RAPID CAPACITY APPRAISAL FOR MALARIA CONTROL IN NIGER STATEA Technical Assistance Report prepared for Niger State Ministry of Health & Hospital Services;

Support to National Malaria Programme (SuNMaP) by

Dr. Andrew Agbenin and Mr. Jonathan O. Igbojiwith william anyebe; February, 2014

Executive SummarySupport to National Malaria Programme (SuNMaP) commenced support to Niger State in 2009. A baseline survey took place in January 2010 to inform the support process. After five years of engagement, a rapid capacity appraisal (RCA)became necessary to gauge progress and the current capacity of the state to lead and coordinate malaria interventions. The findings will inform SuNMaP’s work-plan for Years 7&8 and ultimately, its exit plan. Field Technical Assistance was provided by Dr. Andrew Agbenin and Mr. Jonathan O. Igboji who carried out a focus group discussion (FGD) on the 20th of February 2014. The FGD had twelve discussants, made up of 9 members from the State Ministry of Health, 2 from NGPHCDA and 1 from Hospital Management Board. The discussion was guided by the WHO/MC section of the tool that was used during the baseline assessment.

Between the baseline assessment and this RCA, there has been some improvement in SMCP/SMOH capacity but this is most noticeable in the area of capacity development, M&E and programme management. The least improvement is in regulation and disease surveillance.However, some of the key findings are as follows:

About 70% (4) of the six SMCP team members are Community Health Extension Workers. Only the State Coordinator and her deputy are Registered Nurse/Midwives. Even with the best of intentions, it is doubtful whether such a level of human resource capacity can provide the strategic effort required to achieve the ambitious targets of malaria elimination.

There are no clear enough signs that the State Government is sufficiently in charge of oversight, leadership and coordination of malaria control efforts, including programme management/implementation

There are obvious gaps in the area of data management Although SuNMaP is facilitating an Operational Research on Capacity Building in Niger

State, it does not seem that state functionaries are sufficiently engaged in the process. Thus, it appears that an opportunity to enhance in-state capacity for operational research may have been lost.

The State Governor has signed into law a Bill to establish a Drug Management Agency (DMA) which is yet to become operational.

Recommendations1) Specific and strategic efforts are required for the health sector MDAs in Niger State to

increase funding provision (through budget and imprest release) for malaria control activities. Beyond demonstrating government commitment, increased sustainable funding for malaria will very likely lead to the staffing of the SMCP with higher calibre human resource.

2) Data management system in the State should be strengthened through the expansion of DHIS 2.0 beyond the current 5 LGAs to the other 20 LGAs.

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3) Sustainability could be greatly enhanced if each / every technical assistance to the state henceforth is designed to deliberately involve a core group of technocrats / facilitators.

4) Supporting the state to operationalize the DMA will go a long way in strengthening their Procurement and Supply Management System.

SECTION A: TECHNICAL CAPACITY FOR MALARIA CONTROL

Figure 2: Niger State Ministry of Health in-house Capacity for Malaria Control

A.1 Capacity for Programme Management

Policy developmentNiger State does not have any state policy developed on malaria control or elimination. However, the state is guided by various national policies.

Strategic directions and oversightThe state adopted the National strategy.About 70% (4) of the six SMEP team members are Community Health Extension Workers. Only the State Coordinator and her deputy are Registered Nurse/Midwives. Even with the best of intentions, it is doubtful whether such a level of human resource capacity can provide the strategic effort required to achieve the ambitious targets of malaria elimination.

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Partnership DevelopmentAll the Partners including SuNMaP supporting malaria interventions in the state have Memoranda of Understanding (MOU) signed with the state. There is evidence of monthly meetings with Partners coordinated by SMEP.

StewardshipThere are different fora at which the state enlightens the public on the activities of the Malaria elimination programme. The Honourable Commissioner for Health and Hospital Services organizes press conference on every Malaria Day (address was sighted to confirm this) to inform the populace of the state’s malaria control activities and uses the forum to educate the masses on their own roles to ensure the success of the interventions. Regular meetings are also held where information is disseminated (minutes were seen.).They also have radio jingles on malaria control activities.

Programme planningState has capacity for programme planning. Discussants in addition to others not invited to this FGD participated in the development of the state Annual Operational Plan (AOP) for Malaria control for the past three years. They also planned the state-wide LLINs distribution.

