Nigeria

Country Overview

Malaria overview

Malaria is transmitted throughout Nigeria, with 97% of Nigerian’s living in malaria transmission areas. Malaria accounts for around 60% of all health center visits in Nigeria, 30% of hospitalizations, and some 300,000 deaths each year. Patterns of transmission vary widely across Nigeria, ranging from year-round transmission in the south to three months or less in the north.

Which areas of Nigeria are eligible for SMC?

Districts within 6 of Nigeria’s 36 states are eligible for SMC, with approximately 11 million eligible children. All of these states are in Nigeria’s far north, in the Sahelian climatic zone. Further south, the rainy season, and therefore malaria transmission, is longer than four months. Given that the maximum number of monthly SMC cycles is four, these areas are not eligible for SMC.

What is Nigeria’s experience with SMC?

Before the ACCESS-SMC project, SMC was implemented in three Nigerian states. In Katsina and Jigawa, Malaria Consortium supported the health authorities to implement SMC in a total of four LGAs, while Kano State has experience of SMC in partnership with the Clinton Health Access Initiative (CHAI).

ACCESS-SMC in Nigeria

Where is SMC being delivered?

ACCESS-SMC is supporting the National Malaria Elimination Progam (NMEP) and its state level counterparts to implement SMC in 17 local government areas (LGAs) of Sokoto and Zamfara states, providing SMC drugs to a total of 792,132 children.

• In Sokoto state, ACCESS-SMC is supporting delivery of SMC to over 410,000 children in 2015, with coverage of 10 LGAs: Gada, Goronyo, Gudu, Gwadabawa, Ilela, Isa, Sabon Birnin, Tangazam, Wamakko and Wurno.
• In Zamfara state, ACCESS-SMC is supporting delivery of SMC to almost 380,000 children in 2015, with coverage of seven LGAs: Bakura, Brinin Magaji, Bungudu, Kauran Namoda, Shinkafi, Talata Mafara and Zurmi LGAs. 

When is SMC delivered?

In Nigeria, SMC delivery will begin in July, with monthly distributions continuing until October.

How is SMC being managed?

ACCESS-SMC is working to provide a range of technical, financial and logistical support to the NMEP and its state level counterparts so that they can lead SMC delivery. This support will cover topics such as planning, health worker training and supervision, managing the supply chain and communicating key SMC information to communities. This joint approach will make sure that we leave behind local capacity in these states for them to keep implementing SMC once ACCESS-SMC has finished.

How is SMC administered in Nigeria?

In Nigeria, SMC is being administered to children by 6,601 trained volunteer Community Health Workers (CHWs). They administer SMC drugs to children using two methodologies: ‘door-to-door’ and ‘fixed post’.

• Fixed post methodology is used in large communities or in scattered or hard to reach communities. Teams of three CHWs work at each fixed post, with one to dispense the drugs, one for record keeping, and a third for crowd control. The fixed posts are located in prominent community locations, including community centers, houses of village heads, schools and public spaces (e.g. under a tree).
• Door to door methodology are used in rural or small communities. Teams of two CHWs travel to children’s homes each month to administer SMC drugs. Each of the CHWs take one of two roles, with one dispensing drugs and other record keeping and managing stock.

How do SMC drugs reach the ‘last mile’?

Following delivery and clearance in country, the SMC drugs are delivered straight to state medical stores, where they remain until five days before SMC delivery begins. Each LGA is responsible for movement of the drugs from the state stores to the health facilities. CHWs  collect drugs each morning from these health facilities, returning unused stocks at the end of the day. ACCESS-SMC and the NMEP manage and monitor the progress of SMC drugs through the supply chains system using the existing logistics management information system (LMIS). ACCESS-SMC will provide technical support to strengthen this.