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

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

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

Nigeria: Mapping State LGA 2015 Est Popn U5 2016 Est Popn U5   State LGA 2015 Est Popn U5 2016 Est Popn U5 2017 Est Popn U5 1 Bauchi 20 1,240,643 1,277,955 1,315,267 2 Borno 27 1,101,291 1,134,412 1,167,533 3 Jigawa 1,153,676 1,188,373 1,223,070 4 Kano 44 2,489,447 2,564,318 2,639,189 5 Katsina 34 1,536,744 1,582,962 1,629,180 6 Kebbi 21 859,192 885,032 910,872 7 Sokoto 23 980,797 1,010,295 1,039,793 8 Yobe 17 615,908 634,432 652,956 9 Zamfara 14 864,822 890,832 916,842 TOTAL 227 10,842,520 11,168,611 11,494,702

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

Target number of children Administrative coverage results Nigeria: Targets & coverage Target group Target number of children Administrative coverage results Severe Adverse Events reported 2015 2016 n % 3-11 months 150,088 348,883 151,432 101% 316,308 91% 1 5 12-59 months 642,045 1,474,915 636,043 99% 1,258,957 85% Total 792,133 1,823,799 787,475 1,575,265 86% The 2015 coverage represent 8.3% of total eligible children for SMC in Nigeria while the 2016 coverage represent 14.1% of total Eligible children for SMC in Nigeria Though the system is weak as regards reporting and documentation of PV cases, this is noticed in all ADRs and not only in SMC related. The toll free number was printed on the child card in local languages along with message to encourage parents to report. NAFDAC team in each state and National were coopted as trainers and supervisors

Nigeria: Targets & coverage for 2015 and 2016

Nigeria: Lessons learnt Training - I Numbers Trained 2015 2016 Comments 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 IEC resources 543 TA and 543 CM 1173 TA only Community Mobilizers were not used in 2016 following lesson learnt from 2015 Monitors 391 LGA Team 68 148 Total trained 9860 18,620

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 The supervisors training, the Health facility staff and the CHWs. This strategy has been useful in ensuring coordinated trainings- Key training levels / tools At each level of the trainings feed back received from the facilitators have been used to update the present field guide which is ready for adoption as a National tool making the training a practical has improved the understanding of the CHWs and enhance better delivery services of SM We have 3 levels of training: NTOT, STO, and step down trainings of 3 levels:

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.

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 SMC will go a long way in encouraging care givers to visit the health clinics. This also enable the health facilities staff to have a good control over the catchment communities of the health facilities.

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. Potential issues for consideration may include: - Appropriateness of tools (provide summary of key monitoring and supervision minimum tools) - Fitness-for-purpose, challenges and constraints - In-process monitoring and how data are used / not used to inform implementation - Supervision processes and gaps Quality assurance: How do you make sure children are reached 4 times? How do you assess adherence to home doses? Cross-checking age targets - Existence and reliability of coverage surveys or other surveys - Impact assessment (is there any?) and evaluation gaps

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 FMoH, Planning and FMoF, State Governments, Government parastatals (Customs, CBN and NFDAC) Indicates high acceptance of the intervention and a relief from malaria related illness which is suggestive of reduction in malaria cases and severity. Gaps analysis has been identified to estimate what support is needed. The state Government are being mobilized to allocate some funds for SMC in their budgets.