US President’s Malaria Initiative for States (PMI-S) Task Order 03 Annual Report FY2021

The project supports the Government of Nigeria through its agencies at the federal, state, local government area (LGA), and community levels to reduce under-five and maternal mortality by delivering quality services for managing malaria and its complications and preventing malaria during pregnancy and in children under five. PMI-S is an indefinite delivery indefinite quantity (IDIQ) contract with several task orders (TOs). The project focuses on four states: Akwa Ibom, Cross River, Ebonyi, and Oyo. In these states, PMI-S aims to improve the quality of malaria case management by deploying a mix of strategies, including case management training, dissemination of the national diagnosis and treatment guidelines, and mentoring and supportive supervision of facility staff. The project also targets to reduce the test positivity rate to less than 70% in each of the four states by building the capacity of health facility staff to correctly use rapid diagnostic tests (RDTs) and training selected Medical Laboratory Scientists (MLSs) from high-volume secondary and comprehensive health facilities on malaria microscopy. At the end of the fiscal year (FY), Akwa Ibom and Ebonyi achieved the targets set by PMI-S. Ebonyi state achieved the highest reduction in test positivity rate, from 85% at baseline to 62.4% (a 27.0% reduction from the baseline value). Akwa Ibom equally reduced its test positivity rate from a baseline value of 74.8% to 66.1% (an 11.6% reduction). However, Cross River and Oyo did not achieve the targets set by PMI-S. A frequent observation during visits in some facilities in all states was the disparity in the documented positive cases in the laboratory registers and outpatient department (OPD) registers in the same facility, and in some cases, mutilation of the OPD register when previously documented negative results were changed to positive results, suggesting that the reported positivity rates may be falsely high. The project also focuses on building the capacity of health facility staff to correctly use RDTs and training selected MLSs from high-volume secondary and comprehensive health facilities on malaria microscopy. In addition, PMI-S deployed Behavioral Economics (BE) prototypes in selected high-volume Primary Health Centers in the four TO 03 states to improve the quality of malaria case management. The project's success is measured by the proportion of persons with fever (suspected malaria) who received a parasitological test (RDT or microscopy) and the proportion of persons testing positive with a parasitological test (either RDT or microscopy). The project's targets are to sustain more than 90% fever testing rates in Akwa Ibom, Cross River, and Ebonyi, while a target of 82.0% is set for Oyo based on its relatively lower baseline value. The project's implementation is ongoing, and PMI-S continues to work with the Government of Nigeria and other stakeholders to improve the quality of malaria case management and reduce the test positivity rate in the four states. The project's success will contribute to the reduction of under-five and maternal mortality in Nigeria and will help to achieve the country's goal of eliminating malaria by 2030.