STOP MALARIA PROJECT QUARTERLY STATUS … MALARIA PROJECT . QUARTERLY STATUS REPORT . ... Malaria...

STOP MALARIA PROJECT

QUARTERLY STATUS REPORT QUARTERS 1 & 2:

26 September 2008 – 31 March 2009

.

___________________________________________________________________________________________________________ SMP_PM_Quarterly_Report_Q1Q2_04 May 2009 Page 1 of 27

Table of Contents

Acronyms and Abbreviations ................................................................................................................ 2 Executive Summary ............................................................................................................................... 3 1. Introduction ........................................................................................................................................ 4 2. Project Start-Up Activities ................................................................................................................ 6 3. Achievements by Intermediate Result ......................................................................................... 11 4. Project Monitoring and Evaluation ............................................................................................... 22 5. Communication and Community Mobilization ............................................................................ 24

.


Acronyms and Abbreviations

ACT Artemisinin-based Combination Therapy ANC Antenatal Care ATIC AIDS Treatment Information Centre CCP Johns Hopkins Bloomberg School of Public Health Center for Communication Programs CDFU Communication for Development Foundation Uganda CMD Community Medicine Distributor COP Chief of Party CPHL Central Public Health Laboratory CSO Civil Society Organisations DHO District Health Officer DHT District Health Team HBMF Home Based Management of Fever IEC Information, Education and Communication IDI Infectious Diseases Institute IMM Integrated Management of Malaria IPTp Intermittent Preventive Treatment in pregnancy ITN Insecticide Treated Net JUMP Joint Uganda Malaria training Program LLIN Long Lasting Insecticide Treated Net MC Malaria Consortium MoH Ministry of Health NMCP National Malaria Control Program PLHA People Living with HIV/AIDS PMI President’s Malaria Initiative RBM Roll Back Malaria SMP Stop Malaria Project ToT Training of Trainers UBOS Uganda Bureau of Statistics UHMG Uganda Health Marketing Group USAID United States Agency for International Development WHO World Health Organisation

.


Executive Summary

The Stop Malaria Project (SMP) commenced on 26th September, 2008, with financial support from USAID and the U.S. President’s Malaria Initiative (PMI). The 5-year project of the Uganda Ministry of Health is managed by the Johns Hopkins University Bloomberg School of Public Health Centre for Communication Programs (CCP), Malaria Consortium (MC), the Infectious Diseases Institute (IDI), Communication for Development Foundation Uganda (CDFU), and the Uganda Health Marketing Group (UHMG). SMP is designed to assist the Government of Uganda to reach its goal of reducing malaria-related mortality by 50% by 2010 by targeting children under five years of age, pregnant women, and people living with HIV and AIDS with proven preventive and therapeutic interventions: Artemesinin-based Combination Therapy (ACT) for treatment of uncomplicated malaria, Intermittent Presumptive Treatment (IPT) of malaria in pregnancy, and long-lasting insecticide treated nets (LLINs). SMP is concentrating its efforts in 13 districts in the first year, with comprehensive interventions in five, and will scale-up to 45 districts by the third year of the project. In the first two quarters since SMP began operations, it has made significant progress in its start-up activities, all three intermediate results, monitoring and evaluation, and the cross-cutting areas of communication and community mobilization. Project Start-Up Activities: Project staff were recruited and hired, the year one work plan and branding and marking plan submitted and approved, and the SMP team introduced to NMCP, the PMI Team, and the 13 year one SMP districts. Rapid district assessments were conducted in 13 districts, and district assessment reports completed for 6. The reports were shared with the 6 districts in a meeting in Kampala in March, and year one implementation plans prepared based on the findings. IR 1: Malaria prevention programs in support of the national malaria strategy improved and implemented: SMP supported NMCP to assemble guidelines and evidence to inform the policy/strategy/guideline/tools review process for both IPTp and ITNs, and participated in a policy review meeting in Jinja from 2-6 March. Another three meetings were held with stakeholders to review IPTp and ITN policies and a draft national malaria control policy developed. SMP assessed the current status of IPTp services and training needs during rapid district assessments in 13 districts. The project also began a review of the ANC LLIN distribution mechanism under AFFORD and informed districts of plans for Year 2 ANC LLIN distribution – activities scheduled to take place in Q3. IR 2: Malaria diagnosis and treatment activities in support of the national malaria strategy improved and implemented: SMP participated in the design of a national curriculum for site-based training in severe malaria, which is currently awaiting review to ensure it is inline with the revised malaria control policy. SMP also began adapting the JUMP/ToT curriculum for a 3-day site-based malaria diagnostic training. The project identified a consultant to review existing supervision guidelines and tools. IR 3: National Malaria Control Programme capacity to monitor and evaluate interventions strengthened: SMP carried out a needs assessment of NMCP’s ITN and IRS databases, and assessed NMCP M&E capacity and training needs, especially on ability to manage, analyze and interpret malaria data. The project participated in the last NMCP partners’ meeting. The first SMP quarterly review meeting is planned for 27 April 2009. Monitoring and Evaluation: Both the results framework and the PMP were reviewed by partners, USAID, PMI, and UMEMS, and revised accordingly. SMP designed its M&E system, including formats for data collection, a data entry spreadsheet for compiling data, and guidelines for the project M&E system, which were shared with partners and SMP staff. Quarter 2 output indicators were reported to PMI and UMEMS. Communication and Community Mobilization: Literature reviews on knowledge, attitudes and behavioural issues around malaria prevention (ITNs, IPT) and treatment and diagnosis were completed in Q1 and Q2 in order to lay the groundwork for successful implementation of project communication activities, and a meeting to develop the integrated project communication plan and district communication toolkit is scheduled for May. SMP mapped CSOs, VHTs, and malaria community based activities in 13 districts during the rapid district assessments, and drafted a malaria community self assessment tool that will be pilot tested in Q3.

.


