END MALARIA PROJECT

IntroductionMalaria remains a major public health challenge, especially in sub-Saharan Africa (SSA) where about 93% of the global share of malaria cases and about 94% of malaria deaths take place.

The End Malaria Project is an initiative of GBCHealth's Corporate Alliance on Malaria in Africa (CAMA), established to catalyze private sector capabilities and investment to address this challenge. With the longer-term vision to end malaria across the continent, the End Malaria Project's initial focus is on Nigeria.

Nigeria has the highest number of cases and deaths from malaria in SSA, bearing a disproportionately high share of the global malaria disease burden.

An estimated 97% of the country’s population is at risk of malaria; accounting for about 25% of Africa’s malaria disease burden. It is estimated that 81,640 deaths (about 9 deaths per hour) and about 11% of all child deaths worldwide occur in Nigeria.

Focusing on Nigeria will therefore have the greatest potential impact. Approaches developed and lessons learned in the End Malaria Project can then be adapted and implemented across the continent more widely.

The challenge: NigeriaMalaria is endemic in Nigeria; transmission occurs throughout the year with peaks occurring in the rainy season due to the accumulation of stagnant water where mosquitoes multiply.

It poses major challenges to the country as it impedes human development. Pregnant women and children under 5 with relatively lower levels of immunity are particularly at high risk.

It is also the number one cause of absenteeism in Nigeria resulting in loss in productivity at work – with an estimated US$1.1 billion cost each year due to malaria-related absenteeism and treatment costs.

1

Although there were dramatic reductions in malaria burden from 2000 to 2015, in recent years the annual WHO World Malaria Report indicates that the world, and particularly the high-burden countries (of which Nigeria tops the list), is off-track in achievement of set targets.

The 2014-2020 Malaria Strategic Plan (NMSP) for Nigeria set ambitious goals to reduce malaria prevalence to less than 5% and deaths to near zero by 2020. Findings from review of the NMSP showed that the goals of the NMSP 2014-2020, to a) reduce the malaria burden to pre-elimination levels and b) reduce malaria related deaths to zero, were not fully achieved.

The COVID-19 pandemic has impacted an already dire situation in relation to malaria in Nigeria. The pandemic has caused interruptions in access to malaria commodities and disruptions to insecticide-treated net (ITN) campaigns. This reinforces the need to maintain malaria services and for the global health community to redouble efforts on malaria control and elimination to ensure our hard-won gains are not lost.

The 2021-2025 NMSP goals are to achieve a malaria parasite prevalence of less than 10% and reduce mortality attributable to malaria to less than 50 deaths per 1,000 live births by 2025. These goals will be accomplished through the achievement of the following objectives:

CAMA: END MALARIA PROJECT

• Improve access and utilization of vector control interventions to at least 80% of targeted population by 2025

• Ensure provision of chemoprevention, diagnosis and appropriate treatment for 80% of the target populations at risk by 2025

• Improve generation of evidence for decision making and impact through reporting of quality malaria data and information from at least 80% of health facilities (public and private) and other data sources including surveillance, surveys and operations research by 2025

• Strengthen coordination, collaboration, and strategic partnership to promote efficiency and effectiveness of malaria control activities towards achieving at least 75% improvement from baseline using a standardized OCA tool

• Improve funding for malaria control by at least 25% annually through predictable and innovative sources to ensure sustainability at federal and sub-national levels.

2008/NDHS

29%

8%

29%

13%

ITN OWNERSHIP

ITN USE BY U5

ITN USE BY PREGNANT

WOMEN

IPTp UPTAKE – 2 or more

doses

2010/NMIS

2010/NMIS

2010/NMIS

44%

49%

37%

2015/NMIS

49.5% 2013/NDHS62% 2018/NDHS

2015/NMIS

2015/NMIS

52%

58%

40%

2018/NDHS

2018/NDHS

Progress in Achieving the NMSP Targets

Funding Gap 2020

COMMODITIES NEED (NGR) FINANCED (NGR) GAPS (NGR)Routine LLINs (# number of commodities)

13,736,689 - 13,736,689

SP (# number of commodities) 16,969,859 3,934,676 13,035,183

ACTs (# number of commodities) 39,688,818 32,139,048 7,549,770

RDTs (# number of commodities) 36,999,104 33,402,452 3,596,652

Artes Inj (# number of commodities) 3,546,711 1,231,178 2,315,533

SMC/SPAQ (# number of commodities) 38,595,198 23,159,006 15,436,192

TOTAL 149,536,379 93,866,360 55,670,019

CAMA: END MALARIA PROJECT 2

2018/NDHS

End Malaria Project

AboutThe Corporate Alliance on Malaria in Africa (CAMA) is launching the End Malaria Project as an initiative to galvanize private sector resources and capabilities for sustained support towards malaria control. The initiative will focus on reducing the incidence and prevalence of malaria in the most endemic regions in Nigeria by 2023 – a step towards complementing the government’s effort in achieving a malaria-free Nigeria.

