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

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

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

4. 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

5. 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

6. 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

7. Nigeria: Targets & coverage for 2015 and 2016

8. 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

9. 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:

10. 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.

11. 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.

12. 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

13. 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.