Access to Routine Insecticide-Treated Nets (rITNs) for Women and Children in Ogun State, Nigeria: The Impact of Dwindling Donor Funding

Access to Routine Insecticide-Treated Nets (rITNs) for Women and Children in Ogun State, Nigeria: The Impact of Dwindling Donor Funding | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Access to Routine Insecticide-Treated Nets (rITNs) for Women and Children in Ogun State, Nigeria: The Impact of Dwindling Donor Funding Frederick Ojo IFIJEH This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7767596/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Access to Routine Insecticide-Treated Nets (rITNs) for Women and Children in Ogun State, Nigeria: The Impact of Dwindling Donor Funding Ifijeh F.O 1 ; Bravo O 1 ; Oyeneye E.O 2 ; Biaghere P.O 3 Background : Access to routine insecticide-treated nets (rITNs) is a cornerstone of malaria prevention for women and children in sub-Saharan Africa, who face heightened risks due to pregnancy and underdeveloped immunity. In Ogun State, Nigeria, rITNs are primarily distributed through antenatal care and immunization services, with availability dependent on donor-funded supply chains. Sustained access is critical for reducing malaria transmission and achieving national and global elimination targets. Methods : A desk review of malaria data from the Nigeria Health Logistics Management Information System (NHLMIS) was conducted, covering January 2023 to May 2025. The review focused on 321 Global Fund-supported health facilities across all 20 local government areas in Ogun State. Results : Findings showed an average rITN availability rate of 74% and order fulfillment rate of 82% during the two-year period, indicating the effectiveness of donor-supported distribution systems. However, by May 2025, availability fell to 59% while order fulfillment rate dropped to 31% in over half of the facilities, following a significant reduction in U.S. financial commitments to the Global Fund. The U.S. has historically contributed approximately one-third of Global Fund resources. A scaling back of its support has ripple effects, particularly in countries like Nigeria, where over 60% of malaria elimination interventions depend on donor financing. This reduction directly disrupted procurement and delivery processes. This situation has exposed vulnerabilities in health system resilience and underscores the dangers of over-reliance on external funding 4 . Conclusions : The decline in rITN availability threatens to reverse gains in malaria elimination and increase preventable illness and mortality, particularly among high-risk groups. To ensure sustainability, Nigeria must prioritize domestic resource mobilization, such as state-level malaria trust funds, strengthen last-mile distribution through community-based models and establish public-private partnerships with local manufacturers and logistics providers. Health Policy Malaria prevention rITNs donor funding Nigeria supply chain NHLMIS Global Fund public-private partnerships Figures Figure 1 Figure 2 1.0 Introduction Malaria remains a leading cause of morbidity and mortality in sub-Saharan Africa, particularly among pregnant women and children under five years due to their heightened vulnerability to complications (World Health Organization [WHO], 2023). Insecticide-treated nets (ITNs) are a cornerstone of malaria prevention and have been credited with substantial reductions in malaria incidence and mortality over the past two decades (National Malaria Elimination Programme [NMEP], 2022; RBM Partnership to End Malaria, 2021). Routine insecticide-treated nets (rITNs), distributed through antenatal care (ANC) and immunization platforms, serve as a critical delivery mechanism to ensure consistent and equitable access among high-risk groups (WHO, 2023; NMEP, 2022). In Nigeria, the Global Fund has played a pivotal role in sustaining ITN procurement and distribution systems, especially through its support to the NMEP and affiliated state-level entities (NMEP, 2022; The Global Fund, 2024). However, recent reductions in donor contributions, particularly from major funders such as the U.S., have threatened the continuity and reliability of rITN availability (The Global Fund, 2024; Kates et al., 2023). These disruptions underscore the urgent need to examine donor dependency, health system resilience, and options for sustainable domestic solutions. 1.2 Problem Statement Despite proven effectiveness and established distribution channels, access to rITNs in Nigeria has become increasingly vulnerable to external funding dynamics. Ogun State, like many regions in sub-Saharan Africa, depends heavily on Global Fund-supported procurement and logistics systems for rITN delivery through health facilities (RBM Partnership to End Malaria, 2021). As donor contributions dwindle, especially the recent cutbacks by the U.S., a principal contributor to the Global Fund, rITN stock levels have declined significantly in supported facilities. This shortfall has disrupted prevention efforts and exposed critical weaknesses in the state’s ability to maintain commodity availability and coverage in the absence of external support (The Global Fund, 2024; WHO, 2023). Without urgent intervention, these gaps may reverse progress in malaria control and increase the disease burden among women and children. 