THE UGANDA STOP MALARIA PROJECT … UGANDA STOP MALARIA PROJECT QUARTERLY PERFORMANCE REPORT ... •...

USAID/JHU Cooperative Agreement No. CA 617-A-00-08-00018-00 1

THE UGANDA STOP MALARIA PROJECT QUARTERLY PERFORMANCE REPORT

APRIL 1ST - JUNE 30TH, 2010 Prepared and Submitted to USAID on 30th August, 2010


Table of Contents

LIST OF ACRONYMS ................................................................................................................ 3 BACKGROUND ........................................................................................................................... 4

RESULTS FRAMEWORK ......................................................................................................... 5 SUMMARY OF ACHIEVEMENTS FOR THE QUARTER AGAINST THE TARGET .... 6

IR1: IMPROVING MALARIA PREVENTION BY REACHING 85% COVERAGE OF CHILDREN UNDER FIVE YEARS OF AGE AND PREGNANT WOMEN WITH LONG-LASTING INSECTICIDE-TREATED NETS AND INTERMITTENT PREVENTIVE TREATMENT (IPTP) OF MALARIA IN PREGNANCY ................................................................................................................................ 6 IR2: IMPROVING MALARIA DIAGNOSIS AND TREATMENT....................................................... 7 IR3: STRENGTHENING THE CAPACITY OF THE NATIONAL MALARIA CONTROL PROGRAMME (NMCP) TO COORDINATE, MONITOR, AND EVALUATE THE NATIONAL RESPONSE TO MALARIA..................................................................................................................................................... 8

ASSUMPTIONS/ ISSUES/ CHALLENGES (DESCRIBE ANY ISSUES THAT COULD HAVE AFFECTED IMPLEMENTATION OF WORK FOR THE QUARTER). ................ 9

· IPTP UPTAKE AND MALARIA DIAGNOSIS AND TREATMENT COULD HAVE BEEN SIGNIFICANTLY AFFECTED BY THE STOCK OUT OF THE ESSENTIAL DRUGS.. .......................................................................ERROR! BOOKMARK NOT DEFINED. · LIMITED FUNDING AT HEALTH FACILITIES HINDERS THE DELIVERY OF THE BASIC HEALTH CARE PACKAGE. .............ERROR! BOOKMARK NOT DEFINED. TABLE OF RESULTS ................................................ERROR! BOOKMARK NOT DEFINED.


List of Acronyms ACT Artemisinin-based Combination Therapy ANC Antenatal Care BCC Behaviour Change Communication

CCP Johns Hopkins Bloomberg School of Public Health Center for Communication Programs

CDFU Communication for Development Foundation Uganda CMD Community Medicine Distributor CSO Civil Society Organizations DHT District Health Team DHS Demographic health surveys DQA Data quality Assessments HBMF Home Based Management of Fever HC Health Centre HMIS Health Management Information Systems IDI Infectious Diseases Institute IEC Information, Education and Communication IPTp Intermittent Preventive Treatment in pregnancy IR Intermediate Result ISS Integrated Support Supervision ITN Insecticide Treated Net LLIN Long Lasting Insecticide Treated Net MC Malaria Consortium MDGs Millennium Development Goals M & E Monitoring and Evaluation MIS Malaria Indicator Survey MoH Ministry of Health NMCP National Malaria Control Program PMI President’s Malaria Initiative PMP Performance Monitoring Plan RBM Roll Back Malaria RDT Rapid Diagnostic Testing SMP Stop Malaria Project SO8 Strategic Objective eight SP Sulfadoxine-pyrimethamine ToT Training of Trainers UBOS Uganda Bureau of Statistics UHMG Uganda Health Marketing Group UMEMS Uganda Monitoring and Evaluation Management Services USAID United States Agency for International Development VHT Village Health Team


Background The Stop Malaria Project (SMP) is designed to assist the Government of Uganda reach the PMI and

Roll Back Malaria (RBM) goal of reducing malaria-related mortality by 50% by end of 2010, and

subsequently contribute to the attainment of the Millennium Development Goals (MDGs).

Specifically; the SMP contributes to PMI program objective 3.1.1: Reduced Malaria Mortality. To

achieve this goal, SMP uses an integrated set of approaches that reach beneficiaries at multiple levels,

including: behaviour change interventions at the individual, household, and community levels, service

delivery strengthening at the health facility level, and institutional capacity building at the district and

national levels.