The project will run from April 2021 to April 2023.

Project DescriptionThe activities of the End Malaria project have been designed in line with the World Health Organization (WHO) and National Malaria Elimination Programme (NMEP) key community program elements such as awareness and public education, vector control, early diagnosis and effective treatment.

The key project activities are based on the following strategic objectives:

A- Awareness

B- Bite Prevention

C- Chemoprophylaxis

D- Diagnosis and treatment

Goal: Phase 1To significantly reduce the economic burden of malaria in Nigeria by implementing strategic interventions that complement the efforts of the National Malaria Elimination Program, thereby saving 200,000 lives, and then extending the learnings from this phase to impact other countries across Africa.

Objectivesa. To increase the level of awareness and

improve health seeking behavior of community members for malaria prevention and management, reaching at least 100 million people across the most endemic states in Nigeria.

b. To reduce malaria transmission through indoor residual spraying (IRS) in selected local government areas (LGAs) and distribution of five million long-lasting insecticidal nets (LLIN) across Nigeria.

c. To adopt mandatory malaria chemical prophylaxis among children under five and pregnant women to reduce the malaria morbidity in highly endemic communities across Nigeria.

d. To carry out effective malaria diagnosis and treatment through rapid diagnostic testing for over 80% of residents in select project states and treatment of 80% malaria-positive individuals through Artemisinin-based Combination Therapy (ACT).

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OBJECTIVE 1 AWARENESS

To educate and improve the health seeking behaviors of residents of selected LGAs, especially pregnant women and mothers of children under the age of 5, through building the capacity of community members in using teaching aids, and focus group discussions to educate their communities. Outreach efforts and community seminars that involve sensitizing community members will target 10,000 people in each LGA about the importance of malaria control and prevention, and teach them the signs and symptoms of the disease and benefits of seeking early treatment. The NMEP door-to-door outreach and focus group guide will be adopted for this phase of the project.

To increase the level of awareness and improve health seeking behavior of community members for malaria prevention and management in high burden Local Government Areas (LGAs) across Nigeria.

A B C E F

Baseline Survey

After selecting project communities based on existing evidence from desk review and consultations, varied data from community residents will be collected to determine the number of malaria cases, treatments undergone, testing, number of people who make use of PHCs, malaria morbidity within the LGA, etc., which will be collated at the beginning and end of the project and then compared during the monitoring and evaluation phase.

Mapping of viable PHCs

Field volunteers from the LGAs will map out the closest functional PHCs where people can access malaria tests and prevention commodities for themselves and their families in each LGA.

D

Build capacity of Community Health

Workers (CHEWS)

20 CHEWS will be selected from each LGA to build their capacities in understanding the importance of testing before treating possible malaria cases, administering Intermittent Preventive Therapy (IPT) to pregnant women and infants, and providing quality malaria prevention services according to best practices, by using information education communication (IEC) materials such as booklets, posters and manuals.

Community Outreach

Distribution of Information,

Education and Communication

(IEC) material and Edutainment

Educative entertainment (edutainment) videos to provide visual education aides on 5 key malaria messages, for example on danger signs in pregnant women and children under the age of 5, testing, and complete treatment administration. IECs will contain graphical representation of various malaria prevention approaches. These materials will be used to strategically engage community influencers and members through existing association meetings, antenatal visits and other key moments in the community.

Engage with Key Community and

Government Stakeholders

Meetings will be held with the key community heads and stakeholders (government agencies, community-based organizations etc.) in all 16 LGAs to introduce the project to them, and fully involve them in the project activities and focus group discussions.

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To reduce malaria transmission through distribution of long lasting insecticidal nets

B CA

Establish community taskforce

committees

We will set up a 10-person task force team made up of key community influencers (including youths, women and men) who will oversee control of the mosquito population in each LGA. They will be charged with monthly clearing of bushes and grass in communities, fogging and treatment of stagnant water, larviciding, etc.

Distribute LLINs Residual spraying

Pilot indoor residual spraying in selected LGAs across the most endemic states in Nigeria.

