Post on 19-Jan-2016
Strengthening SME system for Lao PDR National Malaria Programme
(2016-2020)
ByDr. Bouasy, Dr. Viengxay and Dr. Odai
CMPE, Lao PDRWith support from
Dr. Seshu Babu, WHO, Lao PDR
Outline of Presentation NSP Goals, Objectives, Roadmap and Timelines Provinces selected for Surveillance Planning Exercise Review of current SME system: SWOT Analysis, Strengthening of relevant SME areas Plan to strengthen the existing system for malaria elimination PCD & ACD proposed in Lao PDR and Data flow Responsibilities for recording and transmission Case investigation for elimination, Classification and Types of Foci Assessment of human resources needs Revised essential job descriptions for surveillance workers Proposed Indicators Electronic (IT) based data management Field monitoring and Supportive Supervision, Improving the organization of
supervision Communication of results, Evaluation of SME System performance Reporting National Independent Malaria Elimination Monitoring Committee Updating legislation Involvement of private sector
NSP Goals Phase 1 (2016-2020):The overall goal of the phase 1 of NSPMCE is to flatten the malaria epidemic and reduce the impact of multi-drug resistance in the southern part and move progressively towards malaria elimination in the northern and central part of the country while aligning with the GMS regional elimination efforts. Phase 2 (2021-2025):The phase 2 goal of the NSPMCE is to eliminate Plasmodium falciparum malaria in the entire country along with the entire GMS region and to eliminate all species of malaria in the northern/central provinces. Phase 3 (2026-2030):The phase 3 goal of the NSPMCE is to eliminate all forms of malaria by 2030 in the entire country.
NSP ObjectivesPhase 1 Phase 2 Phase 3
1. Reduce the incidence of Plasmodium falciparum to less than 5 per 1,000 in the southern Laos by 2020
2. Interrupt the transmission of Plasmodium falciparum in the northern and central Laos by 2018.3. Reduce the incidence of indigenous cases of Plasmodium vivax to <1 per 1,000 in the northern and central Laos by 2020.4. Prevent reintroduction of malaria transmission in areas where it has been interrupted.
1. Interrupt the transmission of Plasmodium falciparum in the entire country by 2025.
2. Interrupt the transmission of Plasmodium vivax in the northern and central Laos by 2025.3. Prevent reintroduction of malaria transmission in areas where it has been interrupted.
1. Interrupt the transmission of all forms of malaria in the entire country by 2030.
2. Prevent reintroduction of malaria transmission in areas where it has been interrupted.
3. Apply for certification of malaria free status by 2030.
Roadmap to malaria elimination in Laos
PROPOSED TIMELINES FOR MALARIA ELIMINATION IN LAO PDR
(2016-2030)
2017 2020 2025 2030
• 2018: Elimination of Pf in all northern/central provinces except Phongsaly and reduction of API to <10/1,000 in the southern provinces • 2020: Elimination of Pf in all northern/central provinces and reduction of API to <5/1,000 in the southern provinces • 2025: Elimination of Pf from entire country including southern provinces and elimination of Pv in northern/central provinces • 2030: Elimination of Pv from the entire country
CHINA
MYANMAR
THAILAND
VIETNAM
THAILAND
CAMBODIA
VIETNAM
PROVINCES SELECTED FOR SURVEILLANCE EXERCISE
Towards elimination by 2020
Towards pre-elimination by 2020
Province/country/state/region 2014 2015(6 Mth) 2016 2017 2018 2019 2020 CommentName: Saravanh province
Population 414539 424902 435525 446413 457573 469013 480738Based on population projections
with 2.5 % annual pop growth
% of PAR 90% 90% 85% 80% 75% 75% 75%
Population at risk expected to decreased owing to reducing forest cover along with increasing urbanisation limiting areas of transmission coupled with rapid response to foci
PAR 373085 382412 370196 357131 343180 351760 360554
Expected reduction in API 15% 20% 25% 30% 40%
Initially API epected to be increased due to increased coverage of reporting followed by reduction in cases due to interventions
3 prioityies for period 2015 - 20 reported API (local) /1000 PAR 29.12 15.46 13.14 10.51 7.88 5.52 3.31
#local cases reported 12070 5912 4865 3754 2706 1941 1194This province is characterised by high transmission levels
