MOZAMBIQUE INTEGRATED MALARIA PROGRAM Quarterly Technical Progress Report: Year 2 (October 2018–September 2019)
Second Quarter Report: January to March 2019
April 30, 2019
This publication was produced for review by the United States Agency for International Development. It was prepared by Chemonics International Inc. for the Integrated Malaria Program, contract number 720-656-18C-00001.
MOZAMBIQUE INTEGRATED MALARIA PROGRAM
Quarterly Technical Progress Report: Year 2 (October 2018 – September 2019) Second Quarter Report: January to March 2019
Contract No. 72065618C00001
The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.
Contents
1. Program Overview ...... 4 2. Summary of the Reporting Period ...... 5 3. Detailed Report of Activities ...... 6 Objective 1: Support the implementation of proven malaria interventions at community and facility levels, in alignment with MSP ...... 6 Objective 2: Strengthen management capacity of the provincial and district Ministry of Health personnel to provide oversight and supervision of malaria interventions ...... 25 Objective 3: Improve HMIS data reporting, analysis, and use at the provincial and district levels ...... 26 4. Other Activities Requested by the DPS ...... 30 5. Challenges and Actions Taken to Meet Targets ...... 31 6. Success Stories ...... 31 7. Monitoring and Evaluation ...... 32
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. i
Acronyms
ANC antenatal care ACT artemisinin based combination therapy ADPP Ajuda para o Desenvolvimento do Povo para o Povo ADR adverse drug reactions AL Artemether-Lumefantrine APE community health worker (agente polivalente elementar) DDM district medical warehouse (Depósito Distrital de Medicamentos) DDS District Health Directorate DFO director of finance DPS Provincial Health Directorate DQA data quality assessment CBO community-based organization CSO civil society organization CHAI Clinton Health Access Initiative CMAM Central Medical Store (Central de Medicamentos e Artigos Médicos) CUAMM Médicos com África FHI360 Family Health International 360 FDC Foundation for the Development of the Community (Fundação para o Desenvolvimento da Comunidade) GHSC-PSM Global Health Supply Chain-Procurement and Supply Management Project GUC grants under contract HCN Nampula Central Hospital (Hospital Central de Nampula) HF health facility HMIS health management information system ICSN Health Sciences Institute of Nampula IMaP Integrated Malaria Program in Mozambique IPC interpersonal communication ITNs insecticide treated nets IPTp intermittent preventive treatment in pregnancy JHU Johns Hopkins University MA Medical assistant (agente de medicina curativa) M&E monitoring and evaluation MEL monitoring, evaluation, and learning MCSP Maternal and Child Survival Program MCH Maternal and Child Health MIP malaria in pregnancy MoH Ministry of Health MT Medical technicians (técnico de medicina curativa) NED nucleus of district statistics (núcleo de estatística distrital) NMCP National Malaria Control Program MSP Malaria Strategic Plan PES Social and economic Plan (Plano económico social) PIRS performance indicator reference sheets
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. ii
PIRCOM Interfaith Program Against Malaria (Programa Inter-Religioso de combate a malaria ) PMI President’s Malaria Initiative PNAPE National Program of APE (Programa Nacional de Agentes Polivalentes Elementares) PMT Preventive medicine technicians RDT rapid diagnostic tests SBCC social and behavior change communication SDSMAS District Women's Health and Social Action Services SESP education for public health sector (sector de educação para a saúde) SIS-MA Health Information Systems for Monitoring and Evaluation SiFO Training Information System (Sistema de informação para a Formação) SME surveillance, monitoring, and evaluation SP sulfadoxine-pyrimethamine STA senior technical advisor ToT training of trainers TWG technical working group USAID United States Agency for International Development WV World Vision
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. iii
1. Program Overview Program Duration: October 2017 to October 2022 Start Date: October 31, 2017 Life of Project Funding: $23,797,392.34 Geographic Focus: Zambézia, Nampula, Cabo Delgado, and Tete Provinces
Program Purpose
The United States Agency for International Development’s (USAID’s) five-year Integrated Malaria Program (IMaP) in Mozambique is led by Chemonics International with support from Family Health International 360 and Vanderbilt University Medical Center – Friends in Global Health (VUMC-FGH). IMaP aims to strengthen implementation of the Malaria Strategic Plan (MSP), as aligned with global and the Mozambican President’s Malaria Initiative (PMI) strategies and the identified needs of the National Malaria Control Program (NMCP). IMaP builds on previous malaria investments and harnesses the potential of the Ministry of Health (Ministério de Saúde, MISAU), the NMCP, health directorates, communities, and other stakeholders to maximize its impact.
IMaP works side by side at the national, provincial, and district levels to strengthen capacity and facilitate systemic improvements for better decision-making, planning, and guidance. As part of this process, IMAP will use a systematic process for identifying ways to address challenges and opportunities for technical support. IMaP also supports civil society and community-based organizations (CSOs/CBOs) to improve individual health-seeking behaviors through social and behavior change communication (SBCC). IMaP has incorporated data collection into each objective, which feeds into our monitoring, evaluation, and learning (MEL) system and gives access to adequate, timely, and accurate information to monitor performance, evaluate progress, and make adjustments to generate continual improvements. IMaP promotes sustainability by cultivating leadership skills and building ownership of malaria control efforts by health directorates and their partners.
Goals and Objectives
IMaP’s overall goal is to contribute to reducing malaria-associated mortality, morbidity, and parasitemia in four high-malaria-burden provinces (Zambézia, Nampula, Cabo Delgado, and Tete). IMaP will achieve this goal through three objectives: 1. Support the implementation of proven malaria interventions at community and facility levels, in alignment with MSP. 2. Strengthen management capacity of the provincial and district Ministry of Health (MISAU) personnel to provide oversight and supervision of malaria interventions. 3. Improve health management information system (HMIS) data reporting, analysis, and use at the provincial and district levels.
Integrated Malaria Program, Annual Technical Progress Report - Project Year 1, pg. 4
2. Summary of the Reporting Period During this reporting period, IMaP activities were implemented in all four target provinces, including Cabo Delgado, which kicked off activities during this reporting period in early January 2019. In line with its work plan, IMaP implemented a number of critical activities across all provinces.
In Zambézia, IMaP worked hand in hand with the provincial health directorate (DPS) to train 73 supervisors from all districts, as well as 66 Agentes Polivalente elementar (APEs) trainers. Seven provincial and two district-level supervisor trainings were held. During the quarter, IMaP also hosted data discussions in six districts which brought together district directors, chief medical officers, malaria focal points, Maternal and Child Health (MCH) supervisors, pharmacy officers, and health facility (HF) officials. The project also co-hosted a coordination meeting, led by the Deputy Head of Malaria Program from DPS, and with representatives of IMaP, World Vision, PIRCOM (Interfaith Program Against Malaria), Global Health Supply Chain – Procurement and Supply Management (GHSC-PSM) and Johns Hopkins University (JHU). Among other notable activities implemented in this quarter, training was carried out on the implementation of blind re-observation of malaria microscopy slides according to the National Guideline for Blind Re- Observing of Malaria Microscopy, with 38 laboratory technicians participating. During this period, provincial supervision was carried out in seven districts and district supervision for peripheral HFs in two districts
In Nampula, IMaP supported the training of 660 health providers in seven districts on malaria case management update and treatment standards in Mozambique. The project supported provincial supervision and mentoring in nine districts and district supervision for peripheral HFs in two districts. Similar to Zambézia, IMaP also provided training to a number of host-country counterparts, including: • 33 APE district trainers, and training of trainers (TOT) from 11 districts in Nampula • Refresher training for 725 APEs from 11 districts in Nampula, a 23.4 percent increase over the planned amount of trained APEs for the quarter • Monitoring and Evaluation training for 81 district technicians (35 from núcleo de estatística distrital (NED), 23 Malaria Focal Points, 1 nurse, and 21 from the epidemiological vigilance sector; • Training for blind observation of malaria to 37 laboratory technicians in 14 districts
In Tete, IMaP provided logistics support and technical assistance to train 76 supervisors at both district and provincial levels. IMaP also participated in the discussion of cases and deaths at Tete Provincial Hospital. In addition, supervision was carried out in conjunction with the DPS team in two districts during this quarter, with on-the-job training provided to 24 health providers in Changara and Tsangano districts combined, including training for maternal and child health nurses on rapid diagnostic tests and intermittent preventive treatment in pregnancy (IPTp). During supervision visits, IMaP transported antimalarial drugs (ACTs) and rapid diagnostic test (RDT) to Tsangano as requested by the DPS. Unfortunately, heavy rains in the province made additional planned supervisory visits impossible to carry out due to flooding of roads.
Lastly, IMaP officially began operations in its newest province of Cabo Delgado on January 14, 2019. As part of this launch, IMaP technical staff presented newly hired staff and the work plan
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 5
to the Cabo Delgado DPS. In addition, the Cabo Delgado IMaP team supported the DPS in the planning of a net distribution campaign implemented by the Ministry of Health (MOH) and World Vision, and financed by the Global Fund. IMaP also supported the creation of a provincial malaria technical working group, which includes DPS, IMaP, Médicos com África (CUAMM), local NGO Wiwanana, the Fundação para o Desenvolvimento da Comunidade (FDC), and Malaria Consortium, where the mechanisms of collaboration between the partners were discussed. Lastly, as with the other provinces, IMaP provided technical assistance and support, including training of 85 provincial and district supervisors; participated in the discussion of nine malaria deaths in the districts of Balama, Namuno, and Pemba Provincial Hospital; and worked hand in hand with DPS to supervise the health facilities (HFs) of Cariacó, Natite, and Eduardo Mondlane in the city of Pemba.
