Quarterly Progress Report (July – September, 2018) Approval Date: September 30, 2015 QPR Number: [002] Contract/Agreement Number: [AID-611-C-15-00002] Activity Start Date and End Date: [October 1, 2015 to September 30, 2020] Total Award Amount: [$24,389,716.00] Submitted by: [PATH Zambia Office, Stand 11059 Mikwala House, Brentwood Lane, Lusaka] [Tel: +260211378950] DISCLAIMER: The author’s views expressed in this report 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 CONTENTS 1. LIST OF ABBREVIATIONS & ACRONYMS ..................................................................................... 3 2. INTRODUCTION .................................................................................................................................. 4 3. BENCHMARKS AND ACHIEVEMENTS ........................................................................................... 6 4. KEY ISSUES ENCOUNTERED DURING THIS QUARTER ....................................................... 19 5. KEY ACTIVITIES PLANNED FOR THE NEXT QUARTER ....................................................... 19 6. SUCCESS STORIES ............................................................................................................................... 20 1. LIST OF ABBREVIATIONS & ACRONYMS ACT Artemisinin-based Combination Therapy ANC Antenatal Care BRITE Broad Reach Institute for Training & Education CBO Community-Based Organization CCP Johns Hopkins University Center for Communication Programs CHAZ Churches Health Association of Zambia CHW Community Health Worker CSO Civil Society Organization DHIO District Health Information Officer DHIS2 District Health Information System 2 DHO District Health Office DQA Data Quality Audits EDS Electronic Data System ETR End Term Review GRZ Government of the Republic of Zambia GUC Grants under Contract HMIS Health Management Information System iCCM Integrated Community Case Management IPTp Intermittent Preventive Treatment in Pregnancy IRS Indoor Residual Spraying LLIN Long-lasting Insecticide-Treated Net M&E Monitoring and Evaluation MACEPA Malaria Control and Elimination Partnership in Africa MIP Malaria in Pregnancy MIS Malaria Indicator Survey MOH Ministry of Health MRR Malaria Rapid Reporting NMEC National Malaria Elimination Center NMEP National Malaria Elimination Program NMESP National Malaria Elimination Strategic Plan NMSP National Malaria Strategic Plan OR Operations Research OTSS Outreach Training and Supportive Supervision PA Performance Assessment PAMO Program for the Advancement of Malaria Outcomes PHD Provincial Health Director PHO Provincial Health Office PMI President’s Malaria Initiative RDT Rapid Diagnostic Test SBC Social and Behavior Change SHIO Senior Health Information Officer SMEOR Surveillance, Monitoring, Evaluation and Operations Research SP Sulfadoxine-Pyrimethamine TWG Technical Working Group USAID United States Agency for International Development USG United States Government WHO World Health Organization ZMLA Zambia Management and Leadership Academy ZCAHRD Zambia Center for Applied Health Research and Development 2. INTRODUCTION The Program for the Advancement of Malaria Outcomes (PAMO) is a malaria activity program for the United States President’s Malaria Initiative (PMI) in Zambia. The PMI Strategy for 2015–2020 states that “the U.S. Government's goal is to work with PMI-supported countries and partners to further reduce malaria deaths and substantially decrease malaria morbidity, towards the long-term goal of elimination.” In line with this strategy, PAMO was designed to assist the Government of the Republic of Zambia (GRZ) to reach its goal of eliminating local malaria infection and disease in Zambia by increasing access to and uptake of quality malaria control interventions. In 2018, PAMO’s support to the Ministry of Health (MOH) was aligned strategically with the new Zambia’s National Malaria Elimination Strategic Plan (NMESP) 2017–2021 and the PMI FY2017 Zambia Malaria Operational Plan (MOP). PAMO’s geographic focus is on Eastern, Luapula, Muchinga, and Northern provinces, as depicted in Figure 1 below. These provinces were selected due to the high malaria disease burden at the beginning of the project (in 2015). The rural nature of the PAMO supported provinces, with an estimated population of 5,455,218 (Source: CSO 2017), makes PAMO project efforts particularly challenging. Figure 1: Map of Zambia depicting Malaria Parasite Prevalence (Microscopy) Source: MIS 2015 PAMO has three objectives: (1) to support proven malaria interventions in alignment with the National Malaria Strategic Plan (NMSP) 2011–2016 and the follow-on plan of the MOH; (2) to strengthen management capacity of provincial and district