Category Archives: Nigeria

Malaria Consortium in Nigeria: reflections from a new Trustee

My name is Mark Clark and I recently joined the Board of Trustees of Malaria Consortium. My interest in tropical diseases stretches back to a formative summer placement in the early 1980s as a biochemistry undergraduate at Colombo University, Sri Lanka. It was there I first observed the devastating effects of malaria and lymphatic filariasis. Thirty years on and I am delighted to have the opportunity to crystallise this long-held interest at Malaria Consortium, an organisation which makes such a difference to so many lives across Africa and Asia.

Among my first requests on joining the Board was to participate in a field visit so that I could become better informed about Malaria Consortium’s ‘on the ground’ activities. Helping to provide fiduciary oversight and governance is very rewarding in itself but of course there is no substitute for seeing the valuable work of the organisation ‘in action’.

Nigeria currently carries the highest burden of malaria of any country globally and is Malaria Consortium’s single largest funding recipient; it was an obvious choice for a visit. The country team, based in the capital Abuja and headed by the exuberant and inspiring Country Director, Dr Kolawole Maxwell, had already provided me with an extensive itinerary. This comprised a series of counter-party and partner meetings and a trip to Niger state to view one of the most innovative programmes for integrated childhood care, known as RAcE (Rapid Access Expansion).

Mark Clark visits Malaria Consortium staff in Abuja, Nigeria

What was immediately striking from the meetings with Government and State officials, donors and partners, was the esteem with which Malaria Consortium is held in Nigeria. It is seen not only as a key partner in the fight against malaria and other childhood diseases but as one of – if not the – key drivers of innovation and access to care in what is a complex and often difficult healthcare environment.

As an observation at this point, my 30-plus year business career prior was filled with meetings where levels of scepticism between the two sides around the table was the norm – here every meeting I attended was warm, collegiate and with a shared sense of purpose. Very refreshing and very motivating!

The success of the eight-year, DFID-funded SuNMaP (Support to National Malaria Programme), which Malaria Consortium was the lead implementing partner, is widely acknowledged and appreciated. Furthermore, Malaria Consortium chairs the National Technical Working Group on Malaria and has gained a reputation for evidence based innovation in projects such as RAcE, the related iCCM (integrated community case management) activities, and ACCESS-SMC (Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention in the Sahel). We are optimistic about beginning a number of new programmes in the coming year, including some major programmes in nutrition, malaria and neglected tropical diseases.

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Prior to my visit to the project in Niger state, I attended a RAcE/iCCM sustainability workshop where the focus was on how these programmes could, in due course, transition from donor/NGO funding and oversight to federal/state funding and oversight. Of course, the ultimate target for Nigeria is for the government to operate an effective healthcare system for all, rendering the work of Malaria Consortium and other aid organisations unnecessary. However this can only happen in steps given the rather haphazard state of the current healthcare infrastructure, the lack of funding (Nigeria spends a low one percent of GDP on healthcare), and multiple other confounding geographic, political and social factors. It was nevertheless energising to see a group of like-minded individuals from all sides working together to devise a series of specific actions to try to ensure such a transition for RAcE/iCCM as of 2018.

Inevitably though it was the visit to the village of Butu in Paikoro, Niger state that will linger longest in my mind.

Butu is one of many villages in Niger state which benefit from Malaria Consortium’s RAcE programme, which delivers community-based diagnosis, treatment and referral of malaria, pneumonia and diarrhoea – the three biggest killers of under-fives in Nigeria. Central to the delivery of this programme are local community oriented resource persons (CORPs) who are supplied with training, educational materials and medical supplies. Their boxes contain diagnostic kits, artemisinin combination therapies (for malaria), antibiotics (for pneumonia), zinc and oral rehydration salts (for diarrhoea), and other medical necessities (e.g., sterile gloves and sharps boxes).