At the national level, IMaP participated in four meetings of the Advocacy and Communication Technical Working Group (TWG) and participated in the discussion of the methodology to be used for drafting the Social and Behavior Change Communication (SBCC) Strategy. It included a revision of the framework to be used by the consultants responsible for carrying this work. In addition, this draft also incorporated inputs from Emily Bockh from Family Health International (FHI360) and from IMaP’s Nampula team. It is expected that a new version will be reviewed in the next quarter.
3. Detailed Report of Activities
Objective 1: Support the implementation of proven malaria interventions at community and facility levels, in alignment with MSP
Activity 1.1. Strengthen national malaria policies, strategies, and guidelines.
During this reporting period, IMaP provided short-term technical assistance to update the checklist of the national malaria supervision manual to include the NMCP’s six technical areas: management; monitoring, evaluation and surveillance; vector control and entomology; information, education, and communication; case management; and elimination. The first draft of these updates was presented to PMI during this quarter; during the next quarter, the IMaP team will present the next version of the manual to Dr. Candrinho, head of the National Malaria Program at the Ministry of Health. The intention is to then work with the NMCP to support their final pilot and review of the manual. Once MISAU reviews these materials, IMaP will conduct the distribution of integrated supervisory manuals to each district.
To support the strengthening of the national Monitoring, Evaluation and Surveillance Manual, IMaP moderated a meeting of stakeholders involved in the technical group tasked to develop the manual, which includes Malaria Consortium, Clinton Health Access Initiative (CHAI), and PMI. At this meeting, each partner was assigned a specific portion of the manual to update. IMaP is playing the primary coordinating role in finalizing the manual, incorporating inputs from other partners, as well as updating sections related to surveillance data management and analyses, information system maintenance and access, data management, data analyses, and feedback and reporting. The draft manual will be presented to partners and the TWG in Q3.
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 6
Nampula. Under Activity 1.1.4, IMaP supported the meeting of several provincial-level technical working groups to foster collaboration and integrated program management among the DPS and implementing partners. In Nampula, this meeting included the Provincial Head of the Malaria Program, malaria program technicians, the head of the Central Hospital of Nampula (HCN) laboratory and implementing partners Ajuda de Desenvolvimento de Povo para o Povo (ADPP), IMaP, GHSC-PSM, and N’Weti. Among the topics of discussion were the status of case management training; supervision and technical support verified at HCN emergency ward lab; the revitalization of malaria technical subgroups; the status of mosquito nets at Health Facilities (HF) for antenatal care (ANC); the sharing of the Economic and Social Plan (PES) 2019 from the NMCP and implementing partners’ quarterly plans; and data submission rates in the Health Information Systems for Monitoring and Evaluation (SIS-MA).
From several points discussed in the minutes of the meeting, the following recommendations were listed for each partner: 1. DPS a. Advise the Head of HCN to move the RDTs from the emergency ward lab to the outpatient consultation b. Send a note to HCN to request the participation of the malaria focal point and the laboratory chief in the meetings of the technical coordination subcommittee on the first day of each month c. Create working groups in each pillar of the program (case management, monitoring and evaluation, entomology, Information Education and Communication (IEC), vector control), and present the terms of reference of each group at the next meeting d. Provide training at health training institutions (colleges and institutes) to teachers and students in update of malaria diagnoses and treatment guidelines 2. GHSC-PSM: a. Share the quarterly plans for the management of mosquito nets in ANC 3. IMaP a. Share the list of staff trained on updated malaria treatment guidelines to the focal point of SiFO (Sistema de informação para a Formação) 4. All (DPS and Partners) a. Each partner should update their work plan activities in the PES
Zambézia. IMaP supported the provincial-level meeting of stakeholders and partners — including the DPS, PIRCOM, GHSC-PSM, and JHU — which focused on analyzing the trend of malaria cases in the province and preparation for World Malaria Day celebrations. On the former, noting that there had been a 21 percent increase in cases across the province in January and February 2019 compared with the same period in 2018, and that the increase had been universal across districts, partners agreed to intensify preventive measures, improve the notification and registration of cases, and improve early diagnosis and treatment. Specifically, JHU agreed to increase speeches in schools, and World Vision agreed to increase training for teachers on malaria prevention, while IMaP agreed to provide increased advocacy for more speeches about malaria in HFs and communities as well as technical support on case registration, and data reporting, analysis, and discussion at all levels. On the latter, partners
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 7
agreed to all hold Malaria Day events in Q3 on World Malaria Day on April 25, and worked together to coordinate their activities.
Cabo Delgado. IMaP supported the establishment of a technical working group in Cabo Delgado on March 14, including the DPS, Malaria Consortium, FDC, CUAMM, GHSC-PSM, and Wiwanana. As part of this support, IMaP contributed to the creation and approval of the group’s terms of reference and supported two meetings in which joint preparations for World Malaria Day celebrations were scheduled and discussed. The intended event will host the Minister of Health as well as the headquarters of the NMCP in Pemba.
Tete. The technical working group met monthly at DPS, and discussed and approved the terms of reference and selected priority indicators for data/information analysis. These periodic indicators include inpatient and outpatient cases; malaria deaths; IPTp; mosquito nets in the ANC; and number of lectures and people covered in the activities of APEs, HF, Committees of Health and CBO.
Activity 1.2. Improve access to and quality of febrile case management at public health facilities and at the community level to ensure prompt and accurate diagnosis and appropriate treatment of malaria.
Under Activity 1.2.1, IMaP worked with District Women's Health and Social Action Services (SDSMAS) to conduct district SBCC meetings in Nampula. Due to the later launch of activities in Cabo Delgado and Tete, these activities have not yet begin in these provinces. This activity for Zambézia is planned for Q3. The purpose of these meetings is to share key messages on malaria prevention and accessing health services in febrile cases, and to particularly engage with male decision-makers within these community structures so that they replicate their good practices in their communities. In Nampula, IMaP organized and led meetings on SBCC in 11 districts (Monapo, Nacala Porto, Angoche, Liupo, Larde, Nacaroa, Muecate, Meconta, Murrupula, Rapale, and Nampula), with the participation of community leaders and community committees of health. Based on the meetings, action plans were developed that took into consideration the following findings:
• The existence in the HFs of preventive medicine technicians (PMT), responsible for carrying out health promotion activities and disease prevention in communities • The effort made by the different actors to ensure that APEs meet their activity goals (i.e., 80 percent preventive activities and 20 percent curative activities) was found to be positive. • Health facility staff failed to regularly update plans for lectures. • There was often poor planning and compilation of the community mobilization activities by the Education for Public Health Sector (SESP). • There were often delays in care based on men’s inability or unwillingness to accompany their partners to the health facility. • The summary record of communication activities in the districts does not include the people reached by messages per health theme and by gender.
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 8
Actions and recommendations: • The supervision team supported HF Preventive Medicine technicians to properly develop lecture plans; in turn, technicians were recommended to replicate this practice to remaining HFs • IMaP reviewed the tool used by National Health System to accommodate additional data required such as number of lectures, topics desegregation, number of people reached by sex , which was approved by the DPS and now is being used by all districts from Nampula • The role of men as decision makers will be addressed by the SBCC package to be implemented by the end of Year 2
Exhibit 1: Number of Participants in Community Meetings
Number of Community Leaders participate in Nº Districts meeting by Cadre and Sex Total M F 1 Monapo 19 6 25 2 Nacala Porto 25 0 25 3 Larde 24 7 31 4 Liupo 25 5 30 5 Nacaroa 25 0 25 6 Murrupula 27 11 38 7 Muecate 15 10 25 8 Angoche 20 7 27 9 Meconta 0 0 0 10 Nampula 0 0 0 11 Rapale 27 9 36 Total 207 55 262
1.2.3 Conduct clinician malaria case management trainings for 1,700 health professionals from 19 districts in Nampula
Nampula. Under Activity 1.2.3, IMaP continued to conduct training of 660 clinicians in Nampula on updated guidelines for diagnosis and treatment of malaria. Districts targeted were Rapale, Murrupula, Nampula, Angonche, Porto Nacala, Larde, and Monapo, and included clinicians from the HCN and Institutes of Health Sciences of the City of Nampula. (The breakdown of those trained is included in Exhibit 2 below.) This activity continued from training completed last quarter in other districts; as of the end of the second quarter, 1,440 health professionals have been trained, or 85 percent of the overall yearly target of 1,700. The remaining technicians — who missed out on training for reasons such as disciplinary leave, illnesses, or other work assignments — will be reached during supervision and mentoring visits that the provincial teams will carry out in the districts and health units.
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 9
Exhibit 2: Number of Staff Trained by Job Category and Sex in Nampula
Trained
Province Coverage (%) Projected to be Male Female Total Trained HCN e ICSN 450 133 194 327 73 Rapale 70 20 39 59 84 Nampula, 106 33 92 125 118 Murrupula 44 14 24 38 86 Angonche 13 5 6 11 85 Nacala Porto 13 3 7 10 77 Larde 69 16 36 52 75 Monapo 17 8 7 15 88 Total 782 232 405 637 81
Source: IMaP/DPS Nampula Actual Trained by Category General General Province Medical Medical Medicine Medicine Nurses SMI Other Specialist General Technicians Agent HCN e ICSN 23 35 9 0 192 40 28 Rapale 0 2 19 1 15 19 3 Nampula, 0 4 27 6 24 46 18 Murrupula 0 1 7 2 21 7 0 Angonche 0 1 2 1 3 3 1 Nacala Porto 0 0 6 0 2 2 0 Larde 0 1 9 0 23 19 0 Monapo 0 3 4 0 6 2 0 Total 23 47 83 10 286 138 50
Based on this activity, IMaP and DPS jointly concluded that inviting HCN specialist doctors and teachers of the Institute of Health Sciences of Nampula (ICSN) to this training was important value added, as these staff play a role in providing pre-service and in-service trainings. IMaP also received feedback that the training time was short (one day) for the contents covered, and that the merging of different categories of trainees with different previous experience (nurses, specialists, etc.) were items to consider when developing training in the future. (Additional observations and feedback are included in Exhibit 3 below.)