1. Introduction

The Stop Malaria Project (SMP) is a 5-year project of the Uganda Ministry of Health that commenced on 26th September, 2008, with financial support from USAID and the U.S. President’s Malaria Initiative (PMI). The project is managed by the Johns Hopkins University Bloomberg School of Public Health Center for Communication Programs (CCP), Malaria Consortium (MC), the Infectious Diseases Institute (IDI), Communication for Development Foundation Uganda (CDFU), and the Uganda Health Marketing Group (UHMG). SMP is designed to assist the Government of Uganda to reach its goal of reducing malaria-related mortality by 50% by 2010. This will be done by reaching 85% coverage of children under five years of age, pregnant women, and people living with HIV/AIDS with proven preventive and therapeutic interventions:

• Artemesinin-based Combination Therapy (ACT) for treatment of uncomplicated malaria, • Intermittent Presumptive Treatment (IPT) of malaria in pregnancy, and • Long-lasting insecticide treated nets (LLINs).

SMP will assist the National Malaria Control Programme (NMCP) and health services in 45 districts to meet the following intermediate results:

• IR 1: Malaria prevention programs in support of the national malaria strategy improved and implemented Strategic approaches will focus on assisting the National Malaria Control Programme (NMCP) to update and disseminate its policies, strategies, operational guidelines and tools for malaria control; distributing Long Lasting Insecticide Treated Nets to antenatal clients; increasing the uptake of two or more doses of IPTp among pregnant women; community mobilization and behavior change communication to support these interventions.

• IR 2: Malaria diagnosis and treatment activities in support of the national malaria strategy

improved and implemented SMP will assist the districts to implement parasitological diagnosis of malaria through laboratory strengthening; modifying attitudes and practices of health workers and clients to embrace parasitological diagnosis for malaria; improving recognition of danger signs, referrals, and treatment of severe malaria; assisting districts to roll out home based management of fever (HBMF) with ACTs; strengthening the capacity of district and sub-district supervisors to provide mentoring and on-site training/support for malaria services through the government system; and mobilizing communities to combat malaria.

• IR 3: National Malaria Control Programme capacity to monitor and evaluate interventions

strengthened SMP will also assist the NMCP to better monitor, evaluate, and supervise malaria control activities, and coordinate the activities of malaria partners.

Over the five years, the Stop Malaria Project will work with the NMCP and 45 districts of Uganda as shown on the map below. During the first year, the project will concentrate activities in 13 districts located in central Uganda, with comprehensive interventions in five: Wakiso, Kiboga, Mityana, Nakaseke, and Luwero. SMP will lay the groundwork to expand to an additional 19 districts during the second project year; and will reach all 45 by end of the third year. Year 1 districts include: Kayunga, Kiboga, Luwero, Maskake, Mityana, Mpigi, Mukono, Mubende, Nakasongola, Nakaseke, Rakai, Ssembabule, and Wakiso. This quarterly report details the activities of the first two quarters of Stop Malaria Project implementation (26 September 2008 to 31 March 2009).

.


Kob

oko

Masindi

Nakasongola

Kasese

Hoima

KibaaleKiboga

Luwero

Apac

MukonoKAMPALAMubende

Kabarole

Nebbi

Arua

Gulu

Adjumani

Kabale

Mbarara Rakai

Sembabule

Masaka

Kalangala

Jinja

Iganga

Busi

a

Tororo

Pallisa

Kumi

Katakwi

Moroto

Kotido

Kitgum

Soroti

Lira

Mpigi

BushenyiRukungiri

Kamuli

Ntungamo

Moyo

Kamwenge

Kyenjojo

Kayunga

Kanungu

Yumbe

Pader

Sironko

Nakapiripirit

Kaberam

aido

Bug

iriMayuge

Wakiso

Kisoro

Nyadri

Kilak

Kaabong

Abim

Dokolo

Amolatar

Oyam

Amuria

Kapchorwa

Bukwa

Buliisa

Nakaseke

Bundibugyo

Mityana

KiruhuraIbanda

Mbarara

Isingiro

Mba

leBu

buul

o

ButalejaBusiki

Kaliro

Budak

a

YR1 Comprehensive Districts

YR1Non-ComprehensiveDistricts

Other Districts

Others

Map 2: SMPdistricts by project phases

.


2. Project Start-Up Activities

1.0 Progress on Workplan

Achievement / Output

Activity Target/milestone Comment on performance against target

Project Management

Project staff hired Chief of Party, Deputy Chief of Party, Central Zone Team Leader, Community Mobilization Specialist, M&E Specialist, M&E/IT Officer, Communication Specialist, Technical Assistant, Accountant, Driver, and Administrative Assistance recruited and hired.

Project staff hired Chief of Party and M&E/IT Officer will join SMP on 4 May; Deputy Chief of Party will join SMP on 27 April; Technical Assistant will join project on 16 May. All others joined SMP during the reporting period.

Year one workplan submitted to USAID, partners, MOH, and approved

Held workplanning meeting with partners in November, 2008; partners drafted sections of workplan; workplan reviewed, finalized, and submitted to USAID by 30 November; USAID reviewed and SMP re-submitted revised workplan on 18 December, 2008.

Year one workplan submitted to USAID, MOH, partners

Project branding and marking plan

SMP prepared the plan and submitted to USAID by end of October.

Project branding and marking plan

Branding and Marking Plan was reviewed by USAID and revised during November. All partners have been briefed on the plan.

Project team introduced to NMCP and some members of USAID SO8 Team

Project team met with NMCP and USAID/PMI team.

Project team introduced to NMCP, MOH Sr. Management, and USAID SO8 team

When Chief of Party and Deputy Chief of Party join team, SMP will be officially introduced to Sr. MOH management and USAID SO8 team.

Rapid District Assessments

Rapid district assessment tools and methodology

Consultant hired to assist with review of existing assessment tools and design of rapid assessment tools; all partners participated in the design; rapid assessment methodology and tools tested in Kiboga district

Available district assessment tools reviewed

Rapid district assessment tool designed

SMP introduced to districts and rapid

Conducted two one-day meetings to introduce SMP

SMP introduced to representatives of 13

Initial meeting had 10 districts represented. SMP

.


assessments scheduled

to all Malaria Focal Persons and District Health Officers from 13 districts and schedule rapid district assessments.

districts

Rapid district assessment scheduled

subsequently arranged another meeting with remaining 3 districts who were unable to send representatives initially.

13 rapid district assessments

Four teams visited 3 or 4 districts each to conduct assessments in 13 districts

13 rapid district assessments conducted

6 district assessment reports shared with district health offices

By end of quarter 2, SMP had finalized reports from 6 districts and shared them with those District Health Officers and District Focal Persons during a one-day workshop.