% of cases reported 75% 75% 85% 95% 95% 95% 100%
Currently a number of cases don’t seek treatment due to long stays in the forest, self-treatment and seeking care from private faciities that do not report to HMIS
# surveillance staff (person-year of malaria work) (8 districts + 1 PAMS) 10 10 18 18 18 18 18
projected numbers are based on the need to achieve the desired surveilance coverage and reduction in # of cases
Phases(Con/Elim/Prev) control control control control control control Pre- EliminationThe province will be targeted to enter pre-elimination phase by 2020
we selected four province to be representative of 18 provinces in different phases of malaria control - Elimination continuum ( 2 currently in control, 2 in pre-elimination)
Name: Champasack provincePopulation 771510 790798 810568 830832 851603 872893 894715
Based on population projections with 2.5 % annual pop growth
% of PAR 90% 90% 85% 80% 75% 75% 75%
Population at risk expected to decreased owing to reducing forest cover along with increasing urbanisation limiting areas of transmission coupled with rapid response to foci
PAR 694359 711718 688983 664666 638702 654670 671037
Expected reduction in API 15% 20% 25% 30% 40%
Initially API epected to be increased due to increased coverage of reporting followed by reduction in cases due to interventions
3 prioityies for period 2015 - 20 reported API (local) /1000 PAR 32.37 23.85 20.27 16.22 12.16 8.51 5.11
#local cases reported 24970 9431 13967 10780 7769 5574 3428This province is characterised by high transmission levels
% of cases reported 75% 75% 85% 95% 95% 95% 100%
Currently a number of cases don’t seek treatment due to long stays in the forest, self-treatment and seeking care from private faciities that do not report to HMIS
# surveillance staff (person-year of malaria work) ( 10 districts + 1 PAMS) 11 11 22 22 22 22 22
projected numbers are based on the need to achieve the desired surveilance coverage and reduction in # of cases
Phases(Con/Elim/Prev) Control Control Control Control Control Control Pre- EliminationThe province will be targeted to enter pre-elimination phase by 2020
Name: Khammouane provincePopulation 430464 441226 452256 463562 475151 487030 499206
Based on population projections with 2.5 % annual pop growth
% of PAR 80% 80% 75% 70% 65% 60% 60%
Population at risk expected to decreased owing to reducing forest cover along with increasing urbanisation limiting areas of transmission coupled with rapid response to foci
PAR 344371 352981 339192 324494 308848 292218 2995243 prioityies for period 2015 - 20 reported API (local) /1000 PAR 0.67 0.61 0.55 0.50 0.40 0.30 0.20
#local cases reported 288 134 187 162 124 88 60This province is characterised by very low transmission levels
% of cases reported 80% 80% 90% 95% 95% 95% 95%
Currently a number of cases don’t seek treatment due to long stays in the forest, self-treatment and seeking care from private faciities that do not report to HMIS
# surveillance staff (person-year of malaria work) (10 districts + 1 PAMS) 11 11 11 11 11 11 11
projected numbers are based on the need to achieve the desired surveilance coverage and reduction in # of cases
Phases(Con/Elim/Prev) Pre-Elimination Pre-Elimination Pre-Elimination Pre-Elimination Pre-Elimination Pre-Elimination EliminationThe province will be targeted to enter elimination phase by 2020
Name: Hauphan provincePopulation 358721 367689 376881 386303 395961 405860 416006
Based on population projections with 2.5 % annual pop growth
% of PAR 80% 80% 75% 70% 65% 60% 60%
Although there is no apparent local transmission, there is a lot of population movement in and out of the province indicating that there would still be some malaria cases seeking treatment from health facilities.
PAR 286977 294151 282661 270412 257374 243516 2496043 prioityies for period 2015 - 20 reported API (local) /1000 PAR 0.02 0.02 0.02 0.02 0.02 0.02 0.01
#local cases reported 7 4 6 5 5 5 2
This province is characterised by no known transmission (will be verified shortly)
% of cases reported 80% 80% 90% 100% 100% 100% 100%
Currently the cases are presumed to be all imported from other parts of the country.
# surveillance staff (person-year of malaria work) 10 10 10 10 10 10 10
projected numbers are based on the need to maintain the desired surveilance coverage.
