In conversation with Nigeria’s National Malaria Elimination Programme (NMEP)

We spoke with Dr Audu Bala Mohammed, National Coordinator of Nigeria’s NMEP and his team to hear how the partnership with Malaria Consortium is helping to drive the successful delivery of malaria interventions – in particular the seasonal malaria chemoprevention (SMC) programme.

Can you describe the partnership with Malaria Consortium and to what extent Malaria Consortium has helped to support the NMEP’s action plans?

We have been working with Malaria Consortium since 2008 when we worked together on the initial Support to National Malaria Programme (SuNMaP), so it is a very longstanding, productive partnership. In regards to SMC, we started with piloting in only one state and in the early stages, it was with Malaria Consortium that we developed all the tools for training, logistics, data collection, community mobilisation, advocacy and procurement processes. It is this work that has meant we’ve been able to make the intervention one of the most acceptable in the country and has also helped many partners to gain support from the work that was done. Because Malaria Consortium has been able to secure philanthropic financing for SMC, we are able to continue to scale up the intervention in so many of the states that are eligible.

The partnership with Malaria Consortium is also happening not only at the national level but at the sub-national (local) level across mass campaigns and other community health interventions. They have supported the development of coordination framework tools and this has given us a sound network for coordination both inside and outside the country. Malaria Consortium currently holds the Chair of the Malaria Technical Working Group, which is the highest body advising the Nigerian government on how to promote malaria policy and guidelines, and has gone a long way in helping us secure resource mobilisation.

How important is seasonal malaria chemoprevention in reducing malaria cases and mortality?

We know that if we do SMC in the recommended areas (the Sahel part of the West African region), where there is a high malaria transmission period that runs about four months malaria cases have been seen to reduce by 75 percent. The intervention also has an impact on some other complications of malaria, such as anaemia. In this part of the world there are a lot of cases of anaemia in children under five, because of malnourishment or co-infection of other diseases. If children also have the malaria parasite in their red blood cells this can cause the child to develop anaemia so preventing malaria in children reduces this risk.

We have also seen that SMC has reduced a lot of out of pocket expenses for families that were spending money on treatment for their children. It has also drastically reduced admissions in the hospitals due to malaria and this allows more resources to be used for other health interventions. The communities’ awareness of malaria prevention and control has increased and access and demand for malaria services from communities has improved because of the SMC interventions.

What have been the key successes in delivering SMC this year and have there been any innovations or positive changes as a result of COVID-19 that could be incorporated into future campaigns?

The intervention is done between July and October so, of course, this was happening during COVID-19. But, working together with Malaria Consortium, we came up with so many innovative strategies to overcome issues of social distancing, hand washing, use of hand sanitiser and face masks and adapting procedures to still do the door-to-door intervention. Malaria Consortium supported us in procuring personal protective equipment and by providing access to Zoom because of the need to do training online. This has proved really valuable and we have used it a lot in preparation for SMC and even in other interventions such as our long-lasting insecticidal net (LLIN) distribution campaign and other interactions that we have with partners at the state level – it has gone a long way in helping us to be able to carry out the campaign successfully.

We have also used the opportunity of this extra awareness on health to promote the importance of malaria prevention measures and secured the cooperation and support from policymakers, religious and community leaders which has helped the campaign to run very smoothly. We even developed some social media videos that were shared with health workers carrying out the SMC campaign and these things will be good to continue.

What have been the challenges in delivering malaria interventions such as SMC?

Calculating an exact number for how many children in the population that can benefit from the intervention in order to quantify the resources required is a big challenge for us. Unfortunately for Nigeria, not everywhere in the country have children’s ages well recorded. Our last census was done in 2006 and a lot of our rural areas don’t do birth registrations so this has compounded our problem. We are having to work on approximations of beneficiaries. There is also a lot of population movement and some security challenges have also caused some population movement, either from neighbouring countries or inter-state.

Although we plan for an extra five or 10 percent on our estimated numbers, it is a difficult task to predict. This year, because of large numbers of internally displaced persons due to unrest in Borno state, we were lacking over two million doses of the SMC drugs for the number of beneficiaries in that area at that time. As a way forward I feel that we should increase our annual order because the drug has a shelf life of around three years so this would give us more flexibility when population numbers are not as predicted.

We also have challenges we need to address in the issue of payments of personnel in the field. I think we need to be utilising new technology to overcome this. If we don’t pay staff promptly after the first cycle then they will be reluctant to carry out the subsequent cycles and this can affect so much of our planning, but technology is available to overcome this so we must look to adopt it.

What is your hope for SMC campaign success and coverage next year and beyond?

Some of the successes we’re going to have going forward is the increase in coverage. We undertook a stratification exercise and this has enabled us to scale up the project – about one third of the country will now be getting this great intervention. We’re really very excited for this and we remain always grateful to our partners, like Malaria Consortium, Global Fund and other implementers. Everyone is very aware of how successful SMC can be and we’re all hands-on deck to make sure that this intervention is properly implemented.

Learn more about Malaria Consortium’s work and partnerships in Nigeria on our country page