13 district assessment reports

Assessment findings shared with district health offices

Remaining 7 assessment reports will be finalized during April and shared with their respective district health offices

District Workplanning

6 district implementation plans prepared

By end of quarter 2, SMP had facilitated a workshop with representatives from 6 districts to develop project implementation plans for activities through 30 September.

13 district implementation plans prepared

Remaining 7 district implementation plans will be completed in April.

1.1 Project Management

1.1.1 Achievements

CCP signed its cooperative agreement with USAID for the project on 15 October, 2008, and immediately began working on its Branding and Marking Plan, and first annual workplan. The annual workplan was submitted to USAID on 30 November; reviewed by USAID, revised, resubmitted by 18 December; and approved by USAID on 21 December 2008.

Also during the first quarter, SMP wrote position descriptions and advertised for the following positions: Deputy Chief of Party/Sr. Technical Advisor, Central Zone Team Leader, M&E/IT Officer, Community Mobilization Specialist, Technical Assistant, Accountant, Administrative Assistant, and Driver. Communication Specialist Kenneth Mulondo joined the project on 1 November; and the M&E Specialst Phellister Nakamya, and Central Zone Team Leader Denise Meya joined the project in January, 2009; Accountant Linda Lukandwa, Administrative Assistant Martha Muganyizi, and Community Mobilization Specialist Ellen Bajenja joined the project in February, 2009. The Deputy Chief of Party, M&E/IT Officer, and Technical Assistant will join the project in April and May.

Unfortunately, in December, the Chief of Party candidate withdrew his application for the position, and CCP had to recruit another candidate. This proved quite challenging. However, by the end of the second quarter, CCP had recruited a candidate who was approved by USAID and will take up office in May. In the interim, CCP Regional Representative Cheryl Lettenmaier was the acting Chief of Party. In order to support the acting Chief of Party on day to day project management, CCP hired local consultant Sarah Margiotta, who began working with SMP in early March.

On December 1, 2008, SMP opened its office on the Malaria Consortium compound. This involved procuring furniture, computers, and other office equipment, installing a signboard, and working with Malaria Consortium to establish guidelines for the shared server and switchboard. In March, SMP took possession of one vehicle, procured by CCP. Malaria Consortium also began the process for purchasing a second project vehicle, and CCP and Malaria Consortium negotiated the terms of a memorandum of understanding for shared office resources.

.


During the two quarters, CCP also prepared and signed subagreements with Malaria Consortium and CDFU, and prepared the scope of work and budget for a subagreement with IDI. The IDI subagreement will be signed early during the next quarter.

1.1.2 Plans for next quarter

• Orient Chief of Party, Deputy Chief of Party, Technical Assistant, M&E/IT Officer.

• Introduce SMP team to MOH Sr. management and USAID SO8 team.

• Establish cost share tracking and reporting systems for SMP and its partners.

• Orient CDFU, MC, and IDI to subagreement reporting and accounting requirements.

• Finalize project procedures and policies manual.

• Conduct quarterly review meeting and prepare quarterly report.

1.2 Rapid District Assessments

1.2.1 Achievements

One of the major start up activities of the project were rapid district assessments in the 13 districts in central Uganda. The objective was to determine each of the 13 districts’ major malaria control services and activities, funders, partners and stakeholders (at national and district levels), resources, capacities, gaps and needs.

In January, SMP hired consultant Charlotte Zikusooka to assist with the design, analysis and reporting of rapid assessments in the 13 districts. Working with all partners on the SMP project, including the NMCP, Charlotte reviewed existing tools and methodologies, and developed guidelines and tools for the assessments. Tools included a District Health Team (DHT) questionnaire, a District Health Officer (DHO) take-away questionnaire, a health facility questionnaire, and a rapid district assessment compilation tool. The guidelines and tools were pilot tested in Kiboga district and revised accordingly.

The remaining 12 district assessments were conducted by four joint teams of SMP staff, NMCP representatives and district representatives, led by Ellen Bajenja, SMP Community Mobilization Specialist, Kenneth Mulondo, SMP Communication Specialist, Denise Meya, SMP Central Zone Team Leader, and Charles Akora, Malaria Consortium Program Officer. During the rapid district assessments, SMP representatives met with the District Health Teams and the district local leaders including the Chief Administrative Officer (CAO), assistant CAO and the LC V Chairperson among others to introduce the Stop Malaria Project. The assessments took place over a period of 4-5 days in each of the 13 districts during the months of February and March 2009.

After each assessment was completed, teams leaders submitted their reports and notes to consultant Judi Garfinkel, who drafted summary reports. Each summary report was reviewed by the Acting Chief of Party, Malaria Consortium Technical Programme Coordinator Clare Riches, and the respective Team Leader. By the end of the quarter, SMP had finalized assessment reports from 6 districts: Mpigi, Nakaseke, Luwero, Kiboga, Wakiso, and Mubende.

Challenges during the rapid district assessments included limited number of staff at the health facilities, which resulted in a need to reschedule or interrupt the interviews in order to allow respondents to provide clinical care to the patients, as well as competing activities in the district and at NMCP. SMP identified a need to have an SMP liaison from the NMCP.

.


Participants in a Rapid District Assessment in Mityana

Mityana District Health Officer and Malaria Focal Person during the SMP Rapid District Assessment


• Finalize assessment reports for the remaining 7 districts: Mityana, Masaka, Ssembabule, Rakai, Mukono, Nakasongola, and Kayunga.

• Conduct workshop with 7 districts to share district assessments and prepare workplans for SMP support through 30 September, 2009.

1.3 District Workplanning

1.3.1 Achievements

On 27th March 2009, SMP held a one-day workshop with the DHO and MFP from 6 of the 13 districts in central Uganda to discuss and develop district specific work (implementation) plans. SMP project staff and representatives of NMCP also attended this workshop. During the workshop, SMP presented the findings from the district assessments, and then worked with each district to prepare workplans for SMP activities through September 30, 2009. Mpigi, Wakiso, Nakaseke, Luwero, Mityana, and Kiboga districts

.


developed SMP work plans for year one activities. These workplans will be reviewed, finalized, and sent to the districts, and will form the basis for SMP activities in each district.


• Conduct workshop with the DHO and MFPs from the remaining 7 districts (Sembabule, Nakasongola, Rakai, Kayunga, Masaka, Mukono, and Mubende) to develop their work plans for year one activities on 17th April 2009.