OBJECTIVE 2 BITE PREVENTION – IRS AND LLIN

to community residents

1,500 community members in each LGA will be receiving LLINs and will be taught how to effectively use them. Community volunteers will also help residents set them up if need be. Also, we will educate community health promoters to ensure continuous use of LLINs.

OBJECTIVE 3 CHEMOPROPHYLAXIS

To reduce malaria transmission through the use of chemical prophylaxis among children under five and pregnant women

A

B

C

To adopt mandatory malaria chemical prophylaxis

among children under 5 and pregnant women to reduce

malaria morbidity

Provision of Intermittent Preventive Therapy (IPT) in pregnancy for 160 mapped PHCs – PHCs will be provided with azithro-mycin (AZ) and chloroquine (CQ) for Intermittent Preventive Therapy in pregnant women (IPTp) for 16,000 women. These combinations have been proven to effectively protect pregnant women from malaria deaths. By making these treatments available at PHCs, it ensures that more women register for antenatal clinics and have improved health outcomes.

Provision of Intermittent Preventive Therapy in infancy (IPTi) with sulphadoxine pyrimethamine (SP) will be provided to 160 PHCs for children under the age of 5 will also be given free malaria chemoprophylaxis at the PHCs. This will also improve the health seeking behaviours of women in the community by encouraging visits to the health centers rather than resorting to self-medication. 48,000 children will be reached.

Integration of chemoprophylaxis intervention into other community health interventions

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OBJECTIVE 4 DIAGNOSIS AND TREATMENT

To carry out effective malaria diagnosis through Rapid Diagnostic Testing (RDT) for over 80% of residents in select communities and treatment of 80% of malaria-positive individuals through Artemisinin-based Combination

Therapy (ACT)

A

Increase testing for malaria by deploying Rapid

Diagnostic Tests

We will conduct malaria tests for at least 80% of residents using RDTs in select communities in select LGAs, reaching approximately 4,000 people per LGA.

B

Provide ACT for 80% of malaria positive individuals

People who test positive will be given immediate ACT drugs for effective malaria treatment. At an estimation of 10% of those tested being positive, over 10,000 people will receive treatment across the states.

C

Equip PHCs with RDTs and ACTs for effective diagnosis

and treatment of malaria

160 PHCs will be provided with necessary serological materials for malaria testing. They will also be provided with treatment drugs for the benefit of community members.

Expected Outcomes

a. 100 million Nigerians receive accurate information on malaria prevention, diagnosis and treatment.

b. 70% reduction in the incidence and prevalence of malaria among residents in project communities– 200,000 lives saved.

c. Five million pregnant women and mothers of children under five in project states sleeping under LLIN.

d. Two million beneficiaries receive free malaria diagnostic tests and free ACTs.

e. All children qualified for Seasonal Malaria Chemoprophylaxis (IPTi with SP) receive it.

f. Better health outcomes for communities through access to quality malaria prevention, testing and treatment tools.

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Implementation Arrangements

CAMA will work with HACEY Health Initiative, an organization with over 10 years of experience implementing interventions focused on improving the health and productivity of communities across Nigeria, as the implementing partner. We will work together to utilize technology to collect data, track project success and analyze data for increased reach and impact.

Monitoring and Evaluation

Project evaluation will be executed via:

a. Formative Evaluation- this will take place before and during the project’s implementation to improve the project’s design and performance. It will involve a baseline survey and mapping of viable health centers. This evaluation will increase the likelihood of achieving successful outcomes through strategic program design.

b. Monthly Review Meeting- the purpose of monthly review meetings is to review current progress of the project against the goals and objectives. These meetings will be part of our evaluation strategy and will capture a set of key decisions and strategic plans that will greatly contribute to the success and sustainability of the project.

c. Supportive Supervisory Visits- key stakeholders and partners will be invited occasionally to work with project implementers to establish goals and monitor performance. Monitoring officers from CAMA member organizations will help to monitor the project progress.

d. Summative and Post-project Evaluations- we will assess whether the project has reached its goals. We will also quantify the changes in resource use attributable to the project so that we can make results-based decisions on future spending allocations (considering unintended consequences). This will allow us to gather the knowledge to improve future project designs and implementation, including across other countries in Africa in the second phase of the project.

Implementation

CAMA: END MALARIA PROJECT7

01

02

03

04

Sustainability In order to ensure sustainability of the project, the following

measures will be addressed:

Community ownership: Engaging key government officials, and other implementing partners in the evaluation will enhance ownership, mutual accountability for results and credibility for project implementation.

