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Quarterly Progress Report April 1, 2019–June 30, 2019

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Quarterly Progress Report April 1, 2019–June 30, 2019 Program for the Advancement of Malaria Outcomes Quarterly Progress Report April 1, 2019–June 30, 2019 DISCLAIMER: The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development, United States President’s Malaria Initiative or the United States Government. Submission Date: July 31, 2019 Submitted by: Dr. Caroline Phiri, PAMO Chief of Party Mailing Address Private Bag E10, Lusaka, Zambia Street Address Mikwala House, Stand 11059 Off Brentwood Road, Longacres, Lusaka www.path.org © 2019 PATH. All rights reserved. Cover photo: PATH July 2019 1 TABLE OF CONTENTS LIST OF ACRONYMS 4 PROJECT OVERVIEW 6 EXECUTIVE SUMMARY 7 INTRODUCTION 11 BENCHMARKS AND ACHIEVEMENTS 12 OBJECTIVE 1: SUPPORT PROVEN MALARIA INTERVENTIONS IN ALIGNMENT WITH THE NATIONAL MALARIA STRATEGIC PLAN (NMSP) 2011–2016 AND THE FOLLOW-UP PLAN OF THE MOH 12 OBJECTIVE 2: STRENGTHEN MANAGEMENT CAPACITY OF PROVINCIAL AND DISTRICT MOH PERSONNEL TO PROVIDE SUPERVISION AND MENTORING TO IMPROVE DELIVERY OF PROVEN INTERVNETIONS 39 OBJECTIVE 3: STRENGTHEN PROVINCIAL AND DISTRICT HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) TO IMPROVE DATA REPORTING, ANALYSIS AND USE FOR DECISION-MAKING 41 SUCCESS STORY 54 3 LIST OF ACRONYMS AMF Against Malaria Foundation ANC Antenatal care BRITE Broad Reach Institute for Training and Education CHW Community health worker CSO Civil society organizations DHO District health office DQA Data quality audit EDS Electronic data system EHT Environmental health technician EPI Expanded program on immunization GRZ Government of the Republic of Zambia HFCA Health facility catchment area iCCM Integrated community case management ICEMR International Centers of Excellence for Malaria Research IPTp intermittent preventative treatment in pregnancy IRS Indoor residual spraying ITN Insecticide-treated net LLIN Long-lasting insecticide-treated net M&E Monitoring and evaluation MACEPA PATH Malaria Control and Elimination Partnership in Africa MCH Maternal and Child Health MIP Malaria in pregnancy MIS Malaria Indicator Survey MOH Ministry of Health MOP Malaria Operational Plan MRR Malaria rapid reporting MTR Mid-term review NHCs Neighborhood health committees NMEC National Malaria Elimination Centre NMESP National Malaria Elimination Strategic Plan OPD Outpatient department OTSS Outreach training and supportive supervision PAMO Program for the Advancement of Malaria Outcomes 4 PBO Piperonyl butoxide PHO Provincial health office PMI President’s Malaria Initiative SBC Social and behavior change SMAG Safe motherhood action group SMEO Surveillance, monitoring, evaluation and operations research TOT Training of trainers TWG Technical working group WHO World Health Organization 5 PROJECT OVERVIEW Life of project September 30, 2015, to September 29, 2020 Reporting period April 1 to June 30, 2019 Target provinces Eastern, Luapula, Muchinga, and Northern Target population 5,455,218 (Source: Central Statistics Office, 2018) Implementing partners PATH (lead), Jhpiego, and BroadReach Institute for Training and Education Key partners Zambian Ministry of Health (MOH), National Malaria Elimination Centre (NMEC), Provincial Health Offices (PHOs), District Health Offices (DHOs) and health facilities. Malaria Control and Elimination Partnership in Africa (MACEPA), Churches Health Association of Zambia (CHAZ), and other United States Agency for International Development (USAID) implementing partners. Objectives (1) Support proven malaria interventions in alignment with the National Malaria Strategic Plan 2011–2016 and the follow-on plan of the MOH. (2) Strengthen management capacity of Provincial and District MOH personnel to provide supervision and mentoring for improved delivery of proven malaria interventions. (3) Strengthen Provincial and District health management information systems to improve data reporting, analysis, and use for decision- making. Contract number AID-611-C-15-00002 6 EXECUTIVE SUMMARY The Program for the Advancement of Malaria Outcomes (PAMO), a Unisted States President’s Malaria Initiative (PMI) flagship malaria program, is supporting the Government of the Republic of Zambia (GRZ) to achieve as much progress as possible to reach its goal of eliminating malaria. Working in four provinces (Northern, Luapula, Eastern and Muchinga), PAMO targets 47 districts out of which six (Nchelenge, Chama, Mbala, Mambwe, Senga and Nakonde) are focus districts and three (Chadiza, Katete, and Sinda) are pre-elimination focus districts. This is the 2019 second quarter report covering activities implemented between April and June 2019. It highlights key achievements and challenges by objective and tasks as agreed in the year four workplan. Objective 