Our trip began with a two and a half hour drive from the state capital Minna on an increasingly pothole-ridden and near-impassable road. On arrival at Butu village (with the car’s axles thankfully intact!) we were met by the villagers and introduced to the CORP, a retired teacher. The CORP took us to his outbuilding, demonstrated the screening process for children who suffered fever, coughing, fast breathing or diarrhoea, and showed me how he logs each child in a register (which is shared regularly with supervisors in order to capture the records). In the first two weeks of October alone he had seen and treated or referred more than 20 sick children in the village, demonstrating the huge value he brings to the community – it’s truly worrying to think what would have happened had he not been available to those children, with the nearest hospital more than two hours away and with the transport difficulties I have already highlighted.

wavingAfter this I was introduced to the entire village and addressed by the village head who expressed his gratitude to Malaria Consortium for operating the programme. We in turn spoke about our vision where children can grow up without the threat of disease and stressed that the villagers should support the CORP as he is their ‘best friend’ in keeping the community healthy. We were then mobbed by a group of very excited children and many photographs were taken by those villagers with cameras or mobile phones! Notwithstanding the 20 or so sick children that the CORP had to see this month, my memory is of a village teeming with healthy, happy and excitable young children and for that we must, at least in part, thank the success of RAcE. It is why Malaria Consortium does what it does and it is truly heartening.

I have learned a huge amount this week and that I will carry through to perform my role more effectively as a Trustee going forward. Of course I have mainly highlighted the positives and it would be remiss not to re-state again the challenges, which largely revolve around the poor state of current healthcare infrastructure and the relative paucity of government funding. It is imperative for the foreseeable future that Malaria Consortium and its peers remain committed and motivated in this beautiful country if we are to see our mission through.

In closing I would like to express my gratitude for the extraordinary hospitality I received from Dr Maxwell and his team in Abuja and Minna. I was particularly pleased to be presented with a colourful Nigerian national outfit which will give me a new option for ‘dress-down Fridays’! The team in Nigeria really is of the highest quality, their reputation is second to none, and I am proud that they are carrying forward the vision of Malaria Consortium with such passion and involvement.

Malaria Consortium’s Edward Idenu receives best practice award

A child with severe malaria. Photo by William Daniels. 

In March, Malaria Consortium was invited to a meeting in Kampala, which brought together the partners of the Improving Severe Malaria Outcomes (ISMO) project. During this meeting I was delighted to receive an award for ‘Best Practice for Delivery’ in recognition of my work on the project.

A patient can make a complete recovery from severe malaria if it is caught in time and treated correctly. Unfortunately, however, of the estimated 216 million cases of malaria each year, approximately eight million of which are severe malaria cases, treatment is often too slow and makes use of incorrect drugs.

The ISMO project, comprising a consortium of partners: Medicines for Malaria Venture (MMV), Clinton Health Access Initiative and Malaria Consortium, aims to strengthen the market to accelerate access to, and uptake of, injectable artesunate – the World Health Organisation’s preferred treatment for severe malaria. However, market barriers have hampered its uptake. The treatment is expensive and buyers often have concerns due to there being only one World Health Organisation (WHO) already tested and trusted supplier.

Low uptake of injectable artesunate has affected its accelerated adoption, preventing potential new suppliers to delay in making major commitments to marketing the drug. The treatment has also not been readily accepted by providers and patients, due to a lack of advocacy, education and training at all levels.

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It is the role of the ISMO project to successfully create a stable and sustainable market for quality assured injectable artesunate with two or more suppliers, which will guarantee access to the treatment for severe malaria patients. This involves encouraging manufacturers to produce quality assured injectable artesunate and securing a commitment by donors to fund further production of the treatment.  The project is active in six countries, with Malaria Consortium focusing on implementation in Ethiopia, Nigeria and Uganda.

A major obstacle for countries implementing this project is the procurement, shipment, clearance and distribution of injectable artesunate. The process is often complicated by delays which lead to drug expiration, stock outs and subsequent poor uptake from clients. The duty of ensuring that these commodities are received and documented at the airport or sea ports is facilitated by the project with support from National Malaria Elimination programme (NMEP) – the government agency responsible for malaria interventions in Nigeria.

One of the key causes of delay is the time it takes for government documentation in support of the commodities to be issued by the Budget Office of the Federation, within the Federal Ministry of Finance, at the request of the Federal Ministry of Health. This cumbersome task normally takes between 8-12 weeks.

However, because of the strong partnership between NMEP, Malaria Consortium, and our partners in the Federal Ministry of Health, I managed to obtain a duty waiver for UNITAID injectable artesunate, to be used as part of the ISMO project, in just 14 days. It is for this that I received my award.

The timely receipt of the duty waiter ensured that the artesunate was cleared and distributed to all health facilities as planned. One of my main recommendations to partners working on this project is for all malaria commodities to be included in countries’ malaria strategic plans. This gives ownership to the government and ease of reference for commodities at the port of entry.