• Submit work plans to the CAO and DHT of all 13 districts with official letter from NMCP to districts as formal notification of SMP support.

• Implement activities in the 13 districts

• Prepare Memorandums of Understanding with each of the 13 districts.

.


3. Achievements by Intermediate Result

IR 1: Malaria prevention programs in support of the national malaria strategy improved and implemented




IR 1.1 Existing Policies Reviewed and Updated Minutes from stakeholders meeting

Supported NMCP to assemble guidelines and evidence, including relevant implementation experience and internationally recognised guidelines to inform the policy/strategy/guideline/ tools review process for both IPTp and ITNs.

Evidence and implementation experience reviewed Report summarizing document review

Summaries and/or packs of evidence, including papers and documents were prepared for a stakeholders meeting.

3 Meetings with stakeholders to review IPTp and ITN policies

Draft national malaria control policy developed

Convened meetings with stakeholders to review current IPTp and ITN policies, strategies, guidelines and tools. Participation in stakeholder’s meeting to draft national malaria control policy

Stakeholders provide input into revised policies, strategies, guidelines Small working group formed

A draft malaria control policy combining all interventions is available and soon to be submitted to MoH for approval. On approval, SMP will provide support to development of operational guidelines and related tools by intervention. Further work to be conducted in small working groups by intervention next quarter, on approval of overall malaria control policy.

IR 1.2 IPTp Uptake Increased/IPTp Strengthening

Inventory of ANC providers in 13 districts and training needs assessed

During rapid district assessment, identified major impediments to directly observed IPTp, including training needs

Inventory of ANC providers Training needs of IPTp providers assessed

Workplans for 6 districts, including training and support supervision schedule

Developed training and supportive supervision schedule with 6 districts

Detailed schedule for training and supportive supervision in 13 districts

Schedule for the remaining 7 districts to be developed in Quarter 3

IPTp job aides adequate for distribution to health facilities in 13 districts

Inventoried existing IPTp communication materials and tools; collected job aides for distribution during on-site training and supervision

Assessed SP stockouts in 13

During rapid district assessments, assessed stockouts of SP at district

Stock outs of SP averted in 13 districts

None of the 13 districts and none of the HC IV or hospitals

.


districts level and at HC IV and hospitals.

had SP stockouts

IR 1.3 Supply and use of LLINs by target populations increased/Preparation for LLIN distribution

ANC distribution mechanism review started

Reviewed existing tools and methods for the distribution of LLINs through ANC

Review of existing tools and methods for LLIN distribution through ANC Inventory of tools to support LLIN distribution

SMP is ahead of schedule on this activity, as it was not scheduled to take place until Q3-Q4. A review of the ANC distribution mechanism under AFFORD has begun which will inform the start up plans and model for the ANC distribution mechanism under Stop Malaria Project.

13 Districts informed of plans for Year 2 ANC LLIN distribution

Sensitized the first wave of 13 SMP districts to benefit from the ANC LLIN distribution in Year 2

13 districts familiar with SMP ANC LLIN distribution plan

SMP is ahead of schedule on this activity, as it was not scheduled to take place until Q3-Q4. The districts to benefit from the Stop Malaria ANC distribution have been informed about the plans and been involved in the initial planning and activity scheduling session as part of the feedback workshops following the district assessments.

1.1 Existing Policies Reviewed and Updated

1.1.1 Achievements

SMP provided assistance to the NMCP and key malaria partners in Uganda to review the current national IPTp and ITN policies and strategy documents, operational guidelines and tools in line with current WHO recommendations and in light of recently available evidence, including implementation experience in Uganda and elsewhere. Summaries for all key malaria control interventions, including evidence and approaches relating to ITNs and IPTp were prepared by SMP, with this effort culminating in a week long workshop held in Jinja with the NMCP and key partners from 2-6 March. The workshop itself was funded by and coordinated by the Malaria Consortium Clover project (Irish Aid). The meeting aimed to produce one policy document incorporating all components (not an individual policy document by intervention), from which revised guidelines for different components would be developed. Since the Jinja meeting, Stop Malaria Project has met with NMCP on a several further occasions to refine further drafts of the proposed national malaria control policy. The notes from the Jinja meeting and the draft revised policy are available.


• Complete final edits and submit revised national malaria control policy for approval.

• Support the coordination and participate in small working groups to revise the IPTp and ITN operational guidelines and related tools and materials once the policy has been approved.

1.2 IPTp Uptake Increased/IPTp Strengthening

1.2.1 Achievements

SMP assessed the current status of IPTp services and training needs during rapid district assessments in 13 districts. Health facility assessment tools were designed to collect information required to support planning for IPTp training and procurements needs.

.


Key findings from the district assessments included a significant lack of IPTp treatment under directly observed therapy (DOT), which appeared to be largely due to a lack of safe drinking water, concerns by clients about the cleanliness of cups, and fear of taking SP on an empty stomach. There was generally low coverage for IPTp2 reportedly due to late ANC attendances. Distance to health facilities and long waiting times also appeared to be key barriers in the improvements of IPT uptake. Other key challenges relating to the effective delivery of IPTp2 are stock outs of medicines, understaffing and lack of storage space for supplies such as cups.

During the quarter, SMP completed the analysis of assessments and met with six districts to plan for performance improvement for IPTp, and to quantify needs for water purification tablets and cups to support directly observed IPTp at hospital and HCIV levels. For this, data on the water supply status, issues and related requested needs at individual health facilities were collated and reviewed along with the ANC attendance data at hospital and health centre HCIVs. Water purification tablets and cups are being procured from UHMG and will be distributed to districts directly from SMP.

During the work planning meeting with six districts, SMP also planned for training of district supervisors to update antenatal care providers concerning IPTp, and to facilitate performance improvement planning during support supervision visits at HC IVs and hospital antenatal clinics. The first round of support supervision will take place next quarter. SMP also shared the results of the IPTp data collected during the district assessments with the six districts, including data relating to IPTp. The result is an individual workplan for each of the six districts outlining all district level activities.


• Share district assessment information about IPTp with remaining 7 year-one districts, and prepare district workplans for IPTp strengthening through support supervision, on-site training, and procurement of cups and water purification tablets.

