Strengthening surveillance and improving the sharing of disease-related intelligence helps empower decision-makers to make informed and timely choices around interventions. This issue has been magnified by the emergence of the COVID-19 pandemic. In Nigeria, malaria is endemic across the country, while most states have been affected by COVID-19. Oluwatosin Ajibade has recently completed a secondment to Nigeria’s National Malaria Elimination Programme (NMEP) as part of Malaria Consortium’s SuNMaP 2 programme.
Why is data and surveillance so important for disease control in Nigeria?
In Nigeria, insufficient data and evidence limits decision-making. Malaria is endemic across the country and so we cannot just rely on guesswork. We need evidence to inform our decisions so we can apply strategic interventions that are targeted and effective. The contribution of Nigeria to global malaria cases is extremely high – if we can reduce the prevalence of malaria in Nigeria it will have a large impact on global prevalence.
As a result, Malaria Consortium is supporting Nigeria’s National Malaria Elimination Programme, alongside WHO, to carry out implementation research around surveillance and strengthening routine data collection. A National Malaria Strategic Plan which has driven these efforts expired in 2020. Since then, Malaria Consortium has worked with the NMEP to develop a new five-year strategy.
You said that there has been a lack of good data. Is this just down to a lack of routine collection or is there a fragmentation of systems in Nigeria?
It’s true that there are different systems for data collection. The NMEP is working with the Department of Health Planning, Research and Statistics (DHPRS), within the Federal Ministry of Health to input all data collected at local and state levels into the central District Health Information System (DHIS). This data is then aggregated and presented in a uniform way to facilitate analysis. Work is ongoing to ensure all actors, from private sector partners to health centres, are inputting into this system. In many states, this work is supported by donors, but where it is not, the NMEP is supporting local and state teams to meet this reporting requirement.
The NMEP is also working with a range of partners to improve the integration of systems and interventions. One example is the work recently completed by Malaria Consortium to pilot the co-implementation of vitamin A supplementation (VAS) with the existing seasonal malaria chemoprevention programme (SMC). The NMEP is also working with partners to integrate SMC with Insecticide Treated Net (ITN) interventions. It is likely that common tools may be developed in the long run to capture implementation data for both ITN and SMC. This pilot lays the groundwork for future integration and the potential for new tools for integrated data collection across VAS and SMC.
It’s surely been a difficult year with the pandemic ongoing, what are your observations of how this work has gone in the past year? Have there been any learnings from this period?
Yes, data reporting has been affected during the pandemic. Where reporting is happening, it is often late. Due to the similarities in symptoms between COVID-19 and malaria, health-seeking behaviours have changed over fears of being incorrectly diagnosed with COVID-19. This is one example, but we can see that in general on DHIS, the reporting rate has reduced, particularly during the first four months of the COVID-19 pandemic, from March 2020 to June 2020. However, the pandemic did not stop SMC programme implementation. Data capture tools were available and deployed to collect and analyse implementation data for onward transmission to the national data repository. The NMEP has been developing contingency plans to try to mitigate the impact of the COVID 19 pandemic on DHIS reporting.
Will the new National Malaria Strategic plan outline the roadmap for future improvements to data collection and surveillance?
The Strategic Plan addresses the gaps from the previous strategy. In the area of surveillance, we have tried to identify the gaps and identify activities to put into place over the next five years around data collection and use of evidence for decision making, in addition to a plan to monitor the progress of these activities. Colleagues on Malaria Consortium’s SuNMaP2 programme have contributed to this work by conducting baseline studies on current surveillance activities and working alongside other divisions of the NMEP to better understand gaps.
Can you give an example, perhaps relating to the pandemic, of how data and surveillance systems have been used to make a key decision?
Yes, the DHIS system mentioned previously is linked to the National Malaria Data Repository. This is the warehouse for all malaria data nationwide – routine and non-routine. A big positive about this system is that it auto-generates a bulletin with the latest data. Once the bulletin is generated, key malaria stakeholders meet to discuss findings, positive or negative, and then it is here that key decisions can be made and coordinated. The data is central to the process.
On COVID-19 specifically, what impact do you feel it has had on ways of working with health workers and other partners?
Like everyone, we had to quickly learn new ways of doing things. It has saved us on cost as well as the risk to health in that the team are spending less time out and about. However, this comes with obvious challenges. We are working mainly online, but many areas of the country do not have connectivity. In these areas, it is difficult to reach out to colleagues and partners. This has affected the surveillance systems, but we have tried to mitigate by supporting the reporting officers to find an internet connection in other places and keep uploading their data.
But in areas, that do have connectivity, we are reaching more people than ever in some cases. For example, during the development of the National Malaria Strategic Plan, we held virtual meetings, and I looked at the attendance list and we had over 100 participants, which is much more than we would have had if we held the meeting physically. More people are able to take part which is a learning for the future, even after the pandemic.
Oluwatosin Ajibade is an Evidence and Learning Specialist and worked with Malaria Consortium as a part of the SuNMaP 2 programme. He was speaking to Ashley Giles, Senior Communications Officer at Malaria Consortium.