1. Training Workshop: 2012 Web: www.nmcc.org.zmwww.nmcc.org.zm Email: malaria@nmcc.org.zmmalaria@nmcc.org.zm

2. Overview Training Objectives National Malaria Strategic Planning Goals 2011-2015 Improving the surveillance environment Background Solutions Progress to date and plans Opportunities

3. Training Objectives

4. Training Objectives contd … To orient district and health facility staff in Malaria Rapid Reporting System To update participants in the mobile reporting technology

5. Strategic Planning Goals Reduction of malaria incidence by 75 percent and deaths significantly reduced Through above, there will also be a reduction in all- cause mortality by 20 percent in children under 5 Malaria control will also provide economic payoffs at the household and national levels Reduce malaria incidence by 75 percent of the 2010 baseline Reduce malaria deaths near zero and reduce all-cause child mortality by 20 percent Establish and maintain five (5) “malaria free zones” 20102015

6. Establishment of malaria free zones By 2015 have supported and documented five (5) Zambia malaria free zones/districts milestone: - By 2013, malaria has been eliminated in two (2) districts in Zambia

7. Measuring malaria progress Lots of information on malaria interventions and burden (prevalence) in Zambia MISs, DHSs, other surveys Mainly national, not especially helpful for local decision making Programmatic information ITN distributions to districts IRS structures targeted/sprayed Medical supplies (ACTs/drugs/RDTs) going out to facilities through Medical Stores National routine reporting system HMIS recently revised to include additional indicators Confirmed cases, patients tested, IPT

8. Stratification of malaria burden Based on national survey data (3 MISs) Household level microscopy prevalence Suggests consistently much lower burden in Lusaka, Southern and Western provinces New Strategic Plan creates 3 tier stratification to acknowledge this

11. Baseline transmission Reduced transmission Mass Screen and Treat Near-zero transmission Community case management with household re- screen and treat Universal LLIN coverage Driving transmission to near zero level Adapted from WHO Global Malaria Programme: Community-based transmission reduction of malaria May 2011 - DRAFT STEP 1 Zambia Rapid Reporting system STEP 2 Clear parasites from people STEP 3 Surveillance as an intervention STEP 4 All cases identified, investigated and cleared. Document elimination

12. Measuring malaria progress System requirements: Areas with low (<5-10%) prevalence cannot affordably use cluster surveys to measure progress (urban areas and multiple provinces/district) NMCC and local authorities (Communities, Districts, Province s) require greater granularity of measuring progress and targeting interventions Zambia has new indicators in HMIS at facility level that reinforce better information collection routinely Despite ongoing challenges with timely and complete access to routine information Using facilities as sentinels of local level burden via routine reporting Reinforce training and standard definitions of what should be reported Linkage of burden and commodities becoming critical for better targeting Must be more efficient with collection and presentation of results for decision making Scalable STEP 1:Zambia Rapid Reporting system

13. Solutions Reviewed many options SMS versus data (GPRS) Many branded solutions (SMS for Life, RapidSMS, EpiSurveyor, etc.) Settled on DHIS2 and its Mobile Client Internationally recognized Established history of development and practice Customizable by countries to meet their own needs Zambia national HMIS is based on DHIS (1.4) Easy to roll up existing national datasets Access to local developer Open source software (inexpensive) Extensive documentation available STEP 1:Zambia Rapid Reporting system

14. DHIS2 additional leverage Because DHIS 1.4 is the basis of current national HMIS allows direct linkage with existing national datasets in the same system Example: In addition to rapid malaria reporting system, have also profiled national datasets ability to generate malaria data National Malaria HMIS Bulletin (click to view online) National Malaria HMIS Bulletin Tremendous communication potential STEP 1:Zambia Rapid Reporting system

15. DHIS2 and Mobile client DHIS2 accessible through web http://dhis.co.zm/dhis Userid: ‘demo’; password ‘Demonstration1’ Enabling standard profiles and reports for both routine HMIS dataset and Rapid Malaria Report through mobile client Mobile client (Cell phone) Runs on low-end phones (Nokia 2330s and 2690s) Java-based application with data fields STEP 1:Zambia Rapid Reporting system

16. DHIS2 and Mobile client interface STEP 1:Zambia Rapid Reporting system

17. Reporting indicators Prioritized information already available HIA1 (HMIS) routine monthly forms Helps create consistency with compiling monthly reports Added commodities (Logistics R&R form) Coartem by pack size (dispensed and balance on hand) (due to problems with cutting packs and lack of information to inform push and pull with existing forms) RDT stocks (tested and balance on hand) STEP 1:Zambia Rapid Reporting system

19. Information discernible Malaria burden Testing rates (by RDT and/or Microscopy) Positivity rates (by RDT and/or Microscopy, by age) API (testing rate x positivity rate) Relative change in malaria against OPD attendance Transition in diagnosing clinical versus confirmed Stock management Stock controls relative to burden STEP 1:Zambia Rapid Reporting system

20. Progress to date Established test server and mobile client January 3 pilot districts, 3 facilities in each district Kazungula, Chibombo, Kaoma Initial District Health Information Officer training (ToT) early February Pilot facilities began reporting mid February Roll out began in May To date 17 districts currently reporting STEP 1:Zambia Rapid Reporting system

21. Roll out by March 2011 STEP 1:Zambia Rapid Reporting system

22. Roll out during 2011 by May STEP 1:Zambia Rapid Reporting system

23. Roll out during 2011 by August STEP 1:Zambia Rapid Reporting system

24. Planned by 2011 November STEP 1:Zambia Rapid Reporting system

25. Opportunities for collaboration Important to have similar information in cross-border districts to inform progress Particularly important with elimination zone emerging in southern Zambia DHIS2 hosted solution not necessary to replicate Existing DHIS2 server could be used by Senegal, Tanzania, Namibia, Botswana, Zimbabwe, etc. Able to be used across additional disease and reporting areas within Zambia Logistics, notifiable disease, CHWs, etc. Existing DHIS Mobile application used in Zambia could be used by anyone anywhere STEP 1:Zambia Rapid Reporting system

26. Thank you. This system is being developed with support and input from a number of partners including Ministry of Health (NMCC), PATH MACEPA, Akros Research, WHO, and Malaria Institute at Macha STEP 1:Zambia Rapid Reporting system