• Complete procurements of cups and water purification tablets (and potentially jerry cans) and distribute to all districts through first round of support supervision activity (at hospital, HCIV and HCIII levels). Their use will be monitored and supported during supportive supervision visits. To encourage sustainability, efforts will be made to change the culture surrounding DOT for IPTp by encouraging ANC attendees to bring a cup and/or drinking water to future visits.

• Develop training materials and tools for on-site IPTp training and performance improvement activities.

• Train and support district supervisors in 7 districts to facilitate on-site IPTp updates and performance improvement planning, including efforts to improve quantification and ordering of adequate supplies of SP for IPTp.

• Distribute IPTp job aides during support supervision of ANC providers (quantification based on district assessment data). Providers will be oriented to the job aides during on-site training for ANC at hospitals and HCIVs in 13 districts.

• Review the current support supervision approaches and tools in coordination with the MoH and representatives from 13 districts, with the aim of developing a new performance improvement approach including guidelines and tools for use during support supervision visits.

• Continue to work with planning and pharmaceutics departments at MOH and NMS to improve supply of SP, including advocacy for more efficient release of funds from the MOH to the NMS.

1.3 Supply and use of LLINs by target populations increased/Preparation for LLIN distribution

1.3.1 Achievements

Although not planned until Q3-Q4, SMP began a review of the ANC LLIN distribution mechanism under AFFORD, including a tracking study/audit of nets through the system, an ANC retention and use study in Katakwi, and staff consultations on the current model. This review will inform the start up plans and model for the ANC distribution mechanism under Stop Malaria. The next quarter will see further review of existing tools and methods for the distribution of LLINs through ANC. Documentation of this review will be available.

.


Sensitization of the first wave of SMP districts to benefit from the ANC LLIN distribution in Year 2 has begun. The feedback session following the rapid district assessments included the provision of an overview of activities involved in the distribution start up and an initial planning and activity scheduling session.


• Continue review of existing available tools and methods for the distribution of LLINs through ANC to inform development of strategy and model to be adopted under Stop Malaria.

• Begin the design of the system for the ANC distribution of LLINs under Stop Malaria in

coordination with the districts.

IR 2: Malaria Diagnosis and Treatment Activities in Support of the National Malaria Strategy Improved and Implemented




IR 2.1 Support implementation of HBMF in highly endemic areas

District-specific assessment reports for 5 districts

During rapid district self-assessments, identified challenges, in particular relating to supply chain bottlenecks of ACTs to CMDs, as well as other support needs in 5 districts targeted in Yr 1

HBMF challenges and support/ training needs and related appropriate interventions identified and documented

Planning for HBMF activities under SMP to address those needs and challenges has begun

Initial inventory of CMDs in five districts

During rapid district assessments, collected information about existing CMDs in 5 districts

Inventory of existing CMDs in 5 districts

It was not possible to ascertain which CMDs are active or still in existence during the district assessments, so SMP will conduct parish meetings with CMDs to conduct an inventory and mapping of active CMDs next quarter

Workplans for HBMF revitalization in 5 districts

Met with 5 districts to prepare workplans for revitalizing and/or introducing HBMF with ACTs, including plans for pull system of ACTs distribution for CMDs

5 district plans introducing/revitalizing HBMF with ACTs

Review and adapt support supervision systems for HBMF

Recording and support supervision tools currently used under HBMF in Uganda have been compiled. They are currently being reviewed to determine whether changes are necessary

IR 2.2 Service Providers capacity to manage severe malaria improved

Draft curriculum for Designed curriculum for site-based training in

Curriculum for on-site training in severe Curriculum designed by

.


site based training on management of severe malaria

severe malaria malaria management at referral centres

partners including Malaria Consortium. Awaiting review to ensure in line with revised malaria control policy. Once agreed to be complimentary, it will be submitted for approval by the technical working group at MoH

IR 2.3 Malaria diagnostic capacity and services improved Rapid district assessment tool for diagnostics component developed

Assessment tool for diagnostics component developed as part of rapid district assessment tools

Laboratory assessment tool developed

Rapid district assessments of diagnostics conducted

Diagnostics component included in rapid district assessments in 13 districts

District laboratory assessments conducted in 13 districts

Adaptation of JUMP/ToT laboratory training course materials

JUMP/ToT curricula being adapted for 3-day site-based malaria diagnostic training

JUMP/ToT course adapted

Stop Malaria is ahead of schedule on this activity, as it was not planned until Q3

IR 2.4 Capacity of district supervisors and community/facility linkages strengthened

Consultant identified to review existing supervision guidelines and tools

Identified consultant to assist with review; collected and reviewed MOH guidelines and Yellow Star tools.

Review of existing supervisory tools and guidelines conducted

The review will be completed early during quarter 3

Assessment of current support supervision systems in 13 districts

Conducted district assessments in 13 district, including an inventory of supervisors and the status of support supervision

Strengths and weaknesses of support supervision systems in 13 districts assessed

Inventory of district and sub-district supervisors

Supervisory systems in many of the 13 districts are non-functional; and in most irregular.

Deferred to next quarter Self assessment tools drafted for various levels of health facilities

Will be done once review of existing tools and guidelines completed

2.1 Support implementation of HBMF in highly endemic areas

2.1.1 Achievements

During this first work plan year, SMP will prepare for implementation of HBMF with ACTs in five districts: Wakiso, Kiboga, Mityana, Nakaseke, and Luwero. Rapid district assessments were conducted in all of these districts during the quarter to determine the challenges and needs relating to HBMF. The assessments found that HBMF was generally not functioning. A few sub-counties were covered in training on ACTs in HBMF, but there has been no COARTEM for some time and therefore community level treatment is barely existent. The assessments also found that while the previous HBMF structures are in place (i.e. CMDs), the motivation and retention of CMDs remain a challenge. There is not a strong linkage with the health facilities, which has also been exacerbated by the recent stockouts.

.


Planning for the HBMF component began on completion of the assessments. The results were fed back and discussed with the District Health Offices in the 5 districts during a Kampala-based workshop and SMP in coordination with each district prepared a plan for revitalizing or introducing HBMF with ACTs. Focus was given to the key challenges as outlined above and based on partners’ previous experience in HBMF. All districts were sensitized to the introduction of HBMF in the district, although district HBMF advisory committees are yet to be formed.

An inventory of existing CMDs was conducted as part of the rapid district assessments, but comprehensive data on active CMDs was not available at the district level. A further inventory will therefore be conducted through parish meetings, to take place next quarter.