The award demonstrated the results that this project and its staff can achieve when they build networks and partnerships with government stakeholders. Going forward, the network established with key government partners will ensure speedy movement and delivery of commodities required for the next phase of the project.

Malaria Consortium’s RAcE project: Implementing iCCM in Nigeria

Dr Jonathan Jiya is the programme manager of Malaria Consortium’s RAcE project in Nigeria. He recently met with senior leaders of communities in Niger state to discuss the implementation of a project which aims to provide healthcare for 150,000 children under five by 2016.

Malaria Consortium’s Rapid Access Expansion (RAcE) project, funded by the World Health Organization (WHO) and the Canadian Department of Foreign Affairs, Trade & Development (DFATD) aims to improve the community-level management of childhood malaria, pneumonia and diarrhoea in Niger state, Nigeria. In rural areas of Niger state, there is a lack of healthcare services required to treat these conditions, which are the biggest killers of children under five.

The project builds upon existing community-based health interventions, such as integrated community case management (iCCM), and involves working with a number of Nigerian organisations, including the Centre for Communications Programs Nigeria (CCPN) and the Federation of Muslim Women Association Nigeria (FOMWAN).  Malaria Consortium is supporting the Ministry of Health in Niger state to implement iCCM activities in six local government areas (LGAs).

As the project leader for RAcE, I recently met with influential leaders, including senior community leaders and other stakeholders across the six LGAs, in order to mobilise resources and begin implementing iCCM activities. The LGA representatives welcomed the proposed meetings – there were never fewer than 40 people at each one. Discussions focused on the value of iCCM, on reasons why a programme like RAcE is necessary and on how best to select members of each community to take part in the project.

Community leaders and other key stakeholders were briefed on proposed iCCM strategies. As part of the project, Malaria Consortium will train over 1,700 community oriented resource persons (CORPs) and will consequently help to provide basic healthcare by 2016 to over 150,000 children in hard to reach areas of the six selected LGAs. CORPs will be trained to identify and treat the diseases, and will serve as both an access point and a form of continuity of care to existing healthcare systems.

The community leaders I met were asked to select responsible and well-respected members of their communities to be nominated as CORP volunteers. As one objective of the project is to build trust and cooperation between health systems and community members, the input of leaders in selecting role-models from the community is essential. Respected members of the community are in a strong position to influence others and to encourage behaviour changes which can prevent the spread of illnesses.

The second in command to the Emir in Lapai emirate, The Shaba Lapai, welcomed the opportunity to be consulted, saying, “This is the type of project we want. It will save the lives of our children and because the participation of community leaders has been recognised, we will support the project in any way we can for it to succeed”. He went on to say that the community will “support CORPs training and ensure that the community health committees function optimally for progress and abide by the given criteria for selection of CORPs”.

Hajiya Hauwa Usman, a participant at one of the forums, said: “Pneumonia, diarrhoea and malaria bring so much pain to mothers and families each year, especially during the rainy season. Malaria Consortium’s RAcE project will reduce this suffering and help children in their communities.” Mallam Garba Hussaini, an Islamic cleric agreed, stating, “We are appreciative of the effort of the state government and RAcE in selecting our communities to benefit from this project”.

The community forums also provided a chance to clear up logistical issues, such as the problem of a lack of storage facilities for the drugs that are being provided. In this instance, the concerns were addressed by promising the provision of portable storage facilities for each CORP. The most positive outcome of the meetings, however, was seeing that community leaders were appreciative of the opportunity to be included in the planning and implementation of RAcE.

 

Meet the health workers at the frontlines of disease control: Q&A with a rural health worker

Dorothy Ibrahim – rural health worker in Guaraka Nigeria

Dorothy Ibrahim is a rural health worker of many years’ standing. She is a proud contributor to the fight against malaria in the rural settlement of Gauraka, just outside Abuja in Niger State. Nigeria is one of the world’s most malaria endemic countries, accounting for approximately a quarter of all deaths from the disease worldwide. Kolo Yakubu, Senior Technical Malaria Officer at Malaria Consortium in Nigeria, spoke to Dorothy about her role as a rural health worker and the impact that SuNMaP – Support to National Malaria Control Programme – a partnership programme led by Malaria Consortium, has had on her role.

