Key Takeaways from 15th National Joint Annual Programme Review For HIV, Tuberculosis and Malaria in Nigeria

While Nigeria has made significant progress in the control of HIV, TB and malaria (ATM) over the last two decades, the three infectious diseases continue to constitute major public health problems in the country. Over the years, the country has established various platforms and mechanisms to review its performance in the three disease areas and offer policy and programmatic recommendations for improvement. The Joint Annual Programme Review (APR) seeks to consolidate the contributions of these platforms, and to harmonize and build consensus on key issues to inform policy and programming at all levels of service delivery.

Specific objectives of the joint annual program review workshop include the following:

  • Review how ATM programs have performed in 2018 both at national and state levels
  • Review main successes and challenges experienced in 2018 and draw lessons
  • Identify priority areas of action for 2019 building on success areas observed, and to address main challenges experienced
  • Assess the ATM funding landscape and explore opportunities for improving domestic resourcing, ownership and accountability

About 300 persons attended the 15th Edition of the Malaria Annual Review Meeting organized by The National Malaria Elimination Programme (NMEP) and its partners in Abuja on Tuesday 18th June to Thursday 20th June 2019. Some key speakers included Dr. Abdullahi Mashi, Permanent Secretary, Federal Ministry of Health; Dr. Evelyn Ngige, Director of Public Health, Federal Ministry of Health; Dr. Audu Bala Mohammed, National Coordinator, NMEP; and senior representatives from the Global Fund, UN, the UK Department for International Development (DFID), the US government and others. The private sector was represented by  CAMA, Aliko Dangote Foundation and Codix Pharma Ltd etc.

Takeaways

According to the presentation from the NMEP, malaria still remains a critical public health challenge in Nigeria, which accounts for 53% of malaria cases and 45% of malaria deaths in West Africa; the country also bears 25% of the global malaria burden. Annually, there are 53 million cases of malaria in Nigeria and 81,640 deaths from malaria (nine  deaths per hour).

However, it’s not all gloomy for malaria control efforts in Nigeria; the 2015 National Malaria Indicator Survey (NMIS) results show some achievements in the following areas:

  • Improvements in IPTp2 and IPTp3 since 2008, with the most dramatic improvement occurring since 2013
  • Gradual increase in parasitological tests
  • Increase in use of ACTs for treatment of malaria in children
  • Decrease in malaria prevalence from 42% in 2010 to 27% in 2015 at the national level. It has also decreased in both urban and rural areas

Challenges to malaria control and elimination in Nigeria as highlighted by the NMEP include:

  • Inadequate funding
  • Need for in-country GMP Certified manufacturers of malaria intervention commodities
  • Poor infrastructure (enabling environment) especially at the subnational levels
  • Poor data quality
  • Training and capacity building, and high staff attrition
  • Security issues
  • Harnessing the full potential of the private sector
  • Need to sustain the gains already accomplished

Critical next steps for the NMEP include:

  • Address the funding challenges and recommence implementation of interventions in the 13 states with significant gaps
  • Sustain the advocacy to government at federal and state levels for improved domestic funding – with malaria having a direct budget line
  • Develop 2020 Annual Operational Plan (AOP) – ensuring that it aligns with country budget cycle
  • Conduct Malaria Programme Review and develop new Malaria Strategic Plan
  • Conduct of the National Malaria Dialogue

There was clear consensus among the speakers and members of the audience on what is needed to accelerate efforts towards malaria elimination in Nigeria, summarized here:

Recommendations for the National Level Team;

  • Build effective PPPs; establish a focal point/desk for the private sector and review the private sector engagement strategy
  • Improve data reporting; set up a committee of five representing various partners to support the Procurement and Supply Management branch of the NMEP on this
  • NMEP must rise to her responsibility
  • NMEP must reinstate her functions and build capacity to perform her stated functions

Recommendation for the State Level Team;

  • All States should establish a full complement of the Programme Management Team comprised of Programme Managers, M&E Officer, Logistic Officer, etc.
  • Continue to advocate for increased funding for malaria:
    • There is the need to increase government funding for malaria as the allocated funds for malaria are still dismal
    • There is a need to increase support from the private sector
  • While reporting has increased considerably, data quality is still a big issue, and there’s need to incorporate data from Private Health Facilities and Tertiary Hospitals
  • Need to continue to continue to create demand for commodities
  • Need to support effective implementation Seasonal Malaria Chemoprevention in the Sahelian States