Initial planning for a workshop to share experiences in HBMF to inform scale up and the role of the HBMF within the VHT and in the context of the treatment of other communicable diseases began this quarter. The workshop will also provide the opportunity to clarify how the HBMF strategy fits with other approaches such as the VHT and integrated management of pneumonia and diarrhoea and, importantly, to get consensus on key recommendations to the NMCP on amendments to the national HBMF strategy and implementation guidelines. Stop Malaria Project is playing a key technical support role in this workshop, along with WHO, UNICEF and Malaria Consortium. Stop Malaria Project will also continue to provide support to the revision of related policy, guidelines and tools as required at the central level which will eventually, once approved, shape operational activities at the district level under the project. Work has already been done to gather existing CMD HBMF ACT tools. Recording and support supervision tools currently used under HBMF in Uganda have also been compiled and are currently being reviewed. The workshop is being planned for 19 May.


• The first round of support supervision visits will take place during the next quarter. SMP will liaise with the district level to conduct the visits, incorporating those with the ongoing responsibility for the support supervision visits. The visits will act as an opportunity to conduct a comprehensive inventory of the active CMDs, acquired from attendance sheet at the (most likely) parish level meetings which is the form the support supervision visits will largely take. The visits will also serve to update the CMDs on ACT supply, introduce the project to the CMDs and LC1s, explore resource support needs among the CMDs, and orient CMDs to malaria in pregnancy and IPT and train them to discuss IPT with men and women of reproductive age, with a particular emphasis on pregnant women, in their communities. A more detailed picture of the current situation will be useful when planning the training and designing the communication strategy. Because the HBMF activity under SMP relies on ACTs supplied by the MOH through GFATM Round 4 (and other sources), it will not be possible to conduct any training until the ACTs are available which is expected in quarter 4, if this SMP year. As an interim measure, SMP plans to initiate various activities in preparation to the training in HBMF and to train CMDs to promote ANC attendance and the importance of IPT uptake among pregnant mothers, and then commence training in treatment with ACTs once ACTs become available.

• Once an inventory is available as well as a more detailed picture of resource support

needs, the project will quantify and procure supportive resources for CMDs for the effective delivery of HBMF including items such as T-shirts, identification badges, gum boots, medicine boxes, torches and bicycles.

• Support will be provided in the recruitment of further CMDs in areas of attrition as

identified during the inventory conducted during the first round of support supervision. • The workshop to share experiences in HBMF to inform scale up and the role of the

HBMF within the VHT and in the context of the treatment of other communicable diseases as outlined in the section above, will take place on 19 May. This activity is cost-shared with the Malaria Consortium Clover project which is funded by IrishAid. Stop Malaria will play a key technical support role in the workshop. Following the workshop, SMP will continue to provide support to the NMCP in the revision of guidelines, tools and materials for HBMF. Once the HBMF ACT tools have been reviewed, approval will be sought from the MoH and they will be pre-tested.

.


• The HBMF support supervision systems will also be reviewed and adjusted, informed by the rapid self-assessment.

• A workshop to design the project communication strategy to accompany the HBMF activities (as part of the overall project communication plan) will be conducted in early May (see Section 4).

• The HBMF activities will, where possible, link up with and reinforce the community mobilization activities

2.2 Service Providers capacity to manage severe malaria improved

2.2.1 Achievements

The curriculum for site-based training of severe malaria case management has been revised by partners including Malaria Consortium. It is now awaiting a review to ensure the curriculum content is in line with the malaria control strategy which was revised following the development of the curriculum (and which is also awaiting approval). This task will be conducted by Stop Malaria Project during the next quarter. Once agreed to be complimentary, it will be submitted for approval by the technical working group at MoH. Progress with this activity is substantially dependent on MoH review and approval processes.

The severe malaria training materials and job aides are under development but will not be finalised until the curriculum has been approved. On approval and finalisation, the materials and job aides will be pre-tested before being printed and disseminated during the subsequent training cascade.

Details on the severe malaria burden were also acquired during the rapid district assessments. Planning and scheduling of severe malaria activities also took place with the districts during this workshop. The activities are now reflected in the district level work plans.

A literature review on knowledge, attitudes and practices concerning malaria treatment, with emphasis on severe malaria has been completed, with the project communications plan to be developed during the next quarter (see Section 4).


• Review the severe malaria training curriculum to ensure it is in line with the revised malaria control policy, and appropriate for on-site training under SMP.

• Revise curriculum as necessary, followed by submission to the appropriate technical working group within the MoH for approval.

• Continue work on the development of training materials and job aides for severe malaria in coordination with MoH and other partners. Once approval on the curriculum is acquired, the materials and tools will be finalised and the pre-tests conducted.

2.3 Malaria diagnostic capacity and services improved

2.3.1 Achievements

SMP assessed laboratory facilities in 13 districts during the rapid district assessments. The exercise identified significant capacity gaps in the areas of equipment, personnel and infrastructure. The exercise did not assess the accuracy of the laboratory staff in performing malaria microscopy as it was outside the scope of work.

SMP also began adapting the JUMP laboratory training course for a 3-day site based malaria diagnostic training – an activity originally planned for Q3.

.



• Finalize Laboratory Diagnostics/ToT curriculum • Conduct ToT workshop for District Peer Trainers

• Establish external quality assurance system

• Support District Peer Trainers as they conduct on-site training for laboratory diagnosis

of malaria in selected HC IV and hospitals in 5 districts

2.4 Capacity of district supervisors and community/facility linkages strengthened

2.4.1 Achievements

During the quarter, SMP assessed the current support supervision systems in 13 districts, and reported findings back to 6 of them. Findings from the remaining seven districts will be reported back early in the third quarter. In most of the six districts, most if not all supervision is integrated, and is only done irregularly. Few of the supervisors in any of the districts have ever been trained in performance improvement techniques, and none of the six districts were using checklists or tools to structure their supervisory visits to health facilities. All districts stated that they had inadequate funding to conduct quarterly integrated support supervision, as recommended by the MOH; and none of them had funding to conduct technical supervision.

SMP worked with the following six districts to prepare workplans for malaria support supervision strengthening between March and the end of September, 2009: Mpigi, Nakaseke, Luwero, Kiboga, Mubende, and Wakiso.

