1 Assessment of M&E system for Malaria Prevention and Control Program in Jimma Zone Health...

1

Assessment of M&E system for Assessment of M&E system for Malaria Prevention and Control Malaria Prevention and Control

Program in Jimma ZoneProgram in Jimma Zone

Health Monitoring and Evaluation MSc Students 2008/2009 Class

2

OutlineOutline• Background• Problem statement • Rationale of the study• Objectives• Methodology• Findings• Discussion• Conclusion• Recommendations• Intervention

4

BackgroundBackground• In (DTTP) different professionals are practicing

the theoretical to translate the knowledge into practice in the community.

• This contribute to development of the community when identified gaps are implemented.

• M&E students worked on malaria prevention and control M&E system

5

BackgroundBackground….….• Malaria prevention and control program

has the following strategies:1.Case management2.Vector Control3.Epidemic prevention and control4.Supportive

• Education• Human resource development• Monitoring and evaluation.

6

Background cont…Background cont…• The scaling up of these strategies requires:

• Robust surveillance system• Monitoring and Evaluation • Health-information systems (HIS) at all levels

from local to national level• Therefore, M&E is fundamental for decision-

making and Program improvement

7

Problem StatementProblem StatementMalaria is the major Public Health problem in

Ethiopia Among the top ten leading cause of morbidity and

mortality. 2005 report: • 20% admissions • 48% of out patient consultation • 24.9% inpatient death • Affects school attendance by 20% • Contributes to 47% of the child death

8

Problem StatementProblem Statement

In 2006, report showed that despite much progress in the fight against Malaria, still the M & E system for the program has several problems: i. Non-centralized malaria Data base system

& lack of networkii. Impaired data capturing and storage iii. The Roll back Malaria follow-up survey

was not conducted as intended iv. Untimely and incompleteness of the

reports

9

Problem StatementProblem Statement

This has several impacts to the implementation of Malaria prevention & control:• planning done using obsolete /no data at all, • choice of the treatment options done without

information collected from the same settings.

The above situations also applies similar to Jimma Zone, Mana district.

10

Rationale of the studyRationale of the study

• Managers at various levels need quality information to make programmatic decisions.

• Accurate and timely reporting to national authorities and donors is vital in order to secure continued funding

• The study aimed at assessing the factors which can be easily acted upon by local authorities.

11

Scope of the studyScope of the study• M&E system- 12 components by WORLD

BANK: 1. Partnership, People and Planning2. Collection, Capturing and Verification of data3. Data for Decision

Due to factors:- time for the DTTP, resource available and areas of M&E system which can be simply recuperated by means of the resources at the local level: components selected include

12

Scope of the studyScope of the study … …1. routine program monitoring,

2. supervision and data auditing,

3. survey and surveillance

4. M&E data base

• Using identical rationale, research, evaluation and learning practices was discarded form the survey

13

Objectives:Objectives:• General objective To asses the process of data collection,

capturing and verification of Malaria prevention and control M&E system at Jimma Zone

• Specific objectives1. To asses timeliness and completeness of Malaria

prevention and control monitoring reports2. To describe the frequency and coverage of

surveys and surveillance.

14

Specific objectivesSpecific objectives … …3. To assess how Malaria prevention and control

data base operates to generate data

4. To asses whether the supervision and data auditing system of malaria prevention and control is in accordance to the guideline

15

METHODOLOGYMETHODOLOGY

Study Design Cross sectional study. Period 13th April to 15th May . Quantitative and Qualitative methods

Study population:

Staffs involved in M&E system from Zonal Health Department, district health office, health center and health posts

16

Methodology…Methodology…Study Sites Included:

• Jimma Zonal health Department,

• Jimma Town Health Office

• Manna district health office,

• Jimma Health Center

• Yebu Health Center,

• Biturie health post

• Gudeta bula Health post

• Jimma Higher2 Health Center

• Kito/sato Health Post

• Jiren Health Post

17

Methodology Methodology ……

Sampling technique Convenience: study sites including health

facilities Purposive : health care workers

(respondents)

Sample size: A total of 22 health workers responded to

the prepared tools for data collection

18

Methodology …Methodology …

Data collection The data collection process included:

Reviews of documents and reports received from April 2008 to March 2009.

Observation

Semi-structured interviews

19


Data analysis:• Quantitave data entered into SPSS Version 16

• Qualitative data analyzed using thematic approach

20


Ethical consideration:• Officially introduction letters to study sites

• Verbal consented pre requisite.

• Interviewee free to withdraw at any time .

21

FindingsFindings

Demographic characteristics• 22 interviews were conducted• Respondents included

– 11 Jimma Town Health office– 8 Manna District Health Offices respectively. – 3 zonal health department– Their working experience varies from 1 to 4

years.