You’ve been working for many years in this area. What changes have you seen during that time?

When I first started working here, many years ago, I would do all that the books demanded but still lose the baby. Severe malaria claimed the lives of one in 15 children under-five in my area. The traditional healer would prescribe herbal concoctions and tell parents that their baby would get well before morning. But the baby would die of worsened fever that same night.

Years went by and the local health centre was upgraded to a model primary healthcare centre. There was more modern equipment and training from SuNMaP, as well as long-lasting insecticidal nets (LLINs) and intermittent malaria preventive therapies for pregnant women (IPTp). All these have changed the course of service provision. Nowadays, I never see severe cases of malaria in babies at all.

How would you describe your role in malaria control in Gauraka?

I support the home management of malaria by working with community volunteers that we call community care givers. They work with local people to identify fevers and give drug treatment as necessary. I tell them to refer persistent fever cases to me. I also give talks about how to hang the LLINs properly and take care of them, and encourage environmental sanitation and hygiene.

Since the LLINs and IPTp support to first time mothers started, cases of anaemia and severe malaria have declined. There have been none at all in the three years since SuNMaP began.

Support to National Malaria Control Programme

These positive changes have been facilitated by SuNMaP – Support to National Malaria Programme – and other agencies in collaboration with the State Malaria Control Programme (SMCP). SuNMaP provides support to the Nigerian government and people in tackling the massive burden of malaria in the country. It is implemented by international and local partners, funded by UKAid and managed by Malaria Consortium. SuNMaP works in close co-operation with Nigeria’s National Malaria Control Programme (NMCP), in selected states and Local Government Areas (LGAs) across the country.

In addition to mosquito nets and drugs for malaria treatment, SuNMaP has provided training to senior management staff at the LGA level, which has been cascaded down through the LGA to staff, like Dorothy, in health facilities across Nigeria.

Nigeria: Effective diagnostics at the local health centre helps keep malaria under control

Kabir Lawal, Market Support Officer under the Support to the National Malaria Programme (SuNMaP) project in Nigeria, interviews Sanni Garba, laboratory technician, in the rural community of Gauraka.

Sanni Garba is a healthcare professional in northern Nigeria. Today he is at the forefront of efforts to bring standardised malaria diagnostics to the people of Gauraka, a local community in which he grew up.

Garba is a laboratory technician at the government’s Gauraka Model Primary Health Centre in Tafa Local Government Area, Niger State. Garba has been working at the health centre for around six months.

Stepping into his small laboratory within the complex, he carefully slips his white latex gloves on to both hands as he prepares to demonstrate a rapid diagnostic test (RDT) for malaria. In the laboratory, he also carries out other tests, including those for typhoid fever and urinalysis.

On a typical day at work, Garba says with respect to RDT testing: “Sometimes, we have three, sometimes we have four, and sometimes we have none.” When asked the reason for the low patient numbers, he responded: “Patients prefer to go to Wuse in the Federal Capital Territory, Abuja or Suleja, a neighbouring town, which possess more equipped and larger hospitals.” But it is also true that through the work of SuNMaP, rural health workers and community care givers are helping to keep down the number of people coming to the health centre with malaria by diagnosing and treating fever in the community, talking about malaria prevention and the importance of mosquito nets, and through the provision of nets through mass distributions and ante-natal clinics.

Garba carefully tears the flexi-pack of the test kit and lays the kit on his work table. He then takes blood from a blood specimen bottle and places a few drops on a rectangular window in the test cassette. When testing an actual patient, he would be required to prick the fourth finger (counting from the thumb) and then collect a very minute sample of blood which he would then drop onto to the cassette.

After this, he adds a few drops of the buffer solution before waiting 15 minutes wait for the test results to emerge. At the Gauraka Model Primary Health Centre, RDTs are not given out for free but are sold for 200 Nigerian naira (US$1.25).

Garba’s role at the health centre has greatly reduced the chances of malaria misdiagnosis. He has also gained a lot of experience in rapid diagnostic testing. He takes a short glance at the RDT kit that had lain undisturbed on his work table, then says with a smile: “Practice makes perfect.” He then holds up the cassette to display the result and gives a short interpretation of the reading.

Proper diagnosis of malaria is an important step in the prevention of resistance to anti-malarial drugs. Professionals such as Garba are working to support better case management of malaria in communities across Nigeria.

