The Problem: Monitoring and Evaluation of Malaria in the Riverine communities of Bayelsa state of Nigeria
National Malaria Control Programme on Global Fund Round 8 (GFR8), is responsible for implementing activities that are expected to contribute to the goal of Scale Up for Impact (SUFI) on the Malaria control in the following Service Delivery Areas (SDA):
- 1) Prevention through the provision and distribution of Long Lasting Insecticide Treated Nets (LLINs).
- 2) Case Management of Malaria which include provision of drugs: Artemisinin Based Combination Therapy,(ACT), diagnosis, facility and Community Management, and
- 3) System strengthening on Malaria control activities.
Bayelsa State is a major oil and gas producing area that contributes over 30% of Nigeria’s oil production. More than three-quarters of this area is covered by water, the rest being moderately low-lying land. The area lies almost entirely below sea level with a maze of meandering creeks and mangrove swamps. The network of several creeks and rivers in the South, and North characterised by thick forest with arable lands for cultivation made Bayelsa state a unique terrain for monitoring and evaluating malaria intervention efforts a herculean task. Monitoring and Evaluating SUFI of malaria (GFR8) project would in no way be hampered due to terrain.
Terrain is a critical factor in determining success or failure of monitoring projects, particularly for those with many sites or wide coverage such as malaria control. In this project over 60% of the health facilities were situated across water, hence the need to travel by canoe or speed boat (either hired or public). Hired speed boat is more expensive than public, higher when compared with traveling by land. Traveling by water also demand having accessory such as life jacket in case of water wave or boat capsizes, the ease of movement is determined by the type of boat. The challenges are: Fear of wide animals, wave and exuberance of sailors made monitoring and evaluation a risky venture.
Eighty health facilities were supported by Global Fund Round 8 38% of these facilities could only be reached by land travel, representing, a total distance of 1,039 kilometers requiring more than 34 hours movement by vehicle. 62% could be reached by water travel representing a total distance of 5,363 Nautical miles requiring more than 134 hours.
In riverine communities of Bayelsa state, M&E systems face challenges that are peculiar to the environment, some of which are fundamental. From project planning stage, the budget for M&E operations in the riverine was made same with non-riverine communities of other GFR8 supported states, hence implementing M&E systems became a difficult task in the following ways:
- Difficulty of retrieving of data from health facilities and Role Model Caregivers (RMCs) across water,
- No correlation between ACT supplied to health facilities and amount of data retrieved since not all facilities can easily be reached,
- Mentoring and supervision of service providers was difficult due to water barrier, service providers take advantage of difficult terrain to abscond duty,
- Service providers report to LGA who has no technical capacity to supervise their operations
These challenges have led to persistent incomplete reporting and inaccurate data posing a major threat to their utility especially when compare ACT supplied to data retrieved. Reasons include:
- Poor health workers attitude to work,
- Rural-urban shift by service providers,
- Competing priorities and limited resources for collection and use of data;
- Inadequate training of data collection personnel;
- Lack of timely feedback of useful data to those in a position to improve programs;
- Inadequate reporting tools (eg, registers and forms);
- Poor documentation of services provided within health facilities and at the communities and
- Inadequate counterpart funding from the state Government.
