Monitoring and Evaluation of Malaria in the Riverine communities of Bayelsa state of Nigeria
The Problem: Monitoring and Evaluation of Malaria in the Riverine communities of Bayelsa state of Nigeria
National Malaria Control Programme on Global Fund Round 8 (GFR8), is responsible for implementing activities that are expected to contribute to the goal of Scale Up for Impact (SUFI) on the Malaria control in the following Service Delivery Areas (SDA):
- 1) Prevention through the provision and distribution of Long Lasting Insecticide Treated Nets (LLINs).
- 2) Case Management of Malaria which include provision of drugs: Artemisinin Based Combination Therapy,(ACT), diagnosis, facility and Community Management, and
- 3) System strengthening on Malaria control activities.
- Difficulty of retrieving of data from health facilities and Role Model Caregivers (RMCs) across water,
- No correlation between ACT supplied to health facilities and amount of data retrieved since not all facilities can easily be reached,
- Mentoring and supervision of service providers was difficult due to water barrier, service providers take advantage of difficult terrain to abscond duty,
- Service providers report to LGA who has no technical capacity to supervise their operations
- Poor health workers attitude to work,
- Rural-urban shift by service providers,
- Competing priorities and limited resources for collection and use of data;
- Inadequate training of data collection personnel;
- Lack of timely feedback of useful data to those in a position to improve programs;
- Inadequate reporting tools (eg, registers and forms);
- Poor documentation of services provided within health facilities and at the communities and
- Inadequate counterpart funding from the state Government.
Malaria M&E systems constitute the key means of measuring Malaria intervention efforts, through provision of aggregated data to inform national programs while guiding the delivery of high-quality prevention such as distribution of long lasting insecticide treated nets (LLIN), and treatment via Artemisinin Based Combination therapy (ACT). To assess processes, outcomes and impact, project indicators are designed to collect raw data that will provide information on the success or failure of the program. Indicators used are hand tallied from paper-based sources and reported from health facilities to Local Government Area (LGA) then to state and finally to national and international agencies.
|Figure 1: Number of children under and above five treated with ACT from 2010 to February 2011|
|Year||Children under 5 treated||Children above 5 treated|
|Figure 2: Percentage distribution of ACT used, stock balance and unretrieved data from service delivery points|
|Total used||Unretrieved data||Stock balance|
Figure 2 showed that 30% of ACT administered to patients under 5 and above 5 at health facilities and communities through RMCs have not been retrieved, some due to improper documentation of services provided, and poor data management. ACT used represent 21% while 49% represent stock balance.
Lessons learned and strategies adopted
- 1) Community and civil society involvement in monitoring and evaluation of activities of service providers, the community leaders, religious and traditional leaders provided oversight for ACT, LLIN utilization in their domain. They advocated for utilization of ACT in their massages during religious and traditional activities
- 2) high level advocacy to policy and decision makers, program managers/M&E officers at the country office conducted advocacy to state and local governments administrators, which in turn produced awareness and utilization of ACT and LLIN
- 3) increased capacity building of health facility service providers, the M&E officer trained indigenous consultants to provide on the job mentoring and supervision to health facilities service providers
- 4) counterpart funding from the state and Local Government area (LGA) council, the state and LGA provided additional funding to address the gap/challenges with funding monitoring and evaluation of malaria in the riverine communities
- 5) Result based funding strategy was used to increase timeliness and completeness of data reporting by LGA malaria focal persons. Produce your result and be paid monthly data collection fee. This increased timeliness and completeness of data reporting