Building National Capacity for Universal Coverage: Malaria Control in Nigeria

This 28-page learning paper shares the experience of the Support to National Malaria Program (SuNMaP) in Nigeria, which focused on improving the capacity of the Nigerian government to lead the fight against malaria, strengthening public-private partnerships, and reaching the economically poor and vulnerable with interventions such as long lasting insecticidal nets (LLINs). SuNMaP is led by the Malaria Consortium, Health Partners International, and GRID Consulting, and supported by UKAid/Department for International Development. According to the learning paper, while capacity building has been consolidated in the states where SuNMaP works, there is plenty that remains to be done. SuNMaP is currently working with the National Malaria Control Program (NMCP) so it can take on the capacity building process going forward to lead states, encouraging them to undertake capacity building processes for their own staff.

According to the learning paper, capacity building is considered crucial to all six of the core elements, or outputs, that make up the SuNMaP programme: capacity building; harmonisation; prevention of malaria; treatment of malaria; awareness and demand creation; and operations research. At the onset of the SuNMaP programme, capacity building was considered to be confined to the first output, however, it became apparent that it was an essential part of SuNMaP's entire programme, and the strategy was adjusted to take this into consideration. SuNMaP decided to adopt a people-centred, pragmatic, and focused approach that goes beyond training to improve the knowledge, skills, and practices of programme managers and health care providers.

At the start of the programme in 2008, SuNMaP conducted a baseline assessment on the ability of existing field staff, and NMCP and State Malaria Control Programme (SMCP) staff, to deliver malaria control. The assessment helped to inform the design of the capacity development programme. One of the outcomes of the assessment was the realisation that, while there was a wide range of training materials on malaria control in Nigeria, these were not standardised, and at service delivery points there appeared to be poor perception of and adherence to policy recommendations on malaria control. These findings revealed the urgent need for capacity development. As a result, SuNMaP supported stakeholders and Roll Back Malaria partners in each of the programme states to develop a broad and ambitious capacity building plan for the roll-out of service delivery and programme management training. This encompassed policy makers, managers, and health workers, as well as people who worked in the community such as patent medicine vendors and community caregivers.

In the catch-up phase, SuNMaP carried out training of trainers initially so that this would then cascade elsewhere. The programme approach to training focuses on the use of participatory adult learning techniques using simple and adaptable learning aids. During training events, three main objectives are achieved:

• Identification of misconceptions and barriers to best practice;
• Group exercises aimed at improving the understanding of the link between the malaria transmission cycle and key malaria control interventions; and
• Facilitation and consensus building around key messages and best practice.

The Keep-up Phase comprises activities designed to increase the level of coverage of interventions for malaria control in an area. This includes interventions designed for:

• re-enforcing knowledge and skills on malaria case management;
• improving the management and supervisory skills of malaria control teams at the national, supported states and LGA levels;
• strengthening key health systems supporting malaria control interventions to maintain quality of care, availability of supplies and funding; and
• strengthening the institutions responsible for malaria control to ensure sustainability of the programme support.

The programme encountered a number of challenges, which included:

• the limited commitment of funds for capacity building activities at many levels and not all of those who are trained as trainers turn out to be good at it;
• working with NGO colleagues, or programme implementation partners, who have their own capacity building needs;
• lack of commodities, or delays in receiving them, can be a problem;
• comparatively shorter attention span of private sector health providers, which requires stronger facilitation skills and innovation.

Going forward, the paper notes that capacity building must necessarily take into account the fact that SuNMaP will not always be there – so sustainability of any work must always be taken into account. Much of SuNMaP’s capacity building has been done alongside the provision and use of malaria prevention or treatment commodities (such as LLIN s or ACTs). This has been done, for instance, by teaming up with ante-natal clinics to provide nets to pregnant women. If malaria commodities are unavailable, this threatens both the capacity building work, and the motivation of the women who attend that facility.