Eliminating Malaria in Nigeria: Five ways the US President’s Malaria Initiative for States (PMI-S) is making a difference

A health care worker counsels pregnant women on the importance of preventing malaria during pregnancy in Ishelu, Ebonyi State, Nigeria. Photo credit: Oluwatobiloba Akerele/MSH

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An estimated 76 percent of Nigeria’s population are at risk of malaria by living in high transmission areas.  Nigeria accounts for 27 percent of malaria cases worldwide and the highest number of deaths (24 percent) due to malaria in 2019 (World Malaria Report, 2020).  The U.S. President's Malaria Initiative for States (PMI-S) activity managed by USAID recognizes that “it takes a village” to achieve a malaria-free Nigeria. PMI-S is implemented in eight states -- Akwa Ibom, Benue, Cross River, Ebonyi,  Nasarawa, Oyo, Plateau, and Zamfara -- and works with health officials at all levels to improve quality and access to services, as well as reduce under-five and maternal mortality.  Here are five ways USAID is making a difference in Nigeria through PMI-S.

1. Improving skills for delivery of quality malaria services

[A health care worker trains a colleague in Agbowo Primary Health Care Center in Oyo State, Nigeria. Photo credit: Taiwo Olarinde/MSH]A health care worker trains a colleague in Agbowo Primary Health Care Center in Oyo State, Nigeria. Photo credit: Taiwo Olarinde/MSH

 

Through peer-led and cascade training, PMI-S supports the state malaria elimination programs and state primary health care development agencies to deliver better malaria services. Trained local health teams, in turn, train frontline health workers. The transferred knowledge and skills equip health care workers to conduct malaria tests, accurately calculate the dosage of medications, and appropriately refer severe cases. After facilitating the training, PMI-S seamlessly rolled out effective strategies for fever case management. According to health care workers, these prototypes improved adherence to national guidelines. 

“The training has had a positive effect on health care workers in my area,” said Grace Fasasi, malaria focal person, Ibadan North Oyo State. “They no longer reflexively treat fever cases with anti-malaria medication. Rather, they conduct additional tests and make referrals as needed. Not every fever is malaria.”

 

2. Improving evidence-based decision making

[Patients wait to receive malaria services in Agbowo Primary Health Care Center in Oyo State, Nigeria. Photo Credit: Oluwatobiloba Akerele/MSH]Patients wait to receive malaria services in Agbowo Primary Health Care Center in Oyo State, Nigeria. Photo Credit: Oluwatobiloba Akerele/MSH

PMI-S supports the National (NMEP) and State (SMEP) Malaria Elimination Programs in eight states with evidence-based strategies toward malaria control.  PMI-S uses data to measure malaria burden and program impact to support decision making by national- and state-level stakeholders about resource allocation.  One such strategy was collaboration with the Global Fund to develop a central National Malaria Data Repository where public health workers, program managers, and decision makers can access real-time data to track the progress of malaria control, advocate for adequate investments, support appropriate allocation and targeting of resources, and inform disease surveillance to eradicate malaria.

“The Repository is user friendly,” said Cyril Ademu, Monitoring and Evaluation Officer with the NMEP.  “I use the data validation application to identify facilities that are failing basic malaria data validation rules, so I can provide feedback to correct the errors. It has really simplified my work.”

3. Improving strategic documentation for health systems strengthening

[The NMEP electronic toolkit in use by a health care worker in Cross River State, Nigeria. Photo credit: Oluwatobiloba Akerele/MSH]The NMEP electronic toolkit in use by a health care worker in Cross River State, Nigeria. Photo credit: Oluwatobiloba Akerele/MSH

In 2019, PMI-S worked with NMEP to improve information sharing and coordination among malaria stakeholders.  They set up a platform where all strategic documents are archived and easily accessed by malaria program implementers, district health center directors, and non-governmental partners.  Called the NMEP malaria e-toolkit, the publicly accessible platform serves as a reference for planning and patient care.  It also contains up-to-date policies, guidelines, procedures, and job aids for managers and technicians in all malaria programs, as well as for health providers, students, government officials, and donors.

“The e-toolkit has addressed the major challenge of information sharing and coordination in malaria programs,” explained Abel Ajegbe, an IT Specialist with NMEP.  “It provides public health workers a platform where important policy guidelines are organized, up-to-date, and complete.”

 

4. Improving commodity supply for malaria treatment

[Health care worker conducting malaria rapid diagnostic test during cascade training in Cross River State, Nigeria. Photo Credit: Oluwatobiloba Akerele/MSH]Health care worker conducting malaria rapid diagnostic test during cascade training in Cross River State, Nigeria. Photo Credit: Oluwatobiloba Akerele/MSH

PMI-S trains malaria service providers on monitoring malaria commodity use and availability to prevent stock outs in health facilities. Subsequent improvements in maintaining commodity levels prompted PMI-S to encourage health workers in different communities to compare data on consumption and requirements of health facilities, and how to ensure regular supplies are maintained. PMI-S also partners with the USAID Global Health Supply Chain-Procurement and Supply Management Program to ensure availability of critical malaria commodities and rapid diagnostic test kits. 

5. Improving mother and child health in pregnancy through malaria prevention

[A pregnant woman takes her second dose of IPTp at Koseunti Primary Health Care Center in Oyo State, Nigeria. Photo credit: Oluwatobiloba Akerele/MSH]A pregnant woman takes her second dose of IPTp at Koseunti Primary Health Care Center in Oyo State, Nigeria. Photo credit: Oluwatobiloba Akerele/MSHPMI-S works with its eight SMEPs and hospital management boards to provide malaria prophylaxis for expecting mothers during pregnancy, and ensure they have a supply of safe drinking water in prenatal clinics.  The program trains prenatal care providers on the importance of observing their patients while they take their routine medication.  It also encourages adherence to malaria prevention guidelines for pregnancy to improve maternal and child health.

“Administering prophylaxis to pregnant women as “directly observed therapy” has become routine practice in our hospital since PMI-S support began,” explained Oluchi Eze, a maternity nurse at the general hospital in Iboko, Ebonyi State.  “The medication is available right at the antenatal clinic, courtesy of our hospital management.  We also provide clean water, at no cost, for pregnant women, who take their medication in our presence.”

About the U.S. President’s Malaria Initiative for States (PMI-S) project

The U.S. President’s Malaria Initiative for States (PMI-S) project is a five-year USAID flagship malaria project managed by Management Sciences for Health (MSH) with consortium partners Thinkwell, Banyan Global, and the Nigeria Interfaith Action Association (NIFAA). The project supports the Government of Nigeria through its agencies at the federal, state, local, and community level areas to reduce malaria related mortality by delivering quality services for prevention and management of malaria and its complications

PMI-S core objectives at the federal level and across target states (Akwa Ibom, Benue, Cross River, Ebonyi, Oyo, Plateau, Nasarawa, and Zamfara) are to: improve the quality of and access to comprehensive malaria case management; improve data quality interpretation and use; improve drug-based prevention and treatment approaches (Intermittent IPTp and SMC); and strengthen existing health systems, including improving NMEP and SMEP program management.