areas. In the southern part of Nigeria, transmission is uniform whereas in the
far north, there is a marked difference in the transmission rate between rural and urban areas. Three
species of plasmodia are responsible for malaria in Nigeria: Plasmodium falciparum, which accounts
for 90% of all malaria infections, P. malariae and P. ovale.

2.1.3 Seasonality
Map 4 below shows that in the southern half of Nigeria malaria is mostly endemic and perennial
(transmission 7 to 12 months a year), and in the northern half mostly endemic and seasonal
(transmission 4 to 6 months per year).

2.1.4 Vectors
The predominant vector in the savannah areas and cities is Anopheles arabiensis whereas A.
gambiae and A.funestus are common in the forest areas and permanent water areas respectively.

2.1.5 Local resistance to pyrethroid insecticides
Permethrin resistance has been noted in the south of Benin, and in the urban and peri-urban districts
of Cotonou, but mosquitoes were still susceptible to insecticide in the north of the country. Resistance
to deltamethrin has been observed in Cotonou (Benin) possibly due to extensive use of domestic
aerosols. However, pyrethroid treated mosquito nets still work effectively. There has been no reported
pyrethroid resistance in Nigeria 8.




                                                                                                     10
                                                                                                9
               Map 3: MARA map of climatic suitability for the transmission of stable malaria




The map illustrates climatic suitability for stable malaria transmission in Nigeria. Red areas have a high
probability of malaria transmission as predicted by climate.




                                                                                                       11
                                                                                        9
                     Map 4: MARA map of the length of the malaria transmission season




2.2    Malaria control

2.2.1 Government control policies and strategies 10
The National Malaria Control Committee was set up in 1975 with membership drawn from the Federal
and State Ministries of Health and the universities. In 1988 with the adoption of health systems
reforms, malaria control fell within the concept of primary health care. A technical committee was set
up to assist the federal Ministry of Health to plan and carry out its control activities. During the last ten
years, the evolution of the malaria control programme has moved from the National Malaria Technical
Control Committee to a broad based multidisciplinary approach. A malaria therapy network has been
established between the National Malaria Control Programme and donors. In 1989 the National
Guidelines on Malaria Control were prepared by the Federal Ministry of Health and were approved by
the National Council on Health in 1990. In 1996, a National Technical Advisory Committee on Malaria
was reconvened to develop a Plan of Action for Malaria Control. The national symposium on malaria




                                                                                                          12
in Nigeria in 1997 was considered an important milestone in progressing the cause of malaria
research and policy development in Nigeria. The symposium recognized insecticide treated nets
(ITNs) as an important intervention strategy for malaria prevention. The 1996-2001 plan outlines
personal protection as a strategy for prevention of malaria and promoted the widespread use of
insecticide treated mosquito nets.

2.2.2   Major actors

2.2.2.1 Donors
UNICEF, WHO, USAID and DFID have provided support to the malaria programme in Nigeria.
UNICEF in particular pledged $1m for malaria activities in Nigeria over the next year. Both UNICEF
and DFID have consultants in Nigeria in August 2000 to help in the development of a national ITM
strategy.

2.2.2.2 NGOs
There are a limited number of NGOs working with ITMs in Nigeria including the Centre for Health
Sciences Training Research and Development (CHESTRAD), Malaria Care Organization for Africa
(MACOA) and Medecins sans Frontieres (MSF) Holland.


2.2.3   Roll Back Malaria (RBM) in Nigeria

High level political commitment has been expressed for RBM in Nigeria, which has also been the focal
point for gaining political support for the RBM Initiative *, with a "Malaria Summit" held in Abuja in
March 2000. Annex 3 contains four documents related to this summit, which are: a summary
document; the declaration; the plan of action; and a document from a "Public Private Partnership"
meeting held just before the summit.

2.2.4   Past and current programs

2.2.3.1 Free and subsidized ITNs
In 1992, a pilot project funded by USAID in collaboration with the Center for Disease Control, to
investigate the efficiency of permethrin-impregnated mosquito nets and curtains was undertaken in
Nsukka. Preliminary data showed encouraging results with respect to parasite rate and prevalence of
malaria in the under 5's. Mosquito nets were provided free in this project.

A UNICEF project targeted 10 states with 40,000 nets in 1999. Nets and insecticides were sold for
US$4.50 A situation analysis is planned for mid-2000.

CHESTRAD International (Dr. Lola Dare, 29 Aare Ave. New Bodija Estate, Ibadan) is beginning to
implement an ITM project in 3 LGAs in each of the states of Oyo, Ogun and Osun and 4 LGAs in the
state of Ekiti, all in the south-western Health Zone in Nigeria. Some baseline studies have been
conducted and an instructional guide developed” Community Directed Management of Simple malaria
and promotion of the use of Insecticide Treated Bednets: Manual for Community Orientation and
Advocacy Dialogues". As of April 2000, the ITNs themselves have not yet been introduced.

Although details are not clear, MACOA in the Lagos area, were apparently purchasing nets at
N450.00 and selling them at N500.00 and N550.00 to corporate bodies - with some others given out


*
 The RBM webpage has many useful documents - and is searchable for documents related to Nigeria:
<http://mosquito.who.int/cgi-bin/rbm/login_rbm.jsp>

                                                                                                   13
free of charge for promotional purposes. The director of MACOA is Professor Hussain Akande Abdul-
Kareem.

MSF/Holland in Delta State is also engaged in an ITM project, but details are not available.

2.2.3.2 ITNs at cost recovery
A second pilot project under the federal Ministry of Health is underway and has nets donated by
UNICEF. They have started selling nets in four communities selected from the four primary health
care zones of Nigeria. Each net is sold at the US$5. The aim is for full cost recovery 11.


3.      CONSUMER MARKET FOR ITNs

3.1     Policy context

3.1.1 Policies and Political Factors
Nigeria has prohibited imports of textile fabrics including mosquito nets and netting 12. Mosquito
repellent coils are also prohibited. Import permits are not generally required. The procedure for
registration of insecticide is considered to be long 13

Insecticide
Duty: 30% 14
VAT: 15% 15

3.2     Current market

3.2.1 Insect control market
The anti-mosquito market is estimated to be worth US$36 million. Products in this category include
mosquito coils, sprays, liquids, and mats. A study by MoH-Nsukka found that only 10% of the ITN
intervention households reported using other methods, whilst 79% of households reported use of
additional kinds of anti-mosquito products. Despite the prohibition on mosquito coils, there is still
distribution of them (branded Cock) from China with prices very much lower than the market average.
Cock is currently the leading coil brand in Nigeria with 10% market value share 16.

Value Shares of the other anti-mosquito products below:

Table 3: Value shares of aerosols, coils, and other anti-mosquito products

Product description      Product Group        Brands
                         Value Share (%)      Value Shares (%) of total insect control
                                              market
                                              Mobile     19%
Aerosols                         60           Raid       14%
                                              Bygone       7%
                                              Others (Elf, Rambo, Sheltox etc)

                                              Cock      10%
Coils                            10           Raid       3%
                                              Others (Rambo, Bygone, Swan etc)
Other(including
repellents/                      30
powder/liquids)


                                                                                                  14
3.2.2. Nets
Local tailoring covers about 1% of the population 17. The market prices range from US$4-10.
Mosquito nets are mandatory in boarding schools, however, less than 5% of the population use
mosquito nets. This figure is much less in rural areas 18. Importation of readymade nets is prohibited in
Nigeria. The National Malaria Program, with support from UNICEF bought 40,000 polyester, 75 denier
nets which were locally made, and distributed them to 10 sites. Programme managers indicated that
there is good, but latent capacity to manufacture nets.