Fund-raising/resource mobilisationThere is an Advocacy and Social Mobilization Committee which collaborates with other NGOs like HERFON in the state to advocate for fund and to engage in revenue mobilization for the programme. However, State level budgetary allocation and release for malaria interventions reportedly remain a challenge. Consequently, it becomes questionable whether the State Government is sufficiently in charge of oversight, leadership and coordination of malaria control efforts, including programme management/implementation.

Establishing norms, standards, indicatorsThere are established norms, standards, indicators malaria control with evidence of algorithms, and Standard Operating Procedures (SOPs) which are distributed to malaria control staff and to LGAs and health facilities throughout the 25 LGAs of the state. There is evidence of monthly meeting between the SMEP and LGA malaria Focal persons.

Programme coordination/integrationSMEP conducts regular unit meetings for the various thematic areas to keep each area on the-know and update themselves of the direction of the programme. Regular monthly review meeting also holds for all the relevant stakeholders. See also, the section on Strategic directions and oversight(above).

Operational guidance/directionThe SMEP provides operational guidance/direction for all the thematic areas to ensure that activities are carried out properly. SOPS, Chart and other relevant materials are shared during meetings to facility staff to paste in their facilities.

Programme implementationAll participating discussants have been involved in implementing one programme or the other. They all participated in the planning and distribution of LLINs in the state, immunization programmes and other many activities including trainings that have taken place. Discussants were unanimous in their affirmation of active involvement in Programme implementation (activity reports were sighted) e.g. LLINs distribution and immunization programmes.

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AdministrationThe SMEP, which at present has 6 staff, operates from a one-room office and this has lots of implication for staff effectiveness and efficiency. Concerted efforts have reportedly been made in trying to ease this bottleneck but to no avail. Positions of SMEP staff are as presented in the attached organogram.

A.2 Capacity for Capacity Development

Design and planning of Training Needs AssessmentThe SMEP (with technical support from SuNMaP) developed a training plan for malaria control programme and staff at one point in the state (Report sighted). Most of the staff in the various units have benefitted from such trainings.

Design and planning of Training Programmes The SMEP has reportedly designed and planned some training programmes for their staff and LGA focal persons.

Delivery of Training ProgrammesAll the participating discussants have served as facilitators of training events. Examples include training programmes for malaria diagnosis and treatment and the training of LGA focal persons.

A.3 Capacity for Regulation

Establish policy/regulations on malaria commodities/monitor/enforcement of regulationsThe state adopted the National policy and operated within the guidelines on regulations and sanctions.The state has an in-house capacity to regulate but with weak monitoring and enforcement. The state has a functional quality control laboratory. Drugs are checked regularly for quality.

A.4 Capacity for Technical interventions (preventive/curative)

Develop guidelines and protocolsThe state did not develop any guideline and protocol on prevention / case management and so, adopted the National guidelines and protocols and operated with that. These are reportedly available at LGA and health facility levels.

Plan detailed delivery of interventionsThey have planned and delivered some interventions for their staff and LGA focal persons with marginal capacity since not all the members have the same capability to do so. Discussants have participated in various training events and have also been involved in the delivery of interventions.

Manage commodity suppliesThe state receives commodities from NMEP through the state MOH,MSH, SuNMaP, DRF, MDGs and other Partners. These are distributed to LGAs and onwards to Health facilities. The state has a functional procurement and logistics management committee. There is a distribution plan and there are no ambiguities about this but there was no good technology to drive the distribution process; bin cards, SRVs, etc, are still being used to manage commodities.

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Manage commodity stocksMalaria control commodities are managed effectively. There are occasional stock-outs but this is taken care of by the regular supply from the DRF and sometimes by the MDGs. Partners also provide SP, RDTs etc., management of these commodities pose no problems at all as LMIS is fully functional. They also follow the FIFO and FEFO principles.

A.5 Capacity for Monitoring & Evaluation /Quality Assurance

Design of M&E frameworks and systemsThe national malaria control M&E framework was domesticated. They use the harmonized HMIS tool.

Design quality control and quality assuranceThe state developed and domesticated a functional quality assurance/control system. Monthly meetings are held by the M&E unit where data from LGAs are shared, screened and compared by LGAs. Data summary sheets are reportedly available at LGA and health facility levels.

Design of data management systemsFive out of Niger State’s twenty-five LGAs are using the DHIS 2.0 software. The twenty other LGAs operate manual data entry systems. Data management would improve considerably if all the LGAs digitalize.

