THE ROAD TO 2020: MOBILSING THE PRIVATE SECTOR IN NIGERIA'S FIGHT AGAINST MALARIA- THE LAGOS STATE APPROACH - A PAPER PRESENTED AT THE 2015 CAMA ...

THE ROAD TO 2020: MOBILSING THE PRIVATE SECTOR IN
NIGERIA’S FIGHT AGAINST MALARIA-

THE LAGOS STATE APPROACH.
A PAPER PRESENTED AT THE 2015 CAMA ANNUAL TECHNICAL FORUM.

                                          Dr Modele Osunkiyesi
                                    Permanent Secretary (Health)

Synopsis on Malaria in Lagos State
Malaria:
• is endemic in the State.
• is propagated by the cosmopolitan nature of the State, coupled with
  peoples’ behaviour and the abundant distribution of coastal areas. These
  encourage the availability of stagnant water for the breeding of anopheles
  mosquitoes
• remains one of the leading causes of morbidity and mortality in the State.
• poses a major challenge to the State as it impedes human development.
• is both a cause and consequence of underdevelopment.

Reported Cases of Malaria in Lagos State
2004 -2014
                 Reported cases of malaria in Lagos State 2004-2014
                                                                  622562
                                               562869 525870                         566215 547150
                                                                           488780
                           427673 467625
                  366655
300508 260578

 2004     2005     2006      2007     2008      2009      2010     2011      2012     2013      2014

The number of malaria cases increased by 58% from 260,578 in 2005 to 622,562 in 2011. There was a
reduction to 488,780 in 2012 and it increased to 547,150 in 2014.

Key Malaria Indicators (2014)
• Malaria Prevalence: 4.2%
• LLIN Utilization Rate: 18%
• Proportion of pregnant women who received at least two doses of SP for
  intermittent preventive treatment during antenatal care visits : 43%
• Proportion of pregnant women who received LLIN during antenatal care
  visits : 85%
• Proportion of persons presenting at health facility with fever who received
  a diagnostic test (RDT or microscopy) for malaria: 51%
• Proportion of persons that tested positive for malaria at health facility
  (uncomplicated or severe) that received antimalarial treatment according
  to national treatment guidelines : 100%
• Proportion of health facilities with stock out of ACTs lasting more than one
  week at any time during the last one month: Monthly average for 2014- 6%
  (H:12.5%, Lowest: 0.4%).

The Lagos State Approach
Lagos State has institutionalised the following malaria control
interventions since 1999:
1. Malaria Diagnosis with RDT and Microscopy
2. Free Malaria Treatment with ACT
3. Intermittent Preventive Therapy (IPT) with SP for pregnant women
4. Use of Long Lasting Insecticide Treated nets (LLIN).
5. Health Education.

Lagos State commenced integrated vector management which include
Indoor Residual Spraying and Larviciding in 2010.

Lagos State Approach to Malaria Control contd.
• Malaria Control Committee: The State has a Malaria Research, Technical and Advisory Committee
  (LASMARTAC). Inaugurated in October 2008.

• Mandate of the Committee: To provide technical and advisory support for all malaria elimination activities
  in the State

• Composition of the Committee:
    1. Representatives of relevant State Ministries, Departments and Agencies (MDAs).
    2. Developmental partners.
    3. Malaria implementing agencies.
    4. Research institutions.
    5. Civil Society Organizations (CSOs).
    6. The academia.

• The Sub-Committees:
    1. Research subcommittee
    2. Diagnosis and Treatment subcommittee
    3. Integrated Vector Control subcommittee
    4. Advocacy, communication and Social Mobilization subcommittee
    5. Resource Mobilization subcommittee

Lagos State Approach to Malaria Control
contd.
Currently, in line with the National Malaria Strategic Plan 2014 – 2020, the
malaria elimination activities in the State are currently grouped into 7
strategic areas:
1. Prevention
2. Diagnosis
3. Treatment
4. Advocacy, Communication and Social Mobilization
5. Procurement and Supply Management
6. Monitoring and Evaluation
7. Programme Management

Strategic Objectives
• Prevention: To ensure that at least 80% of targeted populations utilize appropriate malaria preventive
  measures by 2020.

• Diagnosis: To ensure that all persons with suspected malaria who seek care are tested with RDT or
  microscopy by 2020.

• Treatment: To ensure all persons with confirmed malaria seen in private or public health facilities receive
  prompt treatment with an effective anti-malarial drug by 2020.

• Advocacy Communication and Social Mobilisation (ACSM): To ensure at least 80% of the population
  practice appropriate malaria prevention and management by 2020.

