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Malaria has remained a huge challenge for many countries in Africa with increasing
mortality and morbidity from the disease. Due to its high mortality rates, it is imperative for
governments to develop policies that are aimed at reducing deaths related to malaria and reduce
the disease progression to fatal disease states, drug resistance to treatment and establishing
sustainable preventive strategies and policies. Malaria is a health issue of concern globally due to
the high mortality rates associated with the disease. According to World Health Organisation
(WHO), (2016), half the world’s population is at risk of malaria globally with Sub-Saharan
Africa contributing 88% of global malaria burden and 90% of global deaths from malaria.
Malaria is hence a key health concern and one that poses a substantial public health concern to
This paper will aim at using a policy analysis framework to analyse Malaria policies in
Ghana and Nigeria, by first describing the malaria policies in both countries. Secondly, the paper
will utilise a policy analysis framework to critically analyse the policies. Thirdly the assignment
will endeavour to address questions and queries on the policy, and create a question that will
elicit a need for further research.
The Malaria policies in both Nigeria and Ghana are based on the Abuja Declaration that was
signed in 2000 with the aim of reducing the prevalence of the disease with the call for rolling
back Malaria. The Declaration required governmental cooperation in reversing Malaria
prevalence and reducing malaria mortality through the strengthening of government and nongovernmental support in the fight against Malaria using already scientifically proven malaria
prevention and treatment approaches.
The Malaria policies in Nigeria and Ghana commonly address anti-malaria drugs policies,
malaria management and care and preventive strategies in the policies. Nigeria policy on Malaria
further include the procurement and financing of Malaria interventions in the country. Both
policies are government driven with other actors involved in the policy development being donor
organisations such as United Nations (UN) and other non-governmental stakeholders. The
policies fail to address future expectations and ramifications in future management and control of
Malaria, a vital aspect of the policies which would bring out a direction for continuity based on
Policy analysis framework and rationale
This paper uses the health policy triangle framework to analyse the Malaria policies in
Nigeria and Ghana critically. The policy triangle model is a model that examines the interrelationships between all factors of the policy development and implementation. The rationale
for using this framework was because it provides a holistic and inter-relational analysis of the
factors involved in policy. The framework generates a critical analysis of the context, content,
process and actors of the policy hence a thorough and systematic policy analysis can be
Policy analysis using policy triangle framework
Policy development actors vary, the actors can include, the government, donors, interest
groups among others. Malaria policies in Nigeria and Ghana are policies that were developed
through a government and non-governmental involvement. The governments, however, took the
lead role in advocating and development of the policies. The Malaria policy in the two countries
extensively addresses the management and prevention strategies. Primary prevention of disease
encompasses involvement of communities targeted by such policies, yet community involvement
in the policy development for both countries is lacking. Lack of proper involvement of
communities who are a primary consumer of the policies is a critical hindrance to the
implementation and success of preventive aspects of the policies. There is notable involvement
of other key stakeholders in Malaria such as World Health Organization, United
Nations departments and research organisations vital in driving antimalarial interventions which
The Nigerian policy comprehensively aims to address Malaria holistically including
prevention, management and research. Ghana policy on Malaria singles out management and
care as the key issue addressed. Both policies address prevention of Malaria as a key component
of care. The policies provide for the prevention of Malaria in pregnancy through a policy
provision on a Malaria prevention in pregnant women. All pregnant women are required to
receive intermittent preventive therapy (IPT), and to ensure they sleep under a treated mosquito
nets. Nwaefuna et al., (2015), in a study on the effectiveness of IPT established that the therapy
lowered malaria prevalence during pregnancy.
The policies outline the standardised treatment protocols for Malaria in both countries
with an anti-malaria drug policy. Ghanaian anti-malaria drug policy adopted the use of
artemisinin based therapy (ACT) in the treatment of Malaria, Sulphadoxine-pyrimethamine for
IPT in pregnancy, seasonal chemoprevention in the Northern areas due to the seasonal
prevalence of Malaria. The policy advocates for prompt treatment of all Malaria cases, this is
strengthened through policy directive for the utilisation of laboratory diagnosis prior to treatment
of Malaria, and tracking of patients on treatment. Landier et al., (2016), established that early
diagnosis and treatment is effective in preventing drug resistance and improving patient
outcomes in Malaria treatment. Other management options outlined in the policy include, indoor
residual spraying and insecticide-treated nets.
Nigeria’s Malaria policy outlines similar treatment and preventive strategies with some
key differences in treatment approaches. The policy allows for Malaria treatment at various
levels; home and in the hospitals. Home treatment is based on clinical diagnoses and does not
insist on testing as a way of ensuring quality in use of ACT. Clinical diagnoses of Malaria as
allowed in the policy is a critical loophole to increasing drug resistance due to possible wrong
diagnoses and treatment non-adherences for home treatments. Prophylaxis is advocated for sickle
cell anaemic individuals, visitors to Malaria endemic areas and pregnant women.