Data collection (record–keeping)Data is collected from the health facilities to the LGAs where they are summarized and then forwarded to the state by the malaria focal person of each LGA. As for malaria specific data collection from private facilities, e.g. the PPMVs, the Society for Family Health(SFH) collects these data from these private facilities they are supporting and forwards to the SMEP manager during their monthly meeting. All the SuNMaP – supported health facilities in the state use the harmonized National HMIS tool for data collection.

Data analysis & reportingThere is a degree of data analysis done by the M&E officer. DHIS 2.0 is used for data reporting in 5 LGAs. The ones shown to us were analysed by month and annually and presented in tables/Bar charts and graphs. These are shared and compared during monthly meetings. Data is used for planning. The state malaria M&E officer equally scrutinises the data before same is forwarded to the federal.

Supervision of data management staffThe state is implementing ISS. Supervision is regular and scheduled using appropriate tools involving all the discussants and others. Data from the supervisory visit is used for planning and OJCB also takes place. M&E officer and HMIS officer attend monthly consultative meetings and share data regularly.

Co-ordination of State systemsThe malaria M&E officer and HMIS officer attend monthly consultative meetings and share data regularly. Co-ordination of State systems is cordial and effective – seen during theFGD.

Quality control/quality assuranceMalaria data QA/QC activities are carried out monthly. 100% of scheduled QA/QC activities are done. Report is shared among stakeholders including LGAs and participating HFs.

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They have a checklist and data is compared and feedback is given at monthly meetings.

Evaluation, Review and FeedbackA functional evaluation system is in place. Routine data is collated, processed and reviewed by the M&E officer. Data from the various LGAs are compared and feedback is provided to frontline staff at subsequent monthly meetings.

A.6 Capacity for Operational Research

Developing research agendaThe SMEP participated in an operational research after the state-wide LLINs distribution. Although SuNMaP is facilitating an Operational Research on Capacity Building in Niger State, it does not seem that state functionaries are sufficiently engaged in the process. Thus, it appears that an opportunity to enhance in-state capacity for operational research may have been lost.

Design of researchThe state conducted an implementation research, following the state-wide LLINs distribution.

Supervision / co-ordination of researchCapacity is limited.

Carrying out researchThe capacity to carry out operational research is not adequate.

Analysis and reportingAnalysis and reporting of research findings led to the development of jingles, social mobilization activities to create awareness on the use of the LLINs at households but no evidence was sighted on this claim.

Dissemination of findingsResearch findings were disseminated at monthly meetings and deliberated on.

A.7 Capacity for Disease Surveillance

Supervision / co-ordination of surveillanceThe state has low capacity for Disease Surveillance as their activities are not properly coordinated. There seem to bea disconnect between the federal government established sentinel sites and the disease surveillance unit in the SMOH. Data on diseases are not collated properly and reports are usually delayed. It is also known that the WHO provides the logistics for Disease Surveillance and Notification all over the country.

Carrying out surveillanceSurveillance is carried out by theLGA’s DiseaseSurveillance and Notification Officers(DSNOs), copies of their reports are sent to the WHO state focal person, state Epidemiologists, state M&E and HMIS officers.

Analysis and reportingData on malaria cases are submitted regularly from the six (6) SuNMaP supported LGAs but not from all the health facilities in the other LGAs SuNMaP is not supporting. Evidence for this was

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also sighted during the FGD. LGAs data areanalysed and feedback given to health facilities staffwhen necessary

Dissemination of findingsFindings from analysed data are disseminated at different fora with stakeholders including MTWG and LGA malaria focal persons.

A.8 Other skills that members of the State Ministry of Health team feel they require to improve Malaria control in the state

1. Data management skills at all levels – computing skills.2. Research/training skills3. Knowledge management skills 4. Advocacy and mobilization skills.

Section B: Drug/Consumables Supply System

Sustainable Drug Supply SystemThe state has a DRF Supply System which is working only for secondary health care facilities. The primary health care facilities have a free health programme for pregnant women and children below five years of age. This thus makes the DRF not accessible at all levels. There are occasional stock outs.

Plans to upgrade the present systemThe State Governor has signed into law a Bill to establish a Drug Management Agency(DMA) which is yet to become operational. The present supply system has the shortfall of not providing for the Primary health facilities.