1.2 Study Justification Routine ITNs are vital to Nigeria’s malaria elimination strategy and remain the most reliable prevention tool for vulnerable populations (WHO, 2023; RBM Partnership to End Malaria, 2021). However, donor-driven supply chains present a long-term sustainability challenge, particularly in settings like Ogun State where over 60% of intervention commodities are externally funded (NMEP, 2022; The Global Fund, 2024; Kates et al., 2023). Given the recent donor contractions, especially from high-level contributors such as the U.S., there is an urgent need to analyze the extent of disruption, quantify its implications, and propose viable, context-specific alternatives (Kates et al., 2023; WHO, 2023). The findings from this study will inform both policy and practice, guiding government and stakeholders on strengthening domestic supply-chain resilience and reducing dependency on volatile external resources. 1.3 Research Questions What has been the trend in routine insecticide-treated net (rITN) availability and order fulfillment rates in Ogun State, Nigeria, from January 2023 to May 2025? To what extent has the reduction in U.S. donor funding to the Global Fund affected the supply chain performance of rITNs in Global Fund-supported facilities? What are the implications of declining rITN availability on malaria prevention efforts among women and children in Ogun State? What alternative models (e.g., domestic resource mobilization, community distribution, or public-private partnerships) could enhance the sustainability of rITN distribution in the absence of robust donor funding? 1.4 Study Objective This study aims to assess the impact of dwindling donor funding on the availability and distribution of routine insecticide-treated nets (rITNs) for women and children in Ogun State, Nigeria, from January 2023 to May 2025. 1.4.1 Specific objectives include: 1. To examine trends in rITN availability and order fulfillment in Global Fund-supported facilities. 2. To evaluate the effect of reduced U.S. donor contributions on rITN supply chain performance. 3. To identify potential implications of stock decline on malaria prevention outcomes. 4. To explore alternative strategies for sustaining rITN distribution in the absence of robust donor support. 2.0 Literature Review Malaria remains a major public health challenge in sub-Saharan Africa, with pregnant women and children under five being the most vulnerable due to reduced immunity and heightened risk of complications (WHO, 2023). ITNs, particularly rITNs distributed through ANC and immunization services, are among the most cost-effective malaria prevention tools, contributing significantly to the decline in malaria-related morbidity and mortality (NMEP, 2022; RBM Partnership to End Malaria, 2021 ). Nigeria has adopted rITN distribution as a key strategy in its malaria elimination framework, with donor-funded programs, especially those supported by the Global Fund, playing a central role in procurement, logistics, and distribution (The Global Fund, 2024 ). However, this dependency on external funding introduces systemic vulnerabilities. The U.S., as one of the largest contributors to the Global Fund, provides a critical share of Nigeria’s malaria intervention resources (Kates et al., 2023 ). Consequently, any reduction in such commitments poses serious risks to sustainability. Recent trends show that dwindling donor support has started to negatively impact supply chains and stock availability at the facility level. Studies indicate that health systems in high-burden malaria countries often lack contingency mechanisms to absorb such financial shocks, thereby threatening the continuity of essential interventions (WHO, 2023; The Global Fund, 2024 ). This highlights the pressing need for diversified funding streams, enhanced supply chain resilience, and innovative public-private partnerships to ensure uninterrupted access to life-saving commodities. 2.1 Contributions to Literature : It provides new evidence on the link between donor dependency and supply chain vulnerabilities for routine insecticide-treated nets (rITNs). It draws attention to the gaps in health system resilience in the face of global funding shifts. The study proposes sustainable alternatives, including domestic resource mobilization and public-private partnerships, to ensure uninterrupted rITN distribution. This work adds critical insight to policymakers seeking to build long-term, self-reliant malaria control strategies in sub-Saharan Africa. 