MOH personnel to provide supervision and mentoring to improve delivery of proven interventions; and (3) to strengthen provincial and district health management information systems (HMIS) to improve data reporting, analysis, and use for decision-making. PAMO’s programmatic focus is on increasing coverage of long-lasting insecticide-treated nets (LLINs); improving malaria in pregnancy (MIP) services; improving access and quality of case management; introducing and scaling up social and behavior change (SBC) activities in support of malaria prevention and control activities; improving and scaling up of surveillance, monitoring and evaluation (M&E) related to PAMO’s interventions. PAMO provides technical assistance and material support to strengthen the capacity of the government to improve malaria outcomes in the four PAMO-supported provinces and their districts. To that end, PAMO established and maintains effective partnerships with the National Malaria Elimination Center (NMEC), provincial health offices (PHOs), district health offices (DHOs), health facilities, communities, civil society organizations (CSOs), and other stakeholders and partners to ensure effective and sustained implementation and scaling up of internationally and nationally accepted strategies to fight malaria. PAMO is currently in its third year of project implementation. This quarterly report describes project achievements during the third quarter (July –September) of 2018 and a brief outline of activities planned for the fourth quarter (October - December) of 2018. 3. BENCHMARKS AND ACHIEVEMENTS A summary of the key achievements and the activities undertaken by the consortium during this quarter is provided below. Objective 1: Support proven malaria interventions in alignment with the National Malaria Strategic Plan (2011-2016) and the follow on plan of the Ministry of Health Task 1.0: Strengthen national technical working groups Overview: Technical Working Groups (TWGs) are important mechanisms designed to bring stakeholders in malaria control and elimination together to share best practices and drive targeted, harmonized programming and policy. PAMO supports the NMEC to improve the functionality of the TWGs and other stakeholder platforms. PAMO’s support includes both technical and material assistance and is limited to only three TWGs. Quarter 3 Planned Activities: TWG meetings are conducted quarterly; therefore, during the third quarter, PAMO planned to support the NMEC to host meetings for the following three TWGs: 1. Surveillance, Monitoring, Evaluation, and Operations Research (SMEOR) 2. Vector control 3. Case management Quarter 3 Achievements: During the reporting quarter, PAMO participated in the Case Management TWG held on the 28th of September and the Vector Control TWG which was held on the 21st September. The SMEOR TWG was held on the 8th October 2018 and will therefore be reported in the next quarterly report. Case Management TWG Some of the key issues which emerged from the last Case Management TWG meetings are listed below: 1. Update on Outreach Training and Supportive Supervision (OTSS) The meeting learnt that in 2018, OTSS has been implemented in eight out of ten provinces. OTSS was not implemented in Lusaka and Western province because the Biomedical Scientists in these two provinces were not trained in the microscopy competence assessment. OTSS will commence in these two provinces in the fourth quarter because the biomedical scientists are now trained. NMEC findings/concerns on OTSS in the provinces where it has been implemented: a. The coverage of microscopy facilities was very low in almost all the provinces b. There are insufficient numbers of Standard Operating Procedures (SOP), quality assurance manuals, and bench aids for malaria microscopy. c. There are inadequate microscopy reagents, equipment and other materials, this is negatively affecting the quality and availability of microscopy. d. The updated Guidelines for the Diagnosis and Treatment of Malaria in Zambia have not yet been distributed to health facilities. NMEC Recommendations a. Partners must ensure that district OTSS teams consist of five members of trained staff who were selected by the DHO. b. Districts need to be reminded to source or identify alternative sources of funding for OTSS in order to maximize coverage. c. Partners implementing OTSS should orient at least five members of staff for provincial OTSS and five members of staff for district OTSS on the Electronic Data Systems (EDS). 2. Integrated Community Case Management (iCCM) Updates • With support from various partners, NMEC would like to train 2,500 Community Health Workers (CHWs) across the country. Since the last TWG meeting,