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 10
Exhibit 3: Findings and Recommendations of Case Management Trainings
Findings Recommended Actions to be Taken
Include the update on case management of malaria in continuing Absence of some planned participants training at health facility without plausible justification Provide in-service and on-the-job training during supervision and mentoring visits
Poor knowledge in the management of Mentoring and job training cases of malaria by the health technicians
Rapid Diagnostic Tests (RDT) administered Withdraw the RDT from the Emergency Lab and allocate RDT in all in the laboratory and not in the service service sectors and respective test consumption maps sectors
Provide and distribute standard operational procedures (SOP) of Weak command of testing procedures steps to conduct RDT
Weak command of dilution procedures, Provide and distribute standard operational procedures (SOP) of administration and dosage of artesunate artesunate dilution, administration and dosage procedures in the mainly for the nursing staff sectors where they prepare and administer
One day of training time is insufficient Increase the time to 2 days
Trainees come from different cadres and Increase training to 2 days to ensure more attention is given to the have different experience (i.e. nurses, groups with less experience specialists, etc.)
Activity 1.2.5 Conduct training to 20 DPS staff members who are already part of supervisory team and SDSMAS staff per district
Under Activity 1.2.5, IMaP continued to conduct training for DPS and district staff members in Zambezia, Cabo Delgado, and Tete in the supervisory approach using the updated checklist; the same training that was conducted in Nampula in Q1. This training is intended to create a supervisory team for malaria to monitor the NMCP intervention at district and peripheral level HF, including at community level through APEs.
Trainees included DPS staff (malaria program focal point, SESP head, malaria program M&E focal point, M&E Officer); physicians from the central and general hospitals of Quelimane and provincial hospitals of Tete and Pemba; and district staff (district chief medical officer; general practitioner, preventive medicine focal point, nucleus of district statistics) for the three provinces. For Zambezia, trainees also included technicians from DPS and 11 districts (Quelimane, Pebane, Mocuba, Derre, Gurrué, Alto Molócue, Ile, Luabo, Inhassunge, Milange, and Nicoadala); the additional 11 districts will be trained next quarter. Exhibit 4 below details trainees by category.
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 11
Training was a two-day workshop, with the first day devoted to theoretical knowledge and discussion and the second day to practical application of the HF supervisor checklist. It was noted that during the practical phase of training, trainees had difficulty in identifying problems and drawing up action plans. Trainers therefore used specific examples (e.g., difficulty in the use of RDT) to build trainee skills in this area. Overall, the number of trainees with a score of 80 percent or higher on their pre-test was around 50 percent; around 85 percent of trainees met that goal on their post-training test. Cabo Delgado in 71 trainees only 67 had a score of ≥80% in post-test Zambézia in 62 trainees only 55 had a score of ≥80% in post-test Tete all participants had scores below 80% in post-test Particularly for Tete IMaP will discuss with DPS to have one extra training for all trainees with and focus the training in themes that was considered with low results, but the final strategy will be discussed with DPS and have a final decision at central level.
Following these trainings, IMaP and DPS staff made the following recommendations for trainees:
• District Chief Medical Officer should lead: o Monthly meetings to analyze and discuss data / indicators of the malaria program o Monthly discussion with the district clinic team of the cases and deaths due to malaria o Job training to MCH nurse to monitor IPTp data register • Supervision should be done at the district headquarters health units by the district supervisory team before they go to peripheral HF • The action plan should be drawn up in the HF with the supervised team, with subsequent submissions attached to the report
Exhibit 4: Number of Staff Trained by Job Category in Tete, Cabo Delgado, and Zambezia
Overall average Minimum score Projecte Total Trained Actually Trained by Category Covera score District d to be Tota GM Nurs ge (%) Pre-test Trained M F GP GMA PMT ST Statistic Pre-test Post test l T e Tete 74 71 53 18 20 14 0 3 20 3 11 96% 58% 65% 40% Cabo 50% Delgad 93 85 72 13 24 18 4 1 21 12 5 91% 77% 90% o Zambez 90 62 45 17 20 14 0 4 18 6 0 69% 76% 88% 40% ia 17 40% Total 257 218 48 64 46 4 8 59 21 16 85% 70% 81% 0
1.2.6 Provide on-the-job training to at least 486 health providers and 108 APEs per quarter as needs and gaps are identified in Zambézia and Nampula and 324 health providers and 36 APEs per quarter in Tete and Cabo Delgado
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 12
Nampula. Provincial teams carried out supervisory visits to nine districts (Muecate, Murrupula, Meconta, Larde, Nacaroa, Liupo, Monapo, Nacala Porto, and Angoche) and 27 health facilities from the same districts.). Through these visits, work training and technical support were provided to 319 health workers, who presented gaps in case management, M&E, and communication. Of the 18 districts planned, only 50 percent were achieved, due to the shifting of DPS priorities to the finalization of case management training, and the filariases campaign.
Exhibit 5: Number of Staff Trained During Supervision and Mentoring Visits in Nampula
Sex Health Care Workers Reached by Category District Male Female Clinical Nurses Laboratory Pharmacy M&A SESP Other1 Muecate 24 22 21 0 0 0 14 11 0 Murrupula 10 15 14 0 0 0 5 6 0 Meconta 17 29 30 0 0 0 4 12 0 Monapo 22 22 23 0 0 0 14 7 0 Nacala 22 21 33 0 0 0 5 5 0 Porto Angoche 18 14 20 0 0 0 8 4 0 Liupo 16 19 20 0 0 0 8 7 0 Larde 17 5 13 0 0 0 6 3 0 Nacaroa 9 17 20 0 0 0 2 4 0 TOTAL 155 164 194 0 0 0 66 59 0
Following the training, the following positives and areas for improvement were identified:
• All patients with suspected malaria were tested and those positives were prescribed antimalarials • Of the three districts where follow-up visits occurred, Monapo showed improvement in compliance with the updated malaria treatment guidelines. Through direct observation of outpatient procedures and patient record revision, IMaP confirmed that the prescription of antimalarial drugs was based on weight, all outpatient consultations had RDT, and technicians used appropriate laboratory criteria for the choice of diagnosis test and correctly prescribed injectable artesunate. • Training in up-to-date approaches to malaria case management encompassed most clinicians in the health units, with particular improvement in all health units in compliance with the procedures for testing, treatment and clinical follow-up at admission • All Districts visited expressed microscopy results in parasite density with the exception of Liupo and Nacaroa • There was availability of mosquito nets and sulfadoxine + pyrimethamine in all 27 HFs visited • Rapid tests for malaria were available in all sectors except in CS Meconta
• There was a lack of updates of the stock records of the Deposits and Pharmacies in the districts of Liupo
1 Others refers to Psychologist, Preventive medicine officers, etc.
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 13
• Some districts did not requisition antimalarials as recommended (Monapo, Muecate, Meconta, Nacaroa) • A map of consumption of RDTs was not available at all HFs • There was a failure to complete the map of Artemether-Lumenfantrine (AL) consumption in Liupo District
Based on these findings, IMaP reached out to the GHSC-PSM program to ensure that supervision of the malaria program in specific areas of the districts of Muecate, Monapo, Meconta, Nacaroa, and Liupo is carried out. In addition, the DPS was also advised to provide technical support in the Laboratory area to the Liupo and Nacaroa District.
Zambezia. During this period, supervisory visits were carried out in seven districts (Mopeia, Morrumbala, Gurué, Ile, Maganja da Costa, Alto Molócue, and Quelimane), out of a total of 18 planned for the quarter, and to 19 health facilities out of 54. Based on that, IMaP reached 158 health professionals with training against a planned 486, and 52 APEs out of a planned 108. The main reasons for these gaps were floods stemming from the cyclone Idai which prevented travel to certain districts, as well as unavailability of DPS for visits due to a previously postponed polio vaccination campaign and other shifting DPS priorities.
Exhibit 6: Number of Staff Trained During Supervision and Mentoring Visits in Zambezia
Sex Health Care Workers Reached by Category District Male Female Clinical Nurses Laboratory Pharmacy M&A SESP Other Mopeia 7 5 4 2 2 0 1 0 0 Morrumbala 6 10 1 4 2 3 0 6 0 Gurué 25 13 7 7 3 3 1 17 0 Maganja da 15 12 12 3 4 6 0 2 0 Costa Ile 14 12 9 4 0 0 0 13 0 Alto 17 10 9 4 3 4 3 4 0 Molócue Quelimane 23 30 26 13 5 5 3 1 0 TOTAL 107 92 68 37 19 21 8 46 0
Tete. Supervisory visits were carried out in the Changara and Tsangano districts and to six health facilities. During these visits, technical and mentoring support was offered to 24 health providers and 8 APEs. Both of these fell below the project’s goals for the quarter, mainly due to flooding, which prevented travel to certain districts. Exhibit 7 below depicts the breakdown of staff trained in Tete.