• Procurement and Supply Management (PSM): To ensure the timely availability of appropriate antimalarial
  medicines and commodities required for prevention, diagnosis and treatment of malaria in Nigeria by 2018.

• Monitoring and Evaluation: To ensure that all health facilities report on key malaria indicators routinely by
  2020.

• Programme Management: To strengthen governance and coordination of all stakeholders for effective
  programme implementation towards an A rating by 2020 on a standardized scorecard.

Activities of LASMARTAC
The following are a few of the researches/studies/activities were
conducted by LASMARTAC:

Research
   1.   Baseline Malaria Household survey in 5 divisions of Lagos State
   2.   Baseline entomological studies in Ojo and Ikorodu LGAs
   3.   Longitudinal entomological studies in 3 senatorial districts of Lagos State
   4.   Baseline malaria prevalence survey in Ojo and Ikorodu LGAs
   5.   Baseline malario-metric survey in 3 senatorial districts of Lagos State
   6.   Pharmacovigilance of Artemisinin Based Combination Therapies (ACTs)
        among U5 children in Ijede LCDA.

Activities of LASMARTAC Cont’d
 1. Institutional based policy and practices of malaria case management in
     Lagos State
 2. Evaluation of malaria microscopy and Malaria RDT in secondary health
     facilities in Lagos State.
 3. Pilot Indoor residual spraying in Ojo and Ikorodu LGAs
 4. Scale up of indoor residual spraying in Ojo, Ikorodu, Kosofe, Ibeju Lekki,
     Amuwo Odofin and Badagry.
 5. Larvicide application and operation in Ajegunle community (Kosofe LGA)
 6. Review of malaria diagnosis and treatment protocol for Lagos State.
 7. Malaria community surveillance
 8. Development and production of malaria BCC/IEC materials
 9. Development and production of malaria documentary and jingles.
 10. Statewide malaria campaign and sensitization
 11. Environmental impact assessment of Indoor residual spraying in Lagos State.

Involvement of the Private Sector
Who are the Private Sector?
• All healthcare providers who exist outside the public sector. They could be profit oriented
  or not-for-profit.
• These include: Hospitals, maternity homes, clinics, pharmacies, patent medicine vendors
  pharmaceutical companies, corporate financiers, non-governmental organizations etc.

Why involve the Private Sector?
• A large proportion of clients, especially in Lagos State, access care from private
  healthcare providers.
• Healthcare costs are a huge burden on the less privileged in society.
• Government resources are limited.
• Development of sustainable private sector partnerships will increase coverage of key
  interventions, better reach in rural/remote areas and increased choice for households

Involvement of the Private Sector: Why?
• A large proportion of clients, especially in Lagos State, access care
  from private healthcare providers.
• Healthcare costs are a huge burden on the less privileged in society.
• Government resources are limited.
• Development of sustainable private sector partnerships will increase
  coverage of key interventions, better reach in rural/remote areas and
  increased choice for households

Involvement of the Private Sector: Specific Roles.
Involvement in market based approaches aimed at improving availability, access
and affordability of malaria care and key commodities. These include:

   • Social Marketing: an approach used to develop activities aimed at changing or maintaining
     people’s behaviour for the benefit of individuals and society as a whole.

   • Social Franchising: organization of multiple, existing, private providers into contractually
     obligated networks to improve access to high quality healthcare that is affordable to
     underserved communities

   • Drug and Commodity Supply:
    Subsidizing private sector supply of ACTs
    Increasing access to diagnostic services such as Rapid Diagnostic Testkits (RDTs)
    Increasing supply and distribution of commodities supporting prevention such as insecticide
     treated nets, insecticides for Indoor Residual spraying and Larviciding

   • Legal and Administrative processes:
    Regulation and Trainings
    Continuous Professional Development
    Participation in Clinical Audits

Involvement of the Private Sector: Available
Opportunities.
• Awareness Campaigns on Prevention, Diagnosis and Treatment of
  Malaria
• Subsidization of ACTs for the Private Sector
• Increase coverage of IRS and Larviciding
• Procurement of High Impact LLINs for communities where there is
  insecticide resistance
• Procurement of LLINs for distribution to pupils in primary and
  students in Secondary Schools
• Logistic support for movement of commodities to facilities
• Quality data collection

Current Partners of the State Programme
• Support to the National Malaria Programme (SuNMaP) -a DFiD
  funded programme
• The Global Fund for AIDs, Tuberculosis and Malaria
• Clinton Health Access Initiative (CHAI)

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