Efforts to eliminate malaria gather momentum
The Federal Ministry of Health (FMoH) has urged all stakeholders in the fight against malaria to accelerate all national and states plan of action geared towards total elimination of malaria in the country.
Permanent Secretary FMoH, Mr. Linus Awute, at the13th Annual Review Meeting of State Programme Managers of the National Malaria Elimination Programme (NMEP) in Abuja, last week, said that malaria reduces Nigeria’s Gross Domestic Product (GDP) growth by one per cent even as he stressed the need for continuous distribution of the Long Lasting Insecticidal Nets (LLINs).
Awute who was represented by the Director, Public Health, Dr. Bridget Okoeguale, said: “The focus on domestic financing for malaria control and elimination is apt, this forum once again presents a unique opportunity for the Malaria Programme Managers, Roll Back Malaria (RBM) partners and other Stakeholders to engage in an interactive manner to among other things review progress in the fight against malaria, identify impediments to rapidly scale up interventions and obtain critical updates in global trends and developments, with the ultimate goal of charting an accelerated way forward towards elimination.”
Meanwhile, as part of efforts to increase domestic financing and provide new but effective strategies towards malaria elimination, experts at the meeting reviewed the existing programmes even as they made recommendations of how to better services.
The stakeholders, in a communiqué released at the end of the meeting, noted the progress made over the years in reducing malaria prevalence that resulted to a nation-wide shift in malaria transmission pattern, and expressed satisfaction in the successful outcome of the bid for malaria grant under the Global Fund New Funding Model (NFM) for 2015-2016 to supplement resources for achieving the goals and objectives of the new National Malaria Strategic Plan (NMSP).
The experts including Okoeguale said the NMEP, state malaria elimination programmes (SMEPs), development partners and private-sector should prompt the Federal and State Governments to commit and release the counter-part funds required to fulfill the Global Fund NFM condition precedent through intensive high-level advocacy;
They also said NMEP, SMEPs and partners should advocate for the Federal and State Governments to institute innovative, domestic financing mechanisms- such as ‘sin’ taxes, community health insurance- specifically for funding malaria programmes in order to ensure sustainability.
The theme of the meeting was “Bringing to Light the Perspective of Domestic Financing in Malaria Elimination.”
Participants included Honourable Commissioners for Health; Directors from Federal and State Ministries of Health (MoHs); State Programme Managers and monitoring and evaluation (M&E) officers; Heads of Branches and Staff of NMEP; and members of the media. Representatives of development and commercial partners were also in attendance including the World Health Organisation (WHO), United Nation Children Fund (UNICEF), Malaria Consortium, West Africa Regional Network (WARN), United States Presidential Malaria Initiative (U.S.PMI), Department For International Development/Support for Nigeria Malaria Programme (DFID/ SuNMaP), Malaria Action Project for States (MAPS), Health Communication Capacity Collaborative (HC3), Association for Reproductive and Family Health (ARFH), Sustainable Healthcare Initiative (SHI), Clinton Health Access Initiative (CHAI), John Snow Initiative (JSI), Institute for Human Virology Nigeria (IHVN), Department of Defence (DoD), Global Business Coalition (GBC).
National Coordinator NMEP, Dr. Nnenna Ezeigwe, said the objectives of the meeting were to advocate and mobilize State-level stakeholders for support for malaria elimination in Nigeria; develop strategies for efficient resource mobilization and deployment for National and State programmes; and provide updates on current technical and programmatic issues including the Global Technical Strategy (GTS) for malaria (2016-2030), the Action and Investment for Malaria (AIM) and the National Malaria Strategic Policy (NMSP) 2014-2020; review progress made at all levels; and support State programmes in identifying gaps, implementation challenges and practical solutions.