3.0 Study Method The study utilized logistics data on routine insecticide net (rITN) stock levels, distribution, and order fulfillment rates reported into NHLMIS across all 20 local government areas in Ogun State. Data were filtered to capture rITNs distributed through routine ANC and immunization service points. Facility-level reports were aggregated to assess trends in availability and supply performance. Key indicators analyzed included: ITN stock availability. Order fulfillment rates (quantities received versus quantities requested). Rate of stockout incidents over time. No human subjects were involved in the study, and only de-identified data were analyzed. 3.1 Study Design This was a retrospective, quantitative desk review using secondary data extracted from the Nigeria Health Logistics Management Information System (NHLMIS). The study employed descriptive analytics to examine routine ITN availability and order fulfillment rates over a 29-month period (January 2023 – May 2025). All health facilities receiving Global Fund-supported malaria commodities in Ogun State were included in the study. 3.2 Inclusion Criteria All public health facilities in Ogun State supported by the Global Fund for malaria interventions were included in the study. Facilities with NHLMIS data entries for routine ITNs between January 2023 and May 2025. 3.3 Exclusion Criteria Facilities lacking complete NHLMIS entries for the review period. Facilities not involved in rITN distribution (e.g., non-ANC or immunization service providers. 3.4 Data Analysis Data extracted from NHLMIS were exported to Microsoft Excel for cleaning and verification, then analyzed using SPSS version 25. Descriptive statistics, including frequencies, means, and percentages, were used to present rITN availability trends and order fulfillment rates. Line graphs and bar charts were employed to visualize temporal changes across the 29-month period. Comparative analysis was used to assess pre- and post-donor reduction effects, particularly after the 2024 U.S. funding cut. 4.0 Results Table 1 Mean Availability of routine insecticide net at GF-supported health facilities Cycle Mean Availability of Routine Insecticide Net (%) Jan-Feb March-April May-June July-August Sept-Oct Nov-Dec AVG Year 2023 65% 77% 77% 69% 71% 75% 74% 2024 73% 79% 84% 72% 71% 72% 2025 63% 59% The mean average availability of routine insecticide net from January 2023 to December 2024 was 74%. Table 2 Mean order fulfillment rate of routine insecticide net at GF-supported health facilities Cycle Mean Order fulfillment Rate for Routine Insecticide Net (%) Jan-Feb March-April May-June July-August Sept-Oct Nov-Dec Year 2023 56% 60% 60% 81% 53% 47% 2024 54% 58% 42% 125% 234% 378% 2025 62% 31% The mean order fulfilment rate from January 2023 to December 2024 was 104% 4.1 Discussion There was a steady on-shelf availability of routine insecticide net at public health facilities from January 2023 to December 2024 as shown in Table 1 above. The average order fulfilment rate for routine insecticide net for the same period was 104% as shown in Table 2 above. This demonstrates that uninterrupted donor supply chain positive influenced on-shelf availability of insecticide treated net. However, from January 205 to March 2025, on-shelf availability of insecticide treated net has dropped from 63% to 59% while the order fulfilment rate for the same period reduced from 62% in January 2025 to 31% in March 2025 (Tables 1 and 2 ). The findings highlight critical vulnerabilities in the rITN distribution system in Ogun State, largely driven by over-reliance on donor financing. The significant decline in availability and fulfillment rates following reduced U.S. contributions to the Global Fund supports concerns about sustainability (The Global Fund, 2024 ; Kates et al., 2023 ). Similar studies in Malawi, Uganda, and Tanzania have shown that donor withdrawal can disrupt malaria prevention services, particularly where governments lack domestic financing mechanisms (WHO, 2023). In Nigeria, over 60% of malaria intervention funding comes from external donors, with minimal budgetary allocation for routine ITN procurement by subnational governments (NMEP, 2022; The Global Fund, 2024 ). The disproportionate effect in rural communities indicates that underserved populations face compounded barriers to prevention, including access and affordability. This undermines equity in malaria control and puts the most vulnerable at further risk. 4.2 Implications for policy and practice The data underscores the importance of diversifying financing models to reduce vulnerability to external funding shocks. Establishing State Malaria Trust Funds, as done in Lagos and Kano States, may offer replicable models for Ogun and others. Integration of community-based distribution models and partnerships with local manufacturers and third-party logistics providers may improve last-mile delivery and buffer against funding delays. 4.3 Conclusion The study provides clear evidence that dwindling donor funding, especially from the U.S., has negatively affected the availability and distribution of routine insecticide-treated nets (rITNs) in Ogun State. This has exposed weaknesses in the state's malaria prevention infrastructure, especially in rural communities. Without urgent action to strengthen domestic funding mechanisms and supply chain resilience, recent gains in malaria control may be reversed. 