National malaria policy

Objectives

Achieve a malaria-free Nigeria by reorienting national programming from malaria control towards elimination, within a policy framework intended to guide coordinated action from federal to community level. The vision is a malaria-free Nigeria, while the mission is to provide equitable, comprehensive, cost-effective, efficient and quality malaria-control services underpinned by transparency, accountability, client satisfaction, community ownership and partnership.[1][2]The policy goal is to direct Nigeria towards elimination in line with Nigeria Vision 20:2020.[2]

• Provide a unified national framework that consolidates previously separate intervention-specific malaria policies and guides programme activities at federal, state, local-government, ward and community levels.[1]
• Achieve and sustain universal coverage of high-impact malaria interventions across the 36 states and the Federal Capital Territory, with the stated target of universal coverage by 2018.[2]
• Prioritise prevention and case management through integrated vector management, chemoprevention, prompt parasite-based diagnosis, effective treatment, advocacy, communication and social mobilisation, commodity regulation, monitoring and evaluation, and operational research.[3][4]
• Protect children under five and pregnant women, identified as particularly vulnerable groups, through prevention, treatment, long-lasting insecticidal nets, intermittent preventive treatment in pregnancy and seasonal malaria chemoprevention.[5][6][7]
• Reduce malaria morbidity and mortality during the Sahelian rainy season through seasonal malaria chemoprevention for children under five in Sokoto, Kebbi, Zamfara, Katsina, Kano, Jigawa, Yobe, Borno and northern Bauchi.[7]
• Ensure quality-assured diagnosis and treatment by using rapid diagnostic tests and microscopy, retaining microscopy as the operational gold standard, using artemisinin-based combination therapies for uncomplicated malaria, and discontinuing antimalarial monotherapy.[7][8]
• Strengthen severe-malaria care through early recognition, pre-referral treatment, referral, effective injectable medicines, and adequately equipped secondary, tertiary and specialist services.[9]
• Regulate malaria diagnostics, medicines and prevention commodities through national and international quality standards, therapeutic-efficacy monitoring, pharmacovigilance, product registration and certification.[10][11]

Implementation

Implement malaria elimination through an integrated, multi-sectoral delivery model combining public and private health services, community-based care, coordinated government action, research partnerships and private-sector participation.[5][12][13]The National Malaria Elimination Programme coordinates prevention, diagnosis, treatment, advocacy and social mobilisation, procurement and supply management, and monitoring and evaluation through the Federal Ministry of Health.[13]

• Deliver vector control through long-lasting insecticidal nets, indoor residual spraying, larval source management, personal protection and insecticide-resistance management.[4][14]Expand net access towards one net per two people at risk, promote use by children under five and pregnant women, and engage private firms in net production, promotion and sale while enforcing product specifications.[15]
• Apply indoor residual spraying selectively in feasible areas, expand it progressively under national integrated vector-management guidance, and use operational plans covering geography, methods, staffing, supplies, equipment, duration and estimated costs.[15]Conduct susceptibility, bio-efficacy and residual-efficacy testing before deployment, using recommended and nationally registered insecticides.[15][14]
• Provide chemoprophylaxis for non-immune visitors and evidence-defined special risk groups, and deliver intermittent preventive treatment in pregnancy through health facilities, communities and private facilities as part of antenatal care.[6]
• Deliver diagnosis and uncomplicated-malaria treatment through public and private facilities, primary healthcare services, trained community providers, integrated community case management and patent medicine vendors, with supervision and referral between levels of care.[8][9]Build diagnostic capacity by maintaining microscopy in secondary and tertiary facilities, deploying rapid diagnostic tests in outpatient and primary-care settings, and training formal, community and informal private-sector providers.[7][8]
• Strengthen commodity systems through quantification, procurement, storage, distribution, quality assurance and supply-chain information systems, addressing stock-outs, fragmented procurement, weak forecasting and inadequate storage.[16][2]
• Mobilise a Roll Back Malaria partnership involving communities, all tiers of government, development partners, bilateral and multilateral agencies, academia, civil society and the private sector.[13]Use the National Malaria Elimination Committee and its sub-committees on publicity and community mobilisation, case management and antimalarial drug policy, monitoring and evaluation, and integrated vector and environmental management, with comparable structures intended at state and local-government-area levels.[17]
• Strengthen accountability through a continuous cycle of planning, implementation, evaluation and re-planning; require partners to report progress and be accountable for delivery; and revise strategies where evidence warrants.[13]Implement monitoring and evaluation across national, state and local-government levels using routine data, surveys, surveillance, evaluations, reviews, research institutions and partner information.[18]
• Improve routine reporting, data quality, surveillance coordination and data sharing across public, private and community providers; operationalise electronic and short message service databases; and link malaria surveillance to the National Health Management Information System.[18]
• Develop a Malaria Health Financing Strategic Framework, advocate for increased malaria allocations within wider health budgets, and mobilise resources from government, development organisations, communities, philanthropy and private-sector actors.[13][17]Government funding is to be provided and released through federal, state and local governments according to malaria burden and needs, although the supplied material does not specify a total policy budget or quantified funding gap.[13][17]

