PAMO Plus Quarter 1 Progress Report January 1, 2021, to March 31, 2021 Cooperative Agreement No: 72061120CA00005 Photo Credit: PATH Submitted by Dr. Caroline Phiri-Chibawe, Chief of Party Submission Date: April 30, 2021 DISCLAIMER: The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID), United States President’s Malaria Initiative (PMI) or the United States Government. Table of contents List of acronyms ............................................................................................................................................................. 2 Introduction .................................................................................................................................................................... 3 Objective 1: Increase capacity of health facilities and community health workers to improve quality and accessibility of malaria case management and services ........................................................................................................................ 3 1.1 Supporting community case management of malaria ................................................................................... 3 Objective 2: Increase accessibility and quality of services to prevent malaria during pregnancy through early antenatal care visits ....................................................................................................................................................................... 6 Objective 3: Improve individual and community uptake of proven malaria control behaviors, products, and services ... 8 Objective 4: Improve malaria surveillance data, including data from facility and community, for effective, data-led decision-making ............................................................................................................................................................. 8 Objective 5: Increase and expand the effectiveness of malaria control measures in districts targeted by PMI’s pre- elimination program ...................................................................................................................................................... 10 Environmental mitigation and monitoring plan compliance .......................................................................................... 11 Collaboration, learning, and adaptation ........................................................................................................................ 11 Key issues encountered ............................................................................................................................................... 12 Planned activities for next quarter ................................................................................................................................ 12 1 List of acronyms ANC Antenatal care CHW Community health worker CSO Civil society organizations DHIS2 District Health Information System 2 DHO District health office GHSC-PSM Global Health Supply Chain-Procurement and Supply Management HMIS Health Management Information System IPTp Intermittent preventative treatment in pregnancy ITN Insecticide-treated net MIS Malaria Indicator Survey MOH Ministry of Health MRR Malaria rapid reporting NMEP National Malaria Elimination Programme OTSS Outreach training and supportive supervision PAMO Program for the Advancement of Malaria Outcomes PHO Provincial health office PMI President’s Malaria Initiative SBC Social and behavior change SMAG Safe Motherhood Action Group SP Sulfadoxine-pyrimethamine 2 Introduction To support the Government of the Republic of Zambia’s goal of eliminating malaria in local communities in the next decade, PAMO Plus, a five-year United States President’s Malaria Initiative (PMI) project, is implementing malaria interventions in four high-burden provinces—Eastern, Luapula, Muchinga, and Northern (Figure 1)—and providing technical support to the National Malaria Elimination Programme (NMEP) to strengthen the national malaria response. This report highlights PAMO Plus activities and presents key accomplishments from the first quarter (January–March) of 2021. Figure 1: Map of PAMO Plus-supported provinces and districts Objective 1: Increase capacity of health facilities and community health workers to improve quality and accessibility of malaria case management and services 1.1 Supporting community case management of malaria PAMO Plus has continued to support 3,657 community health workers (CHWs) that were trained under the Program for the Advancement of Malaria Outcomes (PAMO) project that ended in 2020. In the first quarter of 2021, PAMO Plus implemented three core activities: (a) monitoring CHW activities, (b) assessing CHW