Program for the Advancement of Malaria Outcomes (PAMO) Malaria Health Systems Gap Analysis Report
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Program for the Advancement of Malaria Outcomes (PAMO) Malaria Health Systems Gap Analysis Report PMI/Program for the Advancement of Malaria Outcomes (PAMO) - PATH Mikwala House Stand 11059 Off Brentwood Lane Longarces, Post.Net Box 370, Pvt. Bag E10| Lusaka, Zambia Web: www.path.org Table of contents List of Abbreviations ................................................................................................................................ 5 Executive Summary ....................................................................................................................................... 6 Introduction .................................................................................................................................................. 8 Background ................................................................................................................................................... 9 Justification for the gap analysis .................................................................................................................. 10 Objectives of the gap analysis ..................................................................................................................... 11 Specific objectives .................................................................................................................................... 11 Focus and methodological approach .......................................................................................................... 11 Geographical coverage ............................................................................................................................... 11 Thematic coverage .................................................................................................................................... 11 Data collection .......................................................................................................................................... 11 Data cleaning and Analysis ........................................................................................................................ 11 Presentation and discussion of findings ...................................................................................................... 11 Objective 1: To establish the status of PAMO supported provinces and districts with regard to implementation of proven malaria interventions. ....................................................................................... 12 ITN distribution in target districts ............................................................................................................... 12 IRS coverage in target provinces ................................................................................................................. 16 Improve access to and quality of malaria case management at public health facilities and community level to ensure prompt, accurate diagnosis and appropriate treatment of malaria .................................................... 19 Delivery of Intermittent Preventive Treatment to pregnant women (IPTp) using Sulphadoxine-Pyrimethamine (SP) as part of an integrated package of antenatal services ......................................................................... 23 Civil society and community-based organizations implementing malaria control activities .............................. 27 Objective 2: To assess and document management capacities of provincial and district MOH personnel to provide supervision and mentoring for improved delivery of proven malaria interventions ................ 27 Management capacity ............................................................................................................................... 28 Tailored capacity-building plan ................................................................................................................... 29 Quality HMIS data reporting ...................................................................................................................... 30 Technical/material assistance to DMOs, health facilities, and communities to assist with training for the roll out of DHIS2 in the targeted provinces and districts ......................................................................................... 31 Capacity building for DMOs and health facilities to improve supply chain management for malaria drugs and related commodities in the targeted provinces and districts ......................................................................... 32 Objective 3: To establish the levels of malaria health care financing with focus on financing sources and trends .......................................................................................................................................................... 33 Funding of Malaria Activities ...................................................................................................................... 33 Sources of Funding .................................................................................................................................... 34 Funding Challenges .................................................................................................................................... 34 Major Gaps in Malaria Prevention and Treatment. ....................................................................... 35 Conclusion and Recommendations ............................................................................................................ 35 Annex ........................................................................................................................................................ 37 Malaria health systems gap analysis task team Principal Investigator: Maurice Pengele, BSW, HMP, MCD, AHMP - M&E Technical Specialist – PAMO/PMI – PATH Co-Principal investigators: Godfrey Biemba, MBCHB, M.Sc. - Country Director – ZCAHRD Shadrick Chembe, MCD, B.Phil., M&E Cert. - Consultant List of Abbreviations ANC Antenatal care BCC Behavior change communication BRITE BroadReach Institute for Training & Education CBO Community-based organizations CCP Johns Hopkins University Center for Communication Programs CD Continuous distribution CHA Community Health Assistant CHAZ Churches Health Association of Zambia CHW Community Health Worker COP Chief of Party CSO Civil society organization DMO District Medical Office DHIS2 District Health Information System 2 DHS Demographic Health Survey EPI Expanded Program on Immunization GRZ Government of the Republic of Zambia HMIS Health Management Information System iCCM Integrated community case management IEC Information, education, and communication IPTp Intermittent preventive treatment in pregnancy IRS Indoor residual spraying ITN Insecticide-treated net MACEPA Malaria Control and Elimination Partnership in Africa M&E Monitoring and evaluation MIP Malaria in pregnancy MIS Malaria Indicator Survey MOH Ministry of Health NHC Neighborhood Health Committee NMCC National Malaria Control Center NMCP National Malaria Control Program NMSP National Malaria Strategic Plan OCA Organization Capacity Assessments OR Operations Research OTSS Outreach Training and Support Supervision PAMO Program for the Advancement of Malaria Outcomes PMI President’s Malaria Initiative PMO Provincial Medical Office PMP Performance Monitoring Plan SBCC Social and behavior change communication SMAG Safe Motherhood Action Groups TWG Technical working group WHO World Health Organisation ZMLA Zambia Management and Leadership Academy ZCAHRD Zambian Center for Applied Research and Development Executive Summary With support from the American Government through the President’s Malaria Initiative (PMI), the Program for the Advancement of Malaria Outcomes (PAMO) has been designed with the principal aim of reducing illness and mortality due to malaria by addressing key challenges in malaria prevention and treatment. PAMO contributes to USAID and the President’s Malaria Initiative’s (PMI) goals of strengthening the capacity of Zambia’s Ministry of Health (MOH) to implement the National Malaria Strategic Plans at provincial, district, and community levels. Zambia has made impressive gains in controlling malaria in the last decade due to robust malaria control policies, committed governmental leadership, and strong international partnerships, technical support, and financing. Even so, the PAMO target provinces - Muchinga, Luapula, Eastern, and Northern - require focused interventions to achieve the country’s goal of being free of malaria by 2030. The rural nature of the provinces, which have an estimated total combined population of five million, makes this effort particularly challenging. PAMO specific objectives are to support proven malaria interventions in line with the National Malaria Control Program (NMCP), strengthen management capacity of provincial and district personnel to provide oversight of interventions, and strengthen information systems at provincial and district levels to improve data reporting, analysis, and use for decision-making. Selected strategies include strengthening school- based distribution, looking at multiple distribution channels for ITNs, using technology to examine net coverage and improve use, strengthening capacities of practitioners in diagnosis and case management, strengthening linkages for supply chain management, updating training curricula and guidelines, and working with community leaders to tailor our efforts to specific needs in each