US President’s Malaria Initiative for States (PMI-S) Task Order 03 FY21 Q3 Quarterly Report

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 overall activity implementation in TO 03 states improved in quarter three (Q3) compared to previous quarters (66%, 74%, and 77% in Q1, Q2, and Q3, respectively) as a result of improved planning and collaboration with state stakeholders and other implementing partners. The low performance recorded in Ebonyi State was due largely to non-implementation of integrated Community Case Management (iCCM)-related activities. Following a TO 03 baseline assessment that showed gaps in malaria case management practices across the states, PMI-S trained 2,426 Primary Health Care (PHC) workers on managing uncomplicated malaria, 55 clinicians on managing severe malaria, and 1,263 health workers on behavioral economic prototypes (BEPs) to improve fever case management across the four states in the previous quarters. Following the training, all TO 03 states have consistently met their targets of maintaining above 90% for proportion of suspected malaria cases who received parasitological tests and proportion of patients with confirmed malaria who received first-line antimalarial treatment. Furthermore, PMI-S supported stakeholders in the four states to improve documentation and data use for decision making by conducting data management trainings for 1,006 health records staff across the four states. Reporting rates have not significantly improved from baseline values across the four states because of unresolved issues associated with duplication of health facilities and presence of inactive health facilities on DHIS 2 as well as irregular reporting from some private hospitals. PMI-S supported the Department of Planning, Research and Statistics (DPRS) in all TO 03 states to compile and send the list of duplicated and non-functional facilities to the federal DPRS and will continue to follow up to ensure that the facilities are deleted. PMI-S supported the State Malaria Elimination Programs (SMEPs) in the TO 03 states to sustain advocacy to key stakeholders such as the Honorable Commissioner of Health; Executive Secretary of the State Primary Health Care Development Agency (SPHCDA); directors of public health, medical services, and pharmaceutical services; and hospital Chief Medical Directors by leveraging sulfadoxine-pyrimethamine (SP) consultative meetings, malaria technical working group (mTWG), Procurement and Supply Management (PSM) TWG, and case management TWG meetings to improve availability of SP at ANC units. This contributed to sustained improved uptake of intermittent preventive treatment in pregnancy (IPTp) in all states compared to baseline values, although Cross River observed a decline in IPTp2 uptake in Q3 due to stock-out of SP in some health facilities. PMI-S worked collaboratively with Global Health Supply Chain-Procurement and Supply Management (GHSC-PSM) to facilitate the redistribution of SP from facilities where SP was overstocked to facilities that experienced stock-out in affected states. Review of state malaria annual operational plans (AOPs) for January-March 2021 showed that Akwa Ibom, Cross River, Ebonyi, and Oyo States implemented 46.6%, 66%, 67%, and 46.2% of planned activities, respectively. Poor disbursement of government funds due to delayed approval of funds resulting from poorly defined memos and untimely submission of sub-awards led to low implementation rates in some states.