The status of the state Central Medical Store

There is a functional central medical store with 20 staff who provide 24 hours service. They have good shelves, cupboards, Air-conditioners and ceiling fans, fridge, three Generators which is fuelled by Management Sciences for Health (MSH). The management arrangement is marginal. They observe the FIFO/FEFO procedure. Although they are still using the manual system, there is plan to introduce E-management system. A procurement Committee exists. For accountability, they have Inventory control cards, Bin Cards, monthly inventory and so on. Quantifications are done by TWG-DPS,SuNMaP, M&E,DRF,MSH,MOH in collaboration with NMEP,Pharmacist in charge of the Central Medical Store.Supplies get to the facilities through the LGAs which collect from the state Central Medical Store regularly and on requisition too.

The Ministry of health and the Management Sciences for Health (MSH) are responsible for the system. There is no internal audit but there is external. Record keeping is safe and adequate

Section C: HMISThere is a functional HMIS. They have started using the DHIS 2.0 but only in 5 LGAs. FHI360 is responsible for the system and the present management arrangement is adequate even then, little capacity building will make a significant difference

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State to LGA health system supervision activitiesThe SuNMaP supported ISS covers 6 LGAs of the state and there are plans to scale up to additional LGAs. The management arrangement is adequate but funding from state remains a challenge. The SMEP is part of the ISS team and reports of visits are usually shared with them

State-Level Priority needs1. Scale up of ISS to the remaining 5 LGAs /health facilities.2. Scale up DHIS 2.0 to the rest 20 LGAs.3. Capacity building for staff handling malaria commodities to strengthen LMIS4. Baseline entomological data and capacity for IRS and environmental management 5. Capacity building for focused antenatal care and malaria in pregnancy.6. Increased support for the maintenance of programme project vehicle and other logistics.7. Strong advocacy for resource mobilization to purchase free anti malarial commodities for

the primary health care facilities to cover all the other HFs not covered by Partners.

Prioritising the capacity gaps in terms of the urgency and importance of addressing them

1. Training on focused antenatal care and malaria in pregnancy1. Scale up of ISS to the remaining 5 LGAs health facilities2. Baseline entomological data for IRS and environmental management.3. Capacity building for staff handling malaria commodities to strengthen LMIS4. Scale up DHIS 2.0 to the rest 20 LGAs5. Advocacy for increased funding and logistics support for the SMEP.

Special/Additional areas of required support + justification

This is an area that should be considered in planning an intervention strategy because mothers need to be more aware of pregnancy and its outcome especially the consequences of malaria in pregnancy. During the FGDs, this issue featured prominently of lack of awareness of mothers and some health workers about focused antenatal care, malaria in pregnancy and IPT.ISS is an area that our partners should focus on in terms of scale up and logistics and the state government should be more involved for sustainability of the system.

In terms of capacity of the SMEP, human resource is grossly inadequate, infrastructure and equipments leave much to be desired as SMEP still operates in a one-room office for all the personnel

Issues areasGovernment provides free health services including free antimalarials for pregnant women and children under-5 at secondary health care only. This makes their current DRF system to be unsustainable.

SuNMaP Legacy?1. Integrated Supportive Supervision. 2. Capacity building for malaria programme management3. Demand creation.

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Trend analysisSuNMaP support to Niger state on malaria control has led to a tremendous change in malaria indices in the state. Before now all cases of fever were treated as malaria and over 50% of out-patient attendance was reported as malaria on the basis of fever detection alone but at Present, only cases that are tested and confirmed as malaria are treated as such. Then, the RBM programme had only 3 staff with no structure and functional system on ground, now the SMEP has 6 staff and 6 thematic areas of malaria control functioning. Capacity for annual operational plan development and other programme management capacity were either weak or non-existent (baseline survey, 2010) but now the SMOH has capacity for programme management. Other capacity areas like capacity development, M&E, data management; ISS, etc have all been strengthened. The process of ISS development has been completed. In 2010, there was no M&E officer (2010 baseline report) but now there is an M&E officer who collects, collates, analyses and reports data regularly. Hitherto, all cases of fever were treated as malaria(2010 baseline report) but with effect from 2012 when RDT/microscopy were introduced, only confirmed cases of malaria are treated as such.

