Improving malaria control and prevention in Nigeria has required that a variety of stakeholders work together. About 25-30 organisations have been engaged in a variety of interventions including net distribution campaigns and building capacity for malaria services. With such varied and wide-scale efforts, there has been an urgent need to unify approaches and increase coordination between all those involved in order to achieve maximum results from these interventions.
Harmonisation means working with supporting partners locally and internationally (funders, technical agencies, community organisations and the international private sector to a limited extent). It also involves working with the private and commercial sector.
SuNMaP has had success working with partners to coordinate various efforts and a complex array of donor inputs, priorities, differing ways of working and plans. This is seen as one of SuNMaP’s strengths, as efforts to coordinate and harmonise inputs are sometimes overlooked by development partners and government agencies. It can save resources and offer value for money by achieving conclusive consensus.
SuNMaP’s plan
The central idea behind harmonisation is that all agencies, organisations, projects and programmes supporting malaria control should be working together under national and state government leadership. These are guided by the ’three ones’: one plan; one implementation; and one approach to monitoring and evaluation.
SuNMaP’s approach to harmonisation is issue-based. It used key intervention roll-out planning processes to align the work of all funding sources towards collective strategic goals and objectives, resource leveraging, and identifying priority issues.
The programme also supported the NMEP on wider coordination and harmonisation issues which included funding of long term staff secondments on coordination, development and participation in coordination platforms at all levels and maintaining close contact with global and national partners. The approach worked at all points of the planning, implementation, evaluation and re-planning cycle. It was complemented by the harmonisation of the NMEP implementation.
Since 2008, SuNMaP has been taking the lead on harmonisation with the NMEP. These activities kicked off when objectives and activities of all partners needed to be aligned for the National Malaria Strategic Plan for 2009-13. SuNMaP developed a framework for collaboration and harmonisation, which included:
(1) Identifying priority issues and facilitating dialogue among relevant actors
(2) Developing harmonised implementation methodologies and testing them
(3) Leveraging resources to address gaps in the health system beyond malaria
(4) Harmonised implementation of the plan, with equitable distribution of funding between partners
(5) Monitoring and evaluation implementation and re-planning
(6) Reporting on the impact of harmonised interventions and creating a structure for national roll out.
SuNMaP has also helped build internal capacity of the NMEP to be able to harmonise a range of activities and partners.
What we accomplished
Harmonisation activities have been carried out across all areas of SuNMaP operations: strategy planning, capacity building, prevention, treatment, demand creation and operational research. Here is what we accomplished:
Harmonisation and coordination of the Malaria Programme Review and Strategic Planning Process. At its inception, SuNMaP led other partners to support the NMEP to develop the national malaria strategic plan (2009-2013). This not only informed SuNMaP programme roll-out from the beginning but also served as reference point for other partners. In 2012, SuNMaP also led the malaria programme review for Nigeria involving both national and international partners. The outcome informed the development of the 2014-2020 national malaria strategic plan. The uniqueness of this strategic plan is not only that it was informed by robust evidence, but also that it included private sector contributions and was costed, making long-term resource mobilisation more efficient.
Harmonisation of long lasting insecticidal net distribution campaign. SuNMaP and partners developed a model for nationwide mass distribution campaigns, with pilots taking place in two focal states. In these two states, six million nets were distributed by partners, of which two million were distributed by SuNMaP. The pilot campaign informed a revised strategy which was rolled out nationally. Altogether the national roll-out of the model has led to the distribution of 100 million nets nationwide.
Harmonisation of capacity building. SuNMaP and partners worked together to develop modules for the training of health workers in service delivery and programme management. This included standardised protocols for health workers using two new products: artemisinin-based combination therapy to treat malaria and rapid malaria diagnostic testing kits. These informed future NMEP capacity building guidelines.
Harmonisation of advocacy. The Advocacy, Communication and Social Mobilisation strategy and implementation plan were developed with all partners to unify messaging around malaria awareness.
Harmonisation of monitoring and evaluation and operational research. SuNMaP partnered with the World Bank to conduct a national malaria indicator survey in 2010 and also supported the 2015 edition of the survey. Furthermore, all research related to malaria in the country was pooled into a central resource bank by SuNMaP – the first of its kind.
Lessons learnt
Learn to accommodate individual partners’ yearly programming cycles. One of the key challenges in harmonisation was that each partner had its own yearly programme, governing planning, implementation, review and financing. Careful forward planning proved to be useful in creating a framework for harmonisation which takes account the progress of each partner in their annual cycle.
It is important to address the challenges of working with disparate partners. Encouraging partners to adopt best practices was challenging. Some partners were reluctant to adapt their working practices to become more evidence-based. Others were protective of their territory and were reluctant to share resources. Simple practical issues, such as bringing large numbers of partners together for group meetings, were difficult to overcome. Practicing good planning and communication skills is, therefore, essential. It is also important to be patient and allow for practice and results over time.
Demonstrating achievements can be a challenge. The benefits of harmonisation may be difficult to demonstrate, especially as it involves a range of outputs from different partners and agencies. Progress must be measured by an increase in scope, depth and breadth, and cover large geographical areas. Performance tracking at national level is good both for reporting on progress and for engaging partners in harmonisation, because every partner wants to know what is happening within its own programme and how that fits into the national context.
Recommendations
SuNMaP has taken the lead in building the NMEP’s capacity to harmonise all partners and coordinate all tiers of government and stakeholders engaged in malaria control activities. According to the Organisation for Economic Co-operation and Development aid effectiveness framework, harmonisation is the first step towards achieving ownership. It involves better tracking and sharing of results and mutual accountability between the NMEP and partners. To take harmonisation forward, the NMEP will need to:
Review the lessons learnt from previous harmonisation efforts and adjust and reform where necessary, with focus on strengthening harmonisation at the sub-national levels. This will include better synchronisation between the multi-year intervention roll-out planning process with that of annual operational plans.
Continue to build the NMEP’s internal coordination capacity for better efficiency and performance management. This means maintaining or increasing the current level of funding for malaria control by donors and governments and recognising the usual donor fatigue that comes with a reduction of the malaria burden. As a result, the demand for results and accountability from the NMEP will increase. This will be achieved by review of the processes and systems within NMEP and SMEPs and by working with them to put in place institutions that fit for this new role.
Link with partners and programmes supporting health systems and governance to address wider reform issues. The burden of malaria is declining in Nigeria, and there is a need to address broader health systems issues in other to achieve the pre-elimination target of the NMEP. The current coordination platform which focuses on partners in the malaria sector also needs to be reviewed in order to identify lessons and explore how to include wider health systems partners.
Share lessons globally and learn from others.
The sustainability that every programme seeks to achieve is tied to the involvement of partners and government, working in tandem to specific goals and objectives. Lasting success can only be achieved when partners collaborate and harmonise their efforts.
The central idea behind harmonisation is that all agencies, organisations, projects and programmes supporting malaria control should be working together under national and state government leadership. These are guided by the ’three ones’: one plan; one implementation; and one approach to monitoring and evaluation.
Harmonisation activities have been carried out across all areas of SuNMaP operations: strategy planning, capacity building, prevention, treatment, demand creation and operational research. Here is what we accomplished: