Support to National Malaria Programme

This 12-page paper presents an overview of the Support to National Malaria Programme (SuNMaP) achievements, experiences, and lessons in the course of programme implementation in Nigeria, highlighting implications for other partners and ministries of health involved in implementing malaria control activities SuNMaP works to improve aspects of malaria prevention and control in the country, from facilitating the distribution of nets and distributing preventive malaria treatment for pregnant women through antenatal clinics, to management capacity building within the Ministry of Health National Malaria Control Programme (NMCP). According to the programme assessment, SuNMaP was able to increase coverage of Long Lasting Insecticidal nets (LLIN), promote demand creation for services and malaria prevention resources, and build local capacity for prevention and control.

According to the report, a key achievement was the substantial increase in house hold coverage with Long Lasting Insecticidal nets (LLIN) which has translated into higher LLIN use. The findings from national surveys indicate a rise in household ownership of at least one insecticide treated net (ITN) from 8% in 2008 to 42% in 2010, with household LLIN ownership higher in programme supported states, 50.4%. The use of LLINs also substantially increased, with proportion of children under 5 years who slept under LLINs the night before the surveys increasing from a baseline of 5.5% in 2008 to 28.9% in 2010. Use among children under 5 in programme supported states was slightly higher in programme supported states, 30.4%.
One of the lessons identified in the paper is that provision of commodities is not sufficient alone to bring about high coverage, knowledge among users of the effective and recommended interventions is needed and awareness of where services are available will help to promote prompt care seeking. Together these and other factors create the demand for services that, if matched with supply of quality services, will lead to better health outcomes. SuNMaP supports demand creation through mass media, and community related, and interpersonal communication channels at service delivery and community levels. With improved awareness and knowledge it is envisaged that health seeking practices will be better. The programme has also supported the generic marketing of LLINs, with a view to raising awareness and subsequently demand, thereby contributing to growth of the LLIN commercial sector.

In terms of general awareness and knowledge of malaria and its control interventions are generally quite high. There have been improvements in health seeking behaviour with 34.9% of children with fevers within the last 2 weeks taken for treatment within 24 hours as compared to the 15.2% at baseline. Among women of childbearing age, levels of knowledge of the benefits of LLINs, remain quite high (94%), as well as recognition of the need to seek treatment for malaria within 24 hours, which was up to 91%. Insights into the contextual factors and relevance of channels of communication are probed through community level assessments (CLA), for example while many of the respondents reported regularly using malaria prevention measures, some have indicated constraints such as the cost of purchase in rural settings and among some urban dwellers a feeling of heat or claustrophobia while under the net. However, most CLA respondents and virtually all pregnant women could recall the messages on the benefits of IPT and LLINs.

Lessons identified in supporting demand creation activities include that radio continues to be the most popular channel for delivery of mass media messages. Other channels include interpersonal communication channels through service providers, backed by communication support materials. The use of TV programming is to be considered as a possible channel, particularly as it was repeatedly mentioned by respondents (especially in urban and periurbansettings) as a vital source for health related information.
A feature of SuNMaP’s efforts in human and institutional capacity building is in sound programme management. The harmonised NMCP capacity building package, developed with support from SuNMaP, identifies key areas of planning and plan reviews, general management, monitoring and evaluation, and integrated supportive supervision as essential to the running of a functional malaria control programme. Other topical areas addressed in the package include procurement and supply chain management (PSM), records keeping .and accounting. By March 2o12, about 68 health management teams from SuNMaP supported states had benefited from capacity building efforts on malaria related programme management. Overall about 2,737 health workers and managers across all levels have participate in learning sessions from the capacity building package.