The project activities are implemented in close collaboration with the NMCP and district local

governments. The project currently covers 23 districts in three regions;

Central region: 13 districts

Hoima zone: 4 districts

Soroti zone: 6 districts.

The project activities are designed to meet three intermediate results:

• Malaria prevention programs in support of the national malaria strategy improved and implemented

• Malaria Diagnosis and Treatment Activities in Support of the National Malaria Strategy Improved and Implemented

• NMCP Capacity to Monitor and Evaluate Interventions Strengthened

The activities implemented and results achieved this quarter are presented according to the performance indicators, targets and the results framework below:


Results Framework Figure 1: Stop Malaria Project Results Framework


Summary of Achievements against planned targets for the Quarter IR1: Malaria Prevention Programs in support of the national malaria strategy improved and implemented IR1.1 Access to IPTp is increased Indicators:

• Percentage of pregnant women attending ANC who receive at least two doses of SP IPTp2 uptake stands at 37% compared to 39% though the absolute numbers of mothers attending ANC has increased. Health facility reports indicated frequent stock outs of SP; possibly contributing to 2% decline. Activities A total of 4 meetings were held, 1 meeting with each of the DHTs of the four districts in Hoima zone: Buliisa, Kibaale Masindi and Hoima Districts. The meetings focused on integrated support supervision of IPTp with emphasis on the tools used and how best to coordinate the activity with other stake holders within the districts. There was no major planned activity for IPTp in the central region and Soroti zone districts as most of the activities had been implemented in the previous quarter. IR 1.3 Community knowledge, perceptions and behaviour on the use of LLINs improved Indicators:

• Percentage of women who gave birth in the past two years aware of the correct number of doses of SP required for IPTp to be effective stands at 21.6 % (MIS, 2009)

The original plan was for SMP to distribute LLINs through ANC targeting pregnant mothers. However, during the quarter PMI undertook to support distribution of Global Fund Round 7 LLINs within 13 districts in the central region of Uganda: Kayunga, Mukono, Mpigi, Masaka, Sembabule, Rakai, Lyantonde, Kalangala, Mubende, Mityana, Luwero, Nakaseke and Nakasongola. The PMI support was channeled through the Stop Malaria Project. The distribution targeted specifically children under five and pregnant women, through mass distribution campaigns. In order to increase community knowledge, perceptions and behaviour on the use of LLINs, the SMP developed and distributed IEC materials specific to LLINs, and supported radio talk shows and radio spots that focused on promoting net ownership and usage. The targets for radio spots and IEC materials were not originally computed due to the campaign nature of the activity. IR 1.3: Access to LLINs increased Indicators:

• Number of people trained: 328 MOH and CSO staff, 21402 members of VHTs • Number of LLINs distributed during the quarter: 1,481,050 • Percentage of pregnant women provided with LLIN during the quarter:9.5% • Percentage of children under 5 years provided with LLINs during the quarter:88.4%

Activity Target. Achievement Comment Radio talk shows conducted

24 26 (108%) Support to LLIN distribution campaign.

Radio spots aired 4992 Support to LLIN distribution IEC materials distributed 74500 LLIN specific materials

Activity Target Achievement Comment


Global Fund Round 7 LLINs distribution campaign within 13 districts in the central region increased access to LLINs among children under 5 and pregnant women. In total 1,310 440 under fives and 140,807 pregnant women received LLIN during the quarter. These numbers are expected to rise when districts in Soroti and Hoima zones receive nets in the next quarter. IR2: Improving Malaria Diagnosis and Treatment IR 2.1: Malaria diagnosis, treatment and referral services improved Indicators

• Percentage of children under five with fever in the last two weeks who received treatment with ACTs within 24 hours of onset of fever is at 38% ( MIS,2009) in SMP districts

• Percentage of children under five who received a diagnostic test prior to treatment of fever from the health facility is at 17 %( MIS,2009) in SMP districts

