USAID Umuhimu wa Takwimu za Malaria Malaria (OMDM)

U.S. President's Malaria Initiative

USAID Okoa Maisha Dhibiti Malaria Activity (OMDM), Year 1, Quarter 2 Performance Report 1

USAID Umuhimu wa Takwimu za Malaria

USAID Okoa Maisha Dhibiti Malaria (OMDM) QUARTERLY PERFORMANCE REPORT: YEAR 1, QUARTER 2

Submitted: April 30, 2019

This document was produced for review by the United States Agency for International Development (USAID). It was made possible by the generous support of the American people through USAID and the US President’s Malaria Initiative (PMI). It was prepared by RTI International for the USAID | Okoa Maisha Dhibiti Malaria Activity.


USAID Okoa Maisha Dhibiti Malaria Activity (OMDM)

QUARTERLY PERFORMANCE REPORT: YEAR 1, QUARTER 2

Cooperative Agreement Number: 72062118CA-00002 Contractual Period: August 7, 2018–August 6, 2023

Prepared for:

USAID | Tanzania U.S. Agency for International Development Office of Acquisition and Assistance

Agreement Officer’s Representative (AOR)

Alternate AOR

Director, Office of Acquisition & Assistance (OAA)

Prepared by

RTI International 3040 Cornwallis Road P.O. Box 12194 Research Triangle Park, NC 22709-2194

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USAID Okoa Maisha Dhibiti Malaria Activity (OMDM), Year 1, Quarter 2 Performance Report iii

Table of Contents

1. Program Overview ....................................................................................................................................1

1.1 Program Description ..........................................................................................................................11.2 Summary of Start-up and Q2 Activities, Y1 ........................................................................................1

2. Activity Implementation Progress ..............................................................................................................5

2.1 OMDM Start-Up .................................................................................................................................52.1.1 Kickoff meeting ....................................................................................................................5

2.1.2 Formal Activity introduction to GOT partners .......................................................................5

2.2 Result 1: Malaria Surveillance is Improved ........................................................................................7Mainland Tanzania ....................................................................................................................................7

2.2.1 Activity 1A.1: Engage in wider HMIS/DHIS2 community .....................................................7

2.2.2 Activity 1A.2: Support HMIS/DHIS2, eIDSR, and malaria surveillance implementation ....................................................................................................................8

2.2.3 Activity 1A.3: Strengthen MoHCDGEC and NMCP outbreak response capacity ............... 11

2.2.4 Activity 1A.4: Pilot MCN and reactive case follow-up in areas of pre-elimination .............. 12

Zanzibar 132.2.5 Activity 1B.1: Support ZAMEP to update and implement the malaria surveillance

strategy .............................................................................................................................. 13

2.2.6 Activity 1B.2: Develop interoperability between key HIS ................................................... 16

2.2.7 Activity 1B.3: Enhance and strengthen MCN ICT architecture and sustainability .............. 17

2.2.8 Activity 1B.4: Support MCN implementation ...................................................................... 18

2.2.9 Activity 1B.5: Refine operational thresholds and triggers as MCN data is analyzed .......... 20

2.2.10 Activity 1B.6: Develop strategy and implementation plan to minimize malaria importation ......................................................................................................................... 21

2.3 Result 2: Entomological Monitoring is Improved .............................................................................. 212.3.1 Activity 2.1: Compile and review entomological monitoring data ....................................... 22

2.3.2 Activity 2.2: Conduct entomological monitoring planning and implementation .................. 22

2.3.3 Activity 2.3: Pilot and test new entomological monitoring approaches ............................... 26

2.3.4 Activity 2.4: Provide equipment and supplies for entomological monitoring ...................... 26

2.3.5 Activity 2.5: Entomological investigation and response in hot spot areas/active foci (Zanzibar only) ............................................................................................................ 26

2.3.6 Activity 2.6: Training of new entomological field team in new emerging hot spots (Zanzibar only) ................................................................................................................... 27

2.3.7 Activity 2.7: Strengthen national malaria vector control strategies, policies, and guidelines .......................................................................................................................... 27