Phases(Con/Elim/Prev) Pre - Elimination Pre - Elimination Pre - Elimination Pre - Elimination Elimination Elimination EliminationThe province will be targeted to enter elimination phase by 2018
Review of current SME system: SWOT AnalysisStrengths• Strategic reforms in the health sector including HMIS
using the DHIS2 platform• Strong policy commitments to data use for decision
making • Good progress in Government efforts towards
attaining MDG targets• Clear and robust second Health Strategic Plan with an
M&E component• Increasing support for SME from major funding
agencies• Highly experienced and committed Epidemiology unit
within CMPE• Evolving structure in accordance with function and
strategy at CMPE• Increased capacity for M&E within CMPE and
implementing partners
Weaknesses• Shortage of qualified human resources for
SME at all levels• Lack of clear strategies for working
effectively with the private sector on malaria reporting
• Lack of data on individual malaria patients• Lack of computers at health facilities• Lack of reliable estimates of mobile and
migrant populations• Inadequate malaria surveillance and
information systems that fail to capture data from outside the public health sector
• Lack of confidence to take actions at local level
Opportunities• Strong government support to CMPE• Government's commitment to Public Administration
Reform in order to ensure sustainability of staff motivation and performance
• Increasing participation of other line ministries and NGO partners in surveillance and M&E activities
• GF Grants that focus on M&E Plans and PFs• More partners interested in collaborating on SME• Increasing decentralisation and deconcentration
Threats• Low motivation of health staff (incl. for SME) • Conflicting priorities particularly at provincial level
with neglect of SME• Difficulties in harmonising SME strategies with
other partners • Erratic supply of electricity making it difficult to use
computers, etc.• Potential reduced funding from GF for HR may
affect SME /Epidem. focal persons
Strengthening of relevant SME areas
• The aim of the national malaria program during 2016-20 phase will be to stop the malaria epidemic in the 6 southern provinces and move progressively towards malaria elimination in the northern provinces by scaling up surveillance.
• Once transmission in the south is brought under control the southern provinces will follow the north in moving into pre-elimination.
• Hence one major set of activities during 2016-20 will be the design and implementation of a surveillance and M&E system that will be able to rapidly detect, investigate and respond first to outbreaks in 6 provinces in the south and individual instances of local transmission in the north.
• Necessary domestic and external financial resources will be mobilised for achieving this aim keeping financial sustainability in mind.
Plan to strengthen the existing system for malaria elimination
• CMPE will work with WHO and other partners in the country to develop / update relevant guidelines including SOPs for Passive Case Detection, Active Case Detection, Foci identification and investigation and response, QA Diagnosis, Data management and reporting, Supervision, etc.
• Some of these areas of work are described in the following slides.
PCD & ACD proposed in Lao PDRPCD ACD
Definition: Detection of malaria cases among patients who on their own initiative visit a health post/facility for treatment, usually for febrile disease.
Definition: The detection by health staff of malaria infections at community and household level in high risk population groups. Active case detection can be conducted as fever screening followed by parasitological examination of all febrile patients or as parasitological examination of the target population without prior fever screening.
Purpose:The purpose is to enable measurement of incidence of malaria and define its person, place and time distribution in order to ensure more effective control. “You cannot control what you cannot measure”. It should be ensured that the collection of information is done in a timely, accurate and complete manner at every level in the system.
Purpose:ACD fills the gaps in the information from PCD with the purpose of ensuring that reservoirs of parasites are detected and treated early to interrupt transmission. The focus is on high-risk population groups.
Essential data elements to be collected for each casePCD ACD
• Date• No. of patient• Patient’s name, Age• Sex and Pregnant• Occupation• Address (place of residence)(suggested:
this province, another province and foreigner)
• History of travel• Whether referred from another place• Patient type (e.g. resident, migrant,
etc.)• Probable malaria (based on symptoms)• Type of blood test()• Result of blood test (Negative, Parasite
Species)• Treatment given ( ACT and other drugs)• Referral to hospital• Death from malaria.