SMP also identified a consultant and negotiated the terms of reference for conducting a review of existing guidelines and tools for support supervision. The review will inform the design or adaptation of malaria support supervision tools to be introduced by SMP.


• Report on findings from district assessments to seven remaining districts and develop workplans for SMP assistance through the end of September, 2009.

• Finalize review of existing support supervision guidelines and tools, and design tools/guidelines for malaria technical support supervision in close collaborations with NMCP and district supervisors.

• Conduct 2 rounds of training for district supervisors from all 13 districts in the use of performance improvement tools. Support supervision will use a performance improvement approach, and will be combined with on-site training in malaria in pregnancy.

• Support district and sub-district supervisors in six districts to conduct on-site malaria in pregnancy training coupled with performance improvement exercises for IPT strengthening in all HC IVs and hospital antenatal clinics.

IR 3: NMCP Capacity to Monitor and Evaluate Interventions Strengthened




IR 3.1 M&E Sub-unit of NMCP support and NMCP capacity building

.


Hire and second M&E specialist to NMCP

M&E specialist was hired and reported on Jan. 15 2009

M&E specialist in place by Jan. 15 2009

National M&E Plan finalized and launched by NMCP

NMCP M&E plan 2008-2010 was finalised, printed and launched (endorsed and signed by MOH). SMP participated in launch.

M&E plan signed off by MoH and partners

SMP will support writing of the next M&E plan for 2010 -2013/2015

M&E capacity, skills and training needs of NMCP staff identified

M&E capacity reviewed Capacity building plan for year one

The capacity building plan will be completed in the next quarter. It requires participation of NMCP staff.

At least one training per quarter for MOH M&E Staff

This activity was deferred until the capacity building plan has been finalized; this will happen in Q3. The training needs identified tailored around database management and analysis, yet the database was not available. Agreed to first set up the database for practical training to begin.

IR 3.2 MOH NMCP M&E Database improved and expanded ITN (IRS) databases assessed

ITN database current status was assessed and discussion held with NMCP responsible officers about the plans

Report on ITN database and suggestions for way forward

Need to re-build the database rather than just implementing changes as in the initial work plan.

Procurement plan for NMCP M&E Unit

Technology needs identified and procurement plan made

Computers and printer in place at NMCP M&E Unit

Procurement of computers, office desk, chairs, a printer and other supplies for the networking will be done in Q3

IR 3.3 Coordination among key partners improved

SMP participated in one NMCP Partners' meeting.

Organize quarterly NMCP meetings with national malaria control partners

Preparations underway for the first quarterly SMP review and planning meeting with SMP staff and partners

Organize quarterly SMP review and planning meetings with SMP staff, partners, and MOH

On 27th April will have a quarterly SMP review and planning meeting with partners

3.1 M&E Sub-unit of NMCP support and NMCP capacity building

3.1.1 Achievements

During the quarter, SMP conducted the initial assessment of the plans to implement IR3 with all the NMCP officials. The plans for the M&E Specialist to relocate to MOH and the procedures to refurnish the NMCP offices were finalized and documented, though official documentation from MOH is pending.

.


SMP also assessed NMCP M&E capacity and training needs, especially on ability to manage, analyze and interpret malaria data. As part of SMP’s support to the NMCP M&E sub-unit, the project is involved in the development of the NMCP quarterly report.


• Procure furniture and equipment for NMCP and set up office

• M&E Specialist relocates to NMCP office

• Provide continuous support and encouragement of data sharing and coordination within NMCP

• Monitor supply of data to the NMCP M&E lead person by all officers

• Re-organise data handling and conduct on the job training so that officers can spend more time on data interpretation and results other than data entry

• Provide support for detailed understanding of the M&E concepts and indicators as per the M&E 2008-2010 plan, with a major emphasis on denominators.

• Support the development of the NMCP quarterly report

3.2 MOH NMCP M&E Database improved and expanded

3.2.1 Achievements

In March, Dr. Albert Kilian, M&E Director Malaria Consortium, visited Uganda and assisted the M&E Specialist to assess the M&E database and define SMP’s support to the NMCP. Together, they assessed the available database, with particular emphasis on ITNs and IRS. Workplans were developed to reconstruct these databases and train officers in spreadsheet skills and underlying database management concepts and principles.


• Develop a concept paper on database improvement and implementation guidelines

• Coordinate with WHO and NMCP to bring database in line with NMCP indicators

• Utilize WHO global database and on job training of staff to directly import data as ITN database is rebuilt

• Support the NMCP M&E desk to link with UMSP for authorisation of, access to and use of data from sentinel sites

• Coordinate with Resource Centre to develop standard routine to update malaria related data at the NMCP central database using the HMIS data

3.3 Coordination among key partners improved

3.3.1 Achievements

Stop Malaria has been actively participating in meetings and workshops with malaria partners and working to strengthen coordination and collaboration among national players. SMP team members participated in the NMCP Partners' meeting, held in January.

The SMP Community Mobilization Specialist attended the Fresh Air National Malaria Technical Update and Coordination Workshop on 31st March–2nd April 2009, where she introduced the Stop Malaria Project and presented planned partnership activities with CSOs.

.



• Support NMCP to organize a meeting with national malaria control partners

• Participate in meetings regarding national malaria activities and events, e.g. HPAC Basic Package Working Group

• Organize quarterly SMP review and planning meeting with SMP staff, partners, and MOH.

.


4. Project Monitoring and Evaluation




Project Monitoring and Evaluation

M&E/IT Officer hired

Advertised, interviewed, and hired M&E/IT Officer.

SMP M&E/IT Officer hired

Will join team on 4 May, 2009.

Results framework and PMP reviewed and revised

Results framework and PMP reviewed by partners, USAID, PMI, and UMEMS, and revised accordingly.

Results framework and PMP reviewed by partners and revised

Contacted MACRO DHS, requesting access to SPA data. Data not yet available.

Baseline service provision indicators calculated

SPA data not available for secondary analysis yet.

SMP M&E system designed, including data entry spreadsheet

In March, SMP designed an M&E system, including formats for data collection, a data entry spreadsheet for compiling data, and guidelines for the project M&E system. These were shared with partners and SMP staff.

