Programme profile
SuNMaP: Support to National Malaria Programme
Objective: to strengthen delivery of Nigeria’s National Malaria Control Effort in ten states.
Note: this profile is for the first phase of SunMaP. SuNMaP 2 took place from 2018 -2021. Read their End of programme summary
Market systems focus
1. Malaria Preventive Products (Long Lasting Insecticidal Nets)
Long Lasting Insecticidal Nets (LLINs) are nets treated in the factory with an insecticide incorporated into the net fabric which makes the insecticide last at least 20 washes in standard laboratory testing and three years of recommended use under field conditions. It is estimated that between 2000 and 2010 LLINs has saved more than 908,000 lives, and since 2006 prevented three-quarters of deaths due to malaria.
The LLIN market is however driven by a subsidy from the government and development partners and is seen as a public good. A commercial market did not exist at the time the programme intervened. Dependence on public sector meant that the supply and use of the product declined in absence of a sustainable public sector distribution model.
2. Malaria Curative Drugs (Artemisinin Combination Therapy)
Presumptive treatment and use of oral artemisinin-based monotherapies is considered to be a major contributing factor to the development of resistance to artemisinin derivatives. WHO recommends use of Artemisinin Combination Therapy (ACT) for the treatment of uncomplicated malaria caused by the P. falciparum parasite.
To ensure wide access to ACTs the Global Fund for Aids Tuberculosis and Malaria (GFATM) funded the Affordable Medicine Facility for Malaria (AMFm). This allowed for distribution of ACTs at subsidized prices through the private pharmaceutical distribution and retail channels in Nigeria. But the erratic supply under AMFm meant that the subsidies did not reach all the intended poor households.
3. Malaria Diagnostics Products (Rapid Diagnostic Test Kits)
Patients are required to be diagnosed for suspected malaria cases before taking medication. The high price and unavailability of labs for microscopy tests combined with high rate of malaria infection mean that households resort to treatment without a proper diagnosis (presumptive treatment). Rapid Diagnostic Test Kits (RDTs) are promoted to make diagnosis easily available and affordable to the households in malaria endemic regions. But the sustainability of the distribution and the use of RDTs require that the frontline service providers (Proprietary and Patent Medicine Vendors or PPMVs) in Nigeria are able to appropriately use RDTs.
Programme interventions
1. Malaria Preventive Products (Long Lasting Insecticidal Nets)
- Seed financing/ price support to commercial sector importers and distributors to establish retail channels for LLINs in Nigeria
- Partnership between importers/ distributors and the Association for Community Pharmacists in Nigeria (ACPN) for strengthening retail distribution of LLIN
- Building organizational capacity of importers/ distributors for institutional sales and retail distribution
- Generic Marketing Campaign to raise consumer awareness on the use of LLIN
- Advocacy to the National Malaria Elimination Programme (NMEP) and the State Malaria Control Programmes (SMCP) for the purchase of LLIN from local importers
- Establishing local manufacturing facility in Nigeria for LLIN approved by the WHO Pesticide Evaluation Scheme (WHOPES)
2. Malaria Curative Drugs (Artemisinin Combination Therapy)
- Facilitating partnership between ACT importers and distributors and the professional associations (ACPN, AGPMPN and PPMVs) in Nigeria for rural market penetration of ACTs
- Increase spread and geographical coverage of RDTs through co- bundling with ACTs
- Promoting rational use of ACTs and RDTs through generic marketing campaign
3. Malaria Diagnostics Products (Rapid Diagnostic Test Kits)
- Partnership with professional associations (ACPN) and private hospitals for promotion of RDTs
- Promoting rational use of ACTs and RDTs through generic marketing campaign
Notable results (systemic change, poverty impact)
1. Malaria Preventive Products (Long Lasting Insecticidal Nets)
The project facilitated sales of 2.1 million LLINs in commercial channels of which 1.1 million were sold through retail channels and 1 million through institutional channels. Market assessment conducted at the end of the project period showed the outlets that were reached by the private sector through project interventions had higher average stock of LLINs and wider variety of LLINs.
The project facilitated establishment of a local net manufacturing facility in Nigeria by the end of the project. This addressed the critical systemic challenge of lack of local capacity for production of WHOPES-certified LLIN, which contributed to high price and erratic supply of LLINs in Nigeria. At the moment the factory is supplying LLIN meant for institutional sales so as to break even before expanding into the retail market.
2. Malaria Curative Drugs (Artemisinin Combination Therapy)
Two pharmaceutical companies in Nigeria were supported to strengthen their rural distribution network. This led to distribution and sales of 5.1 million ACT dosages in rural markets that previously had limited access to ACTs. In total, 2,097 Proprietary and Patent Medicine Vendors (PPMVs) were engaged in rural markets. PPMVs are community based drug retailers that also provide treatment for minor ailments. They are trained and supervised by the Ministry of Health and local pharmacists.
The project demonstrated the significance of leveraging other donor interventions (in this case the subsidy provided under the Global Fund AMFm) to fill in a market gap (unavailability of affordable ACTs in rural markets) such that the gains could be sustained and scaled after withdrawal of the project support (the network between the PPMVs and the project’s partner pharmaceutical companies).
3. Malaria Diagnostics Products (Rapid Diagnostic Test Kits)
Prior to the project’s intervention, the private sector importers and distributors of RDTs in Nigeria were selling RDTs to public sector health channels. The commercial market was dependent on illegal supply of RDTs from neighbouring countries and from leakages from public sources.
The project facilitated a private sector importer and distributor to set up a network with 895 pharmacies. The project’s intervention contributed to sale of 749,625 RDT Kits in about 12 month’s intervention period.
[uploaded February 2018]