TOT was conducted for 6 district staff (5 males, 1 female), microscopy training included 12 laboratory technicians (9 males, 3 females); 32 laboratory assistants (21 males, 11 females). Follow up support supervision reached 96 lab staff in 10 districts: Observed improvement in accuracy of the laboratory staff to correctly read both positive and negative blood slides. Various performance gaps were also identified during supportive supervision visits including; lack of functional microscopes at HC IIIs in Mpigi, Mityana, Kayunga and Nakasongola, and lack of reagents. It was also observed that health facilities collected external quality assurance slides but no external agency picked them for analysis and those who had their slides analysed had no

CS0s trained to distribute nets 328 328 (100%)

Civil society organizations took lead in LLIN distribution

LLINs distributed to under 5 in 13 districts 975,623 1,310,440

Registration revealed more children

LLINs distributed to pregnant women in 13 districts

242,881 140,807

Registration revealed less pregnant women compared to UBOS data used to set the target

LLINs distributed to VHTs , LC1 and Women Council members

35,100 29,803

Activity Target. Achievement Comment TOT for district staff in Microscopy and RDT in 4 district 6 trainers 6 (100%) Achieved Training of laboratory staff in microscopy 40 44 (110%) Follow up Support supervision of trainees in 10 districts 134 96 (70%) Procurement of Microscopes for microscopy training

4

Activity carried out to improve quality of training

District Health Teams meeting on severe malaria 23 districts 11 (47%) District Health Team meetings on multiple topics related to malaria 23 districts 14 (60%) Training of health workers in case management of severe malaria with ACTs 850 700 (82%) Pre- referral training of HWs on Severe malaria 1,936 517 (26%) Distribute Job Aids on Severe malaria 765 Distribute IEC materials (wall charts) on severe Malaria 652


feedback provided. Four microscopes were procured for use during training and this improved the ratio of trainees to microscopes and ultimately provides trainees better practical exposure to slide reading during the training. The lack of microscopes at HIIIs in districts that were visited was to be addressed through collaboration with the TBCAP project or to request IDI to incorporate a budget line for microscope service in the FY03. IR 2.3: Community knowledge, perception and behaviour on febrile illness and on prevention and treatment improved Indicator

• Percentage of women who have given birth in the past two years aware of the need for prompt treatment for malaria stands at 28% ( MIS,2009) in SMP districts

VHTs reached 800 households with messages on LLIN consistency usage, early treatment seeking behaviour and male involvement in malaria prevention and treatment activities. The VHTs also referred 380 malaria cases to health facilities and counselled 558 community members. 143 job aids were distributed to VHTs to support increased malaria awareness in the community as well as community knowledge on net usage. IR3: Strengthening the capacity of the National Malaria Control Programme (NMCP) to coordinate, monitor, and evaluate the national response to malaria IR 3.1: Technical resources and skills of NMCP increased Indicator:

• Number of NMCP staff trained in Program monitoring during the quarter: 32 were trained in LLIN monitoring

Activity Target. Achievement Comment House Holds reached by VHT with health education Messages 7,750 800 Distribution of IEC materials by VHTs

2 districts 143 jobs aids

Activity done only in two districts with trained VHTs

District level meeting on VHTs 4 1 VHT training 350 0 Supervision of VHTs in two districts 20 46 TV spots on integrated malaria activities 45 45 Integrated IEC materials distributed 74500 Radio Spots aired on integrated malaria activities 720 580

Activity

Target.

Achievement

Technical support on drafting of Global fund Round 10

Technical assistance provided On going

Technical support on reviewing of HMIS Weekly malaria Indicators incorporated

Weekly Malaria indicators are now part of routine HMIs

Training of MOH staff in monitoring of LLIN distribution 32 32 Review supervision check lists submitted by national or zonal NMCP staff to identify districts supervised. 23 13


During the quarter SMP offered technical assistance during the drafting of Global Fund R10 proposal. This

activity is ongoing and will be finalised in the next quarter. Technical support was also given in review of the

HMIS to align with the NMCP needs; during the process weekly malaria monitoring indicator tools were

developed and incorporated in the HMIS. HMIS final documents will be out in the next quarter. The training

has increased the number of the national level resourceful persons who can monitor and collect quality data for

the net distribution to be able to prepare and carry out net distribution activities in the remaining 3 regions at

once. The data from the supervisor’s tool and reports can be reliably used for net coverage reports and

correlated with the malaria trend analysis.