4.4 Recommendations : Policymakers and program implementers must prioritize: Domestic resource mobilization, Public-private partnerships for ITN manufacturing and distribution, and Community-based distribution innovations. Declarations Ethics Approval and Consent to Participate : Not applicable. This study was based on a desk review of anonymized routine logistics data with no human or animal involvement. Consent for Publication: Not applicable. Funding: No external funding was received for this study. Authors' Contributions Ifijeh Frederick conceived the study, led the manuscript writing, and coordinated data interpretation. Bravo O extracted and analyzed the NHLMIS data. Oyeneye E.O contributed to the contextual interpretation of health facility operations and policy alignment. Biaghere. P supported literature synthesis and editorial review. All authors read and approved of the final manuscript. Acknowledgements: Ifijeh Frederick appreciates the support of the Ogun State Ministry of Health, Management Sciences for Health, Catholic Relief Services and staff of the National Malaria Elimination Programme for access to malaria logistics data. Authors' Information: Not applicable Availability of Data and Materials: The data supporting this study's findings were obtained from the Nigeria Health Logistics Management Information System (NHLMIS). Access to these data may require approval from the Federal Ministry of Health, Nigeria. Competing Interests: The authors declare that they have no competing interests. References Kates J, Michaud J, Wexler A (2023) The U.S. & the Global Fund to Fight AIDS, Tuberculosis and Malaria. Kaiser Family Foundation. https://www.kff.org National Malaria Elimination Programme (NMEP) (2022) Annual malaria program report: Nigeria. Federal Ministry of Health RBM Partnership to End Malaria (2021) High burden to high impact: A targeted malaria response. https://endmalaria.org The Global Fund (2024) Results report 2024. The Global Fund to Fight AIDS, Tuberculosis and Malaria World Health Organization (2023) World malaria report 2023. World Health Organization. https://www.who.int/publications/i/item/9789240079645 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Funding\u003c/p\u003e","fulltext":[{"header":"1.0 Introduction","content":"\u003cp\u003eMalaria remains a leading cause of morbidity and mortality in sub-Saharan Africa, particularly among pregnant women and children under five years due to their heightened vulnerability to complications (World Health Organization [WHO], 2023). Insecticide-treated nets (ITNs) are a cornerstone of malaria prevention and have been credited with substantial reductions in malaria incidence and mortality over the past two decades (National Malaria Elimination Programme [NMEP], 2022; RBM Partnership to End Malaria, 2021). Routine insecticide-treated nets (rITNs), distributed through antenatal care (ANC) and immunization platforms, serve as a critical delivery mechanism to ensure consistent and equitable access among high-risk groups (WHO, 2023; NMEP, 2022).\u003c/p\u003e\n\u003cp\u003eIn Nigeria, the Global Fund has played a pivotal role in sustaining ITN procurement and distribution systems, especially through its support to the NMEP and affiliated state-level entities (NMEP, 2022; The Global Fund, 2024). However, recent reductions in donor contributions, particularly from major funders such as the U.S., have threatened the continuity and reliability of rITN availability (The Global Fund, 2024; Kates et al., 2023). These disruptions underscore the urgent need to examine donor dependency, health system resilience, and options for sustainable domestic solutions.\u003c/p\u003e\n\u003cdiv id=\"Sec2\"\u003e\n \u003ch2\u003e1.2 Problem Statement\u003c/h2\u003e\n \u003cp\u003eDespite proven effectiveness and established distribution channels, access to rITNs in Nigeria has become increasingly vulnerable to external funding dynamics. Ogun State, like many regions in sub-Saharan Africa, depends heavily on Global Fund-supported procurement and logistics systems for rITN delivery through health facilities (RBM Partnership to End Malaria, 2021). As donor contributions dwindle, especially the recent cutbacks by the U.S., a principal contributor to the Global Fund, rITN stock levels have declined significantly in supported facilities. This shortfall has disrupted prevention efforts and exposed critical weaknesses in the state\u0026rsquo;s ability to maintain commodity availability and coverage in the absence of external support (The Global Fund, 2024; WHO, 2023). Without urgent intervention, these gaps may reverse progress in malaria control and increase the disease burden among women and children.