Monitoring & Evaluation

Monitoring and evaluation is positioned as an integral, adequately funded component of malaria control and elimination, using a comprehensive national plan to assess strategic approaches, track progress and support programme adaptation as transmission declines.[18]The policy also envisages a continuous cycle of planning, implementation, evaluation and re-planning, with strategies revised where evidence warrants.[13]

• Strengthen routine reporting completeness and timeliness, expand trained monitoring and evaluation personnel across reporting levels, reduce dependence on paper-based and vertical reporting systems, and accelerate District Health Information Software 2.0 implementation and associated training.[2]
• Use routine Ministry of Health data, national surveys, information systems, surveillance records, evaluations, reviews, collaborating partners and research institutions to monitor outcomes and impact, including progression between endemicity, pre-elimination and elimination stages.[11][18]
• Improve data generation, quality assurance and sharing across public and private facilities and community providers; operationalise electronic and short message service databases; and link malaria surveillance with the National Health Management Information System.[18]
• Establish vector-surveillance sentinel sites and a strong surveillance system for insecticide-resistance monitoring and larval source management.[14]Earlier evidence identified no national coordination of insecticide-resistance monitoring and no vector-surveillance sentinel sites, with important geographical gaps in available resistance data.[19]
• Apply diagnostic quality assurance through nationwide arrangements for malaria diagnosis, laboratory capacity development and microscopy proficiency.[7]Maintain diagnostic and medicine quality assurance with the National Agency for Food and Drug Administration and Control and the Standards Organisation of Nigeria, including regular batch testing through a designated quality-assurance laboratory.[11]
• Assess antimalarial treatment effectiveness through therapeutic-efficacy studies, requiring a day-28 cure rate above 95% for an Artemisinin-based Combination Therapy to be deployed and replacement if the cure rate falls below 90%.[8]Confirm suspected treatment failure parasitologically, preferably through microscopy.[8]
• Conduct field trials of recommended insecticides and larvicides before large-scale deployment, including susceptibility, bio-efficacy and residual-efficacy testing for indoor residual spraying.[14]Test long-lasting insecticidal nets at import entry points and routinely from warehouses through distribution to communities and households.[10]
• Strengthen active and passive pharmacovigilance, analyse safety data with relevant partners, and review antimalarial-use guidance when evidence requires.[11]
• Set and fund operational-research priorities, examine interventions and service-delivery strategies, and translate findings into programme guidance, involving implementing partners and research institutions.[18]
• Require partners to account for implementation delivery and progress reporting, while strengthening monitoring and evaluation capacity at national, state and local-government levels and throughout primary, secondary and tertiary care.[13]The National Malaria Elimination Committee and its sub-committees include monitoring and evaluation functions, with structures intended for replication at state and local-government-area levels.[17]

Available evidence highlights persistent performance weaknesses, including under-reporting of severe malaria, poor pharmacovigilance, irregular medicine-efficacy monitoring, non-functional malaria sentinel sites, low diagnostic testing before treatment, and limited geographical coverage of indoor residual spraying pilots.[19][12][16]A consolidated indicator matrix, reporting timetable, evaluation design and quantitative performance targets are not specified in the supplied extracts.[2][7][13]

Costing & Financing

Financing policy emphasises adequate and timely malaria funding across federal, state, Federal Capital Territory and local-government levels, resource mobilisation through partnerships, and allocations informed by malaria burden and need.[2][13]The extracts do not provide a total implementation budget, itemised activity costing, expenditure ceilings, quantified funding gap or economic assumptions for the policy.[15][13]

• Develop a Malaria Health Financing Strategic Framework and advocate for increased malaria allocations within broader health budgets.[13]
• Provide and release malaria-control funds through federal, state and local governments, alongside contributions from international and local non-governmental development organisations, communities and philanthropic individuals.[13]
• Increase government health-budget allocations at all three levels towards the 15% target referenced through the Abuja Declaration.[17]
• Use the National Malaria Strategic Plan to support annual implementation planning, budgeting and advocacy for resource mobilisation.[20]
• Mobilise resources for prevention, commodity availability and distribution, capacity building, referral, monitoring and evaluation, social mobilisation and operational research.[13]
• Engage private-sector actors in programme funding and create an enabling environment for their participation in malaria implementation.[20]
• Include estimated costs in each indoor residual spraying operational plan, alongside its geographical scope, methods, duration, personnel, supplies and equipment.[15]
• Allocate at least 15% of all long-lasting insecticidal-net procurement to indigenous manufacturers and encourage local production.[15]
• Use public-private arrangements to support subsidised and sustainable larval source management, including potential local production of biological larvicides through collaboration with Economic Community of West African States member states.[14]
• Review taxes and tariffs annually to seek waivers for long-lasting insecticidal nets and adjust taxes and tariffs on mosquito nets to encourage local production.[10]

The foreword estimates annual malaria-related economic losses at 480 billion Naira, covering treatment, transport to treatment sources, lost working time, school absenteeism and other indirect costs.[5]Broader contextual data identify Nigeria as a lower-middle-income country with substantial out-of-pocket health expenditure linked to low national health-insurance coverage; these figures are contextual rather than a malaria programme budget.[21]Funding limitations have constrained the roll-out of District Health Information Software 2.0 and related capacity building.[2]