SuNMaP (Support to National Malaria Programme ) provides support to the Nigerian government and people in tackling the massive burden of malaria in the country. It is implemented by international and local partners, funded by UKAid and managed by Malaria Consortium. SuNMaP works in close co-operation with Nigeria’s National Malaria Control Programme (NMCP), in selected states and Local Government Areas (LGAs), including Anambra, Kano, Lagos states, Niger, Katsina and Ogun states. Work began in a further four states in 2012.

These positive changes have been facilitated by Support to National Malaria Programme (SuNMaP) and other donors in collaboration with the State Malaria Control Programme (SMCP). In addition to bed nets and drugs for malaria treatment, SuNMaP has provided training to senior management staff at the Local Government Authority (LGA) level, which has been cascaded down through the LGA to staff, like Garba, in health facilities across Nigeria.

Nigeria: Community health centres distribute nets to pregnant women

Malaria Consortium’s Senior Technical Malaria Officer, Osita Okonkwo, interviews Fatima Abdulwahab from Wuse District, near Abuja, to hear her views on using mosquito nets.

The true value of long-lasting insecticidal nets (LLINs) can only be understood through the invaluable accounts of consistent users in rural communities, such as Fatima.

Fatima Abdulwahab is a 27 year old mother of three children whom she describes as her ‘precious gifts’. Her husband, Musa, is a factory worker, who earns barely enough to sustain the family. Fatima herself has no formal education and looks after her family. Musa and Fatima previously lived for many years in the northern Nigerian city of Kano. Four years ago Fatima relocated with her children to Wuse District, northwest Abuja, to live with her husband’s parents, although Musa still lives and works in Kano.

Fatima’s only sickness since childhood had been malaria, caused by bites from infected mosquitoes. She was hospitalised several times during her first pregnancy and treated for malaria, during which time she almost lost her life. She recalls how one of her husband’s sisters, a mother of five young children, died of malaria during pregnancy a few years back. Her death, she said, was a turning point in the lives of the family and prompted her husband and some other family members to save money to procure mosquito nets. Although the nets were of low quality, they worked and helped to reduce cases of malaria in the family.

In 2010, Fatima’s nearest health centre in Wuse started free distribution of LLINs for pregnant women. Fatima was among one of the first groups of pregnant women to receive nets from the facility. She said that now she and her children all sleep under mosquito nets, they no longer have malaria. Fatima also made sure that all the pregnant women she knew in her village visited the health centre to receive free nets as well.

Malaria Consortium’s Senior Technical Malaria Officer, Osita Okonkwo, interviews Fatima Abdulwahab from Wuse District, near Abuja, to hear her views on using mosquito nets.

Malaria Consortium’s Senior Technical Malaria Officer, Osita Okonkwo, interviews Fatima Abdulwahab from Wuse District, near Abuja, to hear her views on using mosquito nets.

“Since we started using the nets, my children and I don’t get malaria again. The net is very, very good; it is saving our lives. We sleep under the nets day and night. I cannot sleep without my net. Even when the weather is hot, I must sleep under the net.”

Fatima’s story echoes that of several other women whose lives have been changed by the use of LLINs. All can talk about the benefits of being able to receive and use nets. Their stories demonstrate what can be achieved through sustained net distributions to poor households in rural communities.

SuNMaP (Support to National Malaria Programme ) provides support to the Nigerian government and people in tackling the massive burden of malaria in the country. It is implemented by international and local partners, funded by UKAid and managed by Malaria Consortium.

SuNMaP works in close co-operation with Nigeria’s National Malaria Control Programme (NMCP), in selected states and Local Government Areas (LGAs), including Anambra, Kano, Lagos, Niger, Katsina and Ogun states. Work began in a further four states in 2012.

Following mass distribution campaigns in programme supported states, SuNMaP has successfully distributed about 1,349,356 LLINs through non‐commercial continuous distribution channels. Pregnant women are provided with LLINs during their booking visits as part of the focused antenatal care (ANC) and infants presenting at routine immunization clinics are given LLINs, usually linked to measles immunization or child health weeks. The programme is supporting the state malaria control programme to expand LLIN distribution to more eligible facilities while exploring other viable channels of distribution such as schools and community directed distributors, drawing from lessons gathered from the national RBM partnership.