Exhibit 7: Number of Staff Trained During Supervision and Mentoring Visits in Tete
Sex Health Care Workers Reached by Category District Male Female Clinical SMI Laboratory Pharmacy M&A SESP Other Changara 8 8 3 5 0 2 1 5 0 Tsangano 8 6 4 3 0 3 0 4 0 TOTAL 16 14 7 8 0 5 1 9 0
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 14
Cabo Delgado. No supervision was carried out during the reporting period due to the unavailability of DPS staff. This activity was rescheduled for the month of April.
1.2.7. Conduct APE refresher ToTs to 33 staff members in 11 districts
Nampula. Refresher training was held in March, with three trainees each from 11 districts: Ribaué, Moma, Angoche, Larde, Liupo, Meconta, Mongicual, Mogovolas, Muecate, Murrupula, and Nacaroa. Trainees included each district’s district public health education and community involvement officer (SESP-EC), its district malaria program officer, and its district coordinator of APEs
The contents of the training included: • The APE experience in community work, such as how to allocate their time and curative activities • Identification of key behavioral barriers in the community, including taboos and social norms, and the influence that the APE can exert on changing norms in communities • Training techniques • Interpersonal communication and counseling • Key behavior change messages for mosquito nets, IRS, and malaria in pregnancy • Gender issues in communication activities for malaria • Management of patients with fever and severe illness, and pre-referral treatment • Proper record management (e.g., register book, correct preparation of the APE monthly report and its relationship with the registration book) • Male engagement
As a result of training, facilitators made the following recommendations for follow-up action items:
• There is a need for DPS to standardize the goals of lectures, home visits, and other activities that APEs should report on regularly • There is a need for district SESPs to strengthen oversight of APEs in order to address the difficulties they face in the activities they undertake in their communities • The DPS should review and submit a SESP oversight form so that it can report the number of sessions held per theme in both the HF and the community through the APEs, activists, implementation partners, etc. These data should be broken down by gender.
Zambézia. In this quarter, 66 APE trainers were trained out of a total of 72 planned, a coverage rate of 92 percent; the remaining APE trainers were not available because of scheduling issues from the DPS side. Similar to Nampula, training covered a variety of topics, including health promotion, preventative measures for malaria, community case management, and M&E tools.
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 15
1.2.8 Provide logistics support to DPS and SDSMAS staff to provide training to 630 APEs for APE refresher training (22 districts)
Zambézia. During this period, the IMaP team provided logistical support to DPS and SDSMAS technicians from 9 districts (Alto Molocué, Namarroi, Morangebala, Milange, Namacurra, Maganja da Costa, Pebane, Lugela, and Inhassunge) for APE training. A total of 309 of the 630 planned APEs were trained, corresponding to 49 percent of compliance with planned malaria case management in the community, prevention and health promotion, and correct completion of registration forms. As with Activity 1.2.6, the effects of Tropical Cyclone Idai, as well as unavailability of DPS staff due to other priorities were key factors in falling short of our planned goals.
Exhibit 8: Number of APEs Trained (Zambézia)
Number of Planned Number of APEs District New APEs APEs Trained Pebane 42 42 0 Namarroi 30 30 0 Namacurra 31 31 0 Milange 49 49 0 Morrumbala 47 47 0 Alto Molocue 35 35 0 Inhassunge 29 29 0 Maganja da Costa 19 19 0 Lugela 27 27 0 Total 309 309 0
After the training, the 309 APEs returned to their communities with recommendations on the need to increase the number of lectures, home visits, the Interpersonal Communication (IPC) cycle, case management, and correct completion of registration forms with a view to reducing the number of malaria cases in the communities.
Nampula. As a result of TOT, APE trainers provided training to 725 APEs, an increase of 23.4 percent above the original target of 588. Exhibit 8 details this increase.
Exhibit 9: Number of APEs Trained (Nampula)
Number of Planned Number of APEs District New APEs APEs Trained Ribaue 101 102 1 Moma 79 95 16 Angoche 84 99 15 Larde 14 18 4 Liupo 29 43 14 Meconta 43 55 12 Mongicual 20 29 9 Mogovolas 106 133 27 Muecate 33 42 9 Murrupula 42 62 20 Nacaroa 37 47 10
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 16
Total 588 725 137
Cabo Delgado. In Cabo Delgado, this training was postponed from March to April, due to conflicts with the DPS agenda.
1.2.9. Provide logistics support to SDSMAS to conduct supervisory and mentoring visits to six peripheral health facilities and three APEs quarterly.
Nampula. IMaP provided logistical support for SDSMAS to conduct supervision and mentoring visits from the district level to nine peripheral health facilities in Rapale and Nampula districts (Namaita, Caramaja, Namucaua, Mutolo, Muleheia, Mutivaze, Maratene, Namachilo, and Muhala Expansion). These visits support health facilities that are not reached by province supervision, allowing health workers at these facilities to gain training in skill sets such as case management, IPTp, and communications. IMaP also supported meetings with community structures and key individuals in the communities in support of these visits as described in activity table 1.2.1. This activity will continue in Nampula district into the next quarter, as it had been temporarily halted because DPS resources were required for the district vaccination campaign and filariasis treatment campaign.
Overall, these visits marked the first experience with district staff carrying out supervision and mentoring visits following the completion of district supervisors in November 2018. In terms of lessons learned, participant lists were used for community structure meetings, key personnel meetings, and on-the-job training at supervised sites in the districts of Rapale and Nampula. Additionally, reports from these districts were of poor quality. IMaP and DPS staff will follow up with these areas to ensure the quality of future visits.
Zambezia. In this past quarter, IMaP supported supervisory visits to 10 health facilities in Quelimane and Nicoadala. During these visits, district supervisors performed the following tasks:
• Verifying implementation of 2017 Malaria Treatment Standards • Conducting data quality assessment • In-service training for APEs in malaria case management and registration, where applicable • Training HF in the administration of rapid malaria test dilution, dose (RDT) and the use of intravenous and intramuscular injectable artesunate in the District of Quelimane • Presenting the results of Hematozoario in all laboratories visited in the form of Parasite Density; in all health facilities visited, they administered IPT-4 doses in the maternity ward for the pregnant women who had not had the opportunity to receive them in the ANC
Among the findings of these visits were the following:
• All health units did not update RDT stock control charts, sulfadoxine + pyrimethamine (SP), mosquito nets, and other consumables.
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 17
• The community involvement in activities is taking place on a routine basis, and lectures are given in order to raise awareness among users to prevent diseases within communities. • There were often medical prescriptions with deficient information (patient identification number, age, weight, and place of residence) • Data discrepancies in log books were found under the monthly summaries • There was a lack of artesunate and quinine injectable or oral in CS Domela • There were often a lack of Epidemiological Weekly Bulletin postings
To address the above described findings, the supervisory team provided on-the-job training on best practices for filling medical prescriptions, supported teams to analyze and verify data before sending to the SDSMAS level, supported the ordering of missing antimalarials from the district drug depot, and instructed APEs on appropriate filing practices. In terms of lessons learned, generally this model seems to improve the coverage of HF supervision. However, support and mentoring is still needed from DPS or IMaP – especially on first visits – as district teams still do not have a complete understanding of the various tools used.
Cabo Delgado and Tete. This activity was not implemented in these provinces during this quarter as full implementation had not yet begun during the reporting period.
1.2.10 Participate in at least one discussion session of any deaths due to malaria and a minimum of four clinical cases in at least one health facility (health center, district health center, or rural hospital) in nine districts per quarter.
Nampula. No malaria deaths were reported in the districts supervised in Nampula during this reporting period.
Zambézia. In Zambézia, IMaP staff joined DPS personnel to participate in the discussion of malaria deaths at the Morrumbala District Hospital. Of the two pediatric deaths discussed, both were determined to be inevitable as both were cases of complicated malaria with anemia and/or sepsis, and shock.
In addition to the above items, the integrated DPS and IMaP team participated in the evaluation of malaria inpatient procedures. Eleven cases were evaluated, resulting in the following findings:
• Administration of medication signed in the cardex in the absence of the patient • Temperature evaluation is not conducted as recommended (4 to 6 times a day) • In 40 percent of the processes the discharge of the patient is not by the clinician's decision but the patient's decision.
It was not possible to discuss malaria cases and deaths in Mopeia because clinicians were involved in HIV activities.
Tete. In Tete, discussion sessions were carried out at the Tete Provincial Hospital and Tsangano District, led by the clinical director of the Tete provincial hospital and the chief district doctor of Tsangano, respectively.
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 18
At the Tete Provincial Hospital, three preventable deaths were discussed in the adult ward. The Clinical Director brought to the attention of clinicians, the pharmacy manager, the laboratory, and the chief nurse the need to follow procedures with correct clinical conduct. It was also decided that cases would be discussed separately because clinicians who were in the emergency room when patients were hospitalized were not present.
In the Tsangano district, one adult death was deemed avoidable due to inadequate therapeutic management. Thus, the head of the provincial malaria program stressed to the clinical team the need to follow the correct therapeutic procedures according to the standards advocated by the Ministry of Health.
Cabo Delgado. In Cabo Delgado, this activity was planned for the district of Montepuez involving the districts of Balama and Namuno but was rescheduled for next quarter based on DPS availability.
1.2.11. Conduct monthly discussion sessions of any deaths due to malaria and to clinical cases of severe malaria in hospitalization through district medical chief/clinical director per quarter in each district
In Nampula, the activities scheduled to be held in the district of Ribaue and other provinces were postponed to April as well as in other provinces.
1.2.12 Quarterly, facilitate and provide logistical support to at least one session where clinicians of referral health facilities and of the two largest-volume health facilities in each district, led by a chief medical officer, meet and study clinical cases involving untoward/unexpected outcomes (severe morbidity or mortality)
This activity was postponed for next quarter.