attrition, and (c) conducting a gap analysis to estimate the number of CHWs that need to be trained in 2021 in all four PAMO Plus provinces. a. Monitoring CHW activities: Ensuring that CHWs are providing services is critical to reducing the time it takes for patients to access treatment and ultimately to reducing severe malaria cases and related deaths. To monitor whether CHWs actively provide services, PAMO Plus used a dashboard in Tableau to visualize CHW performance and granted access to provincial health office (PHO) and district health office (DHO) staff to view these data regularly to track which CHWs are active or are no longer active. Two criteria are used to track CHW activity: (1) when only zeros are reported across all data elements in the District Health Information System (DHIS2) by a CHW for six months, which could be due to lack of commodities or an absence of an active CHW, and (2) when there are no reports received from a CHW for a period of six months, which means a particular CHW is not reporting anything into the DHIS2 system and is a signal of CHW 3 inactivity. Table 1 shows that 94% of CHWs are actively providing services while Figure 2 (Luapula, Muchinga, and Northern provinces) and Figure 3 (Eastern Province) show the number of CHWs per district reporting zeros or who did not submit any reports in the previous six months. In the first quarter of 2021, CHWs tested 270,344 people of all ages, out of which 114 815 (43%) were found positive and treated accordingly. Table 1: Proportion of CHWs that did not submit any report (inactive) in the last six months (October 1, 2020, to March 31, 2021) Number of inactive Number of active Province Number of CHWs % active CHWs CHWs CHWs Eastern PAMO Main 317 51 266 84% Eastern Pre-elimination 1,609 60 1,549 96% Luapula 524 25 499 95% Muchinga 609 8 601 99% Northern 598 70 528 88% Total 3,657 214 3,443 94% Figure 2: Number of CHWs who did not report or reported all zeroes in the last six months (October 1, 2020, to March 31, 2021), Luapula, Muchinga, and Northern provinces Figure 3: Number of CHWs who did not report or reported all zeroes in the last six months (October 1, 2020, to March 31, 2021) , Eastern Province 4 b. Attrition rate of CHWs: There are 3,657 CHWs in the four provinces. In assessing the attrition rate among these CHWs, PAMO Plus found that only 116 CHWs (3%) had dropped out of the iCCM program in all PAMO- supported provinces (Figure 4), with relocation cited as the main reason. Figure 4: Number of CHWs that stopped working in all four PAMO Plus-supported provinces; orange denotes pre-elimination districts 35 31 30 27 25 20 15 15 12 10 7 6 No. of CHws that have dropped out dropped have that CHws of No. 5 4 5 3 3 2 1 0 District c. CHW gap analysis: PAMO Plus plans to increase the number of CHWs to meet the goal of saturating health facility catchment areas (1 CHW per 500 population). Under PAMO, by the end of 2020, 10 out of 14 focus districts were saturated. In consultation with the NMEP, PHO, and DHO, PAMO Plus will saturate six additional districts across four provinces. To calculate the number of CHWs needed to be trained in 2021, PAMO Plus carried out a gap analysis that showed a total of 849 CHWs are required to be trained in these additional districts. However, an additional 177 CHWs will be needed in Chipata district beyond 2021 as the training will not saturate that district. 5 Table 2: Number of CHWs to be trained in 2021 and the anticipated gap CHW Adjusted attrition Estimated gap Estimated Partner Gap based no. of No. of (facility Proposed population that No. of on CSO CHWs CHWs gap based number of Gap after Province District (Source supported trained pop & required already CSO pop + CHWs to training HMIS, CSO the CHWs who CHW (ratio trained Attrition & be trained 2021) training have attrition 1:500) stopped Decimal working Point) A. To be trained in the Pre-elimination districts Chipata 312,717 625 169 PAMO 0 456 397 220 177 Kasenengwa 130,701 261 97 PAMO 4 168 130 130 0 Eastern Subtotal 443,418 887 266 4 625 527 350 177 B. To be trained in the rest of Eastern province Lumezi 124,843 250 0 N/A 0 250 250 250 0 Subtotal 124,843 250 0 0 250 250 250 0 Kawambwa 59,017 118 0 N/A 0 0 118 118 0 Luapula Lunga 31,662 63 0 N/A 0 0 63 63 0 Subtotal 90,679 181 0 0 0 181 181 0 Chama 163,744 327 167 PAMO 0 160 163 144 0 Muchinga Subtotal 163,744 327 167 0 160 163 144 0 Mpulungu 137,182 274 0 N/A 0 274 274 0 Northern Subtotal 137,182 274 0 274 274 0 Pre- 443,418 887 266 4 625 527 350 177 Grand elimination total Main 516,448 1,033 167 0 410 868 849 0 program Objective 2: Increase accessibility and quality of services to prevent malaria during pregnancy through early antenatal care visits For malaria in