Table 4: List of net manufactures/importers/distributors

Net Details                  Siamdutch Ltd. - Thailand               SunFlag – Nigeria
Form                         Baby & children nets                    Rectangular
                             Free-standing
Sizes                        Cot and infant sizes (48*26)            Student size (54*90)
                             Single /Family                          Family size (4.5*6)

Packaging                    Printed Plastic Wrap                    Plastic Wrap plus Label
Price                        N210-N250                               N180 – N350 Cedis

Product Visibility/Trade     Limited to baby products                Limited to textile & baby
Channel                      distributors – highly visible           product distributors
Estimated Sales              Not Available                           Not Available



3.2.3. Insecticide
There is little registered insecticide for net treatment available on the commercial market in Nigeria.
AgrEvo does not have any of its net treatments registered.
                                              19
Table 5: List of Insecticides Manufacturers

INSECTICIDES         Zeneca Public Health      Bayer Ltd.        AgrEvo (Aventis)      Cyanamid
DETAILS
Product              Lambda-cyhalothrin        Cyfluthrin        deltamethrin          Alphacypermethrin
Brand name &         Icon CS                   Solfac 5% EW      K-Othrine 1%SC        Fendona
formulation          Iconet                                      K-OTab                10% SC
                                                                 25% deltamethrin
Packaging &          Icon CS community         20ml, 1lt, 20lt   40ml sachets &
pack sizes           pack (500ml bottles)      bottles           1.6g tablets
                     Iconet Kit (6ml
                     sachet)
Price                Not Available             Not Available     Not Available         Not Available
Registration         Being processed           Registered        Planning              Being processed
Status                                                           submission for
                                                                 K-OTab
Approval by          Await approval            Approved          Approved              Not approved
WHOPES
Source (s) of        C. Zard & Co.             Bayer Ltd.        Sarkis Ltd., 5,
products             Ltd.,184, Adeniji                           Sumbo Jibowu
                     Adele Road                                  Street S/W Ikoyi,
                     Idumagbo                                    Box 51413,

                                                                                                           15
                        Lagos, Nigeria                             Faloma, Lagos

ITNs are mainly found in the project areas and cannot be bought in the common market.

3.3        Market analysis

3.3.1      Projected market

Assumptions:
 In every family the mother and father share a bed/mat and two children share one bed/mat.
 The warm market is those currently using sprays, coils or repellents estimated at least 70%
   (section 4.4)
 Families buying nets for the first time would be willing to buy only one net.
 Distribution of nets and insecticides would be nation wide through private sector channels.
 There will be high intensity promotional efforts supported by public and private channels.
 20% of families buying one net would buy a second net the following year.
 30% of these nets would be retreated in every year (twice a year).
 Annual increases in net sales would be 30% in year 2, 25% in year 3 and 15% in year 4.
 Annual increases in insecticide sales assume 30% retreatment of existing and new nets and a
   growth in sales related to the number of nets.
 The low growth represents 15% of the market being reached in year one and all these would be
   sold with insecticide; medium growth represents 25% of the warm market being reached in year
   one and the high growth represents 35% of the warm market being reached in year one, all nets
   being sold with insecticide.

Table 6: Number of households for targeting (market analysis)

Total Population (millions)                                                    121.3
Estimated average family size                                                    7
Warm market (% households)                                                      70
Number of families using other repellents (warm market)                     12,130,000
                                                               *
Table 7: Estimated sales of nets and retreatment for 5 years
(Pending market research)

3.4        Trading issues

3.4.1 Trade channels
Anti-mosquito products are distributed mainly through wholesaler trade, supermarkets and the open
market (consisting of hawkers, kiosks, grocers, and distributor outlets). There are approximately
500,000 retailers and 50,000 wholesalers in the Nigerian market.

The majority of Fast Moving Consumer Goods (FMCG) companies sell their products through the use
of distributors. For instance SCJ has +25 distributors and Lever Brothers has +60 distributors
nationwide. Distributors get the supply of products directly from the manufactures and in turn they
service the wholesale and the retail channels.

On average, the wholesale trade takes a margin of between N10 and N15 per unit of sale; the retail
trade takes between N15 and N20 per unit of sale and the distributor takes +N20 per dozen (or
whatever unit of measurement).

*
    Population growth has not been taken into account

                                                                                                16
3.4.2 Promotional methods
Neither nets nor insecticides are advertised in the media, however, malaria drugs and malaria control
products are.


4. CULTURAL AND BEHAVIOURAL ASPECTS OF ITN USE
Findings from the Nsukka study gave several insights into the cultural and behavioral aspects of ITN
use 20.

4.1    Net ownership
Net ownership was higher in educated people than non-educated.

4.2    Net use
A baseline study of local beliefs in the Nsukka project revealed that 22% of respondents had used a
mosquito net before, and use was lower in those with no education. Reasons for non-use were given
as high cost, non-availability and lack of durability. 45% believed that mosquitoes cause malaria.
Participants believed the nets to be highly efficacious.

4.3    Net treatment / retreatment
In the study area 15% of the users of ITNs washed their nets when they were dirty. Preliminary results
of a contingent valuation of willingness to pay, in four communities in Enugu state, showed that most
respondents were household heads. Willingness to pay for re-impregnation ranged from $0.05 to
$5.26. The median from the aggregated data from the four communities was $0.21 21.

4.4    Factors supportive of or obstacles to ownership, correct use, and treatment
Nets were perceived to beautify the home and increase the social status. 94.9% believed that the net
prevented bites, 22.9% that it kills mosquitoes, 12.7% that it prevents malaria, 25.4% that it kills other
insects and 12.7% that it beautifies the home.

Few people in the community link mosquitoes to malaria. Mosquitoes are considered a general
nuisance but not the cause of malaria. Not many people like sleeping under nets. Window screens are
more common. Most people sleep outside until midnight and go indoors when it becomes cooler. The
study found that the average cost of a net was US$3 (N240) while community members were only
willing to pay N36. Non-use was attributed to being hot under the net, side effects of the insecticide;
many people sleep outside on hot nights and frequently attend nightlong festivals.




5.     OTHER PROMOTION INFORMATION

5.1    Communication information
A variety of communication channels are available in the Nigerian market i.e. TV, Radio, Print
(newspapers and magazines), Outdoor, Cinema, Satellite Cable and Home Video 22


5.1.1 Telephone
The telephone system is average and limited by poor maintenance. Major expansions are in progress.



                                                                                                       17
5.1.2 Television
There are 59 TV stations in Nigeria, of which 50 are government owned and 9 privately owned. The
stations are mainly news based and focus on entertainment. TV viewership is estimated at 30+ million
people (limited by continuous power failure in the country), and TV ownership is estimated at 29% of
the population and 6.1 million television sets (based on 1998 national survey).

Table 8: Television channel coverage, ownership and cost of a 30-second spot

Channel              Coverage         Ownership           30” spot
                                                           price
AIT                  Lagos area        private              $ 66
MITV                 Lagos area        private              $ 58
OSRC                    West         Government
Galaxy                  West           private             $ 60
MST                     East           Private             $ 48
RTV                     East         Government
CTV Kano             Northwest       Government
Katsira STV          Northwest       Government
BATV                  Northeast        Private             $ 11
NTA Maidugari         Northeast      Government            $ 24


5.1.3 Radio
There are 66 Pan-Nigeria radio stations, of which 58 are government owned and 8 are privately
owned. Radio programs focus mainly on news, entertainment and music. Listenership of RADIO is
estimated at 65% of the population. On average 70% of the population own at least one RADIO at
home, with an estimated 17.2 million sets.


Table 9: Radio channel coverage, ownership and cost of a 30-second spot

Channel                 Coverage     Ownership     30” spot price
Ray Power                Lagos        private           $ 17
Radio Lagos              Lagos
OGBC2                  Lagos/West      private          $12
BCOS                      West
BCA                       East         Private
FM Port Harcourt          East
Radio Nigeria           Northeast      Gov’t.
Kaduna
BRC Bauchi              Northeast      private
Radio Nigeria           Northwest      Gov’t.
Kaduna
Radio Nigeria Kano      Northwest      Gov’t.


5.1.4 The Print Media
There are 66 NEWSPAPER TITLES in the country, of which only 16 are government owned and the
rest are privately owned. Of these 66 titles, 17 are circulated nationally. The rest are regional. The
average print run for newspapers is 45,000 copies daily. The frequency of publications ranges from
daily, weekly and evenings. The newspapers focus on news, general interest, politics, sports,
business and entertainment. Pass-on rate of an average newspaper is 5:1. The emergence of a radio



                                                                                                   18
programme on newspaper reviews as an alternative to reading newspapers has impacted on the
demand for the publications.



Table 10: Newspaper title, frequency and circulation

Title                  Frequency        Circulation
                                       (no. copies)
Daily Times                daily          45,000
National Concord           daily          40,000
The Guardian               daily          50,000
Champion                   daily          38,000


As with newspapers, MAGAZINES are privately owned, e.g. of the 50+ magazine titles available, only
8 are government owned and the rest are privately owned. Only 10 titles are circulated nationally, the
rest are regional. The average print run for magazines is 20,000 copies weekly. The frequency of
magazines ranges from weekly, bimonthly, monthly and quarterly with the same focus as newspapers.

Table 11: Magazine title, frequency/type and circulation

Title                 Frequency/Type                   Circulation
                                                      (no. copies)
TELL                  Weekly politics                    50,000
The News              Weekly politics                    47,000
Newswatch             Weekly politics                    40,000
The Week              Weekly business and                45,000
                      politics


The press medium (magazines and newspapers) is generally regarded as a medium for the elite and
the working class, with dominant patronage coming from the corporate world.


5.1.5 The Outdoor media
There are 90+ privately owned outdoor companies in the country managing over 75,000 hoardings (of
which 45% concentrate in the Lagos area).


5.2     Advertising and promotion companies
Media performance is measured mainly through the services of monitoring companies, such as Media
Monitoring Services and Research Marketing Services Media.

Advertising agencies charge a service fee (between 5% and 10%) on gross bills. Media owners allow
media commission to the agency between 15% and 20%. All costs attract 50% VAT.




                                                                                                   19
Table 12: Key players in the advertising industry

Name of Agency              Contact details            Telephone            FAX numbers and e-mail
                                                       numbers              addresses
Centrespread                Mr. Kolawole Ayanwale      (234-1) 4974627      (234-1) 4930316
(FCB affiliate)             3, Aawyer Crescent,                             cesp@alpha.linkserve.com
                            Anthony, Gbagada
                            Phase 1, P.O Box 59,
                            P&T Cappa, Lagos-
                            Nigeria
Ogilvy Benson & Mather      Chief O. Adeniyi           (234-1)              (234-1) 861883
(NIG ) Ltd.                 Williams                   861891/861882
(O&M affiliate)             2/4 Araoti street, Yaba,   /867295
                            P.O Box 2125, Lagos
Prima Garnet                Mr. Lolu Akinwunmi         (234-1)              (234-1) 4936783
Communications LTD          Plot 117, Aina George      967370 /
                            Street, Ilupeju, P O Box   967769 /
                            71398                      4936785
                            Victoria Island, Lagos
MC&A Limited                Mr. Victor O Johnson       (234-1) 014970095/   (234-1) 4970096
                            3, Shony Highway,          49770097/ 963386
                            Shombare Estate
                            Maryland, Ikeja, P O Box
                            4948
                            Surulere, Lagos

STB-McCann Lagos            Mr. Steve Omojafor         (234-1)
(McCann Erikson             356, Murtala Mohammed      860809/860825
affiliate)                  Way, P.O.Box 3633
                            Yaba, Lagos
 Insight Communications     Mr. Jimi Wosika            (234-1) 4949410-15   (234-1) 4979716
Ltd.                        17/19 Oduduwa street,
(Grey advertising           GRA, Ikeja, Lagos
affiliate)
Rosabel Advertising Ltd.    Chief Akin Odungi          (234-1) 49762104
(Leo Burnette affiliate)    31, Aromire Street, Off
                            Adeniyi Jones, P.O Box
                            12607, Ikeja, Lagos
Casers Limited              Mr. Enyi C Odigbo          (234-1) 4936587      (234-1) 4936588
                            1 Joel Ogunnaike Street,
                            G.R.A Ikeja, P.O. Box
                            53820, Ikeja, Lagos

Lawson, Thomas &            Mrs. Bola Thomas           (234-1)
Colleagues Ltd.             9, Randle Crescent,        5870464/5870607/
(JWT affiliate)             Apapa, Lagos               871350/871841
Group Africa (direct face   Mr. Guy Nixon              (234-1) 2695514/5    (234-1) 2695700
to face communication                                                       asdia@nigol.net.ng
agency)

DMS (direct face to face
communication agency)




                                                                                                       20
5.3    Market research companies

Table 13: Key players in the Market Research industry

Research agencies          Contact details         Telephone numbers    FAX number and e-mail
                                                                        address
Research & Marketing       Mrs. Margit             774 1623/ 492 4347
Services (RMS )            Cleveland                                    rmsmedia@cyberspace.net.ng
(focus on media, ad-hock
and in-home penetration
studies (omnibus)

Datagenesis Nig.Ltd.       Mr. B.N Konehi          497 8689
Focus on ad-hock
studies

Market Audit & Research    Mr. Desmond Nweke       774 3625/ 452 6199
Services (MARA)
(focus on retail
audits/distribution
checks)


Research International                             234 1 962 879
(RI)


AC Nielsen                                         234 1 962 879
(focus on ad-hock and
retail audits)




                                                                                                     21
ANNEX 1

Persons contacted

USAID
Mr. John Burdick
Liane Adams – Health and Child Survival Advisor

SC Johnson Nigeria
Mr. Godwin Oteri – General Manager
Mr. Joe Itamen – Marketing and Sales Manager
Mr. John Adekoje – Technical Regulations Manager
Mr. Willy Idemi – Customer Service Manager

SC Johnson Distributors
Mr. AT Olusanmi – Manager (De’Moshedec Distribution)
Mrs. KI Adenubi – Owner
Mrs. Fun’ke – Owner (Fun’fol Enterprises)

UNICEF
Dr. Emmanuel Gemade – Project Officer (Health)
Dr. Vanormellingen – Chief of Health and Nutrition

SC Johnson Research Agency – Data Genesis
Mr. Ben Konyehi

Group Africa
Mr. Gbolahan Mosaku-Johnson

SC Johnson Advertising Agency – Centrespread
Mr. Kolawole Ayawale – MD and CEO
Mr. Akim – Media Manager
Mr. Tunji
Mrs. Foluke Kamson – General Manager