22

Table 3: Provision of Training on M&E and presence of Plan for the M&E components

District/Zone

Malaria Progra

m Monito

ring

Survey & Surveillance

Supervision & Data

Auditing

M&E Database

Jimma Zone HO

Training Yes Yes Yes Yes

M&E Plan

No No No No

Jimma Town HO

Training Yes Yes Yes Yes

M&E Plan

Yes Yes Yes No

Mana district HO

Training No No No No

M&E Plan

Yes No Yes No

23

Figure 3 No of health facilities with at least one person trained on M&E

0

0.5

1

1.5

2

2.5

Manna Jimma town

district health office

No

of fa

cilit

ies

Trained

24

Routine data collection & reportingRoutine data collection & reporting• Expected – number of reports expected

• Submitted -number of reports received

• Completeness- proportions of the reports expected that were submitted

25

Figure 7, No of reports expected that were submitted, compliteness in both Jimma town and Manna districts and Jimma Zone

0

50

100

150

200

250

Manna weekly MannaMonthly

Jimma Townweekly

Jimma TownMonthly

Jimma Zoneweekly

Jimma ZoneMonthly

No

of re

ports

0%

20%

40%

60%

80%

100%

120%

Com

plet

enes

s ra

te

expected received completeness

26

Figure 1: Routine Malaria Program Monitoring System by strategic components in four surveyed facilities, Jimma town Heath office April

2009.

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

ITN's IRS Case Management Epidemic control EnvironmentalManagement

strategy

No

of fa

cilit

ies

Routine data collection and reporting Format for the report Receiving feedback for the report submitted

27

Figure 2 Data collection and reporting system for each component of Malaria prevention and control, Mana district in three surveyed health facilities

0

0.5

1

1.5

2

2.5

3

3.5

Epidemic control Environmentalmanagement

ITN's IRS Case management

strategy

No

of fa

cilit

ies

Routine data collection and reporting Format for the report Receiving feedback for the report submitted

28

TimelinessTimeliness• Though no reliable data to establish the report

timeliness rate, qualitatively it was identified that there was chronic problems of incompleteness, and untimely (timeliness) of the reports at the district level from the health facilities

29

Table 4: Table 4: Number of Supervision planned and Number of Supervision planned and conducted in each for each strategic conducted in each for each strategic

components by districts in the last 12 months components by districts in the last 12 months (xpt Manna)(xpt Manna)

Intervention strategies

Jimma zone Jimma town

Planed Conducted % Planed Conducted %

Case mgt 4 4 100 4 4 100

ITN 4 4 100 4 1 25

IRS 4 4 100 4 1 25

Env’tal mgt 4 4 100 4 2 50

Epidemic control

4 4 100 4 4 100

30

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

No of facilities

Manna Jimma town

District

Figure 5, No of facilities received supervision and feedback in four and three facilities survey in Jimma town and Manna district respectively

Supportive supervision Supervision feedback

31

Table 5: Data auditing practice by Table 5: Data auditing practice by District/ZoneDistrict/Zone

District/zone Data Auditing Plan

Focal Person

Trained Frequency

Jimma town Yes Yes No Not regular

Jimma zone Yes Yes No Quarterly

Manna district

No No No No

32

Figure 6, Number of health facilities in Manna district & Jimma administrative town conducting surveillance activities

0

0.5

1

1.5

2

2.5

3

3.5

Surveillance activities inplace

Responsible person onsurveillance

Received training onsurveillance reports

No

of fa

cilit

ies

Manna Jimma town

33

Table 8: Information on malaria Table 8: Information on malaria survey by district/zone officesurvey by district/zone office

District/zone Ever involved in survey

Has fund for survey

Feedback from conducting

Survey

Jimma zone Yes no No

Manna district Yes no No

Jimma town no no No

34

0

0.5

1

1.5

2

No of facilities

Ever involved insurvey

Availability of fundfor survey

Feedback frompartner who carried

out the survey

Manna

Jimma town

Figure 6: Number of health facilities involved in the survey by district/zone

Manna Jimma town

35

Data baseData base • All districts and zone have database in place.

• The JZHD and JTHO have both paper based and electronic database systems

• Manna district uses paper based database system. • However, all health facilities commonly apply

paper based database system

36

DiscussionsDiscussionsAll the districts surveyed implements five strategic

elements of MPC and is in line with the national guideline and Dr. Yemane’s 2009 Presentation.

– presence of M & E system for each of the elements as also studied by Chilundo et al 2004.

monthly reports as the common reporting frequency in both districts, while Manna have reports that are submitted on a weekly basis.

37

DiscussionDiscussion … …

• At manna, the weekly reports with (87%) incompleteness rate

• Qualitatively it was also identified that there were problems of incompleteness, untimely and underreporting of the reports at the district level from the health facilities.