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Table 1: Niger State SMCP staff profile

SN Name/ Qualification

Sex Phone no /e-mail

Designation Full /part time

Profession Service Duration(year)

1 Dawaba M(RN/RM)

F 08056404203/dawabamercy@yahoo.com

Programme manager

Full time Nurse/Midwife/CHO

5 years

2 Ibrahim BM(RN/RM)

F 08030690034/bjwushishi@yahoo.com

Deputy RBM coordinator

Full time Nurse/Midwife

5 years

3 Muhammed MW(CHEW)

M 08032771888/wasagi@ymail.com

M&E officer Full time CHEW 1yr 6months

4 Muazu M(CHEW)

F 07087660809/maimunamuazu770@yahoo.com

Assist.M&E officer

Full time CHEW 1 year 6months

5 Daniel Iliya(CHEW)

M 08036323013/daniliya30@yahoo,com

Logistics Officer

Full time CHEW 7 years

6 Amina EZ(CHEW)

F 08168195186/azinro@yahoo.com

ACSM Officer Full time CHEW 5years

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List & Profile of FGD Discussants

S/N Name Designation Organization Phone no e-mail1 Shehu A Mairiga DOISS SMOH 08033909083 shehumairiga@yahoo.com2 Muh Mustafa S CMS pharmacist SMOH,CMS 08033140795 Mmsulaiman2008@yahoo.com3 Mohammed K Buhari SDNSO SMOH 08036118304 kudu@yahoo.com4 Rakiya Y Datti SI-DPH SMOH 08037022603 dattiboy@yahoo.com5 Daniel Iliya SMEP Log Officer SMEP,SMOH 08036323013 Daniliya30@yahoo.com6 Bilkisu Ibrahim M DSRBMC SMOH 08030690034 bjwushishi@yahoo.com7 Muh’dMuh’dWasagi M&E SMEP SMOH 08032771888 muhammedwasagi@gmail.com8 Abdullahi Mohammed DMS HMB 08036143652 abdulmohd35@gmail.com9 MuhammedLawalAdamu DDHF NGPHCDA 08033561305 mlalawaladamu@yahoo.com10 Abdullahi B Liman DDF&D NGPHCDA 08065072140 abbalim2005@yahoo.com11 EgbaJibrin HMIS SMOH 07069229924 jibrinegba@yahoo.com12 Dawaba Mercy SRBM SMOH 08056404203 dawabamercy@yahoo.com13 OlatundeOlotu TMM SuNMaP Niger SuNMaP 08036054579 o.olatunde@mc.org14 Sunday Unubi Operations

Officer,SuNMaP,SuNMaP 08069482393 u.Sunday@mc.org

15 Jonathan Igboji Consultant SuNMaP 08035790024 igboyam@yahoo.com16 Agbenin Andrew Consultant SuNMaP 08035285510 agbenin@yahoo.com

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Completed data tool

RAPID CAPACITY APPRAISAL OF SuNMaP SUPPORTED STATES

STATE LEVEL TOOL

Note: All questions are Malaria specific

Section A: Technical Capacity of State Ministry of Health

Scoring Key: 1 = Adequate,2 = Marginal, 3 = Inadequate

A.1 State Ministry of Health in-house capacity for Programme Management1 2 3

Policy development XStrategic direction / oversight XPartnership Development X Stewardship X Programme planning X Fund-raising/resource mobilisation X Establishing norms, standards, indicators X Programme coordination/integration X Operational guidance/direction X Programme implementation X Administration X

A.2 State Ministry of Health in-house capacity for Capacity Development1 2 3

Design and planning of Training Needs Assessment X Design and planning of Training Programmes X Delivery of Training Programmes X

A.3 State Ministry of Health in-house capacity for Regulation1 2 3

Establish policy/regulations on malaria commodities X Monitor/enforce regulations X

A.4 State Ministry of Health in-house capacity for Technical interventions (preventive/curative)

1 2 3Develop guidelines and protocols XPlan detailed delivery of interventions X Manage commodity supplies X Manage commodity stocks X

A.5 State Ministry of Health in-house capacity for Monitoring & Evaluation /Quality Assurance

1 2 3Design of M&E frameworks and systems X

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Design quality control and quality assurance X Design of data management systems X Data collection (record–keeping) X Data analysis & reporting X Supervision of data management staff X Co-ordination of State systems X Carry out quality control/quality assurance X Evaluation, Review and Feedback X

A.6 State Ministry of Health in-house capacity for Operational Research1 2 3

Developing research agenda X Design of research X Supervision / co-ordination of research X Carrying out research X Analysis and reporting X Dissemination of findings X

A.7 State Ministry of Health in-house capacity for Disease Surveillance 1 2 3

Supervision / co-ordination of surveillance XCarrying out surveillance X Analysis and reporting X Dissemination of findings X

A.8 Other skills that members of the State Ministry of Health team feel they require to improve Malaria control in the state?

