Nigeria's Malaria Gains Are Real. Lessons from Rwanda and Senegal Show How to Make Them Last
In this article, Scott Dubin, Lead, Fraud Prevention and Integrity at the Global Fund’s Office of the Inspector General and creator of the Logistics Marketplace, argues that Nigeria’s malaria gains will only be sustained if the country strengthens the systems that deliver medicines reliably to the point of care, drawing on lessons from Rwanda and Senegal on the importance of coordination and smarter use of existing capacity.
Nigeria has achieved some of the most ambitious malaria control campaigns globally. In 2023, nearly 29 million children were reached through Seasonal Malaria Chemoprevention – the highest number anywhere in the world, protecting children during the peak transmission season. Yet despite this achievement, the country still carries the heaviest malaria burden globally, accounting for roughly 27 percent of all cases.
This exposes a clear paradox. Nigeria can mobilise at an extraordinary scale when a campaign demands it. What it has not yet cracked is the same reliability, accountability, and coordination when it comes to routine care. Across nearly 1,900 health facilities surveyed in northern states, more than half reported stockouts of the malaria treatments needed by patients, not because the medicines were unavailable in the country, but because distribution failed to get them to the point of care.
Delivery failures are not neutral. They fall hardest on the most under-resourced and hardest-to-reach communities – the people most likely to be turned away from care because treatments are out of stock. As such, strengthening delivery systems is not only an efficiency issue, but an equity imperative that needs to be addressed with utmost urgency.
Nigeria already has much of what it takes to combat malaria. The challenge now is translating the efficiency of campaign logistics into everyday system discipline. Achieving this is arguably the quickest and highest-return investment the country can make in malaria today, especially as external health financing contracts and Nigeria, like other high-burden countries, faces growing pressure to do more with what it already has. That makes this the moment to use remaining support to strengthen delivery systems while it still exists. Once that support declines further, the cost of fixing broken logistics will rise significantly.
The question, then, is how Nigeria can make this shift.
Technology has a role to play. Today, one of the biggest constraints in Nigeria’s health supply chain is the difficulty of finding capable logistics providers. The country is home to many qualified providers able to deliver across the country, to the very last mile. Yet they often remain invisible to governments, donors, and manufacturers trying to move health products efficiently. This consistently results in a persistent mismatch between demand and supply, particularly during periods of heightened need.
Centralising this market – using technology to create a single, accessible space where buyers and logistics providers can find each other – therefore becomes important. Platforms like the Logistics Marketplace are beginning to address this by making qualified providers visible and streamlining procurement. Governments, global health partners, humanitarian agencies, and manufacturers can more easily identify, assess, and engage capable providers, turning existing capacity into capacity that is actually used.
But visibility at the system level is only part of the solution. The greater test is whether technology improves decision-making at the point of care. The goal should not be simply to track shipments, but to ensure that the person running a rural clinic knows what they have, what they are about to run out of, and how to trigger a resupply before patients are turned away. Without that level of visibility and agency at the frontline, digital tools risk becoming reporting mechanisms that serve the top of the system rather than the point of care.
Partnership with the private sector is equally central to closing this gap. Like in many other sectors, private logistics networks already move the majority of goods across Nigeria. Integrating this existing capacity into health delivery naturally becomes a practical way to extend reach without building parallel infrastructure. This must be structured so that integration is accountable, transparent, and performance-driven. Poorly designed collaborations carry risks, including inefficiency and diversion.
Senegal offers a lesson on how such partnerships could work. It was the first country to launch the “Zero Malaria Starts With Me” campaign, explicitly integrating the private sector into its response, and achieved a 73 percent reduction in malaria cases and a 13 percent decline in deaths between 2000 and 2019. Its progress was driven by strong national ownership, reliable data systems, and deliberate use of private sector capacity, including logistics. This is a model for what Nigeria could look like with stronger coordination between government and private logistics providers.
Rwanda also offers a complementary lesson on what is possible when delivery systems are treated as core infrastructure. Between 2016 and 2022, malaria incidence fell from 409 cases per 1,000 people to 76, while deaths dropped by more than 89 percent. These gains were not primarily driven by new drugs or major increases in funding, but by deliberate investment in delivery systems. Rwanda trained 30,000 community health workers to diagnose and treat malaria at home, built a reliable last-mile supply chain, and introduced data visibility so managers could act before shortages occurred. As a result, facility-level stockouts fell from around 10 percent to just 1 percent over five years. The lesson is that delivery system investment, not just health product investment, drives outcomes.
These successes are replicable in Nigeria, though we must not underestimate the intricacies of the country. Running reliable last-mile delivery across a country of more than 200 million people, with Nigeria’s geographic and infrastructure variation, is comparable to managing a commercial distribution network across multiple countries. But that level of complexity is not beyond reach. Nigeria already has the people, partners, and underlying capacity required – it now needs to coordinate them more effectively to deliver a reliable system.
Why This Matters
Nigeria's ability to reach nearly 29 million children through seasonal malaria chemoprevention demonstrates that the country can operate at scale. But the persistence of stockouts across more than half of surveyed health facilities in northern states shows that campaign-level ambition has not yet translated into routine system reliability — and it is the most underserved communities that bear the cost of that gap.
The experiences of Rwanda and Senegal suggest that this is a solvable problem. Both countries achieved significant reductions in malaria cases and deaths not by introducing entirely new tools, but by investing in delivery infrastructure, frontline capacity, and structured partnerships with the private sector. Nigeria already has many of these building blocks in place. The challenge is one of coordination, accountability, and sustained attention to the systems that move treatments from warehouses to the point of care.
With external health financing contracting, the window to make these investments is narrowing. Strengthening delivery systems now, while support still exists, is both the most practical and most equitable step Nigeria and other high-burden African countries can take to protect any malaria gains already made — and to ensure they last.