38

Discussion Discussion ……– According to the Ethiopian HIMS 2008, the cut

off point for the incompleteness of the reports is when 80% or greater of the expected reports to be submitted are submitted.

– Similar findings by MCP report 2006, untimely and incompleteness to be rampant problems across the country.

39

ConclusionConclusion• Indeed, it is clear from this study that monitoring

and evaluation system in Jimma zone is severely crippled in the area of data collection, capturing and verification.

• Challenges seem to vary with districts and also within different level of health services delivery system.

• The monthly reports is the frequent used mode of reporting,

40

Conclusion Conclusion ……• The supervision of the health facilities is

conducted in all districts; however the frequency varies between the districts and mostly is less than quarterly visits to the health facilities.

• Surveillance of Malaria cases which is done in majority (71%) of the surveyed facilities has at least one trained focal person in each of the facilities undertaking the activities.

41

RecommendationsRecommendations• Case management reporting needs to be sustained

• The Weekly reports need to be improved in completeness as per the standard

• The supervision should be as per guidelines

42

RecommendationsRecommendations … …• The survey being conducted with in the district

should involve the staff

• Efficient information management system is highly required for surveillance of disease and control program

• Process evaluation of the M&E system to involve all stakeholders and come up with explanations of the observed deficit in the system

43Wednesday, April 19, 2023

43

InterventionIntervention Purpose of intervention• Aimed on improving the capacity of health

professional involved in data collection, capturing and verification.


44

Intervention………Intervention………• The group selected to intervene only with knowledge

gap due to time and resource constraints.

• Manual for training were prepared, they included the following topics:

– Malaria prevention and control monitoring and evaluation process,

– Supportive supervision and data auditing/verification,

– Surveillance and survey, monitoring and evaluation – Database management, and recording and reporting.


Intervention……Intervention……Training methodology

• Power point presentation using LCD• Training manual power point presentation

materials were distributed to the participants• Explanation using flip chart• Group Discussion


Intervention……….Intervention……….Training contents• Objective of the study• General findings of the study• Monitoring and Evaluation

• Concepts• Purpose • Importance • Basic Terminologies


Training…….Training…….• Process components of Monitoring and Evaluation

– Routine program monitoring• Performance monitoring

– Methodologies of performance monitoring • Tools of routine monitoring

• Surveillance and survey– Concepts & Differences and similarities– Purpose and uses, types of surveillance– Key sources of malaria surveillance data– Features of good surveillance system


Training………Training………• Supportive supervision and data auditing

– Concepts & components of supportive supervision

– Steps in conducting supervision– Methodology of data auditing/verification

• Monitoring and Evaluation Database– Data entry, Data collection and interpretation– Relevance of database– Importance of proper filing and keeping of

database


Results of Pre and post test.Results of Pre and post test.Pre and post test result of Jimma town training participants

Code Pre-test result Post-test result Difference % change

1 53 75 22 29%

2 75 89 14 16%

3 38 65 27 42%

4 5 30 25 83%

5 38 60 22 37%

6 69 87 18 21%

7 50 NA

8 71 90 19 21%

9 NA

10 65 85 20 24%

Average % change 34%


Results.……Results.……Pre and post test result of Manna district training participants

Code Pre-test result Post-test result Difference % change

4 40 60 20 33%

H2001 52 64 12 19%

1 24 52 28 54%

8 28 32 4 13%

M9 24 80 56 70%

0 20 84 64 76%

7 16 16 0 0%

GB1 20 40 20 50%

GB2 24 88 64

73%

51

ConclusionConclusion • The result from Paired T-Test show that the

differences in mean scores between the Pre-Test and Post Test are Statistically Significant t(8) = -3.541, p = .008. The test show that the chance of the mean occurring by chance alone is about 0.008 (or 0.8%).


Intervention…….Intervention…….Discussion during training

Major problems which were discussed by participants included. – Untimely reports – Incomplete reports– Inadequate skill on monitoring and evaluation– Shortage of logistic supplies– In appropriate format– Lack of regular supervision and feedback– Lack of graphical presentation of data


intervention………..intervention………..Proposed solutions• Timely submission of Reports

• Provision of the necessary logistics

• Managing the database properly

• Preparing checklist for supportive supervision


Solution……..Solution…….. • Conduct regular supervision and feedback

• Appropriate and standardized report formats

• Monthly performance assessment of the work done at all level

• Utilization of tools of monitoring (e.g preparation of graphical data)


Dissemination of final findings Dissemination of final findings

While discussing with the heads on final dissemination of findings, an agreed up on plan of action has been developed to be consumed by the offices for implementation.

56

THE END

1 Assessment of M&E system for Malaria Prevention and Control Program in Jimma Zone Health...

Documents

Transcript of 1 Assessment of M&E system for Malaria Prevention and Control Program in Jimma Zone Health...