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003e1.2 Study Justification\u003c/h2\u003e\n \u003cp\u003eRoutine ITNs are vital to Nigeria\u0026rsquo;s malaria elimination strategy and remain the most reliable prevention tool for vulnerable populations (WHO, 2023; RBM Partnership to End Malaria, 2021). However, donor-driven supply chains present a long-term sustainability challenge, particularly in settings like Ogun State where over 60% of intervention commodities are externally funded (NMEP, 2022; The Global Fund, 2024; Kates et al., 2023). Given the recent donor contractions, especially from high-level contributors such as the U.S., there is an urgent need to analyze the extent of disruption, quantify its implications, and propose viable, context-specific alternatives (Kates et al., 2023; WHO, 2023). The findings from this study will inform both policy and practice, guiding government and stakeholders on strengthening domestic supply-chain resilience and reducing dependency on volatile external resources.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1.3 Research Questions\u003c/strong\u003e\u003c/p\u003e\n \u003col\u003e\n \u003cli\u003e\n \u003cp\u003eWhat has been the trend in routine insecticide-treated net (rITN) availability and order fulfillment rates in Ogun State, Nigeria, from January 2023 to May 2025?\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eTo what extent has the reduction in U.S. donor funding to the Global Fund affected the supply chain performance of rITNs in Global Fund-supported facilities?\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eWhat are the implications of declining rITN availability on malaria prevention efforts among women and children in Ogun State?\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eWhat alternative models (e.g., domestic resource mobilization, community distribution, or public-private partnerships) could enhance the sustainability of rITN distribution in the absence of robust donor funding?\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ol\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003e1.4 Study Objective\u003c/h2\u003e\n \u003cp\u003eThis study aims to assess the impact of dwindling donor funding on the availability and distribution of routine insecticide-treated nets (rITNs) for women and children in Ogun State, Nigeria, from January 2023 to May 2025.\u003c/p\u003e\n \u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003e1.4.1 Specific objectives include:\u003c/h2\u003e\n \u003cp\u003e1. To examine trends in rITN availability and order fulfillment in Global Fund-supported facilities.\u003c/p\u003e\n \u003cp\u003e2. To evaluate the effect of reduced U.S. donor contributions on rITN supply chain performance.\u003c/p\u003e\n \u003cp\u003e3. To identify potential implications of stock decline on malaria prevention outcomes.\u003c/p\u003e\n \u003cp\u003e4. To explore alternative strategies for sustaining rITN distribution in the absence of robust donor support.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"2.0 Literature Review","content":"\u003cp\u003eMalaria remains a major public health challenge in sub-Saharan Africa, with pregnant women and children under five being the most vulnerable due to reduced immunity and heightened risk of complications (WHO, 2023). ITNs, particularly rITNs distributed through ANC and immunization services, are among the most cost-effective malaria prevention tools, contributing significantly to the decline in malaria-related morbidity and mortality (NMEP, 2022; RBM Partnership to End Malaria, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNigeria has adopted rITN distribution as a key strategy in its malaria elimination framework, with donor-funded programs, especially those supported by the Global Fund, playing a central role in procurement, logistics, and distribution (The Global Fund, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, this dependency on external funding introduces systemic vulnerabilities. The U.S., as one of the largest contributors to the Global Fund, provides a critical share of Nigeria\u0026rsquo;s malaria intervention resources (Kates et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Consequently, any reduction in such commitments poses serious risks to sustainability.\u003c/p\u003e\u003cp\u003eRecent trends show that dwindling donor support has started to negatively impact supply chains and stock availability at the facility level. Studies indicate that health systems in high-burden malaria countries often lack contingency mechanisms to absorb such financial shocks, thereby threatening the continuity of essential interventions (WHO, 2023; The Global Fund, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This highlights the pressing need for diversified funding streams, enhanced supply chain resilience, and innovative public-private partnerships to ensure uninterrupted access to life-saving commodities.\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.1 Contributions to Literature\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIt provides new evidence on the link between donor dependency and supply chain vulnerabilities for routine insecticide-treated nets (rITNs).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIt draws attention to the gaps in health system resilience in the face of global funding shifts.