• Date• No. of patient• Patient’s name, Age• Sex and Pregnant• Occupation• Address (place of residence)(suggested:
this province, another province and foreigner)
• History of travel (esp. in the last 2 weeks to forest)
• Patient type (e.g. resident, migrant, etc)• Symptoms and date of onset• Temperature (if measured)• RDT blood test• ? G6PD RDT• If slide/filter paper blot also collected• Result of blood test ( Negative, Parasite
Species)• Treatment with ACT
Data Flow(PCD)
PR/DCDC
Ministry of Health
18 PAMS
CMPE
143 District Anti Malaria Nuclei (DAMNs)
850 Health Centers
18 Provincial Hospitals / Military Hospital/Police
Hospital
148 District Hospitals(monthly by 143 DHs in malaria
areas )
2000 Villages in malaria areas (Zone 2 & 3)
5 central Hospitals (Setthathiath, MahosothMilitary HospitalPolice HospitalFriendship Hospital)
PPM Network(total 347)
Private Companies
Data Flow(ACD)
PR/DCDC
Ministry of Health
18 PAMS
CMPE
143 District Anti Malaria Nuclei (DAMNs)
850 Health Centers
High risk area/population group surveyed
Responsibilities for recording and transmission(PCD)
Data flow Responsible for recording
Responsible for transmission
Responsible for decision making
Village VHV/VMW HC staff (collect during monthly meetings)
Health center Chief (# of RDTs/ACTs for replenishment)
Health center Chief/Nurse Chief of HC HC Chief (planning services), Chief of DAM (supplies, response to outbreaks)
District Antimalaria Nucleus
Epidemiologist of DAMS
Epidemiologist of DAMS
Chief of DAM (supplies, response to outbreaks, HR deployment, etc.)
Hospital (district/province)
Laboratory technician
Laboratory technician
Chief of PAM (supplies, response to outbreaks, HR deployment, etc.)
Provincial Antimalaria Station
Epidemiologist of PAMS
Epidemiologist of PAMS
Chief of PAM (supplies, response to outbreaks, HR deployment, etc.)
Responsibilities for recording and transmission(ACD)
Data flow Responsible for recording
Responsible for transmission
Responsible for decision making
Health center HC team with VHVs (if available) in high risk area
Chief of HC HC Chief (planning additional services), Chief of DAM (supplies, response to outbreaks)
District Antimalaria Nucleus
Epidemiologist of DAMS
Epidemiologist of DAMS
Chief of DAM (supplies, response to outbreaks, HR deployment, etc.)
Hospital (district/province)
Laboratory technician
Laboratory technician
Chief of PAM (supplies, response to outbreaks, HR deployment, etc.)
Provincial Antimalaria Station
Epidemiologist of PAMS
Epidemiologist of PAMS
Chief of PAM (supplies, response to outbreaks, HR deployment, etc.)
Recording of data on blood examination
PCD:• Type of test: Microscopy or RDT or PCR• Result of blood examination:
Negative or Parasite species (Pf, Pv and Mixed)ACD:• Type of test: RDT and Microscopy or PCR• Result of blood examination:RDT: Negative or Parasite species (Pf, Pv and Mixed)- For positive cases, DOT with antimalarials.
Microscopy/PCR: Negative or Parasite species (Pf, Pv and Mixed). For positive cases, the HC staff will have to return to administer full course of antimalarial treatment
Use of data in the control phase
PCD:
1. At the same level to identify disease trends and plan effective control and prevention interventions.
2. At the higher level to manage logistics for routine services and also potential outbreaks and institute prevention and control measures.
ACD:
3. At the same level to identify population groups at special risk and provide effective control and prevention interventions to these groups in order to reduce transmission.
4. At the higher level to plan and implement additional investigation, control and prevention measures to limit the spread of the disease .
Case investigation for elimination phase in the north
What is it?• Every case in a low incidence area is reported and
investigated immediately (and also included in the weekly/monthly reporting system).
• Cases are graphed daily or weekly to identify trends that require attention and are mapped by village to identify clusters of cases.
The purpose of case investigation:• The purpose is to identify the persons with malaria, the
extent of malaria around the case (who else is affected) and probable sources of infection (local or imported from another province/country).
• To identify and institute measures to interrupt further transmission.
Case Investigation form and details• The form: see word file
• Who will fill in the form: • Malaria health staff (either from health center or district level)
and in future surveillance teams at district level.
• What is the timeline for completion : • Within a week of case being reported from a previously low
incidence area it will be investigated
• How will it be transmitted:• Immediately after investigation, the information will be conveyed
to the next higher level by telephone and physically submitted within 48 hours.
• Who will check it:• Malaria staff at the next higher level
Classification and use of Data• Who will classify the case:• Same level based on clear criteria and information
collected through the investigation.• Who will use the data for what:1. At the same level to classify case, identify potential
focus and institute immediate response measures.2. At the higher level to plan more detailed
investigations if necessary, confirm classification of the cases and institute necessary response measures.