Project M&E Guidelines and formats

Monitoring tools reviewed by partners

Database designed

HQ, Zonal, district, partner staff trained

To be done during quarter 3 and 4, after M&E/IT Officer joins team

Quarter 2 output indicators reported to PMI and UMEMS, using M&E reporting formats

Data reported by MC and CCP for the second quarter and reported to PMI and UMEMS

Project output data received and entered into database

As the M&E/IT Officer had not joined the project yet, the Central Zone Team Leader entered the data into the PMI quarterly reporting format.

4.1 Project Monitoring and Evaluation

4.1.1 Achievements

During November and December, SMP developed its Performance Monitoring Plan (PMP), with input from all partners. The draft PMP was submitted to USAID/PMI and UMEMS at the end of December, 2008, for review. In January, UMEMS and USAID/PMI provided feedback, and the PMP was revised by mid-February and re-submitted. During March, CCP Senior Research and Evaluation Officer Marc Boulay visited Uganda for two weeks to work with the newly recruited M&E/IT Officer Ambrose Muhumuza, who joined the project temporarily as a consultant. Together, Marc and Ambrose reviewed and revised PMP indicators based on reporting feasibility, and designed a system for routine reporting on quarterly output indicators, including a data entry spreadsheet that the M&E/IT Officer will use to compile data from all partners and districts. Marc and Ambrose also prepared guidelines for the M&E system, and briefed SMP staff, partners, and USAID on the system.

.


Also during the reporting period, SMP provided input to PMI on its quarterly data reporting format; and provided advice to the Ministry of Health concerning the questionnaire for the Uganda AIDS and Malaria Indicators Survey.


• SMP M&E/IT Officer joins SMP team on 4 May, 2009

• Data collected during quarters one, two and three entered into data entry spreadsheet

• Partners, SMP project staff, and districts trained in SMP M&E system

• Quarterly reports for SMP and PMI prepared

.


5. Communication and Community Mobilization




Communication Job aides – 5,000 copies of both the gestational wheels and IPTp wallcharts collected

Established inventory of existing IPTp communication materials and tools

Collection of IPTp communication materials and tools

Usable materials are currently available

Literature review on IPTp, LLIN, treatment knowledge, attitudes and behaviours conducted

Conducted literature reviews on IPTp, LLIN, and treatment knowledge, attitudes and behaviours

Literature review conducted and findings disseminated

The dissemination of results will take place in quarter 3 during the project communication plan and tool kit development workshop

Soft copies for LLIN posters and flyers received from other projects

Collected existing LLIN communication materials

LLIN media materials included in district malaria communication toolkit

Communication toolkit will be developed next quarter

Community Mobilization

Community mobilisation specialist recruited

CDFU signed a subagreement with JHU; recruited and hired a Community Mobilization Specialist who joined the project in mid-February.

Community Mobilization Specialist hired

CSOs, VHTs, and malaria community based activities mapped in 13 districts

During rapid district assessments and in consultation with MACIS, SMP identified potential CSO partners in several districts; and mapped subcounties with VHTs and community based malaria activities.

Potential CSO partners identified

VHTs and malaria community based activities mapped

This activity is ongoing, as some of the CSOs working in the districts were not reported by the District Health Offices; SMP will verify next quarter

Draft community self assessment tool developed

Based on tools developed by RBM for the “Malaria Community Competency Model,” SMP drafted a community malaria self assessment tool

Community self-assessment tools designed

Tool to be pilot tested next quarter

6 district implementation plans for community mobilization prepared

By end of quarter 2, SMP had facilitated a workshop with representatives from 6 districts to develop project implementation plans for activities through 30 September.

13 district implementation plans for community mobilization prepared

Remaining 7 district implementation plans will be completed in April.

.


5.1 Communication

5.1.1 Achievements

During Q1 and Q2, the project focused on building the foundation for the successful implementation of project communication activities. On the part of communication, key activities included the rapid district assessment, and literature reviews on the behavioural aspects of malaria prevention (IPTp, LLIN use) and malaria treatment and diagnosis. The rapid district assessments also revealed that, from the community to the district level, there is a much stronger emphasis on and visibility around HIV/AIDS compared to malaria, evidenced in part by the fact that there are no existing community-based networks for malaria. A further challenge was the effectiveness of the distribution system for IEC materials. Materials often remain at district or health facilities, rather than being disseminated to the communities.


• Develop an integrated project communication plan which addresses both prevention and diagnosis and treatment aspects of malaria.

• Based on integrated project communication plan and existing communication materials,

design district malaria communication tool kit, e.g. outlines for radio talk shows, radio spots, scripts for local dramas, etc.

• Assist 13 districts to develop malaria communication plans as part of their district work plans.

• Disseminate IPT job aides during the training and supportive visits of the ANC providers. • Review, pre-test and print CMD HBMF ACT tools. • Design, pre-test and disseminate severe malaria job aides.

5.2 Community Mobilization

5.2.1 Achievements

Information on key influential persons and organizations in communities involved in promotion of malaria prevention and control activities, as well as existing structures and organizations with potential to undertake community mobilisation activities was gathered during the rapid district assessments. Using this information, DHOs and MFPs from Mpigi, Kiboga, Nakaseke, Wakiso and Mityana developed district-specific plans for community mobilization activities for malaria prevention and control.

A community self assessment tool for malaria competence has been adapted and will be pilot tested in the third quarter.

These accomplishments notwithstanding, the community mobilisation interventions are challenged by weak community mobilization interventions in the 13 districts of the central region, inadequate funding for malaria interventions, and absence of the VHT structure in most of the districts, which is considered the entry point for community mobilization activities.


• Design training materials for malaria community self-assessment and mobilization • Pilot test community malaria self-assessment tools in selected communities • Train 4 district facilitators in each of 5 districts in the competence framework • Facilitate 20 communities in 5 districts to conduct self assessments for malaria competence • Develop a curriculum for community mobilisation

.


• Undertake a stakeholder review of the draft curriculum • Pilot-test curriculum with district and national level trainers and incorporate changes

proposed from the pre-test • Identify CSOs in 13 districts to implement community mobilization activities during Year 2

STOP MALARIA PROJECT QUARTERLY STATUS … MALARIA PROJECT . QUARTERLY STATUS REPORT . ... Malaria...

Documents

Transcript of STOP MALARIA PROJECT QUARTERLY STATUS … MALARIA PROJECT . QUARTERLY STATUS REPORT . ... Malaria...