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe study proposes sustainable alternatives, including domestic resource mobilization and public-private partnerships, to ensure uninterrupted rITN distribution.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThis work adds critical insight to policymakers seeking to build long-term, self-reliant malaria control strategies in sub-Saharan Africa.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"3.0 Study Method","content":"\u003cp\u003eThe study utilized logistics data on routine insecticide net (rITN) stock levels, distribution, and order fulfillment rates reported into NHLMIS across all 20 local government areas in Ogun State. Data were filtered to capture rITNs distributed through routine ANC and immunization service points. Facility-level reports were aggregated to assess trends in availability and supply performance. Key indicators analyzed included:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eITN stock availability.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eOrder fulfillment rates (quantities received versus quantities requested).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eRate of stockout incidents over time.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eNo human subjects were involved in the study, and only de-identified data were analyzed.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Study Design\u003c/h2\u003e\u003cp\u003eThis was a retrospective, quantitative desk review using secondary data extracted from the Nigeria Health Logistics Management Information System (NHLMIS). The study employed descriptive analytics to examine routine ITN availability and order fulfillment rates over a 29-month period (January 2023 \u0026ndash; May 2025). All health facilities receiving Global Fund-supported malaria commodities in Ogun State were included in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.2 Inclusion Criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAll public health facilities in Ogun State supported by the Global Fund for malaria interventions were included in the study.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFacilities with NHLMIS data entries for routine ITNs between January 2023 and May 2025.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.3 Exclusion Criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFacilities lacking complete NHLMIS entries for the review period.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFacilities not involved in rITN distribution (e.g., non-ANC or immunization service providers.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Data Analysis\u003c/h2\u003e\u003cp\u003eData extracted from NHLMIS were exported to Microsoft Excel for cleaning and verification, then analyzed using SPSS version 25. Descriptive statistics, including frequencies, means, and percentages, were used to present rITN availability trends and order fulfillment rates. Line graphs and bar charts were employed to visualize temporal changes across the 29-month period. Comparative analysis was used to assess pre- and post-donor reduction effects, particularly after the 2024 U.S. funding cut.\u003c/p\u003e\u003c/div\u003e"},{"header":"4.0 Results","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean Availability of routine insecticide net at GF-supported health facilities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCycle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003eMean Availability of Routine Insecticide Net (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eJan-Feb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMarch-April\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMay-June\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eJuly-August\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSept-Oct\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNov-Dec\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAVG\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e69%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e74%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e72%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean average availability of routine insecticide net from January 2023 to December 2024 was 74%.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean order fulfillment rate of routine insecticide net at GF-supported health facilities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCycle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eMean Order fulfillment Rate for Routine Insecticide Net (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eJan-Feb\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMarch-April\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMay-June\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eJuly-August\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSept-Oct\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNov-Dec\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e53%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e125%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e234%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e378%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean order fulfilment rate from January 2023 to December 2024 was 104%\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Discussion\u003c/h2\u003e\u003cp\u003eThere was a steady on-shelf availability of routine insecticide net at public health facilities from January 2023 to December 2024 as shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above. The average order fulfilment rate for routine insecticide net for the same period was 104% as shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e above. This demonstrates that uninterrupted donor supply chain positive influenced on-shelf availability of insecticide treated net. However, from January 205 to March 2025, on-shelf availability of insecticide treated net has dropped from 63% to 59% while the order fulfilment rate for the same period reduced from 62% in January 2025 to 31% in March 2025 (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The findings highlight critical vulnerabilities in the rITN distribution system in Ogun State, largely driven by over-reliance on donor financing. The significant decline in availability and fulfillment rates following reduced U.S. contributions to the Global Fund supports concerns about sustainability (The Global Fund, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kates et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSimilar studies in Malawi, Uganda, and Tanzania have shown that donor withdrawal can disrupt malaria prevention services, particularly where governments lack domestic financing mechanisms (WHO, 2023). In Nigeria, over 60% of malaria intervention funding comes from external donors, with minimal budgetary allocation for routine ITN procurement by subnational governments (NMEP, 2022; The Global Fund, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe disproportionate effect in rural communities indicates that underserved populations face compounded barriers to prevention, including access and affordability. This undermines equity in malaria control and puts the most vulnerable at further risk.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Implications for policy and practice\u003c/h2\u003e\u003cp\u003eThe data underscores the importance of diversifying financing models to reduce vulnerability to external funding shocks. Establishing State Malaria Trust Funds, as done in Lagos and Kano States, may offer replicable models for Ogun and others. Integration of community-based distribution models and partnerships with local manufacturers and third-party logistics providers may improve last-mile delivery and buffer against funding delays.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Conclusion\u003c/h2\u003e\u003cp\u003eThe study provides clear evidence that dwindling donor funding, especially from the U.S., has negatively affected the availability and distribution of routine insecticide-treated nets (rITNs) in Ogun State. This has exposed weaknesses in the state's malaria prevention infrastructure, especially in rural communities. Without urgent action to strengthen domestic funding mechanisms and supply chain resilience, recent gains in malaria control may be reversed.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.4 Recommendations\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePolicymakers and program implementers must prioritize:\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDomestic resource mobilization,\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePublic-private partnerships for ITN manufacturing and distribution, and\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCommunity-based distribution innovations.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval and Consent to Participate\u003c/em\u003e:\u003c/strong\u003e\u003cp\u003eNot applicable. This study was based on a desk review of anonymized routine logistics data with no human or animal involvement.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNo external funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthors' Contributions\u003c/h2\u003e\u003cp\u003eIfijeh Frederick conceived the study, led the manuscript writing, and coordinated data interpretation. Bravo O extracted and analyzed the NHLMIS data. Oyeneye E.O contributed to the contextual interpretation of health facility operations and policy alignment. Biaghere. P supported literature synthesis and editorial review. All authors read and approved of the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\u003cp\u003eIfijeh Frederick appreciates the support of the Ogun State Ministry of Health, Management Sciences for Health, Catholic Relief Services and staff of the National Malaria Elimination Programme for access to malaria logistics data.\u003c/p\u003e\u003cp\u003eAuthors' Information:\u003c/p\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAvailability of Data and Materials:\u003c/h2\u003e\u003cp\u003eThe data supporting this study's findings were obtained from the Nigeria Health Logistics Management Information System (NHLMIS). Access to these data may require approval from the Federal Ministry of Health, Nigeria.