Use of different laboratory methods in the elimination provinces
Level RDT Microscopy
Village √
Health center √ √ (if microscope and microscopist available)
District √ √
Province √ √
1. We will refine SOPs after returning to Laos2. Slides will be collected from the field and examined at the nearest
laboratory.3. Upon microscopy confirmation, the appropriate treatment by DOT will
be provided to those found to be positive.4. Negative RDT results will be double-checked by microscopy on a sample
basis5. Discrepancies will be handled by reference to clearly developed SOPs
and institution of quality assurance measures
Microscopy
Types of Foci
Definition Operaional criteria Case detection measures VC measures
An area with conditions for transmission, where transmission has ceased and currently no cases are
Transmission in the past, no cases for 2 years, under adequate surveillance
PCD, with supervision 4 times per year (with ABER at least 3%)
Promotion of mosquito nets .
One or more cases but no local transmission (relapse or induced or imported)
Transmission in the past, no indigenous cases for 2 years or more, under adequate surveillance.
PCD, with supervision 4 times per year (with ABER at least 3%)
Distribution of one round of LLINs or 1 round of focal IRS
Introduced and indegenous cases and active transmission in the last 2 years or more
Transmission on going with introduced and indigenous cases for 2 years or more, under adequate surveillance.
PCD and ACD with supervision 4 times per year (with ABER at least 3%)
Focal IRS with one round of LLIN distribution followed by continuous distribution of LLINs for new arrivals, MMPs, pregnant mothers and replacements. Cluster of imported cases (
from outside country or outside province) no evidence of local transmission
No local transmission but a number of imported cases reported recently, under adequate surveillance.
PCD, with supervision 4 times per year (with ABER at least 3%)
Not required
Type of focus
Potential foci
Active foci
Pseudo focus
Cleared up focus
Assessment of human resources needsLevels Positions
requiredPositions in place
Gaps to be filled Total gap for Lao PDR
Provincial level:• Coordinator of PAM• Epidemiologist• Lab technician• IT • Entomologist• logistic
• 1• 3• 2• 1• 2• 2
• 0• 2• 1• 0• 0• 1
• 1• 1• 1• 1• 2• 1
District level:• Malaria management• Epidemiologist• Lab Technician• Logistics Manager
• 1• 2• 2• 1
• 0• 1• 1• 0
• 1• 1• 1• 1
To be estimated separately for elimination and control areas after further analysis at CMPE.
Health center level:• Lab Technician• Monitoring Officer
• 1• 1
• 0• 0
• 1• 1
Village level:• VHV/VHW • 2 • 1 • 1
Need for new people: - Yes, for e.g. Coordinator PAM, IT, Logistics, etc
Challenges to recruit these positions:• Government policies and procedures• Limited availability of skilled HR at provincial and district
level• Competition from private sector and NGOs for skilled HRHow to recruit:1. Approach concerned authorities within Government to
allow MOH for special recruitment for Saravane province
2. Undertake temporary recruitment of contract staff with donor support- clear handover arrangements to GOV staff to be written in to the MOU with donor.
How will training and supervision be done
1. Training needs analysis will be undertaken2. Curricular committee to be set up3. Curricular committee to design/redesign training curricula, training plans
and training materials4. Training of trainers will be undertaken for CMPE and provincial trainers with
WHO and other partner support5. Training courses and on the job training will be conducted in a cascade
manner [ including at community level}6. Supervision guidelines and checklists will be updated by CMPE staff with
provincial representatives and implementing partners7. Supervision guidelines and checklists will be included into the ongoing
training courses8. Quarterly Supervision plans will be developed at all levels and implemented.9. Supervision visit reports will be followed up to track changes in programme
implementation and correlated with other data at monthly and quarterly review meetings.
Need for HR once elimination has been achieved • Many of the staff will be needed when the
province enters into elimination phase since surveillance will need to be further strengthened at that stage.
• A fresh HR needs analysis will be undertaken at that stage and staff redeployed or assigned revised tasks as per requirement.
• Once elimination is achieved, malaria specific staff will be redeployed for other vector borne and parasitic disease control and also to prevent re-introduction.
Revised essential job descriptions for surveillance workers
Detailed TORs will be developed for Surveillance Staff at different levels incorporating the following key tasks.
