ACTwatch Lite - Nigeria 2024

The ACTwatch Lite Nigeria 2024 study provides critical insights into the private sector malaria commodity market across Lagos, Abia, and Kano states. This report highlights key findings from the study on market composition, availability, pricing, market share, supply chains, provider behavior, outlet characteristics and business practices, and regulatory challenges. The results serve as essential evidence to inform malaria case management, surveillance, and policy interventions, particularly within the private sector, which remains a dominant source of malaria treatment in Nigeria. Key results: PPMVs remain the main outlet type for antimalarial distribution, accounting for most market share. The antimalarial market is diverse, with no single predominant manufacturer or brand across the three states surveyed. ACTs and injectable artemisinins are increasingly dominant compared with previous surveys, yet there is an apparent disconnect between antimalarial availability and malaria testing in Abia and Lagos states. While antimalarials are primarily distributed through PPMVs in all three states, testing is only commonly found in PPMVs in Kano. WHO-prequalified and non-prequalified ACTs were similarly priced across all states. However, in Abia and Lagos, diagnostic tests were priced similarly or slightly higher than an adult-equivalent treatment dose (AETD) of ACTs, whereas in Kano, diagnostics were significantly cheaper, costing less than half the price of ACTs. Reporting of malaria cases remains extremely low in the private sector, even within formal outlets, while supervision of those who do report is minimal. These findings underscore the need for targeted interventions to strengthen malaria case reporting, improve diagnostic accessibility, and ensure effective regulation across different regions. Findings from the qualitative component reinforce these insights, highlighting persistent regulatory and economic challenges that affect product availability and affordability. Delays, high fees, and inconsistent enforcement hinder market entry and fair competition, while currency volatility and high import duties drive up costs. The prevalence of counterfeit products and supply chain inefficiencies further exacerbate market instability, with companies struggling to manage fluctuating demand and distribution constraints. Addressing these issues requires regulatory streamlining, economic stabilization policies, and enhanced supply chain management to improve the accessibility, quality, and affordability of antimalarials across Nigeria. Finally, scoping of e-pharmacies in Nigeria suggests that while this outlet type exists in the Nigerian marketplace, and may grow in its market share in future, currently the online sector appears to be relatively nascent, and gathering data from these outlet types may require further methodological innovation. Conclusion: The ACTwatch Lite study presented here provides standardized data for three states in Nigeria. These data contribute to evidence-base required for decision-making and strategic planning for malaria control efforts. The ACTwatch Lite approach offers a replicable model for other Nigerian states or other countries seeking to strengthen private sector surveillance and improve malaria case management.