Almost the entire population (97 percent of 177 million) of Nigeria is at risk for malaria, with 21.6 million suspected malaria cases and 7,878 malaria-attributed deaths recorded in 2013. The World Health Organization’s (WHO) health profile for Nigeria estimates that 20 percent of deaths among children under age five are caused by malaria.
MEASURE Evaluation worked in Nigeria for more than a decade and recently USAID has asked us to return to help assess malaria control efforts, working with the Nigerian Malaria Elimination Program (NMEP) and its partners on a rapid impact assessment (RIA) in four states, supported by the President’s Malaria Initiative (PMI). NMEP, at the Federal Ministry of Health, plays a key role in efforts to scale up effective malaria interventions to achieve pre-elimination and reduction to zero of malaria-related mortality by 2020.
The study objectives are to assess malaria trends after the scale-up of interventions, assess the quality of interventions, compare indicators for PMI-supported and non-PMI-supported primary health care facilities, and to make recommendations to the NMEP to improve data quality.
The survey compiles data from routine health information systems (RHIS), from other demographic and health surveys, and also primary data collection. Because it is based primarily on routine data, it is an opportunity to audit data quality that can reveal issues and data gaps that should be addressed. Understanding the findings will assist the government to make best use of donor funds, which have increased in the malaria arena from about $20 million a decade ago to about $800 million overall. These investments have allowed for increased coverage of key malaria interventions, such as insecticide-treated nets (ITN), preventive treatment for malaria in pregnancy, and diagnostics and treatment. Nevertheless, coverage of these key interventions remains below desired target levels. For example, the proportion of children sleeping under bed nets is still under 20 percent and only about 11 percent of children are tested for malaria with diagnostic blood sampling.
The NMEP is taking necessary steps to significantly increase coverage of malaria control and appropriate treatment. If these efforts are to succeed, Nigeria will need a strong malaria information system that can provide the high-quality data needed for guiding program implementation and for measuring achievements at all levels.
In other recent work, MEASURE Evaluation assisted with a rapid costing analysis for antiretroviral therapy (ART) services in several states. Information on HIV funding is critical information for donors and is essential to help address HIV infection and onward transmission. Prior surveys undertaken in Nigeria were focused on national spending across the country using aggregated data. This survey developed data on unit costing for HIV services at six selected secondary and tertiary facilities, supported in three states by USAID and implementing partners; it is now available to guide decision making for ART programming.