Malaria Programs Implementation in Ebonyi State, Nigeria: Where Are We?

Jhpiego has developed a tool to help malaria programs understand implementation successes and challenges. Bright Orji, Daniel Umezurike, Lawrence Nwankwo, Boniface Onwe, Gladys Olisaekee, Enobong Ndekhedehe, and Emmanuel Otolorin outline the application of this tool for the malaria program in Ebonyi State, Nigeria at the 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene in the Poster Session of 6th November 2017. Their abstract follows:

Despite important strides in recent years, Nigeria has yet to achieve global targets of universal coverage for malaria case management nor 80% coverage for malaria in pregnancy. While available malaria interventions are effective, critical health system challenges undermine implementation. Jhpiego has developed a health systems framework and planning tool to assist malaria control programs identify and respond to these challenges.

The tool was recently used with the Ebonyi State Malaria Control Program (MCP) with Jhpiego’s guidance. An initial situational analysis used the 2015 Malaria Information Survey to highlight that 89% of state households had long lasting insecticide treated bed-nets but only 50% of children under five used them.

Likewise, intermittent preventive treatment during pregnancy (IPTp) was only 44% for two IPTp doses and 41% for three. Use of parasitological diagnosis for malaria was low and unacceptable. A subsequent meeting among MCP and Jhpiego staff was held to review nine health systems areas to determine reasons for the low performance on malaria indicators. The group reviewed strategies and annual workplans and then ranked each health system area on a scale from 1 (low) to 4 (high) to reflect level of progress, and then the average score computed.

The highest scoring components were human resource capacity (3) and integration and coordination (3), based on findings such as integrated supportive supervision and the holding of monthly coordination and review meetings among partners at the state and local level. Community Involvement (1.9) and finance (1.8) scored lowest, based on lack of community outreach and engagement, in control efforts, and late/ sporadic release of funds for program implementation, respectively.

In response, the group drew up action plans to address identified weaknesses and used monthly partners meetings for advocacy and learning. In conclusion Nigerian health workers can use health systems analysis and planning tools to identify best practices, address challenges, and create an action plan to help advance their state (and country) along the pathway to malaria elimination.

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