AS Nigeria joined the rest of the world to mark this year's World Malaria Day, April 25, Minister of Health, Prof Babatunde Osotimehin, in this interview with Sola Ogundipe, unveils a host of initiatives lined up by the Federal government to aggressively tackle the menace of malaria in the country. Ministry of Health . Excepts:

On this year's World Malaria Day, what's new in the national malaria response?

The World Malaria Day is another opportunity for us to take stock of what we have been doing, evaluate our response and decide on how we can do things better towards the ultimate goal of eradicating malaria from our country. Some people will hardly believe that we can eradicate malaria.

It is possible. It takes proper planning and getting everybody on board the train, especially at the level of leadership wherein examples are laid and direction is provided. There are many new angles now in our response which were not there before. We are taking the opportunity of the World Malaria Day of this year to unveil our plans and solicit cooperation of every stakeholder in the fight against malaria.

Specifically what are the new initiatives against Nigerians are expecting from the Federal Ministry of Health?

There are several. Our initiatives are encapsulated under an integrated approach to attacking malaria. We are attacking malaria very ferociously henceforth. With what we will be doing, Nigerians will notice a perceptible decline in the incidence of malaria very soon.

What are the components of this integrated approach?

The first approach is to enlist the support of all Nigerians. When everybody understands where we are going and what the essence of it all is, it would not be difficult to carry them along and get their cooperation. Mass mobilisation is the word. We intend to educate Nigerians along three major lines, which is, first, our plans and programmes; second, provide health information and education that will enable people make the right decisions about their health. This will, on the long, run lead to a vast reduction in the incidence of illness among the populace.

Our health education programme will cover malaria, diarrhoea, CSM, measles, polio, cancer, diabetes etc. If at the advent of certain symptoms, they are able to recognise that their health is at risk and therefore, take necessary steps to prevent a breakdown of health.

What is the third approach?

The third item on our mass mobilisation campaign list is distribution of bed nets and is the major activity in the next 12 months We are placing two mosquito nets in every household in Nigeria. These are not just the traditional mosquito nets as we used to know it. They are long lasting nets that have been treated with insecticides.

These do not just repel mosquitoes, they kill mosquitoes. The nets are special and very efficacious in tracking down and killing mosquitoes. They are called LLIN (Long Lasting Insecticidal Nets). This is a product of new technology. They are ready for use and are pre-treated. They are also dirt repellants and are kept clean longer than usual. The nets are such that such that if you have it in a room, mosquitoes within a considerable circumference will gravitate towards it and be killed immediately.

What I am saying is that mosquitoes will not be able to operate anywhere there are nets, and that is aside the issue of sleeping under it. The nets are also safe for pregnant women and children. From this you will agree that we can stamp out malaria by this singular measure of making nets available and getting them into the Nigerian household.

This is a massive programme. How do you intend to cope with the logistics of distribution?

We are not unaware of the difficult terrain we will be working in order to get this done, and this is where adequate planning comes in. From past experience in this country, we have to learn to confront challenges, no matter how difficult it appears. If we do not do that, we will not be able to achieve anything.

We need to confront and overcome the challenge of pessimism in order to move forward. The programme involves the placement of over 61 million nets into about 31 million households in Nigeria and we intend to reach everyone. It is indeed a very gargantuan plan. We have been making our plans underground are ready to launch now. We have taken so many things into consideration and we have done our best to take make provisions for unforeseen circumstances. All that needs to be done as regards mapping and planning has been done and we are right now putting measures in place to activate the plans.

Where are resources for this project coming from?

We have the resources. We need human resources and we have the people. We have leadership in the President, therefore, the resources we require from the government is available.

Very important also is the goodwill and support of our development partners. This is also a direct result of the confidence they have in us to deliver. So, with all of these put together, we have all we need. It does not mean there are no challenges in terms of resources, but the truth is we have enough with which to take off.

Apart from prevention with bed nets, what measures are Federal government taking with regards to treatment of malaria?

Before now, we used to treat with chloroquine. You need to give kudos to Nigeria when talking about malaria treatment. We came up with studies that showed that malaria had started developing resistance to chloroquine and based on that we took the bold step of phasing it out. Based on research in this country, a policy was developed in 2005 recommending use of Artemisinin based Combination Therapies (ACT) for treatment of uncomplicated malaria.

Since the commencement of the implementation of this policy in 2006, about 28 million doses of ACTs have been provided for distribution to all the states of the Federation by the Federal government and development partners. This is worthy of applause. If the states take it up from there, there will not be any need for anybody to buy malaria drugs in the market again. But we hope to get there very soon.

How do you intend to get there? Are you saying Federal government will provide malaria drugs free to the people?

Exactly. That is where we are headed. We have a couple of initiatives in this regard, which will come on stream and crystallise to free case management of malaria in Nigeria very soon. With the drugs we are providing at this point in time, we will be providing free case management of malaria with ACTs for about 80 per cent of cases. Not just that, there is a new initiative with which, working with the private sector, malaria drugs will be almost free even on the shelves of pharmacy shops. It is called AMFm meaning Affordable Medicines Facility malaria. It is essentially a global subsidy for malaria drugs.

What does this mean to the average Nigerian?

As I earlier said, it is an initiative towards the reduction of the price of ACTs. Championed by the Global Fund, it will reduce the manufacturer sales price of ACTs to public, profit and not for profit sector buyers of malaria drugs. The Global Fund will do this by negotiating a lower price for ACTs and then paying a large proportion of this directly to manufacturers on behalf of buyers. The agreement in this regard has been signed last month and Nigeria is one of the countries where the first phase of it is being piloted.

The sum total effect of this is that the cost of each treatment dosage will reduce by more than 20 times its original price. As a country, we thought it is right for us to take up the little cost remaining on the drug. The only other issue that might be outstanding is probably the cost of carriage and handling. It is the reason why I spoke about 80 per cent the other time. That is also yet another reason why I said the State Governments needs to take responsibility and come to the aid of the people. If the States can take up this cost, malaria drugs will become totally free in this country.

There are reports of free treatment for pregnant women?

On our own we are providing free anti malaria drugs for pregnant women. They don't need to pay for it at all. This is because we consider pregnant women as an especially vulnerable group. A woman should not have malaria at all during pregnancy. It is very dangerous to the woman and the unborn child alike.

Thus, for the prevention of malaria during pregnancy, using what we call Intermittent Preventive Treatment which is freely available to women attending ante natal, we have distributed over 800,000 doses of Sulphadoxine - Pyrimethamine (SP) and late last year, Federal government procured six million doses which are currently being distributed to the States. An additional six million doses have been procured by our development partners and distributed to the States in like manner.

How are you scaling up in order to achieve maximum impact within the populace?

So many measures are already in place and more are in the pipeline to enable us reach out to every Nigerian affected by malaria. We are determined to ensure that never again will malaria be a normal or usual disease for our people. As a matter of fact, we intend to start it from people's homes, which led to the development of home management of malaria at the household level. The idea is that people should be able to deal with malaria without going to hospital or seeing any health worker. In short, we are training every Nigerian to be a health worker.

This is also co-terminus with our mass mobilisation campaign. The concept of management of malaria at the household level has been broadened with the training of over 9,000 Role Model Mothers (RMM) in the communities spread across the States. With the feedback we are currently getting about this initiative, we will expand it considerably. We are also using integrated vector management as a battle ax against malaria, while working on indoor residual spray, environmental management, training and retraining of health workers and very importantly, research and development.