Continuous provision of malaria prevention and treatment commodities to PHCs.

Redistribution of educative materials (videos, pamphlets, posters) after project end. Videos will be converted to mobile phone formats and sizes to facilitate information sharing among communities.

Development of case study: The project outcomes and lessons will be shared with key partners, donors and organizations to foster the adoption of the project and its implementation in other communities. This project is also in line with the National Malaria Elimination Program strategic plan, thereby creating better prospects for its acceptance, continuation and sustained impact.

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Scale As indicated in the introduction, the End Malaria Project's vision is to catalyze private sector capabilities and investments to contribute to ending malaria across Africa, beginning with a focus on Nigeria for the first phase of the project, before extending the project to other African countries.

During the initial stage of the Project, CAMA will analyze the approaches implemented in Nigeria to determine their potential for impact, and will then work with partners in other countries to explore how learnings and investments from the End Malaria Project's initial work in Nigeria can be leveraged for further impact across Africa.

The End Malaria project will employ the knowledge management process of CAMA and HACEY Health Initiative. The process ensures:

Dissemination of information to relevant stakeholders such as CAMA, government, non-governmental organizations (NGOs), international organizations, etc. At the end of each phase, documents such as policy briefs, articles, position papers and manuscripts targeting each audience will be published. Research results will be available as an open source for other researchers’ reference and use.

Knowledge Management

The End Malaria Project will employ the knowledge management process of HACEY Health Initiative. The process ensures:

Effective collection and analysis of data (using qualitative and quantitative approaches)

Storage of data using manual and automated methods

Data Storage

Data Collection

Information Distribution

CAMA and HACEY Health Initiative will be the repository of all information, documents and contacts related to the project.

Key Opportunities The End Malaria Project will work with staff of CAMA member companies, who will serve as members of the project’s advisory committee, and as volunteers, educators and observers during this project. This will help to increase staff knowledge on prevention, treatment and management of malaria, and will support member companies' goals on malaria and sustainability. Also, this project will help in the development of a comprehensive malaria response plan for CAMA members' staff working in the endemic communities.

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200,000 lives saved, thereby reducing the economic burden of malaria

in Nigeria by 50%.

IMPACT

OUTCOMES

Accurate information on malaria prevention, diagnosis and treatment reaching 100 million Nigerians.

2 million beneficiaries’ complete dosage of malaria drugs.

70% reduction in the incidence and prevalence of malaria among beneficiaries in project states.

All children who are qualified for Seasonal Malaria Chemoprophylaxis (IPTi with SP) will recieve it.

5 million pregnant women and mothers of children under 5 in project states sleeping under LLINs.

Increased health outcomes of community members through access to quality malaria prevention testing and treatment tools.

AWARENESS

Strategic communication and health promotion

BITE PREVENTION

Indoor Residual Spraying and Long-lasting Insecticide

Treated Nets

CHEMOPROPHYLAXIS

Deploying malaria drugs to pregnant

women and children

DIAGNOSIS AND TREATMENT

Scaling up provision of rapid diagnostic testing and

Artemisinin-based Combination Therapy (ACT)

ISSUEMalaria remains a major public health challenge, especially in sub-Saharan Africa (SSA) where about 93% of the global share of malaria cases and about 94% of malaria deaths take place. Nigeria bears a disproportionately high share of the global malaria disease burden, with the highest number of cases and deaths from malaria in SSA. An estimated 97% of the country’s population is at risk of malaria; accounting for about 25% of Africa’s malaria disease burden. It is estimated that 81,640 deaths (about 9 deaths per hour) and about 11% of all child deaths worldwide occur in Nigeria.

97% of the country’s

population is at risk

of malaria

97%

25% of Africa’s

malaria disease

burden

25%

11% of all child

deaths worldwide

occur in Nigeria.

11%

81,640 deaths

(about 9 deaths

per hour)

INPUT

- Established partnerships with key influencers. - Increased knowledge on importance of malaria prevention, testing and treatment among Nigerians. - Community Health Workers equipped with skills and best practices to track, test and refer people for malaria treatment. - Available data on malaria response in Nigeria

- Emergence of champions focused on ensuring their community adopt malaria prevention practices. - Five million pregnant women and mothers of children under 5 receive LLIN. - Selected communities benefit from indoor residual spraying.

- Women and children receive malaria chemoprophylaxis - Malaria response integrated with other community health programs

- 3 million beneficiaries receive free malaria diagnostic test and free ACTs.

1 2 3

4

OUTPUT

70%

END MALARIA PROJECT - THEORY OF CHANGE

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