Research Agency – RM Media
Mrs. Margit Cleveland – General Manager




                                                       22
ANNEX 2

Bibliography

1.    Federal Office of Statistics
2.    Food and Agriculture Organization (FAO) website www.fao.org
3.    Nigeria Survey The Economist 15th January 2000
4.    World Bank internet website: http://www.worldbank.org
5.    National Malaria Control Programme Plan of Action (1996-2001). Malaria and Vector Control
      Division Federal Ministry of Health P.M.B. 2014, Yaba.
6.    The Malaria Work Programme. Report on DFID-supported National Symposium on Malaria in
      Nigeria. 4-5 November 1997. Nigerian Institute of Medical Research, Lagos, Nigeria.
7.    De Savigny, D., MARA, Personal Communication, November 1999.
8.    Chandre F, Manguin S, Brengues C, Dossou Yovo J, Darriet F, Diabate A, Carnevale P,
      Guillet P. (1999) Current distribution of a pyrethroid resistance gene (kdr) in Anopheles
      gambiae complex from west Africa and further evidence for reproductive isolation of the Mopti
      form. Parassitologia. Sep;41(1-3):319-22
9.    Mapping Malaria Risk in Africa (MARA) website www.mara.org.za
10.   The Malaria Work Programme. Report on DFID-supported National Symposium on Malaria in
      Nigeria. 4-5 November 1997. Nigerian Institute of Medical Research, Lagos, Nigeria.
11.   Obwujekwe, O. Personal communication, December 1999.
12.   GATT, 1995.
13.   Goose, J., AgrEvo, Personal Communication, December 1999.
14.   PATH Canada. Malaria intervention for child survival in sub-Saharan Africa. Final report to
      IDRC, June 1997.
15.   Simon, J. Paper presented at ITN conference in Dar es Salaam, Tanzania. October 1999.
16.   Distributors Personal Communication March 2000
17.   Vestergaard, T., Vestergaard-Frandsen, Personal Communication, November 1999.
18.   Amajoh, C.N. The prospects of the use of insecticide impregnated materials (bednets, door,
      window and eaves curtains, window netting) for malaria control in Nigeria (1996) Malaria
      Society of Nigeria Newsletter 1 (1). July-December 1996.
19.   Path Canada Directory of Suppliers of Insecticides and Mosquito Nets for sub-Saharan Africa.
      Malaria Control with insecticide treated nets, June 1998.
20.   Breiger, W.R. Nwanko, E., Ezike, V.I., Sexton, J.D., Bremen, J.G., Parker, K.A., Robinson, T.
      Social and behavioral baseline for implementing a strategy of insecticide impregnated bednets
      and curtains for malaria control at Nsukka, Nigeria. International Quarterly of Community
      Health Education 1996-7; 16 (1): 47-61.
21.   Onwujekwe O, Shu E, Chima R, Onyido A, Okonkwo P. (2000) Willingness to pay for the
      retreatment of mosquito nets with insecticide in four communities of southeastern Nigeria. Trop
      Med Int Health. 2000 May; 5(5): 370-6.
22.   Centrespread Agency – Personal Communication March 2000




                                                                                                  23
ANNEX 3

Documents from the Abuja Summit

                               African Summit on Roll Back Malaria
                                         Summary Report

The African Summit on Roll Back Malaria was held in Abuja, Nigeria on the 25th of April 2000. It
reflected a real convergence of political momentum, institutional synergy and technical consensus on
malaria (and, to some extent, other infectious disease issues).

Forty-four of the fifty malaria-affected countries in Africa attended the summit. Nineteen country
delegations were led by the Heads of State, while the remaining delegations were led by senior
government officials including the Vice President, Prime Minister or, in some cases, the Minister of
Health. The Summit was also attended by the senior officials from each of the four founding agencies
-- Director General of the WHO, Vice President of the World Bank, Executive Director of UNICEF, and
Director of UNDP Africa, as well as other key partners including UNESCO, the African Development
Bank, USAID, DFID, CIDA, and the French Co-operation. The Heads of State and other delegates
reviewed evidence, debated options and ratified an action-oriented declaration with strong follow-up
processes. WHO, UNICEF, the World Bank, the African Bank, CIDA, DFID, USAID and other
development partners worked as one in supporting the preparation and the Summit itself. The next
stage for RBM in Africa will be intense: catalyzing more effective activity within communities,
strengthening capacity in countries, managing expectations and finding mechanisms to ensure
support for malaria actions within evolving health sector and human development strategies.

We sense that there has been a step-up in prospects for the next decade: it certainly felt like it in
Abuja as Heads of State, supported by Jeffrey Sachs, invited us all to re-appraise past thinking about
the costs for Africa's development associated with ill health, and the benefits of global support for
effective interventions in Africa.

Technical Briefing

Preceding the summit, a technical session was held at the same venue on the 24th of April 2000.
Ministers of Health, senior Ministry of Health officials and malaria control programme managers,
attended the technical session. Participants heard presentations on:

      Overview of malaria in Africa (significance of RBM),
      Burden of malaria,
      Evaluation of different intervention measures for malaria control in Africa,
      Health systems reform, policies and resource mobilization for malaria control,
      Use of insecticide treated nets (UNICEF experience in five African countries),
      Home management of malaria,
      Malaria vaccine development and field evaluation in Africa, and
      Malaria research in Africa.

Finally, the draft Declaration and the Plan of Action were thoroughly reviewed and debated. In closing
the session, a task committee was established to strengthen the draft Declaration and Plan of Action
in preparation for the Heads of State Summit.

African Summit on Roll Back Malaria




                                                                                                   24
His Excellency, Chief Olusegun Obasanjo the President of Federal Republic of Nigeria, chaired the
Heads of State Summit. The Summit ran the full day on the 25th April 2000 from 8:00 AM to 19:00 PM.
Delegates heard speeches from the Heads of State (or delegation), and the partner agencies. The
Summit concluded with the review and signing of the Declaration and the Plan of Action (all countries
present signed the Declaration).

By signing Declaration, the African leaders rededicated themselves to the principles and targets of the
Harare Declaration of 1997. They committed themselves to an intensive effort to halve the malaria
mortality for Africa's people by 2010, through implementing strategies and actions for Roll Back
Malaria, as agreed at the Summit. In addition, they agreed:

    to catalyze actions at regional level to ensure implementation, monitoring and management of
     Roll Back Malaria;
    to initiate actions at country level to provide resources to facilitate realization of RBM
     objectives;
    to work with partners towards stated targets, ensuring the allocation of necessary resources
     from private and public sectors and from non-governmental organizations; and
    To create an enabling environment in their countries which will permit increased participation
     of international partners in malaria control actions.

The Leaders resolved to initiate appropriate and sustainable action to strengthen the health systems
to ensure that by the year 2005:

    at least 60% of those suffering from malaria have prompt access to, and are able to correctly
     use, affordable and appropriate treatment within 24 hours of the onset of symptoms,
    at least 60% of those at risk of malaria, particularly children under five years of age and
     pregnant women, and benefit from the most suitable combination of personal and community
     protective measures such as insecticide treated mosquito nets and other interventions which
     are accessible and affordable to prevent infection and suffering, and
    At least 60% of all pregnant women, who are at risk of malaria, especially those in their first
     pregnancies, have access to chemoprophylaxis or presumptive intermittent treatment.


The Heads of State called upon all countries to undertake and continue health system reforms, which
will promote community participation and joint ownership of Roll Back Malaria actions to enhance their
sustainability. Health systems should make diagnosis and treatment of malaria available as
peripherally as possible, including home treatment, and accessible to the poorest groups in the
community. In addition, countries must continue to maximize vigilance to prevent the re-emergence of
malaria.

Development partners were called upon to cancel in full the debt of poor and heavily indebted
countries within Africa in order to release resources for poverty alleviation programs, such as Roll
Back Malaria and to allocate substantial new resources of at least US$ 1 billion per year to Roll Back
Malaria. Additional resources are also needed to stimulate the development of malaria vaccines
appropriate for Africa and to provide similar incentives for other anti-malaria technologies. The
collaboration between research institutions within Africa and partners throughout the World should be
strengthened and sustained to ensure the full utilization of research knowledge and programme
experience.
The Leaders themselves pledged:

    to implement the agreed Plan of Action within their own countries;



                                                                                                    25
    to develop mechanisms to facilitate the provision of reliable information on malaria to decision-
     makers at household, community, district and national levels, to enable them take appropriate
     actions;
    to reduce or waive taxes and tariffs for mosquito nets and materials, insecticides, anti-malarial
     drugs and other recommended goods and services that are needed for malaria control
     strategies,
    to allocate the resource required for sustained implementation of planned Roll Back Malaria
     actions;
    to increase support for research (including operational research) to develop a vaccine, other
     new tools and improve existing ones;
    to commemorate this summit by declaring April 25th each year as African Malaria Day;
    to call upon the United Nations to declare the coming decade 2001-2010, a decade for
     Malaria, explore; and
    To develop traditional medicine in the area of Malaria control.