2.4 Result 3: Drug Efficacy Monitoring is Improved ............................................................................... 272.4.1 Activity 3.1: Develop a TES toolkit ..................................................................................... 27

2.4.2 Activity 3.2: Plan, monitor, and implement TES ................................................................. 28

2.4.3 Activity 3.3: Provide equipment and supplies for TES ....................................................... 29

2.4.4 Activity 3.4: Test efficacy of new antimalarial drugs .......................................................... 29

2.4.5 Activity 3.5: Strengthen national malaria case management strategies, policies, and guidelines ................................................................................................................... 29

2.5 Result 4: GOT’s Evidence-Based Decision-Making is Improved ..................................................... 292.5.1 Activity 4.1: Strengthen Tanzania’s capacity for SOTA analysis and interpretation

of surveillance, entomological, and drug efficacy data ...................................................... 30

2.5.2 Activity 4.2: Conduct SOTA analysis and interpretation of surveillance, entomological, and drug efficacy data ............................................................................... 31

2.5.3 Activity 4.3: Disseminate OMDM results through various channels ................................... 31

iv USAID Okoa Maisha Dhibiti Malaria Activity (OMDM), Year 1, Quarter 2 Performance Report

2.5.4 Activity 4.4: Conduct study tours ....................................................................................... 32

2.5.5 Activity 4.5: Implement Learning Agenda .......................................................................... 33

3. Implementation Challenges..................................................................................................................... 33

4. Gender Considerations ........................................................................................................................... 33

4.1 Progress in Q2, Y1 .......................................................................................................................... 33 4.2 Planned for Q3 ................................................................................................................................. 34

5. Environmental Compliance ..................................................................................................................... 34

6. MEL Plan: Progress on OMDM Performance Indicators ......................................................................... 34

7. Management ........................................................................................................................................... 34

7.1 Collaboration with OMDM Partners and Stakeholders ..................................................................... 34 7.2 List of All Documentation Submitted to the Development Experience Clearinghouse (DEC) .......... 36 7.3 Certification that all Participant Training Information has been Entered in the TraiNet

Database ......................................................................................................................................... 36

8. Upcoming Events .................................................................................................................................... 36

Annex 1. Performance Indicator Summary Table........................................................................................... 37

List of Figures

Figure 1. OMDM Results Framework ........................................................................................................1 Figure 2. Species Composition in Sprayed and Non-Sprayed Sites ....................................................... 26

List of Tables

Table 1. Summary of progress during OMDM’s start-up period and Y1, Q2 .............................................2 Table 2. Active Case Detection Results, January–March 2019 .............................................................. 21 Table 3. Vector species and location data, ZAMEP entomological monitoring ....................................... 23 Table 4. Malaria vectors collected in Pemba........................................................................................... 23 Table 5. Malaria vectors collected in Unguja........................................................................................... 23 Table 6. Revised districts for fiscal year 2018/2019 insecticide resistance monitoring ........................... 25 Table 7. 2019 TES Schedule .................................................................................................................. 28 Table 8. OMDM Q2 collaboration with partners and stakeholders .......................................................... 34 Table 9. Upcoming events ...................................................................................................................... 36

USAID Okoa Maisha Dhibiti Malaria Activity (OMDM), Year 1, Quarter 2 Performance Report v

Abbreviations and Acronyms

ANC antenatal care

AO Agreement Officer

app (mobile) application

BS blood slide

CBS case-based surveillance

CDC-LT CDC light trap

CHMT Council Health Management Team

COP Chief of Party

DBS dried blood spot

DC District Council

DHIS2 District Health Information System 2

DMO District Medical Officer

DMSO District Malaria Surveillance Officer

DQA data quality analysis

eIDSR electronic Integrated Disease Surveillance and Response

ELISA enzyme-linked immunosorbent assay

eLMIS electronic Logistic Management Information System

FAA fixed amount award

FELTP Field Epidemiology and Laboratory Training Program

GOT Government of Tanzania

HMIS health management information system

HR human resources

ICT information and communication technology

IDWE infectious disease week ending

IEC information, education, communication

IPD in-patient department

IRS indoor residual spraying

LLIN long-lasting insecticidal net

LOA letter of authorization

LTC light trap catches

M&E monitoring and evaluation

MCN malaria case notification

MEEDS Malaria Epidemic Early Detecting System

vi USAID Okoa Maisha Dhibiti Malaria Activity (OMDM), Year 1, Quarter 2 Performance Report