1.2.13 Conduct refresher training to 30 laboratory technicians (two from 15 district laboratories) and microscopists in malaria diagnosis using RDT and microscopy
Zambézia. Refresher laboratory training was conducted from January 8 to 10, 2019, on the implementation of national guidelines on blind re-observation of malaria microscopy slides. A total of 38 laboratory technicians attended from 16 districts (Alto Molocué, Gurue, Ile, Inhassunge, Lugela, Mangaja da Costa, Milange, Mocuba, Mocubela, Mopeia, Morrumbala, Namacurra, Namarroi, Nicoadala, Pebane, and the City of Quelimane). During this workshop, trainees were taught to conduct a baseline evaluation of the level of malaria microscopy activities; monitor the daily preselection process; and implement registration and retention of the slides in participating laboratories.
In addition, IMaP staff conducted a survey of the general conditions of work for malaria microscopy in laboratories supported by IMaP, using the NMCP checklist; the findings will be available in the next quarter. IMaP also provided technical support to laboratory staff to ensure that random selection of malaria slides was carried out on a daily basis and properly conserved;
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 19
and provided tutorials in the preparation of smears for laboratory diagnosis of malaria (thick smear and smear) until the processes of staining, microscopic observation, and delivery of the results. Exhibit 10 below details the specific laboratories visited.
Exhibit 10: Laboratories Visited
Zambezia Province District Laboratory 1 Quelimane CS 24 de Junho 2 Alto Molocué HR Alto Molócue 3 Gurué HR Gurue 4 Ile CS Ile 5 Inhassunge CS Inhassunge 6 Lugela CS Lugela 7 Maganja da Costa MD Maganja 8 Milange HR Milange 9 Mocuba HD Mocuba 10 Mocubela CS Mocubela 11 Mopeia CS Mopeia 12 Morrumbala HR Morrumbala 13 Namacurra CS Namacurra 14 Nicoadala CS Nicoadala 15 Pebane CS Pebane
Nampula. In Nampula, training was conducted from January 22 to 24, 2019, in Nampula and attended by 38 participants from 14 districts (Angoche, Nampula, Nacala Velha, Mossuril, Mogovolas, Muecate, Meconta and Mecuburi, Monapo, Erati, Island of Mozambique, Malema, Memba, Nacala Velha, and Nampula Central Hospital). The purpose of the workshop was to differentiate the PNAEQ (National Quality External Evaluation Program) and PPGQ (Provincial Quality Assurance Program), to explain quality assurance for the diagnosis of malaria, and to discuss the guidelines of the blind re-observation of malaria. Visits to laboratories in Nampula will be carried out in Q3.
1.2.14 QI/QA laboratory assistant along with the DPS laboratory supervisor will implement a pre-implementation assessment for the malaria external quality assessment (EQA) (blinded rechecking) in 15 laboratories from 15 districts
During this quarter, this activity was only conducted in 15 labs in Zambezia. In Nampula, this activity was postponed to Q3 due to a change in priorities for the NMCP in order to create the provincial external quality assurance core group for laboratories certification..
1.2.15. QI/QA laboratory assistant will carry out quarterly external blinded cross- checking of routinely taken slides
This activity is planned for Zambezia and Nampula in Q3.
1.2.16. Develop actions plans for low performing laboratories
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 20
This activity is planned for Q4.
1.2.17. Provide technical assistance to DPS and SDSMAS for monitoring requisitions and control of ACTs and RDT stock
Zambézia. IMaP conducted stock monitoring during supervisory. In all visited health facilities, there was availability of RDTs and AL no record of (AL) stockout.
Nampula. Only Lalaua, Meconta, Monapo, and Liupo reported RDT stockout in this quarter, for a period of less than 3 days. Monapo, Nampula, Muecate, and Larde all reported stock out of SP for a period less than five days. There was no record for AL stockout at the provincial level.
Tete. During the joint supervision visit conducted in the districts of Changara and Tsangano, IMaP provided technical support of updating stock control records form of antimalarial drugs Artemisinin based combination therapy (ACTs) and RDTs in two HF in Changara and in only Health Center of Kalipale in Tsangano. There were no reported stockouts of antimalarial drugs and RDT.
Activity 1.3. Increase delivery of the full course of IPTp using sulfadoxine- pyrimethamine as part of an integrated package of antenatal visits.
1.3.1 Provide technical assistance to DPS and SDSMAS for monitoring requisition and control of SP and mosquito net stocks in prenatal care during supervisory and mentoring site visits in districts
Nampula. During supervisory visits, there was a lack of stock control records of consumables in some HFs, as well as lack of updates in the CPN in all HFs, except for the stock of mosquito nets. Action was taken to correct this situation; the supervisory team provided stock control records forms in four HFs that were lacking them, and in five HFs, records were updated.
Zambézia. During supervisory visits, IMaP staff provided technical support by training pharmacy technicians, mother and child health nurses (MCH nurses), and mother and child health supervisors on the quantification of malaria products. For the period, there was a stockout of mosquito nets in the Maganja da Costa Districts (CS Namurromo, CS Nante, CS Moneia, CS Moloa, and PS Vila Valdez) and Ile District (CS Mugulamo). For the CS of Mugulamo, as a solution, it was proposed to make available nets from other HFs in the district until the Mugulamo CS receives the lot from DPM. During the data discussion, it was verified that the remaining 38 percent of HFs of the district has stockout of mosquito nets and with the same percentage of HFs with the potential for stockouts. IMaP shared this finding with GHSC-PSM.
Tete. In Tete, logistic support was provided to the district of Changara in the transport of mosquito nets to the district warehouse from the provincial warehouse. During supervisory visits, IMaP staff also trained the focal point in requisition of mosquito nets for peripheral health facilities and trained two MCH nurses in the correct use of control cards for stock management. As for the district drug store, IMaP staff verified warehouse conditions, including
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 21
the presence of shelves, correct delivery of the drugs, correct filling of the SIMAM (Sistema de Informacao de Medicamentos e Artigos Medicos) stock, infrastructure, and use sheets. In Tsangano, the warehouse was noted to be lacking in adequate space and faces issues with rats.
Cabo Delgado. There were no supervisory visits during this reporting period.
1.3.2 In coordination with DPS and SDSMAS, conduct in-service training as needs and gaps are identified, provide training to at least 27 mother and child health nurses in the entry of data into the prenatal consultation registry, and data collection for monthly and district summaries, in nine districts per quarter
Nampula. IMaP staff supported the DPS in conducting work-specific training for maternal and child health nurses on IPTp and records during the supervision and mentoring visits as gaps or problems are identified. This action aims to improve the administration and coverage of the second and fourth doses of IPTp through provision of SP during ANC visits and correct reporting through registration and monthly summaries. During this past quarter, 39 MCH nurses from 11 districts in Nampula were trained in data collection, the use of registers, and monthly cohort reporting.
Zambézia. In this past quarter, 24 SMI nurses from seven districts and 19 health units received on-the-job training on completing the register book, data collection, monthly summary, and use and data reporting.
Tete. In-service training for seven MCH nurses on appropriate dosage and timing of IPTp, correct data collection for the monthly summaries and US and district cohort, and correct data entry into the ANC registration book was conducted. Data from the month of January in the CS Changara were analyzed by monthly recount versus logbook, with a 7 percent discrepancy found on the second dose of IPTp, and a 4 percent discrepancy observed in the fourth dose. Based on this, the MCH nurses were oriented to a good analysis and data collection for the monthly report.
Cabo Delgado. This activity will be conducted in the next quarter.
1.3.3 In coordination with malaria focal points and SMI district officials, monitor availability of SP and mosquito nets on a monthly basis and determine if information on drug stock has been sent to respective provincial malaria program focal point.
In Nampula, there were no stockouts of mosquito nets, and stockouts of less than five days of SP in Monapo, Nampula city, Muecate, and Larde.
In Zambézia, SP availability was verified at all sites visited. However, as mentioned in point 3.1.1 regarding the District of Maganja, it has been found that five HFs had some instance of mosquito net rupture, as well as one HF in the District of Morrumbala. Measures to mitigate this problem have been described in section 3.1.1.
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 22
Of the districts visited in Tete during supervision, the district of Changara and Tsangano did not have a stockout of mosquito nets or SP during the last two months.
1.3.4 In coordination with DPS and GHSC-PSM, support the districts to make requests for medications and take them to district drug warehouses during supervisory and mentoring site visits to be given to the patients
During the supervisory and mentoring and refresher visits to APEs in the districts, IMaP provincial staff in Nampula supported the transport of medicines and other inputs such as RDTs to Murrupula, Ribaue, and Mogovolas districts.
Exhibit 11: Drugs Transported
Quantity District Input Name Ordered Provided Mogovolas Rapid diagnostic test 725 396 Rapid diagnostic test 555 264 Amoxicillin 1,550 810 Ribaue Syphilis test 45 20 Acetylsalicylic acid 10,000 10,000 Stock Forms 1,000 250 Amoxicillin 2,000 648 Murrupula Erythromycin 100,000 44,800 Metronidazole 600 600
Zambézia. In the districts visited, there was no need to take medicines or other products.
Tete. Mosquito nets were transported from the provincial warehouse to Changara district and from the district to peripherals HF. In addition, medicines including ACT and RDT were transported to the HC of Goba and Mazoe. For Tsangano district, antimalarials, rapid tests, and other drugs for the district drug warehouse were delivered to the Chinanan, Fonte Boa, Kalipale, and Ntengo Mbalame Health Facilities.
Activity 1.4. Strengthen SBCC implementation.