According to a communiqué released at the end of the meeting, other recommendations include: NMEP should structure the strategies/interventions in line with subnational stratification by malaria risk as recommended by the new Global Technical Strategy; NMEP should strengthen malaria surveillance to function as a core intervention in line with the recommendations of the new Global Technical Strategy; NMEP, SMEPs and Partners (development and private-sector partners) should provide resources for regular production and distribution of HMIS forms; and funds for ensuring timely data entry into District Health Information System (DHIS 2), periodic data validation, regular On the Job Training (OJT) and supportive supervision, and monthly review meetings; SMEPs should ensure timeliness (before State budget approvals) in the review and development of Annual Operational Plans (AOPs), along with a Road Map; and demonstrate ownership and coordination of partner involvement.
DHIS 2 is the preferred health management information system in 30 countries and even more organizations across four continents. DHIS 2 helps governments in developing countries and health organizations to manage their operations more effectively, monitor processes and improve communication. DHIS 2 currently being used at various levels in 47 countries.
Others include: NMEPs and SMEPs should operationalize the National EQA Guidelines, identify gaps and build capacity of health workers in Quality Assurance (QA)/Quality Control (QC) for malaria commodities; SMEPs should engender State Governments to maintain existing malaria parasite sentinel sites and establish at least one in every State; and that NMEP, SMEPs and partners should accelerate Scale-up of Long Lasting Insecticide treated Nets (LLINs) and deployment of other vector control measures such as Indoor residual spraying (IRS) based on strict epidemiological and entomological monitoring.
Several issues were discussed extensively and these include: Poor data management and utilization for programming and re-programming of interventions at all levels; significant data quality issues at all levels across the country; lack of organizational capacity and resources in some States to develop and review AOPs, which are often not aligned with annual state government budgets; persistent quality assurance and quality control issues with Artemisinin Combination Therapies (ACTs), Rapid malaria Diagnostic Tests (mRDTs) and other malaria products yet to be addressed; and malaria parasite sentinel sites are inadequate and lack adequate State support.
Others include: Low level of Integrated Vector Management implementation and monitoring results have shown rising degrees of vector resistance to the commonly used insecticides; low improvement in the level of uptake and demand for some malaria interventions such as Intermittent Preventive Treatment in Pregnancy (IPT) and IRS use across the country; and lack of reports on commodity utilization as well as weak sustainability plans for Malaria Commodities Logistics System (MCLS) in several states.
Awute further stated:“ The ownership of at least one Insecticide Treated Net (ITN) per household increased from two per cent in 2003 to 55.5 per cent in 2013, according to the National Demographic Health Survey (NDHS 2013), and utilization by vulnerable groups also increased over the years. The number of pregnant women who sleep inside ITNs increased from five per cent in 2003 to 16 per cent in 2013 with similar increases also amongst children under five (from one per cent in 2003 to 17 per cent in 2013).
“More importantly, the 35 per cent reduction in under-five mortality over the last decade as demonstrated by the NDHS, from 201 in 2008 to 128/1000 live births in 2013, is largely due to the malaria control efforts in the country. Also the Rapid Impact Assessment conducted by NMEP in 2013 with the support of the Global Fund, demonstrated a gradual decline in reported health facility malaria deaths, which is attributed to the scale-up of ACT in recent years from the collective efforts of the RBM partners and stakeholders.
“However, we must work harder to improve on these figures bearing in mind that malaria reduces Nigeria’s GDP by 1% annually. Besides we need to key into the current global malaria agenda of fast tracking towards elimination.”
He further explained that the current global fund malaria grant has an incentive of $45.7million, stating that the incentive funding is for replacement campaigns in some states in Nigeria.
He said: “I wish to inform that the current Global Fund Malaria Grant has an incentive component of $45.7m, which is expected to be matched, dollar for dollar before it can be accessed. This incentive funding is earmarked for replacement campaigns in some States. However as of today, no source of that matching fund has been identified, meaning that unless these states provide the required finances replacement campaign cannot be conducted in these states.”
He went on: “ While we advocate for states to take up responsibility for the replacement campaigns, it is important that we strengthen the routine distribution channel. I am happy that the guideline for Routine Distribution is one of the policy documents to be presented at this meeting.”