In recent months, the UK government’s messaging on ‘Global Britain’ has increased, Cornwall has hosted the G7 summit and the Foreign Affairs Committee has launched an enquiry into the UK-Nigeria relationship following the release of the Integrated Review. With the UK also hosting COP26 (the UN climate conference) this November, it is clear that the government is making a concerted effort to present the UK as a geopolitical authority that will take the lead in overcoming the great global challenges of rebuilding from the COVID-19 pandemic, combatting the impacts of climate change and promoting secure and equitable trade.
‘Global Britain’, above all else, seeks to build resilience at home and overseas. To this effect, the UK government has identified Nigeria as a key ally. The Integrated Review said of Nigeria, “It is undoubtedly a key player in the fields of frontier technology, pharmaceuticals and public health and the balance of power in West Africa and the Sahel […] It is an increasingly important ally and trading partner to the UK […]”[1] Clearly, with eyes firmly focused on a post-Brexit world, the UK government is looking to identify opportunities to improve economic and diplomatic relations with Nigeria, both as a trading partner and as a potentially stabilising force in an unstable Sahelian region. Nigeria has its own security problems, particularly in the north of the country, yet it is the largest economy in Africa and holds a great deal of influence in African diplomacy. An increased presence in Nigeria may lead to further trading opportunities in the Sahel in the near future.[2]
Viewed from this lens, this is positive for both the UK and Nigeria. However, dig marginally deeper and there are glaring holes in this Global Britain approach. As a result of the UK aid budget being cut from 0.7 to 0.5 percent of Gross National Income (GNI) and GNI decreasing overall, this year the aid budget was unfortunately cut by £4.1 billion. This will severely impact Nigeria, with particular regard to ongoing health and disease programmes. Nigeria has the largest malaria burden in the world, accounting for 27 percent of global cases and 23 percent of global deaths each year.[3] This is a burden that creates a significant dampening effect on Nigeria’s economic and human potential. Adults who contract malaria are unable to work and generate income while they are ill, for themselves and their families; children who contract malaria require their parents who would otherwise be working to take care of them; children also miss school days, impacting their education which in turn makes it harder for them to secure the opportunities to contribute economically later in life. Out-of-pocket expenditure on health also continues to be catastrophic, especially for the poorest.[4]
Many aid programmes such as those with a focus on humanitarian assistance and our own Support to the National Malaria Programme 2 (SuNMaP2) have been cut by the UK government. Operational since 2018, SuNMaP 2 ceased with immediate effect three years before it was due to conclude. SuNMaP 2 was continuing the vital work begun by its precursor, SuNMaP (2008-2016), that was highly successful in targeting and planning effective intervention and saw national malaria prevalence decrease from 42 percent to 27 percent among children aged 6 to 59 months.[5] Additionally, the longevity and multi-faceted properties of SuNMaP and SuNMaP2 meant that while the primary focus was reducing Nigeria’s malaria burden, it used this as an entry point to support and strengthen the wider health system.
Malaria is both a cause and consequence of poverty – without structured, long term plans to reduce the malaria burden, Nigeria’s health system cannot be resilient. Lack of a resilient health system will keep people in poverty: it negatively impacts the education levels of the populace; reduces the rate at which an economy can grow; and limits employment opportunities. The consequences of this can be particularly severe for communities in rural and hard-to-reach areas, where limited access to vital malaria and other health services leaves them particularly vulnerable.
Dr Perpetua Uhomoibhi, National Coordinator of the Nigerian National Malaria Elimination Programme (NMEP), reinforced these points in a recent interview with Malaria Consortium.
“[…] In terms of what is at risk if investment and effort is directed elsewhere […] we start to experience a reversal of the gains that have been made […] that morbidity and mortality from malaria sink to the levels of 2000 […] we are also at risk of an inability to meet the country’s target towards achieving the 2030 global technical strategic target for malaria elimination. Increasing mortality and deaths from malaria would also affect the socio-economic development of the country as a result of huge out-of-pocket expenditure for malaria prevention and treatment services, as well as the huge [person-hours] lost due to absenteeism from work and caring for children with malaria […] We know that malaria is directly relational to poverty so the more people sick from malaria will affect socio-economic empowerment.”
The macro-level goals of the G7, along with the current manifestation of Global Britain, takes no account of the destructive impact that a parochial focus on trade and security will have in Nigeria. The consequences of regressive UK malaria policy and the withdrawal of malaria funding will keep many Nigerians in poverty and unfairly limit their human potential. Increased domestic financing and private sector contributions will play key roles as part of a collective approach towards health systems resilience and malaria elimination in high burden countries. Situated alongside the negative impacts of other diseases and health concerns, it becomes all the more imperative that the UK government rethink its approach and acknowledge that resilient health systems must form an integral part of any and all post-pandemic rebuilding strategies.
[1] https://committees.parliament.uk/call-for-evidence/478/implementing-the-integrated-review-in-nigeria/
[2] IMF World Economic Outlook (WEO), October 2020
[3] WHO, 2020. WHO, World Malaria Report. Found at: https://www.who.int/publications/i/item/9789240015791
[4] Wagstaff et al. Out-of-pocket expenditures on health: a global stocktake. The World Bank Research Observer, Volume 35, Issue 2, August 2020, Pages 123–157, accessed at: https://doi.org/10.1093/wbro/lkz009
[5] https://www.malariaconsortium.org/resources/publications/1214/support-to-the-national-malaria-programme-in-nigeria-2
Cover photo: Joe Darams on Unsplash