The Leaders mandated the Government of Nigeria to report the outcome of this Summit on Roll Back
Malaria to the next OAU summit for follow up action. In addition, they requested the Regional
Committees of the African and East Mediterranean Region to follow up the implementation of this
Declaration and regularly report to the OAU and seek collaboration with UN agencies and other
partners.

The Summit host, His Excellency Olusegen Obasanjo, President of Nigeria, in his closing remarks
observed, "Today we have begun to write the final chapter of the history of malaria. We have raised
the hopes and expectations of our people - we must not let them down. We cannot afford to let them
down. May malaria be rolled out and development rolled in all African countries."

Reflections on Next Steps for the Global Partnership

The Abuja summit has provided both the momentum and tools required to transit into scaling up
phase at country level. The RBM partnership should take advantage of this opportunity to provide
much more clear information on available resources and procedures for accessing them, to swiftly and
systematically bring to conclusion the inception phase with the necessary drama for partnership
building, and to mount a concerted effort for inter-country activity.

1. Strengthening of country level resource base.
Several partners used the Summit as an opportunity to pledge additional resources to rolling back
malaria. The Secretariat should work with these partners to make these resources available, informing
countries as to the best method to access the resources.

2. Swift and systematic conclusion of the inception phase with country-level joint missions
and round table discussions
The RBM partnership should take advantage of the momentum generated by the Abuja summit to
launch scaling up activity in over 30 malaria-affected countries. This should be in line with agreed
strategies, plans of work, milestones, resource management mechanisms and monitoring and
evaluation frame and systems. This process has been facilitated by the adoption of the action plan,
targets and monitoring frame by the 44 country delegations that signed the declaration.

The inception process has already led to; broad-based consensus within countries, structured
situation analyses, and, in some cases, additional resources. The RBM partnership, working through a
series of rapid consultations, could, for each country, agree:
    a. Base-line situation in relation to the indicators agreed in Abuja



                                                                                                   26
   b. Milestones for scaling up of malaria interventions and strengthening of systems using the
      framework agreed in Abuja, and the draft strategy and situation analyses prepared by country
      partnerships
   c. Resources and sources to be committed in each country
   d. Financing arrangements and essential management capacities (paying particular attention to
      resource absorption issues) suited to each individual country scenario to ensure that the
      resources pledged in Abuja are disbursed efficiently and effectively.

It may be possible to stagger the commencement of the implementation phase across Africa:

   1. June - July 2000
      Country tracking information indicates that Botswana, Namibia, South Africa, Kenya, Ghana,
      Ethiopia, Eritrea, Mozambique, Mali, Zimbabwe, Sudan, Zambia, and Uganda, have either
      finalized or are about to finalize their national strategy documents. These countries would then
      be ready to bring the inception phase to a close and allow the partnership to commence the
      implementation of activities for scaling up. This could take place in June - July 2000 in these
      countries.

   2. October 2000
      By August 2000, Senegal, Mauritania, Burkina Faso, Tanzania, Niger, will have completed
      situation analysis and will be ready for implementation. A second round could take place in
      October 2000.

   3. November - December 2000
      By October 2000, Benin, Côte d'Ivoire, Togo, Gabon, Cameroon, Gambia, Chad, Nigeria,
      Djibouti will have completed situation analysis and should be ready for implementation which
      could take place in the November-December 2000 period.

   4. January - February 2001
      Angola, DRC, Sierra Leone, Liberia have already initiated intensive activity for rolling back
      malaria in a combination of approaches with some areas covered by government led
      partnerships and other through NGO activity. It should be possible working through the
      complex emergency network to mount a series of consultations towards more structured
      exercises for scaling up RBM activity by the beginning of next year.

Within the next nine months, scaling up activity could therefore be launched in over 30 malaria-
affected countries in line with agreed strategies, plans of work, resource management mechanisms,
and monitoring and evaluation systems.

3. Scaling up of inter-country activity
The Declaration explicitly calls for neighboring countries to work together on cross border strategies. A
plan for strengthening the existing multi-country initiatives should immediately be developed. In
addition, other countries should be encouraged to explore areas/issues for inter-country cooperation
and collaboration. Partners could work together intensively to plan a facility that will make this
possible, establishing institutional mechanisms to manage it, new approaches to enabling poor people
to access goods and services, and mobilizing the necessary resources for this purpose.




                                                                                                      27
                                                   AFRICAN SUMMIT
                                                          ON
                                                ROLL BACK MALARIA
                                                The Abuja Declaration
                                                          on
                                               Roll Back Malaria in Africa

                                    by the African Heads of State and Government
                                                    25 April 2000,
                                                    Abuja, Nigeria

We, the Heads of State and Government of African countries, meeting in Abuja, Nigeria on 25 April,
2000,

Recalling the Organization of African Unity (OAU) Harare Declaration of 4th June 1997 on Malaria
Prevention and Control in the context of African Economic Recovery and Development, and the
subsequent African Initiative for Malaria control in the 21st century which became Roll Back Malaria in
Africa in late 1998,

Bearing in mind other major Declarations on health and development adopted by the Organization of
African Unity,

Recognizing the disease and economic burden that malaria places on hundreds of millions of Africans
and the barrier it constitutes to development and alleviation of poverty,

Taking note that
    Malaria accounts for about one million deaths annually in Africa,
    Nine out of ten cases of malaria worldwide occur in Africa south of the Sahara,
    Malaria costs Africa more than US$12 billion annually, and can be controlled for a small
       fraction of that amount,
    Those who suffer most are some of the continent's most impoverished and that malaria keeps
       them poor,
    A poor family living in malaria affected areas may spend up to 25% or more of its annual
       income on prevention and treatment,
    Malaria has slowed economic growth in African countries by 1.3% per year. As a result of the
       compounded effect over 35 years, the GDP level for African countries is now up to 32% lower
       than it would have been in the absence of malaria,
    Malaria can re-emerge in the areas where it is under control,

Considering that malaria is preventable, treatable and curable,

Acknowledging:
    The strong commitment to improving health and promoting well-being of Africa's people by
      their governments, communities and development partners,
    That all African countries have signed and ratified the Convention on the Right of the Child
      (CRC) which recognizes the right of all children to good health and nutrition,

Appreciating the momentum offered by Roll Back Malaria movement to help reduce their malaria
burden,

Emphasizing that a unique opportunity now exists to reverse the malaria situation in Africa,


                                                                                                    28
1.    REDEDICATE OURSELVES TO:
     The principles and targets of the Harare Declaration of 1997.

     2. COMMIT OURSELVES TO AN INTENSIVE EFFORT TO:
     i. Halve the malaria mortality for Africa's people by 2010, through implementing the strategies
          and actions for Roll Back Malaria, agreed at the summit.
     ii. Initiate actions at regional level to ensure implementation, monitoring and management Of Roll
          Back Malaria.
     iii. Initiate actions at country level to provide resources to facilitate realization of RBM objectives.
     iv. Work with our partners in malaria-affected countries towards stated targets, ensuring the
          allocation of necessary resources from private and public sectors and from non-governmental
          organizations.
     v. Create an enabling environment in our countries, which will permit increased participation of
          international partners in our malaria control actions.

