A conceptual framework on the role of backward integration in sustainable access to malaria intervention commodities in Nigeria

BACKGROUND: Over the last two decades, global stakeholders and the Nigerian government have invested approximately 2 billion in malaria control, reducing parasite prevalence to 23% from 42% to 2010. However, there is a risk that the modest gains will be reversed due to unmet resource gaps. Backward integration is presented in this paper as a viable option for sustainable funding of malaria intervention commodities in Nigeria. METHODS: Following a critical appraisal of the resource profile and malaria expenditure, a conceptual framework on backward integration as a means of ensuring long-term supply of malaria intervention commodities was developed. The study analysed secondary annual data from the National Malaria Elimination Programme to estimate commodity needs for the period 2018-2020, as well as total resources committed and the financial gap. RESULTS: The funds needed to implement national malaria interventions from 2018 to 2020 totaled US 1, 122, 332, 318, of which US 531, 228, 984 (47. 3%) were funded. The Nigerian government contributed 2. 5%, the Global Fund (26. 7%), the President's Malaria Initiative (16. 5%), and the UK Department for International Development (6. 2%). The funding shortfall was 591, 103, 335, or 52. 7% of the needs. Various funding scenarios were evaluated for their relative merits and limitations, including advocacy for more external funding, bank borrowing, increased domestic resources, and backward integration. CONCLUSIONS: The study concluded that backward integration should be used, based on a government-led public-private partnership that will increase local production of malaria intervention commodities that are accessible and affordable through market-based demand and supply arrangements.