Who benefits from the donor-supported malaria programme in Enugu State, Nigeria? A benefit incidence analysis

Nigeria bears the highest global burden of malaria, accounting for 25% of cases and 19% of deaths worldwide. Development partners provide substantial support for malaria prevention and treatment in Nigeria. This study examines the financial burden of malaria on households and the benefit incidence of donor-supported bed net services in Enugu State, Nigeria. We conducted an interview-administered household survey in urban, semi-urban and rural regions in Enugu State in 2020. We collected data on the use of malaria services and out-of-pocket (OOP) payments. Socioeconomic status (SES) was estimated using household assets ownership. The benefits of malaria services were calculated by multiplying the unit cost of services while the net benefit was calculated by subtracting OOP payment from the benefits. A concentration index was used to assess equity in spending on malaria across socioeconomic quintiles. We estimated the gross and net benefit incidences for malaria services by deducting the OOP payment from the gross benefits. Most respondents were women, married, and had attained secondary education. Over 53.9% of surveyed households owned bed net. About 31.6% of households used malaria drugs in the past months. All users paid OOP for malaria drugs, sprays and lab services and over one-third of households incurred OOP costs for bed nets. The total OOP expenditure for malaria in the past month was $0.53 per household. The gross benefit incidence for malaria services was $1836.7. The net benefit and donor benefit were $1679.5 and $705.4, respectively. Both gross and net benefit for malaria services favored less-poor households. Households in Enugu State incur OOP expenses for malaria diagnosis and treatment, and less-poor households benefit more from government- and donor- subsidized malaria services, including bed nets. It is imperative to improve the accessibility and affordability of malaria diagnosis and treatment in Nigeria to ensure equitable access to malaria services.