3.      RESOLVE TO:
     Initiate appropriate and sustainable action to strengthen the health systems to ensure that by the
     year 2005,
     i. At least 60% of those suffering from malaria have prompt access to and are able to use
          correct, affordable and appropriate treatment within 24 hours of the onset of symptoms.
     ii. At least 60% of those at risk of malaria particularly pregnant women and children under five
          years of age, benefit from the most suitable combination of personal and community protective
          measures such as insecticide treated mosquito nets and other interventions which are
          accessible and affordable to prevent infection and suffering.
     iii. At least 60% of all pregnant women who are at risk of malaria, especially those in their first
          pregnancies, have access to chemoprophylaxis or presumptive intermittent treatment.

4.      CALL UPON:
     All member states to undertake health systems reforms which will,
     i. Promote community participation in joint ownership and control of Roll Back Malaria actions to
           enhance their sustainability.
     ii. Make diagnosis and treatment of malaria available as far peripherally as possible including
           home treatment.
     iii. Make appropriate treatment available and accessible to the poorest groups in the community.
     iv. Continue to maximize vigilance to prevent the re-emergence of malaria.
           All development partners to:
     v. Cancel in full the debt of poor and heavily indebted countries of Africa in order to release
           resources for poverty alleviation programs including Roll Back Malaria.
     vi. Allocate substantial new resources of at least US$ 1 billion per year to Roll Back Malaria.
     vii. Invest additional resources to stimulate the development of malaria vaccines appropriate for
           Africa and provide similar incentives for other anti-malaria technologies.
     viii. Strengthen and sustain collaboration of research institutions within Africa and with partners
           throughout the World.
     ix. Foster the collaboration of research institutions with agencies implementing Roll Back Malaria,
           to ensure full utilization of research knowledge and programme experience.

5.      PLEDGE TO:
     i. Implement in our countries the approved Plan of Action attached to this Declaration.
     ii. Develop mechanisms to facilitate the provision of reliable information on malaria to decision-
          makers at household, community, district and national levels, to enable them take appropriate
          actions.

                                                                                                          29
   iii. Reduce or waive taxes and tariffs for mosquito nets and materials, insecticides, anti-malarial
        drugs and other recommended goods and services that are needed for malaria control
        strategies.
   iv. Allocate the resource required for sustained implementation of planned Roll Back Malaria
        actions.
   v. Increase support for research (including operational research) to develop a vaccine, other new
        tools and improve existing ones.
   vi. Commemorate this summit by declaring April 25th each year as African Malaria Day and to call
        upon the United Nations to declare the coming decade 2001-2010, a decade for Malaria.
   vii. Explore and develop traditional medicine in the area of Malaria control.

6. REQUEST:
The Regional Committees of the African and East Mediterranean Region to follow up the
implementation of this Declaration and report of the OAU regularly and seek collaboration with UN
agencies and other partners.

7. MANDATE:
The government of Nigeria to report the outcome of this summit on Roll Back Malaria to the next OAU
summit for follow up action in conjunction with the United Nations Agencies and other partners.




                                                                                                   30
                                 PLAN OF ACTION
                          FRAMEWORK FOR MONITORING
                     THE PLAN OF ACTION, ABUJA DECLARATION


A. ELEMENTS OF THE PLAN

PRIORITY AREAS             APPROACHES AND ACTIVITIES
                              Improve the managerial capacity of ministries of
                                Health. Ensure the existence of health policies and
                                integrated programs for priority disease management
                                and prevention. Develop core indicators to monitor
                                and evaluate progress of health system performance.
                              Promote decentralization of the health system in
                                order to improve access to services.
                              Build and strengthen capacity for health delivery at
                                district and community levels.
                              Health system decentralization should match
                                decentralization in other sectors.
                              Strengthen partnerships with NGOs and the private
Organization and                sector to provide universal coverage and access with
management of the health        built in complementarity, consistency and continuum
systems                         of care.
                              Build and strengthen partnerships with other sectors
                                whose activities promote malaria transmission, by
                                ensuring that Environmental Impact Assessment
                                (EIA), Health Risk Assessment (HRA) and Health
                                Risk Management (HRM) of all development projects
                                take place.
                              Broaden health-financing options at community level
                                so as to improve accessibility and affordability of
                                malaria treatment and preventive measures.
                              Strengthen existing financial management system to
                                ensure transparency, equity and probity in the
                                utilization of funds at all levels.
                              Develop packages of interventions to address priority
                                diseases (curative and prevention) such as IMCI.
                              Ensure the allocation of necessary resources and
                                facilitate collaboration of all members of the health
                                team in the delivery of priority intervention packages.
                              Encourage and support community based programs
                                for the early diagnosis, prompt and adequate
Disease management
                                treatment of malaria.
                              Take appropriate measures to ensure that adequate
                                treatment for severe malaria is available and
                                affordable for the poorest section of the community.
                              Improve the quality of diagnosis and treatment by
                                continuing training and supervision. Provide
                                functioning laboratory facilities, appropriate

                                                                                          31
                                 equipment and essential drugs supply at referral
                                 centers.
                                Provide health education and communication to
                                 schools, work places, and parents, especially
                                 mothers and persons caring for young children, on
                                 the recognition of malaria. Improve capacity for
                                 treatment at the home and for recognizing when to
                                 seek assistance for severe cases.
                                Establish guidelines for management of malaria and
                                 other priority diseases by health personnel at all
                                 levels.
                                Develop mechanisms to ensure adequate,
                                 uninterrupted and prompt delivery of supplies,
                                 especially drugs, insecticides and other malaria
                                 control related materials.
                                Produce and update National drug policies for all
                                 priority diseases and ensure their implementation and
                                 review across the government and private sectors.
Provision of anti-malarial
drugs and malaria control       Promote rational prescribing of anti-malaria drugs in
                                 both the public and private sectors. Establish or
related materials
                                 strengthen an efficient regulatory authority that
                                 critically reviews all applications for drug registration
                                 and has a strong inspection and enforcement
                                 capacity.
                                Support and contribute to the establishment and/or
                                 maintenance of national and regional independent
                                 drug quality control laboratories
                                Sensitize the population and promote preventive
                                 measures, such as house screening, ITN and other
                                 measures such as environmental management.
                                Support and encourage environmental measures
                                 taken by families and communities to reduce
                                 mosquito-breeding sites.
                                Support and promote the formulation and use of
Disease prevention
                                 traditional medicines for malaria control.
                                Support and promote the use of malaria preventive
                                 measures such as chemoprophylaxis and/ or
                                 presumptive intermittent treatment for pregnant
                                 women especially those in their first pregnancies.
                                Initiate strategies to prevent the re-introduction of
                                 malaria to malaria free areas.
                                Strengthen health information system to ensure
                                 reliable reporting of malaria cases and deaths as part
                                 of the integrated disease surveillance system.
                                 Provide such health information to health workers
Disease surveillance,
                                 and policy makers for appropriate decision making.
epidemic preparedness and
                                Establish an alert mid effective epidemic
response
                                 preparedness and response capability to detect and
                                 contain any outbreak as rapidly as possible.
                                Establish an effective system to alert malaria control
                                 authorities and policy makers in other relevant


