Data Reviewers - Kebbi at Malaria Consortium

Background

• In response to the re-emerging high malaria burden, the National Malaria Elimination Programme (NMEP) with support from bilateral organizations, donors and implementing partners is leading and coordinating malaria control efforts (including commodity donations and accountability) to reduce the morbidity and mortality associated with the disease.
• Malaria Consortium, based on GiveWell Foundation’s recommendation as a top charity organization, receives funds from several sources which are classified as philanthropic funding (PF); and with PF support is implementing the seasonal malaria chemoprevention (SMC) campaign in Bauchi, Borno, the FCT, Kebbi, Kogi, Nasarawa, Oyo, Plateau and Sokoto states.
• The SMC campaign utilizes door-to-door channels with the health facilities serving as a hub unit of operation and quality assurance points for health product management, training, supervision and M&E. The recommended drug for SMC in Nigeria is a combination of sulphadoxine-pyrimethamine and amodiaquine (SPAQ).
• The distribution strategy for these commodities was designed to fit into the National Malaria Commodity Logistics Management System (MCLMS). In addition, State Governments have the responsibility of ‘last mile’ distribution (LMD) and reverse logistics during the intervention.
• The LMD of the commodities flows from the state straight to the health facilities, and the community drug distributors (CDDs) for use in the communities.
• However, the LGAs interface to document the quantities reaching the respective health facilities and communities.

Rationale

• It is important to demonstrate accountability in the management of all SPAQ used during the 2025 SMC round. Each blister of SPAQ provides the opportunity to prevent malaria and save the life of a child.
• A good commodity management system should therefore minimise leakages, losses and wastages, and ensure an uninterrupted availability of SPAQ to ensure maximum number of children are reached to prevent them from coming down with malaria. Also, commodities should also not filter into the private sectors to be sold.
• In the 2025 SMC campaign, management of SPAQ will be through the state supply chain system and handled by government staff with the LMCU in hands-on support/management, and the Supply Chain Officer from Malaria Consortium actively involved.
• Other major indicators for the commodity management audit (CMA) include availability and suitability of stores, safety and security of the storage facilities, availability of and accuracy of records on inventory tools, and compliance with policies and procedures.
• The commodity management audit aims to confirm if the commodities used during the SMC round were managed well.
• The audit is also necessary to determine the strengths and weaknesses of the supply chain system for the purpose of providing feedback for subsequent interventions. It is also the responsibility of Malaria Consortium to demonstrate judicious use and accountability for the SMC commodities.
• The auditors are expected to provide objective and professional opinion on level of accountability demonstrated in the management of SPAQ during 2025 SMC intervention.
• Malaria Consortium has been supporting annual commodity management audits at the conclusion of every SMC round in each of the supported states/the FCT. Recent findings indicate improvements on the audit measurement indicators. For e.g. in 2022 CMA, the accuracy of inventory averaged >80% for all supported states/the FCT, ranging from 39% for SPAQ1 (Kebbi State) to 100% in the five of the 9 states/the FCT; and 92% for SPAQ 2 (Plateau State) to 100% in the five other states. In 2023, this improved to 100% for SPAQ1 (Kebbi State) with an average of >90% for all 9 supported states/the FCT. In 2022, the wastage rate for SPAQ1 was highest in Plateau State (1.7%) and this improved to 0.8% in 2023 for the state. For safety and security of storage facilities, commodities and tools, indicators on firefighting equipment availability received the lowest score across board in both the health facility and the local government in both 2022 and 2023.
• There were improvements in the availability of inventory tools and accuracy of the records.
• These improvements resulted from the corrective actions implemented during the 2023 SMC campaign, which included enhanced supervision, LMD spot checks and regular commodity management review meetings. On the availability and suitability of storage facilities at both the LGA and health facility levels, a 92% score was obtained in both 2022 and 2023. This finding was due to the lack of funding from state to address the infrastructure deficit. This is an area that needs improvement.
• Preliminary analysis of the 2024 audit reports shows marginal improvements.
• Therefore, the current CMA is to professionally assess and inform if progress has been made across the indicators for the 2025 SMC round, as listed on the protocol or to inform on relapses that would necessitate urgent attention before the commencement of the 2026 SMC round.

