Leading Voices: Meet Victoria Erinle
Leading Voices: Meet Victoria Erinle
MSH, as a partner to the government of Nigeria and sub-recipient to Catholic Relief Services, supports the Global Fund Malaria grant in building Nigeria’s capacity to implement malaria control activities, strengthen the quality of care for malaria, and improve the use of health data across 13 states.
Leading up to the 2020 Annual Meeting of the American Society of Tropical Medicine & Hygiene (ASTMH), we got on the phone with Dr. Victoria Erinle, Senior Technical Manager for the Global Fund Malaria grant, to discuss the work she is supporting to strengthen the integration of malaria and maternal and child health services.
How did you first become involved in malaria work?
I had planned to specialize in obstetrics and gynecology, but after medical school, I entered the national youth service program with the NMEP [National Malaria Elimination Program] within the Ministry of Health. That’s really where I fell in love with public health. You can save many more lives when you teach people how to prevent diseases and care for their own health, rather than just treating it— particularly in parts of the country where people can’t afford to pay for care when they need it.
Traveling to different states for the NMEP, what differences did you observe?
In some parts of the country, cultural upbringing and environment colors the way people perceive health care and their health seeking behavior. In the south, where more people have been exposed to public health concerns, you see a good number of health workers caring for the population and observe people taking medication for malaria. If you go to the north, however, you might see families managing malaria in their children with local medicines and herbs. By the time they come to a hospital, their child is already unconscious. You also see more complications due to malnutrition or other illnesses. There are fewer health care workers in the north. In fact, you may find just one health worker in an entire hospital. Doctors are overworked and don’t have what they need to do their work.
Malaria has been endemic for so many years here. It is so commonplace that many health workers were taught to treat a fever with an antimalarial drug. So we see a lot of medicine wasted this way, since a fever could be something else altogether, and not malaria.
Tell us a bit about the work you are supporting under the Global Fund Malaria grant.
Much of what we do is focused on systems strengthening at the health facility level: providing supportive supervision so that health care workers can do their jobs better; improving the availability of health commodities at those facilities; and improving data collection and use. Essentially, investing in systems that are sustainable.
A major goal of the NMEP is to ensure that at least 80% of the population has access to preventive measures, such as long-lasting insecticidal nets. And we’ve supported distribution campaigns to make sure that households across the country know how to prevent malaria infection and how to use these nets.
Another central goal for us is to make sure that every single person with malaria is treated immediately. In the last two years, we trained around 10,000 health workers on malaria case management, net distribution, monitoring and evaluation, and commodity logistics systems. It has been good work.
Malaria is still a big killer here, and there’s a lot more to be done. Over 54 million cases of malaria occur every year in Nigeria alone. That represents 25% of all cases worldwide, even though we make up only 3% of the world’s population. And, of course, it is women, newborns, children, and adolescent girls who continue to be disproportionately affected.
How can disease-specific programs leverage resources to improve overall quality of care for women and children?
The big opportunity that I’m excited about is strengthening the integration of malaria prevention and treatment services into Nigeria’s national reproductive, maternal, child, and adolescent health [RMNCAH] strategy.
The NMEP has faithfully driven malaria treatment and prevention activities across the country─and with lots of success─but even so, the health indicators for pregnant women and children under 5 years old are poor. In addition, health service delivery often happens in silos; when you are working on malaria only, you are limited to whom you can reach.
Yet the primary health system interacts with women and children all the time, and we have to be able to leverage these interactions to reach more women. When talking to a pregnant woman at a health center, she needs information about how to prevent malaria. She should receive a net and medicines to prevent malaria during her pregnancy, along with counseling on when and how to take these medicines. Health workers should be trained and ready with all the information pregnant women need on malaria prevention when they deliver care.
MSH, through the Global Fund Malaria, worked with the NMEP, the Reproductive Health Division of the Federal Ministry of Health, Catholic Relief Services, and the World Health Organization [WHO] to look for areas where we can better integrate and amplify malaria care. The services and platforms we looked at included antenatal care, the expanded program on immunization [EPI], the use of malaria preventive and curative services, and integrated community case management of malaria. We proposed changes that have been adopted now, and the government has really taken over this process.
Here’s a good example of how this worked. The NMEP has their own guide for preventing and treating malaria during pregnancy. However, by working together to review and update the national antenatal care guidelines to include information about malaria prevention women should receive at each visit, we are now ensuring that women receive a more holistic approach to care.
We brought state representatives together to present this new framework to and helped them develop annual work plans, so that they could begin integrating and budgeting for priority malaria activities in their RMNCH services. So far, 16 of the 36 states in Nigeria have adopted the coordination structures and use the platforms to foster collaboration within their program areas and to quickly address implementation challenges. In addition to these efforts, we also reviewed integrated training guides for management of childhood illnesses [malaria, pneumonia and diarrhea].
The integration of malaria and RMNCH services is something that is relatively new in Nigeria. Stakeholders are asking, “How is this going to change how we’ve been working in the past? How will this make what we do better?” We are seeing a growing willingness and enthusiasm for these platforms and the understanding of how they can reach more and more people to improve health across the country. It is exciting as we start to see this model employed in other disease programs, such as in the integration of HIV with RMNCAH.