                                                                                             32
                                sectors of new development projects, population
                                movements, as well as environmental and climatic
                                changes that could impact the malaria situation.
                               Promote essential multi-sectoral action to ensure that
                                projects and activities do not create vector breeding
                                sites, or expose workers, families and communities to
                                a risk of malaria. Enact and enforce appropriate
                                legalization and regulations to support control
                                strategies.
                               Promote awareness among the business community
                                on the negative economic impact of a continuing
                                malaria problem and influence them to provide
                                material and financial support to malaria control at all
Sustainable control             levels. Provide official recognition to those making
                                sustained and substantial contribution.
                               Provide special incentives such as soft loans,
                                exemption from excise, import and stiles taxes that
                                would reduce the cost of materials and supplies for
                                malaria control.
                               Establish and enforce appropriate legislation and
                                regulations that promote health and prevent disease.
                               Build and strengthen partnerships with schools and
                                work places to increase access to malaria treatment
                                and preventive measures.
                               Provide continuing education opportunities for health
                                services personnel and communities to enable them
                                keep abreast with national policy and guidelines on
                                malaria control.
                               Establish short, medium and long-term human
                                resources development programme following
                                capacity building needs assessment, for all levels of
                                health services delivery.
                               Ensure that standards and guidelines for case
Human Resources                 management, disease prevention, epidemic
Development                     surveillance, transmission and control are
                                incorporated into pre-service and other training
                                activities, and that they provide a basis for evaluating
                                competencies acquired by trainees during training
                                and work performance.
                               Regularly review the curriculum of schools of
                                medicine, nursing, public health, allied sciences and
                                other training institutions to ensure that they are up to
                                date with regard to national policies and disease
                                management standards.
                               In collaboration with appropriate institutions, develop
                                or strengthen the capacity and capability at all levels
                                to conduct research including interdisciplinary
Research including inter-
                                operational research on issues of direct relevance to
disciplinary operational
                                the control objectives, and ensure that results provide
research
                                guidance for programme changes as necessary.
                               Exchange research results between countries of the
                                region, particularly those sharing similar problems

                                                                                            33
                                 and interests.
                                Establish mechanisms for the development of priority
                                 research agenda and co-ordination at country level.
                                 Ensure that results are incorporated into control
                                 strategies.
                                Support multi-center studies for the development of
                                 vaccines, new drugs and tools for malaria control.
                                Promote research and development of traditional
                                 medicine.


B. INDICATORS FOR MONITORING
2000 -2005

                                No of countries with a health policy.
                                No of countries with district health plans which reflect
                                 the policy.
                                Policy of universal coverage for all with a basic
                                 intervention package, including malaria interventions.
                                Percentage of health facilities that have applied the
                                 intervention packages.
Organization and
                                Percentage of total Government expenditures
management of the health
                                 devoted to health.
system
                                Ratio of health expenditures between primary,
                                 secondary and tertiary facilities.
                                % of districts systematically collecting and using
                                 health information for planning.
                                No of countries with anti-malarial drugs policy.
                                No of countries with integrated disease Surveillance
                                 system.
                                % of districts at country level that are implementing
                                 IMCI at facility, community and household levels to
                                 manage childhood illnesses.
                                % of high-risk persons with a malaria attack getting
Disease management               appropriate treatment in eight hours.
                                No of countries with protocols for referrals at facility
                                 level.
                                % of household with access to anti-malarial drugs
                                 within 24 hours.
                                % of facilities with 1st and 2nd line anti-malarials
Provision of anti-malarial
                                 available
drugs and malaria control
related materials               % of facilities with adequate parasite detection
                                 services
                                % of under fives sleeping under ITNs.
                                % of pregnant women sleeping under ITNs.
                                % of pregnant women receiving chemoprophylaxis or
Disease prevention               presumptive intermittent treatment.
                                % of sprayed houses.
                                Development of legislation and regulations on control
                                 strategies for malaria.


                                                                                            34
                               % of health projects with environment and health
                                impact assessment.
                               % of malaria epidemics detected within two weeks of
Disease surveillance,
                                onset.
epidemic preparedness and
response                       % of malaria epidemics properly controlled within two
                                weeks of onset.
                               No of countries that have instituted tax reduction
                                measures or waivers on anti-malarial drugs,
                                insecticide treated mosquito nets and other anti-
                                malarial products.
                               % of countries where environmental risk factors for
Sustainable control
                                malaria are taken into account in the planning of
                                development projects.
                               No of countries where malaria prevention and
                                treatment seeking is integrated into primary school
                                curriculum.
                               Presence of technical skilled staff (including IMCI) at
Human resources                 the required level of service delivery.
Development                    % increase in knowledge, attitude and practices at
                                community level.
                               No. of new anti- malarial drugs and tools developed
                                for use at community and institutional levels.
                               % of countries with effective collaboration in
                                operational research between national institutions
                                and Ministries of Health.
Research including inter-      No of countries that have established mechanisms for
disciplinary operational        the development and co-ordination of priority
research                        research agenda at country level including vaccine
                                development.
                               Research findings incorporated into control
                                strategies.
                               New findings in traditional medicine.




                                                                                          35
C. FRAME WORK FOR REPORTING


INSTITUTIONS             MECHANISMS
                            The WHO/AFRO/EMR0 Regional Directors in
                             consultation with the OAU Secretary General will
1. REPORT TO THE HEADS
                             provide a progress report on the implementation of
OF STATE AND
                             the POA of the Abuja Declaration to the annual
GOVERNMENTS.
                             meeting of the Heads of State and Government of the
                             OAU.
    OAU MEETING OF
                            Evaluation -Extra ordinary meetings of Heads of
      HEADS OF STATES
                             State and Government will be held to review and
      AND GOVERNMENT
                             evaluate the progress made in the years 2005 (mid
                             term) and 20 10 (end of term).
                            The WHO/AFRO/EMRO Regional Directors in
                             consultation with the OAU Secretary General will
                             provide a progress report on the implementation of
                             the POA of the Abuja Declaration to the annual
2. REPORTING TO THE          meeting of the Ministers of Health of the OAU.
MINISTERS OF HEALTH         The WHO/AFRO/EMRO, Regional Directors, sub-
    OAU MINISTERS OF        regional groupings such as ECOWAS, East African
      HEALTH                 Community (EAC), Southern African Development
    REGIONAL                Community (SADC), Common wealth Regional
      COMMITTEE              Health Secretariat for Eastern and Southern Africa
      MEETING/AFRO/EMRO      (CRHSESA) and other partners in consultation with
                             the OAU Secretary General will provide a progress
                             report on the implementation of the POA of the Abuja
                             Declaration to the WH0 Regional Committee
                             Meetings for AFRO and EMRO.
                            The WHO/AFRO/EMRO Regional Directors in
3. REPORTING TO              consultation with the Project Manager RBM/HQ will
PARTNERS                     provide a progress report on the implementation of
    GLOBAL MEETING OF       the POA of the Abuja Declaration to the RBM Global
      PARTNERS ON RBM        partners meeting.
      (GENEVA)              The WHO/AFRO Regional Director will provide a
    REGIONAL MEETING        progress report on the implementation of the POA of
      OF PARTNERS / TASK     the Abuja Declaration to Regional meeting of
      FORCE ON RBM           partners/Task force on RBM.
    PARTNERS AT            Ministries of Health will report to partners at country
      COUNTRY LEVEL          level on progress made on the implementation of the
                             POA of the Abuja Declaration.
                            In collaboration with countries and partners
                             WHO/AFRO/EMRO will develop a format to enable
4. REPORTING BY
COUNTRIES                    countries use existing information to report annually
                             progress made on the implementation of the POA of
    ANNUAL REPORTS
                             the Abuja Declaration.




                                                                                       36
PRIVATE SECTOR/STAKEHOLDERS’ SITUATION ANALYSIS MEETING ON RBM IN NIGERIA,
APRIL 19TH 2000 AT NICON HILTON HOTEL, ABUJA


We, the private sector participants at the above mentioned meeting.


Recognizing the burden of Malaria in Nigeria.