Objective of the Assignment
Specific Objectives:

• Review and finalize Malaria Health Product Management Audit protocol and Tools.
• To determine the availability and use of relevant tools for proper tracking and control of the distribution at every point in the supply chain.
• Determine accuracy of record keeping for key activities such as receiving, warehousing and distribution at each point in the supply chain.
• Determine the concurrence or otherwise, between paper-based inventory and the digital application (Digit-HCM) inventory
• Ascertain the quantities of individual malaria health products and other commodities that passed through every holding and transit point in the supply chain/pipeline, including quantities ordered from manufacturer, received at Nigeria port, delivered to state CMS and distributed to health facilities for the 2025 SMC implementation.
• Determine from the service database, quantities of SPAQ used for treatments, including main dosing, re-dosing, after-referral-dosing, wasted and damaged.
• Do physical count and document of the quantities, conditions and expiry dates of commodity at each state CMS and LGA stores currently holding SPAQ.
• From 3 – 5 above and annex 1 (SDP Categorization and Applicable Audit Activities), determine loss and wastage rate for the product of interest.
• Assess the capacity (Knowledge, Training, and Commodity Management practices) of the health workers at the facility levels to manage malaria commodities generally and on digital applications.
• Assess the knowledge of health workers involved in the SMC campaign on pharmacovigilance.
• Do an assessment of the availability and compliance (Screening and reporting of all suspected cases of ADR) with pharmacovigilance process for drug safety during SMC implementation?
• Assess the distribution strategy for the commodities to determine compliance with state malaria supply chain management strategy, national policies and procedures as well as best practices for management of malaria commodities.
• Do a rapid assessment of the stock (bad, good or expired).
• Do assessment of the storage conditions for SMC commodities at the state CMS and selected health facilities (capacity, environmental conditions, safety and security) and at holding or transient points.
• Carry out a survey of private outlets across the states to identify the type and cost of antimalarials sold in the outlets (This will allow for the identification of diverted SPAQ).
• Submit report with appropriate recommendations on key findings.

Scope

• The end of round (EoR) commodity management audit (CMA) will be conducted in the nine (9) PF supported states – Bauchi, Borno, the FCT, Kebbi, Kogi, Nasarawa, Oyo, Plateau and Sokoto.
• The exercise will involve reviewing SPAQ management documents related to 2025 round and interviewing officials from Malaria Consortium and government (state, LGAs, and health facility workers) in the nine states.
• The assignment will focus on supply chain management and survey of private outlets on malaria commodities.

Methodology
Data Collection Method
The audit will entail the following:

• Document (Commodity delivery and transaction documents) review at the state office of Malaria Consortium.
• Record (Commodity delivery and transaction documents) review at state CMS, LGA and zonal stores where applicable.
• Record (Commodity delivery and transaction documents) review at health facility level.
• Back-end DIGIT-HCM commodity data review
• Assessment of storage facilities at the different holding/transit stores and health facilities.
• Collection of SMC related pharmacovigilance forms at the health facilities where available.
• Key Informant interviews with relevant staff of Malaria Consortium and government (state, LGAs, and health facility workers) in the nine states that have roles and participated in 2025 commodity management and service delivery. The lot quality assurance sampling (LQAS) methodology would be adapted for this commodity audit.

Sample size:

• Although the sample size for Health Facilities to be audited will be calculated as guided by the revised protocol, all State Central Medical Stores and Zonal/LGA stores in supported LGAs will statutorily be audited.

The following activities will be undertaken by the data reviewers:

• Visit sampled health facilities for the collection of data.
• Retrieve unused SPAQ at any health facilities and LGA stores.
• Interview health workers in sampled health facilities on knowledge in the management of malaria commodities and pharmacovigilance.
• Interview health workers in the sampled health facilities on the challenges in the management of SMC commodities during the 2025 SMC campaign
• Examine the conditions of the commodities and categorize them into good, bad or expired.
• Examine the conditions of the stores at the selected health facilities and classify as conducive, safe, secured, adequate or otherwise using rated template.

Profile Requirements of Data Reviewers / Collectors

• The ideal data collector/record reviewer must have previous experience as a data collector in similar public health projects in the assigned states. In addition, s/he is required to have:
• A minimum of Bachelor’s /HND degree.
• Minimum of 2 years’ postgraduation experience.
• Demonstrable ability to work in a resource scarce environment.
• Strong interpersonal and communication skills.
• Ability to give attention to details.

Expected Output/Deliverables for Data Reviewers
Submitted data on SurveyCTO from the survey sites capturing the following.

• Availability and use of commodity logistic tools.
• Physical count and reconciliation of SPAQ in the selected locations.
• Data information on the assessment of Malaria Health Product stock and store conditions.
• Information on the assessment of compliance with the laid down policies and procedures.
• Geolocations of the survey sites.