SMC in Nigeria current status lessons learnt Dr

SMC in Nigeria: current status & lessons learnt Dr. Ntadom Godwin Head Case Management Branch NMEP, FMo. H, Nigeria 1

Nigeria: Operational Map Current geographical coverage (ideally maps for 2015 and 2016) 2

Nigeria: SMC policy § SMC has been adapted as a strategy to for the control of malaria in Nigeria. § It has been included in the 2014 -2020 National Malaria Strategic plan § National SMC Working Group was inaugurated in 2016 §Though included in the GF grant request for 2018 – 2020, there is still a huge funding gap which has been analyzed for external funders to key into 3

Nigeria: Mapping 1 Bauchi 20 2 Borno 27 3 Jigawa 27 4 Kano 44 5 Katsina 34 6 Kebbi 21 7 Sokoto 23 8 Yobe 17 9 Zamfara 14 2015 Est 2016 Est 2017 Est Popn U 5 1, 240, 64 1, 277, 95 1, 315, 26 3 5 7 1, 101, 29 1, 134, 41 1, 167, 53 1 2 3 1, 153, 67 1, 188, 37 1, 223, 07 6 3 0 2, 489, 44 2, 564, 31 2, 639, 18 7 8 9 1, 536, 74 1, 582, 96 1, 629, 18 4 2 0 859, 19 885, 03 910, 87 2 2 2 980, 79 1, 010, 29 1, 039, 79 7 5 3 615, 90 634, 43 652, 95 8 2 6 864, 82 890, 83 916, 84 2 227 10, 842, 52 11, 168, 61 11, 494, 70 0 1 2 State TOTAL LGA 4

Nigeria: Funding map Partner/Districts covered Number Eligible Districts* (LGAs) 2016 2017 2018 227 227 UNITAID DFID Euro Bond Total funded Unfunded (Gap) 37 LGAs 2 LGAs Nill 39 LGAs 188 LGAs 37 LGAs Nill 37 LGAs 190 LGAs * By WHO criteria 5

Nigeria: Targets & coverage Target group Target number of children 2015 2016 Administrative coverage results Severe Adverse Events reported 2015 n 3 -11 months 12 -59 months 150, 088 348, 883 2016 % 151, 432 n 642, 045 1, 474, 915 636, 043 792, 133 1, 823, 799 1, 258, 957 787, 475 5 0 0 1 5 85% 1, 575, 265 99% 1 91% 99% Total 2016 % 316, 308 101% 2015 86% 6

Nigeria: Targets & coverage for 2015 and 2016 2, 000 Target number of children 2015 1, 800, 000 1, 600, 000 Administrative coverage results 2015 1, 400, 000 1, 200, 000 1, 000 Target number of children 2016 800, 000 600, 000 Administrative coverage results 2016 400, 000 200, 000 0 3 -11 months 12 -59 months Total 7

Nigeria: Lessons learnt Training - I Numbers Trained 2015 2016 National Trainers 25 30 State Trainers 140 277 Supervisors 586 3292 Health Facility Workers 1354 1416 Community Health Workers 6601 11893 Public Criers, and other 543 TA and 543 IEC resources CM 1173 TA only Monitors 0 391 LGA Team 68 148 Total trained 9860 18, 620 Comments Community Mobilizers were not used in 2016 following lesson learnt from 2015 8

Nigeria: Lessons learnt Training – II § Trainings were decentralized for easy coordination and management § The use of a pictorial job aid for the training of CHWs made understanding of the MDA process easier. § Provision for adequate supervision and evaluation of trainings by engaging the states to provide more supervisors for the trainings may improve quality of training 9

Nigeria: Lessons learnt Delivery approaches § Two approaches were used, which are the fixed post and the house-to-house. The house-to-house method has been found to be a better choice based on coverage and acceptability. § We have integrated into the existing systems such as the DDIC, the LGA structure, the logistics tools and system, engaging volunteers that have experience of working in other health programs. § Poor motivation due to low remunerations remains a threat. § It is important to plan for how to overcome the challenge of difficult terrain. 10

Nigeria: Lessons learnt Eligibility and referrals § Age setting worked well in Nigeria because it has been used in the past for development accreditation. So the people are familiar with it. § The engagement of health facilities staff working in the clinics to attend to all referrers and also to administer § RDTs and ACTs availability was inadequate in some places, because the project relied on the existing system to provide. § Propose more engagement with the relevant authorities to ensure the availability of RDTs and ACTs is needed. § To continue to use the health facilities as referrer and fixed post 11

Nigeria: Lessons learnt Monitoring, supervision & evaluation of reach § Most of the tools were appropriate because where gaps were identified they were improved upon. Daily summary tools for capturing data at all levels on the daily basis were introduced in Nigeria § Paper-based data capturing methodology results in delay in transmission of data from the lower level up to National; electronic data transmission methods could improve timeliness § There is a generally low capacity for M&E among CHW acting as supervisors. There is a proposal to use teachers as supervisors in subsequent rounds. §The continued use of paper based systems for reporting, poor inventory control management and reporting. 12

Nigeria: Lessons learnt Key messages / recommendations / conclusions § Positive feedback from the health workers and communities §The country is exploring mobilizing resources from Euro-bond for SMC. § Poor commitment (and little resource allocated) to implementation of SMC by the Government, § To leverage on lessons from LLIN campaign’s State Support Teams concept to provide operational support to SMC implementation in the country §Joint advocacy team visit to the Ministers of FMo. H, Planning and FMo. F, State Governments, Government parastatals (Customs, CBN and NFDAC) 13

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