Considering the disastrous effect of malaria on the socio-economic development of our people

Bearing in mind the renewed efforts and political will of the Government for controlling this disease in
the population of Nigeria

Noting
- that drugs will continue to play a major role in the control of malaria, and the use of insecticide
   treated bednets to reduce the mortality and morbidity associated with malaria.
- the fact that awareness and correct utilization of bednets and antimalarial treatment is very low.
- the importance of establishing a sustainable demand in a competitive market.
- the current high taxes and tariffs for chemicals and materials for vector control of malaria


Commit Ourselves to supporting Malaria control through RBM, by

1.     Producing good quality and affordable antimalarial drugs and insecticide treated bednets and
       making them available to all Nigerians.

2.     Supporting sustainable methods for informing and educating the public, especially the rural
       communities, on the use of antimalarial drugs and bednets, in partnership with all stakeholders

3.     Commercializing and making antimalarial drugs and insecticide for retreatment available to the
       public in special packaging formats to improve compliance – immediately

Call upon the Government to:

1.     Improve collaboration between the public and private sectors, by instituting immediately a
       standing committee headed by the minister of health

2.     Improve the regulatory environment for manufacturing and distribution of quality, affordable
       antimalarial drugs and ITNs, by NAFDAC and Standard Organization of Nigeria respectively

3.     Support the local drug and bednet manufacturers by creating an enabling environment for
       improved competition

4.     By mid 2,000, remove taxes and tariffs (similar to the waiver granted to agra-chemicals from 30
       to 0% with exemption from VAT) on the raw materials and to improve infrastructure (electricity
       and communications, water) needed to produce the drugs and bednets,

5.     Improve the financial allocation of federal funds to Primary Health Care, the management at
       the LGA level, and call upon increased support from partners

6.     Update immediately and implement the National Drug Policy (1990) by Federal Ministry of
       Health

                                                                                                        37
The undersigned, endorsed by the major partners in controlling malaria in Nigeria



 S/N   NAME OF PARTICIPANT              DESIGNATION/ORGANIZATION

 1.    George Sarkis                    Managing Director, SARKIS Nig. Ltd., Ikoyi, Lagos

 2.    Andy Tembon                      PHC Specialist, DFID, 18b Nasarawa Rd, Markurdi

 3.    W.E. Adetifa                     Pharmaceutical Director, Swisspharma Nig. Ltd., Lagos

 4.    I. M. Imam                       Medical Rep., Swisspharma Nig. Ltd., Abuja

 5.    R. A. Agbali                     Medical Rep., Swisspharma Nig. Ltd., Abuja

 6.    Sunday Agamah                    Medical Rep., Emzor Pharmaceuticals.

 7.    J. O. Adekoje                    Technical Manager, Johnson Wax

 8.    G. O. Oteri                      Managing Director, Johnson Wax

 9.    J. I. Odumodu                    Managing Director, May and Baker

 10.   Dr. D. I. Ukpong                 Deputy Medical Director, Mobil Nig. Lagos

 11.   G. N. Mbong                      ACHEO, FMOH, Abuja

 12.   Ramzi Abou-Hassan                Executive Director, Salennab Nig. Ltd.

 13.   Kodjo Soroh                      Medical Advisor, SmithKline Beecham

 14.   R. A. Lawal                      Sales Manager, C-Zard & Co.

 15.   Yinka Subair                     S.F.M. Sanofi Synthelabo, 118 Ogudu Road, Lagos

 16.   Chris Ufomadu                    PM/DRA, Novartis Pharma Services, Lagos

 17.   Dr. O. Kareem                    Programme Analyst, UNDP, Lagos

 18.   Philip Obomighie                 Medical Rep. Novartis Pharma Services, Lagos

 19.   Segun Yewande                    Managing Director, Sodequantum Ltd., Lagos

 20.   Charly Ibeawuchi                 AHC, DFID, Lagos

 21.   Frans Claassen                   UNICEF, Pretoria, South Africa

 22.   Jerry Wright                     C. Zard Nigeria

 23.   A. C. Dike                       Pharma Coordinator, St. Michael Pharma

 24.   Kola Kareem                      Chief Executive, Karran Bednets, Lagos

 25.   Yomi Isafiade                    Reg. ACCTE Manager, DHL Intl. Nig. Ltd.

 26.   Garba Abdu                       Programme Manager CHS, USAID Nig. Lagos


                                                                                                38
27.   Lynn Gorton                  Director, Health and Education, USAID, Lagos

28.   Dr. Pap Williams             ADB, DPU 316, ABIDJAN 01

29.   DR. F. Mueke                 WHO, Lagos

30.   Liz Tayler                   DFID, BHC, Abuja

31.   A. I. Eyeoyibo               Managing Director, Thompson ... & Sons. Ltd.

32.   J. O. Ayodele                Country Advisor, BASICS, 18 Temple Rd., Ikoyi

33.   A. A. Akinpelumi             Prog. Officer, BASICS, 18 Temple Rd, Ikoyi

34.   Dr. O. E. Nwokolo            SMOI, NMUCA

35.   Prof. L.A. Salako            CEO, FMOH/FVBL

36.   Prof. Sokomba                Director, NAFDAC

37.   MRS. S. O. Aiyegbusi         Deputy Director, NAFDAC

38.   Mrs. M. O. Otsemobor         Head, Parasitology Unit, FMOH

39.   Dr. (Mrs.) O. O. Ojo         Deputy Director (EPID), FMOH

40.   Tom Obaseki                  Acting General Manager, ChurchBells Pharma. Nig. Ltd.

41.   Lady (Mrs.) E. .U. Ekaette   President, Pharmaceutical Soc. Of Nigeria, (PSN), Lagos

42.   Loretta Chi                  President, AL Tech

43.   Ikwubiela Onobu              NTA, Abuja

44.   Dr. E. Arolede               Shell Petroleum Dev. Coy, 21/22 Marina, Lagos

45.   Dr. A. O. Asagba             Director, FMOH, Abuja

46.   Dr. L.K. Sadiq               WHO

47.   Alhaji Suleiman              Permanent Secretary, FMOH, Abuja

48.   Dr. M. O. George             WHO/     Harare

49.   R. K. Omotayo                Director, FMOH

50.   Mr. Kunle Okelola            Deputy Executive Secretary, PMGMAN

51.   Dr. Taiwo Avbayeru           Prog. Officer, CDPA/FMOH

52    Dr. E Abebe                  Director, PHCDC, FMOH

53    Dr. A. Awosika               Director/CE, NPI, FMOH

54    Dr. C. Voumard               Representative UNICEF

55    Dr. Koen Vanormelingen       Chief Health & Nutrition Section, UNICEF

56    Dr. E. Gemade                Program Officer Health, UNICEF


                                                                                             39
 57       Ms Sweet Giwa Osagie            PSFR Officer

 58       Soji Adeniyi                    Supply Officer, UNICEF
 59       Dr. Ntadom BNG                  M.O. NMVCD FMOH Yaba, Lagos

 60       Mr. Okunlola Abimbola           Project Manager NAZAKE Nigeria Limited, Bednet manufacturer,
                                          Lagos
 61       Mr. Olumuywa Alabi              Executive officer MUAS, Nigeria Limited, Bednet manufacturer,
                                          Lagos




8/24/00
      The purpose of this document is to serve as a resource for those interested in planning and
      launching ITN promotional activities in Nigeria.

      An initial briefing book was assembled by Ms. Rima Shretta of the Malaria Consortium in
      December 1999, who carried out a “desk review” and compiled already-existing information
      on ITNs in Nigeria and was updated by Jayne Webster of the Malaria Consortium in
      September, 2000. This expanded briefing book incorporates supplemental information
      obtained during in-country visits made in February and March by:
      Dr Michael McDonald, Technical Advisor, NetMark and BASICs; and Ms Mamapudi
      Nkgadima, SCJ Programme Manager for NetMark.




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