IR 3.2: Collection, processing and use of data from districts and implementing partners improved Indicator

• Number of NMCP staff trained in data collection management and analysis in the quarter is 25 • Number of NMCP staff trained in supportive supervision in the quarter is 11

SMP supported 5 consultative meetings and discussion with the key malaria stakeholders namely; WHO, RBM,

and other partners to support the functionality and re-structuring of the NMCP database. A work plan to update

the database was developed and shared with stake holders.

IR 3.3: Coordination among key partners improved Indicator

• Number of malaria partner meeting during the quarter: 1 SMP supported 5 coordination meetings among the key malaria partners compared to the usual one per quarter. The aim was to strengthen coordination among the implementing partners and ensure smooth implementation of NMCP net distribution campaign in the central region. Assumptions/ Issues/ Challenges (describe any issues that could have affected implementation of work for the quarter).

• Global Fund Round 7 LLIN distribution through CSOs

Facilitation M & E staff to attend Monitoring and Evaluation course for LLIN distribution 2 2

Activity

Target.

Achievement

Comment

Review HMIS reports to identify districts with data from all HFs on malaria indicators

23 districts 23 districts

Not all districts provided data on stock outs of ACTs

Support consultative meetings to review NMCP malaria database 5 5 Training of NMCP staff in data collection, management and analysis 25 25

The trainees were from different zones

Training of NMCP staff in supportive supervision 11 11 Emphasis was on LLIN


o The macro- and micro-planning processes involved many activities from preparation to actual implementation that, to be done well, took a considerable amount of time.

• There remains a lack of ACTs in many health facilities. There was also skeleton staff in most of the health facilities where severe malaria and pre-referral training was planned thus fewer health workers were trained than initially hoped.

• Changes of NMCP staff have at times delayed decisions and activities to be implemented.

• The delays in the release of HSSP III and HMIS reviewed documents have led implementation of HMIS strengthening to be postponed to Q4.

• Significant human resource constraints at the service delivery points in most of the districts (district staffing stands at 48% - MoH, Human Resources for Health Audit report, May 2009) posed difficulty in conducting the project activities within the stipulated time.

Planned activities for the next quarter

The following activities are planned to be implemented in the next quarter: IR 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy improved and implemented

• Follow up on VHTs in Rakai • Secure radio properties on 15 stations • Print and place 2,300 community posters • Print and place 10 malaria integrated billboards to cover the 23 districts • Print 2,500 integrated job aides • Conduct pre-referral training for severe malaria in 19 District (HCIII and II staff only) The 4 districts (

Nakasongola, Mukono , Mityana and Nakaseke ) were covered during the quarter • Print ANC cards • Print Inpatient Observation Forms

IR2.3 Malaria Diagnostic Capacity and Services Improved

• Train 12 TOTs for 6 districts • Train 100 laboratory staff from 6 districts • Train 110 laboratory staff from Bukedea, Soroti and Kibaale • Follow up 44 laboratory staff from Sembabule, Rakai, Masindi and Buliisa • Follow up 320 laboratory staff from 9 ( Katakwi, Amuria, Kaberamaido, Kibale, Bukedea, Soroti ,Kumi,

Rakai and Hoima ) districts and 2nd year districts • External Quality Assurance • Laboratory Equipment • Laboratory Reagents • Infection Control

IR3: Improve the Capacity of the NMCP to Monitor/Evaluate Interventions

• Facilitate NMCP to carry out support supervision in Teso and Midwestern zones • Data management of support supervision activities • Participate in quarterly Malaria partner meetings • Participate in collection of key malaria indicators and structuring the NMCP database and correlation of

Malaria indicator survey data


• Participate in NMCP quarterly meeting • Support M and E National TOT • M and E coordinate, train and participate in the distribution of LLINs • Ensure MoH website for sharing and disseminating information is active • Conduct data quality assessment rollout to Hospitals and HCIVs • SMP website development • Quarterly Monitoring and Evaluation Support Supervision • Print HMIS tools i.e. Manuals & Report forms for Mukono, Wakiso and Masaka • Roll-out of HMIS in Mukono, Wakiso and Masaka

THE UGANDA STOP MALARIA PROJECT … UGANDA STOP MALARIA PROJECT QUARTERLY PERFORMANCE REPORT ... •...

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