In February, provincial District and Community Engagement Specialists, the Maputo-based Social and Behavior Change STA, and short-term technical assistance for FHI360 collaborated to draft the IMAP SBCC Strategy. More detail is provided in Activity 1.5 below. In the next quarter, IMaP expect to finish the revision of the package of SBCC materials for the CBOs, as well as have completed the award process of grants.
In addition, during this period IMaP supported refresher trainings for 309 APEs in Zambezia and 725 APEs in Nampula on health promotion and updated malaria treatment guidelines (community treatment). Lastly, as IMaP supported Phase 1 of the pilot of ITN distribution through schools occurred in the district of Namarrói, IMaP also supported the second phase by
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 23
working jointly with the NMCP to revise and adjust the SBCC materials for the campaign. The campaign itself will take place in the next quarter.
Activity 1.5. Support CSO/CBOs to implement malaria control activities.
During this quarter, IMaP staff submitted a revised SBCC strategy to USAID and are awaiting final approval of the deliverable, expected early in the next quarter. Based on comments and guidance from PMI, IMaP used the draft SBCC strategy to launch the Request for Applications under this activity during Q2; grants awarded under this RFA will go to CBOs and CSOs who will support the project in implementing SBCC activities at the community level. Applications for grants are due early in Q3, and it is expected that by the end of Q3, the project will have selected grantees and begun the grants award process.
1.5.9 Continuous mapping of CSOs/CBOs in province
As part of the implementation of its work with CSOs and CBOs, IMaP provincial staff continued to conduct and update mapping of CSOs and CBOs as well as community radios within each province. In Nampula, two additional organizations were identified: ACDL (Community Association for Local Development) and AMULTDS (Multisectoral Association for Sustainable Development), both working in the areas of health, agriculture, education, and environmental sanitation. In Zambézia, the mapping was updated in the districts of Quelimane, Alto Molocué, Ile, and Maganja da Costa, adding Quelimane radio FM and Community Radio of January to the list.
In Tete, mapping identified 18 community radio stations (six pertaining to ICS, four private and eight government entities associated with the government) as well as several CSOs and CBOs. Exhibit 12 lists the CSOs and CBOs identified.
Exhibit 12: Organizations Identified
Acris Association Protection Tete Old The Network of Good Man (APITE) Governance Associations (RAMBOG) Rural Development Association The Association of Therapeutical The Anglican Church (ADRM) Group (AGT) Ademucha The Christian Council of The Association Kupulumussana Mozambique (CCM) Chiguirizano The Zuwa Association Organization Hope Mocambique (OREMO) Isabel Jacopo Association The Africa Juvenile Network Utchessa Association Azemap Association Raju Kuthandizana Kurchira Association (KK) A Family Association (ASUFA) Twassamale Association ADELT CARITAS Diocesana Eco AIDS Together Access to Medicamentojam
Activity 1.6. Conduct operations research.
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 24
IMaP is currently awaiting a workshop led by the NMCP to finalize the OR agenda and timeline, scheduled to take place in Q3. In the interim period, IMaP staff have developed a draft research agenda to present to the NMCP when the workshop is held and is supporting the review of the draft terms of reference and agenda.
In addition, IMaP is also moving forward with an operations research study that looks at IPTp data quality and provider protocol adherence in Mozambique. The goal of this study is to determine factors and strategies that can improve the delivery of malaria prophylaxis for pregnant women. The study will use health facilities assessments, client-provider observations, semi-structured interviews with providers, and records review. This activity is underway, and there is currently a preliminary partnership with the INS that will culminate in a memorandum of understanding for the activity implementation. During this period, IMaP worked with INS to finalize their SoW and is moving forward with budget development by INS.
Objective 2: Strengthen management capacity of the provincial and district Ministry of Health personnel to provide oversight and supervision of malaria interventions
Activity 2.1. Determine malaria-related health systems constraints and appropriate solutions.
2.1.1 Present the capacity maturity needs assessment tool to DPS and train them on how to use the tool
During this period, a consultant was identified to adapt the needs assessment tool based on the pilot of the tool in Nampula in November 2018. In the next quarter, this activity will be completed, and the results presented to USAID.
Activity 2.3. Enhance quality of programmatic implementation through strengthened monitoring and mentorship at the district and facility levels.
2.3.1 Accompany mentors on quarterly site visits, coaching as they mentor SDSMAS officials and clinicians.
IMaP’s case management specialist participated in joint supervision with DPS in order to monitor district mentors in the following districts: Meconta, Muecate, Monapo, Murrupula, Larde, Liupo, Nacala Porto, Nacarôa, and Angoche. In general, district supervisors were found to have no means of transport to conduct technical support visits to the US peripheral except for headquarters; normally, they take advantage of provincial supervisory visits to conduct technical support to HF.
Due to the unavailability of the DPS in Zambezia, this activity was postponed for this quarter.
Activity 2.4. Facilitate provincial-level coordination.
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 25
Under Activity 2.4.1, as part of its coordination activities, IMaP provincial staff in Nampula participated in a coordination meeting. As part of the outcome of this meeting, IMaP staff will participate in a mapping of activities, led by MSI’s MMEMS project. Coordination meetings for Tete and Cabo Delgado will occur later this year.
2.4.2 Present Year 2 Work Plan in the province to DPS
This activity was previously completed in Zambezia, Nampula, and Tete DPSs. During this quarter, IMaP provincial and national staff presented the Year 2 Work Plan to the Cabo Delgado DPS. After the presentation, the following recommendations were made by DPS:
• Align program activities with PES activities of DPS and District Social Economic Plan (PESOD) at district level • Form a malaria technical working group that works closely with the DPS and not only within the partners, and which mirrors the geographic areas of the province • Meet with the provincial chief of the Department of Planning and Cooperation • Present the memorandum of understanding and performance with DPS.
2.4.3 Conduct one-day meeting to share approved Year 2 Work Plan and ensure participation of DPS, CMO, malaria focal point, and maternal and child health nurses from each district and DPS and NMCP representatives
In Tete, IMaP staff presented the Year 2 Work Plan on March 22, 2019, with the participation of DPS staff and district chief medical practitioners (MCDs), SMI focal points, and nurses from all districts. Based on the presentation, the DPS chief emphasized the need to appropriate all activities supported by IMaP as an opportunity to leverage them to help reduce malaria morbidity and mortality in the province. The remaining provinces have scheduled this activity for Q3.
Objective 3: Improve HMIS data reporting, analysis, and use at the provincial and district levels
Activity 3.1. Strengthen quality of routine data.
3.1.1 Support logistics and provide technical assistance to DPS to carry out two-day M&E refresher training
In partnership with the Nampula DPS, IMaP conducted M&E refresher training for 81 district technical staff from Nampula. This training targeted the NED focal point, statistic epidemiological vigilance and district-level malaria focal points, and provincial-level nurses; the remaining targeted staff were not available. The purpose of the refresher training was to update participants on malaria M&E and SIS-MA contents and indicators. Trainees also received an introduction of the new procedures for data quality assessment issues. During this training, all participants received practical training on the use of SIS-MA; for example, trainers had staff use their own data to directly input data into SIS-MA and had malaria district focal points review
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 26
this data. Based on training results, trainees are expected to implement the knowledge received in the workplace; replicate the training for other district staff and HF data; and improve data quality by ensuring monthly reports are entered and reviewed correctly. Exhibit 13 depicts trainees by category and gender.
Exhibit 13: Number of M&E refresher training in Nampula in Quarter 2, Year 2 by gender and category
Staff Trained
Gender Category Coverage
Malaria NED Projected Epidemiological rate (%) Male Female Total Focal Focal Nurses Other to be vigilance Province Point Point Trained Nampula 92 70 11 81 23 35 1 21 1 88%
The table below shows the level of participants’ knowledge in the content of this M&E training both on the pre-test and post-test. There was unsatisfactory progress, stemming from questions on the DQA. To respond to this gap, the IMaP team in coordination with the DPS and NMCP is organizing a specific DQA training for the next quarter.
Exhibit 14: Test Scores on M&E Training
NOTA (Pre-Test) NOTA (Post-Test) Number of Number of Number of Pre-Test Number of Post Test Improvement Correct Correct questions Scores questions Scores Answers Answers 810 447 55% 810 501 62% 12%
For Zambezia, this activity was rescheduled for the third quarter based on DPS availability. For Tete and Cabo Delgado, this activity is scheduled for the third quarter.
3.1.3 Support DPS, including logistical support, on routinely collected data, identifying districts with the largest discrepancies of data and prioritizing them in district-level data discussions, led by a district medical officer and attended by staff members
Nampula. During the reporting period, a joint team of IMaP M&E staff at the central and provincial levels and DPS Nampula was created to support the districts of Mozambique Island and Monapo, which had found large discrepancies in their data (Mozambique Island was selected based on high discrepancies between malaria cases and AL distribution and Monapo was based on high increase of malaria cases). Monthly data collection and data discussion were held on March 18 to 22 (Mozambique island) and March 25 to 29 (Monapo).
On Mozambique Island, data cleaning for the February 2019 period in two health facilities (Sede and Sangane) revealed discrepancies between the primary source (HF registry book), HF
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 27
monthly report and SIS-MA data were -14 percent in Sede and -2 percent in Sangane. Results were discussed at the district level as with HF directors, clinical directors, malaria district focal point, and pharmacy technicians. Data on several malaria indicators was also discussed, including IPTp2 and IPTp4 coverage as well as cases of malaria. Based on these findings, health facilities with data that showed improvements in these indicators were requested to share their activities and lessons learned. Similarly, in Monapo, the team supported the district to elaborate on the March statistical report and helped conduct the monthly data discussion.