1: Support proven malaria interventions in alignment with the National Malaria Strategic Plan (NMSP) 2011–2016 and the follow-on plan of the MOH Task 1.0: Strengthen national technical working groups (TWGs): PAMO has provided technical and/or material support to the four TWGs; Vector Control, Case Management, Social and Behavioral Change, and Surveillance, Monitoring, Evaluation and Operations Research (SMEO) TWG. In the Vector Control TWG PAMO presented findings of the assessments of Long Lasting Insecticide Treated Net (LLIN) distribution during ANC. The assessment found major challenges with record keeping and logistics management and recommended strengthening those aspects. The Case Management TWG has identified the need for revising the iCCM training to make it more participatory and adult learner centered instead of the current lecture-based training. In the SMEO TWG various issues were discussed key among them was to identify the reason why in spite of high LLIN coverage (88.2%) in Luapula, parasite prevalence remained high at 30.4%. It was suggested that the NMEC should consider overlaying the MIS data with other data such as climatic conditions to figure out this disparity. In the SBC TWG the key discussion was around planning for World Malaria Day events. Task 1.1: Strengthen insecticide-treated net distribution: PAMO focused on three activities; the first was the preparation for school-based distribution of LLINs. Through provincial and district planning meetings PAMO has set a target to distribute LLINs to 44,695 children currently enrolled in Grades one and four in 322 schools in Katete, Chadiza, Sinda and Nchelenge districts. The distribution will take place in the third quarter. The second activity was capacity building on continuous LLIN distribution through public health facilities and schools. PAMO supported provincial meetings during which participants were introduced to the NetCalc tool and trained on how to monitor and how to report on LLINs issued through public health facilities. The third activity was LLIN durability monitoring study. PAMO has collected second round data which will be compared to first round data that was collected in 2018 to establish both chemical durability and physical integrity of the nets. This information will be used for future LLIN distribution planning. PAMO also participated in the NMEC’s LLIN Task force which focused on planning for 2020/2021 mass distribution campaign. Task 1.2: Improve access to quality of malaria case management in public health facilities and communities to ensure prompt, accurate diagnosis and appropriate treatment: PAMO focused on improving quality access to case management at community and health facility levels. At Community level, PAMO planned to train and deploy 1,379 CHWs in integrated community case management (iCCM), 40 iCCM trainers, and 115 iCCM supervisors. These targets have been met; 1,401 CHWs (102 percent of the target), 41 iCCM trainers, and 137 iCCM supervisors (119 percent of the target) have been trained. CHW are testing and treating malaria at community level using passive and 7 active case finding strategies. A total of 179,739 people have been tested (77,067 passive and 102,772 active cases) out of which 87,064 were confirmed malaria cases (42,702 passive and 34,362 active). Of the 87,064 confirmed malaria cases, 75,483 (98%) were treated (41,493 passive and 33,990 active). Some confirmed malaria cases were not treated but were referred to a health facility for further management. To strengthen case management at health facility level PAMO conducts outreach training and supportive supervision (OTSS). This year the target is to conduct two rounds of provincial OTSS in health facilities with microscopes and two rounds of district OTSS covering health facilities using RDTs to diagnose malaria. PAMO has performed first round OTSS. In pre-elimination districts all the 10 hospitals while in the rest of the provinces 92.5% (86 out of 95) facilities with microscopes were visited. For district OTSS PAMO targeted 368 health facilities in the first round. In the second quarter we reached 256 (69.5%). The remainder will be reached in July 2019. The results of OTSS are encouraging. There are improvements in observational composite scores e.g. RDT observations improved from 89 percent in 2017 to 93 percent in 2019 and laboratory observation from 65 percent to 78 percent in the same period. Task 1.3 Increase delivery of IPTP-SP as part of an integral package of ANC services: to prevent malaria in pregnancy IPTp-SP is important and yet the 2018 malaria indicator survey reports very low uptake. In the second quarter of 2019 PAMO focused on increasing community awareness of early ANC booking and the importance of IPTP. In nine districts of Northern province PAMO has oriented
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