\u003c/p\u003e\u003cp\u003eCompeting Interests:\u003c/p\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKates J, Michaud J, Wexler A (2023) The U.S. \u0026amp; the Global Fund to Fight AIDS, Tuberculosis and Malaria. Kaiser Family Foundation. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.kff.org\u003c/span\u003e\u003cspan address=\"https://www.kff.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Malaria Elimination Programme (NMEP) (2022) Annual malaria program report: Nigeria. Federal Ministry of Health\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRBM Partnership to End Malaria (2021) High burden to high impact: A targeted malaria response. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://endmalaria.org\u003c/span\u003e\u003cspan address=\"https://endmalaria.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Global Fund (2024) Results report 2024. The Global Fund to Fight AIDS, Tuberculosis and Malaria\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2023) World malaria report 2023. World Health Organization. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240079645\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240079645\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Management Sciences for Health","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Malaria prevention, rITNs, donor funding, Nigeria, supply chain, NHLMIS, Global Fund, public-private partnerships","lastPublishedDoi":"10.21203/rs.3.rs-7767596/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7767596/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAccess to Routine Insecticide-Treated Nets (rITNs) for Women and Children in Ogun State, Nigeria: The Impact of Dwindling Donor Funding\u003c/p\u003e\u003cp\u003eIfijeh F.O\u003csup\u003e1\u003c/sup\u003e; Bravo O\u003csup\u003e1\u003c/sup\u003e; Oyeneye E.O\u003csup\u003e2\u003c/sup\u003e; Biaghere P.O\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e: Access to routine insecticide-treated nets (rITNs) is a cornerstone of malaria prevention for women and children in sub-Saharan Africa, who face heightened risks due to pregnancy and underdeveloped immunity. In Ogun State, Nigeria, rITNs are primarily distributed through antenatal care and immunization services, with availability dependent on donor-funded supply chains. Sustained access is critical for reducing malaria transmission and achieving national and global elimination targets.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e: A desk review of malaria data from the Nigeria Health Logistics Management Information System (NHLMIS) was conducted, covering January 2023 to May 2025. The review focused on 321 Global Fund-supported health facilities across all 20 local government areas in Ogun State.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e: Findings showed an average rITN availability rate of 74% and order fulfillment rate of 82% during the two-year period, indicating the effectiveness of donor-supported distribution systems. However, by May 2025, availability fell to 59% while order fulfillment rate dropped to 31% in over half of the facilities, following a significant reduction in U.S. financial commitments to the Global Fund. The U.S. has historically contributed approximately one-third of Global Fund resources. A scaling back of its support has ripple effects, particularly in countries like Nigeria, where over 60% of malaria elimination interventions depend on donor financing. This reduction directly disrupted procurement and delivery processes. This situation has exposed vulnerabilities in health system resilience and underscores the dangers of over-reliance on external funding \u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e: The decline in rITN availability threatens to reverse gains in malaria elimination and increase preventable illness and mortality, particularly among high-risk groups. To ensure sustainability, Nigeria must prioritize domestic resource mobilization, such as state-level malaria trust funds, strengthen last-mile distribution through community-based models and establish public-private partnerships with local manufacturers and logistics providers.\u003c/p\u003e","manuscriptTitle":"Access to Routine Insecticide-Treated Nets (rITNs) for Women and Children in Ogun State, Nigeria: The Impact of Dwindling Donor Funding","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-06 11:54:56","doi":"10.21203/rs.3.rs-7767596/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"316b6cbb-0897-458f-bbeb-bc7ae34d62c7","owner":[],"postedDate":"October 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55680211,"name":"Health Policy"}],"tags":[],"updatedAt":"2025-10-06T11:54:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-06 11:54:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7767596","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7767596","identity":"rs-7767596","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}