Malaria Interventions Assessment in Nigeria Is “First of Its Kind”
Malaria is a major public health burden in Nigeria, where the entire population is at risk for contracting the disease. In 2014, the country reported more than 7.8 million confirmed cases of malaria and more than 6,000 malaria deaths. About 21 percent of deaths among children under five years of age are caused by malaria.
To reduce the malaria burden, the National Malaria Elimination Programme (NMEP) of the Federal Ministry of Health has been working with partners to significantly expand key interventions, including insecticide-treated nets, targeted indoor residual spraying, intermittent preventive treatment in pregnancy, and effective case management.
Since 2011, the U.S. President’s Malaria Initiative (PMI) has supported malaria control efforts in Nigeria. In 2015, PMI commissioned an evaluation to document the progress of malaria control interventions and assess changes in malaria outcomes from 2008 to 2016 in four Nigerian states that received PMI support since 2011: Cross River, Ebonyi, Nasarawa, and Sokoto.
Checking Progress
PMI engaged the U.S. Agency for International Development-funded MEASURE Evaluation project to lead the evaluation. The main aim of the evaluation, undertaken in collaboration with the NMEP, PMI, and the research firm Nielsen Nigeria, was to provide information to guide and streamline future PMI support and strategies on malaria control and elimination in Nigeria.
The assessment used an innovative and comprehensive mixed-methods approach that included both primary data collection and secondary data compilation and analysis. The evaluation team visited public health facilities in each of the four states, where they did a comprehensive collation of routine malaria data from the facilities; conducted observations of the availability of malaria commodities; interviewed patients about their treatment and the quality of care they received; and spoke with key stakeholders to gain a better understanding of the implementation of malaria interventions in each of the four states.
“This assessment is a first of its kind,” says Samantha Herrera, a monitoring and evaluation technical specialist for MEASURE Evaluation who helped lead the effort. “Other evaluations haven’t looked at so many different elements of the malaria program at the same time. They’ve been more narrowly focused— for example, on impact and whether malaria control interventions have resulted in reductions in child morbidity and mortality. This evaluation not only looked at impact, but also at quality of care, availability of key malaria commodities and trained health workers, trends in coverage of malaria interventions, and the quality of routine malaria data.”
Key Findings
Significant improvements in malaria intervention coverage were made across all four states during the study period. Overall, the findings showed there was greater availability of malaria commodities, trained health workers in malaria case management and malaria in pregnancy, and other necessary inputs (e.g., laboratories, microscopes, national malaria treatment guidelines); higher quality of care; and generally better data quality in primary health care facilities supported by PMI compared to those that did not receive any direct PMI support.
“The evaluation shows the added value of PMI support,” Herrera says. “The findings also suggest that PMI support had an overall positive effect on the quality of routine malaria data at non-PMI supported health facilities in the four states, as well.”
The study findings also highlight gaps in coverage and show that more needs to be done. A large gap remains in household access to insecticide-treated nets, and intermittent preventive treatment in pregnancy and diagnostic testing and treatment coverage all remain very low across all states. Further efforts are also needed to ensure availability of all malaria commodities at health facilities and to improve health facility reporting rates, and the completeness and accuracy of routine malaria data. The final report provides recommendations to address these issues.
Lessons Learned
The evaluation results will help the NMEP and PMI decide how and where to best to target their resources for malaria interventions and identify best practices that can be rolled out across the country. “The evaluation provides stakeholders with a lot of useful information for improving their programming and more efficiently targeting their resources,” Herrera says.
This experience in Nigeria will also help inform future evaluations in other countries. “We’re using lessons learned from this evaluation to advocate for other similar comprehensive evaluations in other PMI-supported countries,” she adds. “Particularly, adopting the comprehensive approach and the tools used for data collection.”
For More Information
To learn more about MEASURE Evaluation’s work to assess health system performance and impact in developing countries, visit https://www.measureevaluation.org/our-work/evaluation.
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Assessment of Malaria Interventions in Four Nigerian States: Final Report