– Verification, quality review and compilation of data collected through passive case detection from public health facilities, PPM outlets and communities
– Organising and implementing Active Case Detection in high risk areas (hotspots) and population groups (hot pops)
– Monitoring of ecological and social determinants incl MMPs and development projects
– Organising Rapid response during outbreaks and following ACD – Case and foci investigations in elimination areas– Coordinating with other malaria staff in use of data for decision
making– Report and provide feedback at all levels
Proposed Indicators in Selected Province in Malaria Elimination Phase
# Selected Indicator name
Definition (numerator/denominator)
2014 data Remarks
1.
ABER N= total test done during the year( RDT+Micro+Both)D= Total Pop ( at risk) of the province (mid-year estimate)
0.13 Will decline over time in elimination areas
2.
% expected monthly reports received from health facilities and laboratories
N= Total # of expected monthly reports received from health facilities and laboratories D= Total # of health facilities and Laboratories
96.3% Emphasis will be on receipt of timely and complete reports
Name of selected Province: HUAPHAN PROVINCETotal population: 35872Population at Risk of Malaria: 35872Annual Parasite Incidence (2014): 0.02
Proposed Indicators in Selected Province in Malaria Elimination Phase (contd.)
# Selected Indicator name
Definition (numerator/denominator)
2014 data Remarks
3. % of confirmed cases fully investigated
N= Total # of fully investigated confirmed casesD= Total # of confirmed cases
0% To be monitored only in the elimination provinces. Full investigation includes case investigation form, focus investigation form and active case detection.
4. % of foci fully investigated and registered (on register, with maps of each focus)
N= Total # of foci fully investigated and registeredD= Total # of foci identified and reported
0% To be monitored only in the elimination provinces.Full investigation of a focus includes focus investigation form, entomological investigation form and active case detection.
Upgrade Malaria Information System o The MOH is introducing a national health information system (DHIS2) o This will have a module for malaria data o In the meantime CMPE will recruit a short-term technical advisor to upgrade
the current MIS taking into account the revisions to the M&E plan and to develop an integrated database covering all aspects of the national malaria control/elimination effort, both technical (e.g. drug resistance, bednets, entomology and insecticide resistance etc.) and administrative (e.g. HR [including volunteers], PSM, infrastructure etc.).
o Mapping will be incorporated to allow detailed spatial analysis of all relevant aspects of the program and to thereby improve targeting.
o The system will be designed to produce a quarterly bulletin that summarizes the epidemiological situation and highlights important trends.
o Data collection forms will be simplified and data collection, analysis and interpretation will be strengthened and supported through on-the-job training and supportive supervision.
o The program will ensure adequate supply of reporting forms (or access to computers/printers/copiers for printing).
Electronic (IT) based data management
Introduce 'mHealth' for surveillance. omHealth will be rolled-out to enable real time reporting
by health staff and volunteers. Staff and volunteers will be provided with smart phones as required.
o This will be integrated into the mHealth initiative for supply chain management.
o Elimination specific data entry formats will be introduced in areas targeted for elimination.
o Data collection will be expanded to include results of case investigations, DOT and weekly follow-up to ensure clinical cure.
Electronic (IT) based data management (contd.)
Strengthen routine supervision and programmatic M&E
Conduct routine programmatic monitoring and supportive supervision at all levels.
Detailed SOPs, updated checklists and discussion topics will be provided to supervisors to ensure that all activities are thoroughly assessed at every level. Emphasis will be placed on problem solving.
Mechanisms will be developed to ensure that feedback is provided to supervisees at all levels and to ensure that follow-up occurs, and continues to occur until issues are resolved.
Field monitoring and Supportive Supervision
Improving the organization of supervisory visits
Intervention: Malaria diagnosis by microscopy.Problems How to manage (solutions)
Diagnosis Improve skills in identifying species
Slide preparation Train in correct slide preparation including cleaning of slide before preparation and preservation.
Poor staining Coach on following proper staining procedures
Poor maintenance of microscopes Demonstrate how to clean and maintain microscope before and after.
Outline of an improved organization of supervisory visits for the intervention considered
Where What and who to supervise
Supervisory methods
When:Frequency
Who will conduct sup. visits
Other interventions that could be supervised at the same time
Community Not applicable
Health center with microscopy
Microscopy service of HC lab technician
On the job supervision by hospital lab technician
Once per month
District hospital lab technician
Check stock of slide, reagents, RDT and ACT.
District level
Microscopy service of district lab technician
On the job supervision by hospital lab technician
Once per month
Province hospital lab technician
Check stock of slide, reagents, RDT and ACT.