1) Knowledge management skills2) Advocacy/mobilization skills3) Data management skills at all level-computing skills4) Research skills5) Training skills

Section B: Drug/Consumables Supply System

Scoring Key: 1 = Adequate,2 = Marginal, 3 = Inadequate1 2 3

B.1 Is there a Sustainable Drug/Consumable Supply System? X B.2 Are there plans to upgrade/change the present system? Yes

If there are get the details: Drug Management Agency(DMA) bill has been signed by the Governor of the stateB.3 Who is responsible for the System?: The state ministry of health(MOH)

B.4 What is the status of the State Level Store? X B.5 Are the management arrangements adequate? X B.6 Who is responsible for quantification?: They are management services for health(MSH),State Ministry of health(SMOH) in collaboration with the national malaria control programme(NMCP),Drug revolving fund(DRF)-members include the state malaria elimination programme manager, director of pharmaceutical services, the pharmacist in-charge of the central medical store, M&E officer of the state

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B.7 Who is responsible for procurement?These are the state ministry of health(SMOH) in collaboration with the national malaria elimination programme(NMEP),the state malaria elimination programme(SMEP) and supporting partnersB.8 Who is responsible for distribution?: The Central Medical StoreB.9 What are the accountability arrangements?:These involve the use of inventory control cards, proper record keeping of drug inflow and outflow, monthly stock takingB.10 Is there internal and external audit?: There is no internal audit but there is usually external auditB.11 When was the last external audit?: December,2013B.12 Is there safe keeping of value books – cheques, receipt books, invoices, etc.?:YesB.13 Is the record keeping adequate? x

Section C: HMIS1 2 3

C.1 Is there a functional HMIS? X C.2 Have you started using the DHIS 2.0? If yes in how many LGAs?: It is being used in 5 LGAs for nowC.3 Who is responsible for the System?: FHI360C.4 Are the management arrangements adequate? X C.5 Would a small amount of capacity development make a significant difference? Yes, it will

Section D: State to LGA health system supervision activities 1 2 3

D.1 Is there a functional Supportive Supervision system between State and LGAs? X

D.2 If to some LGAs only specify which: ISS was set up and rolled out last year but they only visited one LGA since roll outD.3 Are there plans to upgrade/change the present system. NoD.4 Who is responsible for the System?: SuNMaP/SMEPD.5 Are the management arrangements adequate? X D.6 Is transport and fuel always available for planned supervision? If not clarify how big a

problem this is for the supervision and why it is not available. Since the set up of ISS, the only visit they made to the only LGA they visited was by self-sponsorship, no money to fund the trip

D.7 Would a small amount of capacity development make a significant difference? YesD.8 How does the State Malaria Control Unit interact with this supervision system?:Participate in visit and always get a report of the supervisory visit

Section E: State-Level Priority needs

What other priority needs are there?:1) Scale up ISS to the remaining 5 LGAs2) Scale up DHIS 2.0 to the remaining 20 LGAs3) Capacity building for staff handling malaria commodities to strengthen logistics and

management information system(LMIS)4) Capacity building for indoor residual spraying(IRS) and environmental management5) Capacity building for focused antenatal care and malaria in pregnancy(MIP)6) Training on IRS for the generation of baseline entomological data

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7) Increased support for the program project vehicle and other logistics8) Strong advocacy for resource mobilization to purchase free antimalarial drugs for PHCs

Section F: How would you prioritise the capacity gaps in terms of the urgency and importance of addressing them?

1) Capacity building for focused antenatal care and malaria in pregnancy(MIP)2) Scale up ISS to the remaining 5 LGAs3) Training on IRS for the generation of baseline entomological data4) Capacity building for staff handling malaria commodities to strengthen logistics and

management information system(LMIS)5) Scale up DHIS 2.0 to the remaining 20 LGAs6) Capacity building for indoor residual spraying(IRS) and environmental management7) Strong advocacy for resource mobilization to purchase free antimalarial drugs for PHCs

SuNMaP Exit/Sustainability

1) The state government should be more responsible and release budgets as approved for malaria control programmes

2) Programme integration/basket funding3) More partners

Adding Value: SuNMaP legacy:

1) ISS2) Capacity building for malaria programme management3) Demand creation.

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