Zambezia. In Zambezia, data discussions were held in six districts (Lugela, Milange, Nicoadala, Mopeia, Namacurra, and Maganja da Costa), and included district health directors, clinical directors, malaria focal points, SMI supervisors, pharmacy technicians, and HF directors. Districts for data discussion were selected in coordination with DPS based on the data discrepancies reported in January and February 2019 in SIS-MA, as well as those found in comparisons between the primary source (HF registry book) and the monthly summary conducted during district visits that occurred over the last two quarters. In general, the main problems were found in the following indicators: total cases tested, confirmed malaria cases (RDT and HTZ), and consumption of AL. The main findings from the data discussion meeting were an increase of malaria cases in all districts and lower coverage of IPTp compared with the same period in the previous year. In addition, all HFs were found to have malaria commodities with the exception of Maganja da Costa, who revealed that they have low stock of treated nets. It was also revealed that the APEs are more involved in malaria treatment compared to prevention/health promotion. In this meeting, it was also related that all districts experience some data quality issues because they are not using the appropriate book record of external consultation.
In general, for all districts that conducted data discussions in both Nampula and Zambézia, IMaP recommended that malaria indicators be included in their monthly data discussions, and committed to sharing the provincial data analyses matrix in coordination with the DPS as a guide for data discussion in the district level. Based on those findings identified in data discussion meetings, IMaP also helped district staff develop recommendations for action plans, including intensifying prevention activities; improving reporting in HF registry books; conducting routine data verification between HF registry books and monthly summary reports; increasing administration of IPTp; and increasing in APE supervision. IMaP shared information on net stockouts with GHSC-PSM.
Cabo Delgado and Tete. This activity was not conducted in either of these provinces because IMaP SME staff were not yet available during this reporting period. It is anticipated that this activity will be completed in Q3 in these two provinces.
3.1.6 Conduct DQA in 22 districts
Zambezia. The IMaP team in coordination with the NMCP and DPS are planning to conduct in the third quarter a DQA training using the tool developed with malaria partners. IMaP will also begin conducting routine DQAs using the tools approved by the NMCP in the next quarter.
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 28
For the other three provinces, IMaP is expecting to conduct the DQA training during Q3 and Q4 based on the DPS and NMCP availability.
Activity 3.2. Support utilization of DHIS-2 in alignment with the Mozambican MOH priorities.
3.2.1 Coordinate with the NMCP and Health Information Department (Departamento de Informação para Saúde, DIS) twice a year to collect and update the SIS-MA priorities so that IMaP can provide technical support.
For this quarter, this activity was conducted in Nampula and Tete. The main findings included: • Clinical staff do not have access to SIS-MA even for data visualization • There are connectivity issues for SIS-MA managers at the provincial level • The SIS-MA system works very slowly, especially during the monthly data entry and summary period (system infrastructure issues) • Staff requested more autonomy at the provincial level for general system management, such as provincial user management, to add or disable the HF or health services • There is a lack of validation system for malaria monthly summary forms
To address those findings as well as others from previous quarters, IMaP will organize a meeting with SIS-MA managers at the central level in the next quarter to discuss and address issues that cannot be solved at the provincial level. In addition, IMaP will facilitate a SIS-MA workshop with all malaria partners and NMCP to discuss this finding and others from partners and managers.
3.2.4. Provide two computers to each DPS
During the information flow management and SIS-MA needs assessment in Nampula, Zambezia, and Tete, IMaP also assessed the computers required by DPS with SIS-MA support capabilities and necessary work flexibility to malaria departments. These specifications will be used to purchase and deliver computers to DPS in Quarter 3.
3.2.6. Coordinate with NMCP and DPS to carry out refresher trainings to staff members who already handle SIS-MA with participation from malaria district focal points and NEDS staff members
In Nampula, this activity was carried out simultaneously with Activity 3.1.2. Within M&E refresher training, participants received orientation on the SIS-MA, including practical demonstrations of its functions or operationalization (e.g., dashboards, data quality, data entry, use of pivot tables, and system management). This activity is scheduled in Zambezia, Tete, and Cabo Delgado provinces for the third quarter, as described in Activity 3.1.1.
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 29
3.2.7 Work monthly side by side with DPS to provide support on analysis of completeness, consistency, and timely entry into SIS-MA and provide feedback to districts throughout the year
Nampula. IMaP’s provincial SME worked closely with DPS on a monthly basis to guarantee data completeness and feedback to districts. In January and February, the submission rate was 87 percent and 85 percent respectively by the end of each month; these gaps were due to problems with SIS-MA as described under Activity 3.2.1. In March, the submission rate increased to 99 percent.
Zambezia. As described in the activity 3.1.1 based on the DPS activities overlapping and SIS-MA access limitation at the provincial level, during the supervisory visits the team worked with NED in Maganja da Costa and Mopeia to verify data inconsistencies, completeness and advised NEDs to prepare feedback to the HF through WhatsApp and/or SMS.
Tete. In Tete, during the M&E activities startup, IMaP supported DPS in February data analyses, completeness verification and feedback to districts. This activity continued in March and will be part of the routine task of provincial IMaP SME to support DPS.
Activity 3.3. Strengthen data-informed decision-making, including management and supervision.
3.3.1 Work with the DPS to produce feedback to districts and health facilities on performance of malaria program and encourage districts and health facilities to use data for decision making during implementation of malaria activities
As described in activity 3.2.7, the data in Nampula was analyzed and feedback sent to the district for data cleaning and correction in SIS-MA. DPS and IMaP are using this to decide where the supervision must be done, but this process still needs to be used by SDSMAS and HF. IMaP is still working with SDSMAS to use the data for decision-making in malaria activities and support HF to do the same procedure. In Nampula, Zambezia, and Tete, data feedback to districts is done monthly for HF. IMaP and DPS are still working to have this process at the district level.
3.3.2. In coordination with NMCP and DPS, review and standardize the malaria indicator feedback template
Nampula, Zambezia, and Tete already use their own district feedback template, which IMaP is working to harmonize and standardize for all provinces. This tool will be tested in the second month of the third quarter and is proposed to be used at the provincial level, and for district to HF the process will be the same. These tools will be available to all provinces during quarter 3.
4. Other Activities Requested by the DPS
In addition to activities in its work plan, IMaP is occasionally requested to perform other activities at the provincial level. This section details those activities.
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 30
Zambezia. During this quarter, IMaP participated in the integrated micro planning with DPS, MISAU, and GHSC-PSM for the mosquito net distribution pilot in primary schools in Namarrói. IMaP was responsible for the production of all communication materials for the entire campaign, including before, during, and after distribution of the nets to 136 primary schools. Materials included pamphlets, posters, and simple leaflets aimed at specific audiences: teachers, students, the school board, and the community in general. In addition, IMaP also supported the Maquival Health Center in the district of Quelimane by delivering several data collection tools and instruments, following the findings of a visit by PMI to support the improvement of TIP making and quality of registration and record.
5. Challenges and Actions Taken to Meet Targets
Across all provinces, based on the number of supervision visits per quarter – around 12 to 18 per quarter per province – supervision teams are stretched thin and cannot always conduct the supervision visits at the level that is recommended. For example, it is not always possible for staff trained in case management, M&E, or communications to participate in supervision visits, leading to missed opportunities. To address this issue, IMaP will work with DPS teams to ranking the districts by defined criteria in order to prioritize the supervisions to be performed on a monthly basis. That will give more time for each health facility visit.
In addition, the unavailability of DPS staff due to a multitude of reasons – but primarily due to staffing challenges or competing priorities – often challenges IMaP implementation. For example, in Zambézia Province, the lack of a provincial malaria manager from the NMCP made it difficult to design a comprehensive work plan. Activities such as immunization campaigns scheduled for weeks for supervision visits often draw DPS staff away from IMaP activities. IMaP will work with NMCP staff more closely in the planning of DPS activities implemented at the provincial level to ensure central level support for collaboration with IMaP.
6. Success Stories Please see Annex A for Success Stories.
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 31
7. Monitoring and Evaluation
As the project’s updated MEL plan was approved after the end of the reporting period, but before the finalization of this report, we have included project data collected under previous indicators in the format of the new MEL plan indicators.