The policy further provides for the procurement, packaging of anti-malarial medications.
This is depends heavily on the private and non-governmental stakeholders in the policy
development to produce with the role of production and supply delegated from federal and state
government. The policy requires for the government to encourage local production of
antimalarial. Research is enshrined in the policy as a vital aspect in the fight against malaria and
ought to be need driven to advise changes and progress in disease management.
The content of the policies reviewed is based on scientifically proven interventions on
malaria treatment and prevention. There stands out some critical differences in policy directives
between the two countries which contradict the common goal of eradicating or reducing malaria
prevalence by 50%. Nigerian policies are both treatment oriented, vector control provisions and
management of drugs and procurement as opposed to Ghana which only leans more on
integrated holistic preventive and treatment policy. Such divergence is observed in the test and
treat option in Ghanaian policy which Nigerian policy allowing for clinical diagnoses even at
home level and level 1 hospitals. Such dissonance begs the question of standardisation of policy
development and implementation in Africa a large.
Context analysis any situational, structural, cultural and international factors that may
have a bearing on the health policy under review. The effects of such factors may strengthen or
weaken the policies. Perhaps the essential factor influencing policy in Ghana was the formation
of The US Government Malaria Strategy which aimed at establishing malaria-free zones in
Africa with a long-term aim of global eradication. This international development and Ghana’s
inclusion as one of the beneficiary countries strengthened the country’s malaria policy with
According to Salami and Kehinde, (2012), policy reversal, frequent change in leadership
and weak institutional patterns contribute immensely to failures in policy in Africa. Policies in
both countries are further affected by structural changes and shifts such as government and
political shifts through time. Nigeria’s periods of political instabilities, unstable oil prices (which
forms a bulk of the country’s revenues), could have had implications for the implementation of
its policies more so reach for the underserved communities. Awaisu, Kilu and Nana, (2014),
retaliate the negative effects political gimmicks have had on policy implementation in Africa
over the decades, health policies have been no exception to this. One key criticism to the success
of the malaria policies in both countries is the persistently high mortality and morbidity rates that
have remained over the years of their implementation. Whether it is a lack of political or social
goodwill is a question yet to be answered.
Process in policy analysis evaluates the way policies are developed, formulated,
communicated, negotiated and implemented. Process is a vital aspect of policy. At times, policy
can be developed based on a consideration of its advantages and disadvantages while other times
policy processes are incremental and are made with no real goals.
The policies discussed in Nigeria and Ghana are policies that were developed in
conjunction with many stakeholders, with a goal of reducing malaria infections in the countries.
The policy objectives were directed towards achievable targets which were to be achieved
through government support and contribution. The implementation of the malaria policies in
both Ghana and Nigeria are dependent on the government structures such as hospitals and drug
supply chains for implementation. Government factors hence are a key factor in the efficiency of
the policies. Involvement of international players such as WHO is essential as it provides a lead
role in treatment policy development. In Ghana, international support from the United States has
been an adjuvant in the implementation of the anti-malaria drugs policy.
The policy implementations are clearly outlined in the policy on malaria more so in
Nigeria which identifies the coordination of activities aimed at implementing the policy. Nigeria
emphasises a need for involvement of the community through mobilisation and advocacy for
behaviour change communication, use of publicity material to pass messages on the treatment
and prevention interventions. The policy outlines a structure through which policy
implementation is coordinated through the National Malaria Coordination Committee.
Policy implementation outlines critical points which would determine the success of the
policy. An important approach is the involvement of the community through mobilisations. I,
however, feel that community involvement in policy must not start at the implementation level
but from the point of conception of the policy. A key strength in the process of the policies in the
two countries is the formulation of the policies which was made with the adequate involvement
of other health and financing stakeholders. The policy formulation also involved an interactive
and deliberative process of identifying the alternatives available in malaria interventions hence
establishment of goal-oriented policy directives.
Malaria policies in both Nigeria and Ghana have been in place for many years since the
inception at the Abuja Declaration of 2000. Prior to the declaration Malaria treatment and care in
most both Nigeria and Ghana were disjointed and poorly coordinated, with no well-established
standards in management. Development of policies addressing these concerns has revolutionised
malaria prevention, care and improved access to treatment in the countries. There are notable
concerns and criticisms to the policy formulations, implementations and support both from
governmental and non-governmental actors in the policies discussed. Essentially policies in the
two countries have a common goal which is aimed at reducing malaria prevalence by 50%, this
achievement has been long overdue with achievements although critical, constantly missing to
achieve the ultimate goal despite the resources and efforts allocated towards such endeavours.
This constant failure of the policies to achieve the main aim is a gap that requires being
addressed to establish why malaria policies in Nigeria and Ghana have not achieved the ultimate
goal of 50% reduction in prevalence in over a decade?
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