Provincial level
Microscopy service of province lab technician
On the job supervision by central lab technician
Once in three months
CMPE lab technician
Check stock of slide, reagents, RDT and ACT.
Central Level
Internal QA of microscopy
External QA Once in two years
WHO hired expert
National slide bank
Communication of resultsOutcome 1: Enlist support of provincial governor for launching LLIN mass distribution campaigns
Message Audience Media Timing Resources
LLINs if used regularly and correctly can bring down malaria significantly in our province.
Provincial governor
PowerPoint presentation to the Governor with charts showing malaria declines in provinces with good LLIN coverage
One-to-one meeting arranged at least 2 months prior to campaign launch date
Money- not requiredHR- need ministry senior officials to support and attend the meeting
Outcome 2: Enlist support of director of province health department to improve quality of malaria microscopy
Message Audience Media Timing Resources
Malaria microscopy is the gold standard for malaria diagnosis for malaria elimination and this is currently poor in province X
Health department of province X
Supervision report and slide cross check result for province X
Debriefing at the end of supervision visit
Participation of province health director, chief of provincial malaria station and microscopists.
Communication of results (contd.)
Baseline SME System assessment has been commissioned by ERAR and carried out by MC in collaboration with DCDC and CMPE.
The baseline assessment findings will be disseminated in a workshop in early Nov 2015 and an action plan to address weaknesses will be finalized.
This action plan will be nested within the National M&E Plan for 2016-20 to be finalized by Dec. 2015.
Mid-term SME System assessment will be incorporated into the National Malaria Programme Review to be carried out in 2017.
An end of term SME System assessment will be incorporated into the National Malaria Programme Review to be carried out in 2020.
Evaluation of SME System performance
Reporting Type of Reports
Contents of reports
Recipients/audience
Comments
Immediate • Malaria cases and deaths
• Malaria commodities
• Case and focus investigations
Surveillance and response staffLogistics staff
Real-time reporting will be introduced in a phased manner in order to provide prompt response.
Monthly • Malaria cases and deaths
• Malaria commodities
• Summary of case and focus investigations
Programme, surveillance and response staffLogistics staff
Standardised reports will be generated and disseminated both upwards and downwards in the system.
Reporting (contd.)
Type of Reports
Contents of reports
Recipients/audience
Comments
Semi-annual
1. Performance against selected key indicators
2. Overall performance, challenges and plans for following periods.
Ministry of HealthDonorsImplementers
Semi-annual malaria bulletins and standardised reports will be generated and disseminated both upwards and downwards in the system in addition to being submitted to donors (for e.g. GF, ADB) and MOH.
Annual As above As above As above
Ad-hoc/ special
For e.g. outbreak reports, focus response reports, special reports to Government, UN agencies, etc.
Ministry of Health and stakeholders making special requests
Reports will be prepared and submitted as required from time to time.
Establish a National Independent Malaria Elimination Monitoring Committee
An external Quality Assurance Committee will be constituted comprising of the following members and tasked with providing external quality assurance for implementation of the NSP.– National level epidemiologists– Former malaria programme managers– Retired WHO experts– Others nominated by government and development
partners
Updating legislation, as part of enabling environment
CMPE will advocate and coordinate efforts for enacting and updating facilitative legislations:– Mandatory notification initially in elimination provinces
and later extended to entire country ; – Compulsory parasite based diagnosis; – Private sector participation; – Appropriate treatment and follow up of confirmed
cases;– Access to quality anti malarial medicines(ban on
monotherapy and counterfeit/substandard antimalarials)
Involvement of private sector Expansion and improvement of the existing PPM initiative. • The network of licensed private sector providers will be expanded to cover
all six southern provinces. • Abetter enforcement by FDD on the accreditation scheme (used for
continuing issuance of licenses) under the GPP (good pharmaceutical practice).
• SOPs for PPM have already been designed, but need to be revised and implemented better.
• PPM facilities will be provided with free RDTs and ACTs and in return will have to ensure all suspected cases are confirmed, notified, investigated and appropriately managed and provide reports on cases diagnosed and treated to the malaria programme.
• Training and support for referrals will be prioritised. Engagement of the corporate sector • The program will engage the corporate sector and encourage corporate
support/sponsorship for malaria control/elimination efforts (including World Malaria Day activities).
Khop jai lai lai!Thank you very much!