Monitoring and Evaluation of Malaria in the Riverine communities of Bayelsa state of Nigeria | USAID Health Care Improvement Portal
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Monitoring and Evaluation of Malaria in the Riverine communities of Bayelsa state of Nigeria

Improvement Report
Awoleye Joshua Olatunji

Topics: CHW role, Community involvement, Country ownership, Documentation/data collection, Equipment/supplies, Home-based management of malaria, Insecticide-treated nets (ITNs), Malaria, Malaria case management, Malaria treatment in adults, Malaria treatment in children, Monitoring and evaluation, Motivation/incentives, Performance evaluation, Program design, Program evaluation, Program management, Supervision, Training

Region and Country: Africa, Sub Saharan, Nigeria

Organization: Association for Reproductive and Family Health
The Report

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.


Malaria M&E systems constitute the key means of measuring Malaria intervention efforts, through provision of aggregated data to inform national programs while guiding the delivery of high-quality prevention such as distribution of long lasting insecticide treated nets (LLIN), and treatment via Artemisinin Based Combination therapy (ACT). To assess processes, outcomes and impact, project indicators are designed to collect raw data that will provide information on the success or failure of the program. Indicators used are hand tallied from paper-based sources and reported from health facilities to Local Government Area (LGA) then to state and finally to national and international agencies.

In Bayelsa state at the inception of the project M&E tools were distributed to health facilities, M&E trainings were conducted for state M&E officers, 16 LGA personnel (8 focal persons and 8 M&E officers), 80 service providers at the health facilities and 128 role-modelcaregivers to enable accurate reporting of services provided at service delivery points. Project indicators included: number of children under five with uncomplicated malaria treated with ACT 1 and 2; number of children above five with uncomplicated malaria treated with ACT 3 and 4; number of people trained on LLIN; number of LLIN distributed and so on.
Malaria treatment services are carried out in the health facilities (HFs) and at the communities while HFs aggregate the data. Focal persons at LGA aggregate the data generated at LGA levels, which they report to the state Roll Back Malaria Manager (RBM), the later then report to national/NMCP and implementing agency.

Figure 1: Number of children under and above five treated with ACT from 2010 to February 2011
Year Children under 5 treated Children above 5 treated
Aug-10 763 1413
Sep-10 2597 3252
Oct-10 6839 8990
Nov-10 2597 3252
Dec-10 2745 3051
Jan-11 8796 8796
Feb-11 2807 4062


Treatment of malaria is a daily service provided at the health facilities, Figure 1 represents number of children under 5 (U5) and children above 5 (5+) treated with ACT from August 2010 to February 2011. ACT was supplied at the tail end of July 2010, however awareness was low until October. This explains the low number of treatments in August and September. In addition, the female Anopheles mosquito operates at the lowest ebb in the months of November and December, leading to a drop in malaria cases reported and hence number of treatments in those months. In February there were stock out of ACT in some health centres, hence a drop in the data reported.


Figure 2: Percentage distribution of ACT used, stock balance and unretrieved data from service delivery points
Total used Unretrieved data Stock balance
21% 30% 49%

Figure 2 showed that 30% of ACT administered to patients under 5 and above 5 at health facilities and communities through RMCs have not been retrieved, some due to improper documentation of services provided, and poor data management. ACT used represent 21% while 49% represent stock balance.


Lessons learned and strategies adopted

  • 1) Community and civil society involvement in monitoring and evaluation of activities of service providers, the community leaders, religious and traditional leaders provided oversight for ACT, LLIN utilization in their domain. They advocated for utilization of ACT in their massages during religious and traditional activities
  • 2) high level advocacy to policy and decision makers, program managers/M&E officers at the country office conducted advocacy to state and local governments administrators, which in turn produced awareness and utilization of ACT and LLIN
  • 3) increased capacity building of health facility service providers, the M&E officer trained indigenous consultants to provide on the job mentoring and supervision to health facilities service providers
  • 4) counterpart funding from the state and Local Government area (LGA) council, the state and LGA provided additional funding to address the gap/challenges with funding monitoring and evaluation of malaria in the riverine communities
  • 5) Result based funding strategy was used to increase timeliness and completeness of data reporting by LGA malaria focal persons. Produce your result and be paid monthly data collection fee. This increased timeliness and completeness of data reporting