LOP LOP LOP Quarterly Indicators Province FY18 FY19 Q1 FY19 Q2 FY19 Q3 % LOP Anal Baseline Total Target Progress yses PROJECT GOAL: REDUCE MALARIA-ASSOCIATED MORTALITY, MORBIDITY, AND PARASITEMIA IN FOUR TARGETED PROVINCES OF MOZAMBIQUE Nampula 5% N/A N/A N/A 3% 1. Percent of inpatient deaths Zambezia 8% N/A N/A N/A 4.8% in targeted provinces whose primary cause was Tete 5% N/A N/A N/A 3% malaria (Impact/Custom) Cabo N/A N/A N/A 7% 4.2% Delgado Nampula 310‰ N/A N/A N/A 186‰ 2. Incidence of malaria per Zambezia 321‰ N/A N/A N/A 192.6‰ 1000 persons in targeted provinces Tete 277‰ N/A N/A N/A 166.2‰ (Impact/Custom) Cabo N/A N/A N/A 372‰ 223.2‰ Delgado Objective 1: Support implementation of proven malaria interventions in alignment with the NMSP IR 1.1: Strengthen national malaria policies, strategies, and guidelines 3. Number of national malaria policies, strategies, and guidelines that IMaP contributes to in order to National 0 0 0 0 10 0% meet international standards (Output/ Custom) IR 1.2: Improve access to and quality of febrile case management at public health facilities and at the community level to ensure prompt and accurate diagnosis and appropriate treatment of malaria Nampula N/A N/A N/A 0 100% 4. Percent of trained health N/A N/A N/A 0 care workers who are Zambezia 100% observed following Tete N/A N/A N/A 0 100% identified critical case Cabo N/A N/A N/A 0 management protocols 100% Delgado N/A 637 5. Number of health workers Nampula 1775 36% in targeted districts trained in malaria Zambezia N/A 62 1775 3,5%
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 32
LOP LOP LOP Quarterly Indicators Province FY18 FY19 Q1 FY19 Q2 FY19 Q3 % LOP Anal Baseline Total Target Progress yses laboratory diagnostics Tete N/A 71 1350 6.1% (RDTs or microscopy) Cabo N/A 85 with USG funds 1350 6.3% (Output/Contract) Delgado Nampula 51.3% N/A N/A N/A 100% 6. Percent of children under five years old with fever in 100% Zambezia 72.4% N/A N/A N/A the last two weeks for whom advice or treatment 100% was sought (Outcome/ Tete 79.9% N/A N/A N/A Contract) Cabo 100% 63.4% N/A N/A N/A Delgado 7. Percentage of children Nampula 98% N/A N/A 100% 100% under five years of age Zambezia 97% N/A N/A 103% 100% who were tested positive 97% 100% for malaria and who Tete 96% N/A N/A received treatment Cabo 105% 100% 98% N/A N/A (Outcome/ Custom) Delgado Nampula 98% 95% 100% 8. Percentage of pregnant women who were tested Zambezia 97% 93% 100% positive for malaria and Tete 96% 79% 100% who received treatment (Outcome/ Custom) Cabo 105% 100% 98% Delgado 1100 9. Number of women who Nampula 8052 9787 94% received a laboratory Zambezia 12409 1530 15083 92% diagnosis for malaria Tete 2753 1810 3346 136% during pregnancy Cabo 1327 (Outcome/ Contract) 8160 9919 96% Delgado Nampula 34.9% N/A N/A N/A 87.5% 10. Percent of children under five years old with fever in Zambezia 51.6% N/A N/A N/A 87.5% the last two weeks who N/A N/A N/A had a finger or heel stick Tete 55.1% 100% (Outcome/ Contract) Cabo N/A N/A N/A 48.3% 87.5% Delgado Nampula N/A 637 1175 54.2%
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 33
LOP LOP LOP Quarterly Indicators Province FY18 FY19 Q1 FY19 Q2 FY19 Q3 % LOP Anal Baseline Total Target Progress yses 11. Number of health workers Zambezia N/A 62 1175 5.3% in targeted district trained in case management with Tete N/A 71 1350 6.1% artemisinin-based 85 combination therapy Cabo N/A 1350 6.3% (ACTs) with USG funds Delgado (Outcome/ Contract) 0 12. Percent of APE Nampula N/A 100% supervisors in health 0 100% facilities visited by IMaP Zambezia N/A during the reporting period who received at 0 100% least one supportive Tete N/A supervision visit Cabo 0 100% (Output/Custom) N/A Delgado IR 1.3: Increased delivery of the full course of IPTp using sulfadoxine-pyrimethamine as part of an integrated package of antenatal services 138 13. Number of health workers Nampula N/A 500 27.6% in targeted district trained Zambezia N/A 4 450 0.08% in intermittent preventive treatment in pregnancy Tete N/A 5 250 0.2% (IPTp) with USG funds Cabo 0 (Output/Contract) N/A 300 0% Delgado Nampula 56% N/A N/A 68% 80% 14. Percent of pregnant women who received Zambezia 51% N/A N/A 65% 80% IPTp2 for malaria in N/A N/A 68% 80% targeted health facilities Tete 51% (Outcome/Custom) Cabo N/A N/A 66% 80% 49% Delgado N/A N/A 41% 15. Percent of pregnant Nampula 37% 60% women who received Zambezia 25% N/A N/A 41% 60% IPTp4 for malaria in Tete 29% N/A N/A 40% 60% targeted health facilities Cabo N/A N/A 41% 60% (Outcome/Custom) 20% Delgado IR 1.4: SBCC implementation strengthened Nampula TBD N/A N/A N/A
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 34
LOP LOP LOP Quarterly Indicators Province FY18 FY19 Q1 FY19 Q2 FY19 Q3 % LOP Anal Baseline Total Target Progress yses 16. Proportion of people who Zambezia TBD N/A N/A N/A are confident in their ability to perform a Tete TBD N/A N/A N/A specific malaria-related Cabo behaviour TBD N/A N/A N/A (Outcome/Custom) Delgado
17. Proportion of people who Nampula TBD N/A N/A N/A report the intent to Zambezia TBD N/A N/A N/A practice the Tete TBD N/A N/A N/A recommended behavior Cabo (Outcome/Custom) TBD N/A N/A N/A Delgado Nampula N/A N/A N/A 0 1,440,000 18. Number of people reached by IMaP social Zambezia N/A N/A N/A 00 1,150,000 behavior change communications activities Tete N/A N/A N/A 0 621,000 supported by USG funds (Output/Custom) Cabo N/A N/A N/A 0 568,000 Delgado IR 1.5: Support to CSOs/CBOs to implement malaria control activities improved Nampula TBD N/A N/A 0 19. Average organizational capacity score among Zambezia TBD N/A N/A 0 supported local organizations Tete TBD N/A N/A 0 (Outcome/Custom) Cabo TBD N/A N/A 0 Delgado IR 1.6: Operations research conducted Nampula N/A N/A N/A N/A 3 20. Number of studies Zambezia N/A N/A N/A N/A 3 conducted in collaboration with NMCP and PMI Tete N/A N/A N/A N/A 2 (Outcome/ Custom) Cabo N/A N/A N/A N/A 2 Delgado Objective 2: Strengthen management capacity of the provincial and district MOH personnel to provide oversight and supervision of malaria interventions IR 2.1: Malaria-related health system constraints and appropriate solutions determined
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 35
LOP LOP LOP Quarterly Indicators Province FY18 FY19 Q1 FY19 Q2 FY19 Q3 % LOP Anal Baseline Total Target Progress yses 21. Percent of targeted Nampula TBD N/A N/A N/A districts that implement TBD management capacity Zambezia N/A N/A N/A development plans for Tete TBD N/A N/A N/A malaria programming Cabo TBD N/A N/A N/A (Output/Contract) Delgado IR 2.2: Increased management capacity of provincial and district health systems Nampula TBD N/A N/A N/A 22. Average score of capacity maturity of targeted health Zambezia TBD N/A N/A N/A system actors supported Tete TBD N/A N/A N/A through USG assistance Cabo TBD (Outcome/Custom) N/A N/A N/A Delgado IR 2.3: Enhance quality of programmatic implementation (e.g. CM, MIP, IRS) enhanced through strengthened monitoring and mentorship at district and facility level enhanced Nampula N/A N/A N/A 0 80% 23. Percent of follow-up N/A actions determined during Zambezia N/A N/A 0 80% integrated mentoring visits of DPS to SDSMAS that N/A are completed within Tete N/A N/A 0 80% three months of report Cabo N/A (Outcome/ Contract) N/A N/A 0 80% Delgado IR 2.4: Provincial-level coordination facilitated and increased IR 2.5: Coordination of provincial and district malaria activities improved Objective 3: Strengthen the HMIS at the provincial and district levels to improve data reporting, analysis, and use IR 3.1: Quality of routine data strengthened Nampula N/A N/A N/A N/A 70% 24. Percentage of supervised Zambezia N/A N/A N/A N/A 70% health facilities that meet data quality standards Tete N/A N/A N/A N/A 70% (Outcome/Custom) Cabo N/A N/A N/A N/A 70% Delgado
25. Percent of facilities Nampula N/A N/A N/A N/A 100% receiving quarterly
supervision visits that Zambezia N/A N/A N/A N/A 100% perform analysis of key malaria indicators and identify recommendations Tete N/A N/A N/A N/A 100%
Integrated Malaria Program, Quarter Technical Progress Report - Project Year 2, pg. 36
LOP LOP LOP Quarterly Indicators Province FY18 FY19 Q1 FY19 Q2 FY19 Q3 % LOP Anal Baseline Total Target Progress yses for improvements Cabo N/A N/A N/A N/A 100% (Output/Contract) Delgado Nampula N/A 81 368 22% 26. Number of persons Zambezia N/A 0 368 0% trained in SME topics Tete N/A 0 368 0% (Output/Custom) Cabo N/A 0 368 0% Delgado 27. Percent of health facilities Nampula 64% 98% 90% in the targeted provinces
that report complete and Zambezia 70% 97% 90% on time HMIS data Tete 66.8% 99% 90% through DHIS2 Cabo 74% 96% 90% (Outcome/Contract) Delgado Nampula N/A N/A N/A N/A 5% 28. Average percent Zambezia N/A N/A N/A N/A 5% difference between targeted health facility Tete N/A N/A N/A N/A 10% primary records and HMIS Cabo N/A N/A N/A N/A 10% Delgado 3.2: Utilization of DHIS-2 increased in alignment with the Mozambican MOH priorities 3.3: Data-informed decision-making strengthened, including management and supervision Crosscutting gender indicators
Nampula N/A 64% 40% 29. Proportion of female Zambezia N/A 27% 40% participants in IMaP training (Outcome/ Tete N/A 23% 40% Contract) Cabo N/A 15% 40% Delgado
Integrated Malaria Program, Quarterly Technical Progress Report - Project Year 2, Second Quarter, pg. 37