MEL monitoring, evaluation, and learning

MERLA monitoring, evaluation, research, learning, and adapting

MLC man-landing catches

MOH Ministry of Health

MoHCDGEC Ministry of Health, Community Development, Gender, Elderly

and Children

MOU memorandum of understanding

mRDT malaria rapid diagnostic test

MSA master service agreement

MSDQI malaria services and data quality improvement

MUHAS Muhimbili University of Health and Allied Sciences

MVS malaria vector surveillance

NA not applicable

NIMR National Institute for Medical Research

NMCP National Malaria Control Program

OAA Office of Assistance and Acquisition

OMDM Okoa Maisha Dhibiti Malaria (Save Lives, End Malaria)

OPD outpatient department

OR operational research

PCR polymerase chain reaction

PMI US President’s Malaria Initiative

PORALG President’s Office—Regional Administration and Local

Government

PSC pyrethrum spray catches

PTC pit trap collection catches

Q1/2/3/4 quarter 1/quarter 2/quarter 3/quarter 4

RDT rapid diagnostic test

RHMT Regional Health Management Team

s.I. sensu Iato

s.s. sensu stricto

SBCC social behavior change communication

SIS School Information System

SME surveillance, monitoring and evaluation

SMS short message service

SOP standard operating procedure

SOTA state of the art

USAID Okoa Maisha Dhibiti Malaria Activity (OMDM), Year 1, Quarter 2 Performance Report vii

SOW scope of work

Swiss TPH Swiss Tropical and Public Health Institute

TA technical assistance

TBD to be determined

TES therapeutic efficacy studies

ToR terms of reference

TWG technical working group

UDSM University of Dar es Salaam

UNC University of North Carolina at Chapel Hill

USAID US Agency for International Development

WHO World Health Organization

Y1 Year 1

ZAMEP Zanzibar Malaria Elimination Program

ZILS Zanzibar’s Integrated Logistic System

ZMEAC Zanzibar Malaria Elimination Advisory Committee

USAID Umuhimu wa Takwimu za Malaria, Year 1, Quarter 2 Performance Report 1

1. Program Overview

Program Name: Okoa Maisha Dhibiti Malaria Activity (OMDM)

Activity Start Date and End Date: August 7, 2018 to August 6, 2023

Name of Prime Implementing Partner: RTI International

Agreement Number: Cooperative Agreement No. 72062118CA-00002

Geographic Coverage: Mainland Tanzania and Zanzibar

Reporting Period: Year 1, Quarter 2: January 1 to March 31, 2019

1.1 Program Description

As part of the US Government’s continued commitment to reduce the burden of malaria in Tanzania, the US Agency for International Development (USAID) awarded to RTI International a five-year cooperative agreement aimed at supporting the Government of Tanzania (GOT) in strengthening malaria surveillance and monitoring and moving the country toward malaria elimination. USAID’s Okoa Maisha Dhibiti Malaria Activity (OMDM; Save Lives, End Malaria) seeks to institutionalize malaria surveillance and monitoring at all government levels, maximizing the epidemiological impact of implemented malaria interventions by improving the targeting and implementation of interventions, refining approaches to manage transmission foci and respond to outbreaks, and providing key data to the GOT and stakeholders for policy development and programmatic decision-making. Figure 1 shows OMDM’s results framework underpinning the Activity’s programs.

OMDM’s Year (Y)1 work plan, approved in January 2019, was developed in coordination with Mainland Tanzania’s National Malaria Control Program (NMCP) and the Zanzibar Malaria Elimination Program (ZAMEP). This quarterly performance report focuses on quarter (Q)2, Y1 OMDM activities conducted between January 1 and March 31, 2019.

1.2 Summary of Start-up and Q2 Activities, Y1

Table 1 summarizes OMDM’s progress toward achieving results during Q2. Please see Section 2 and Annex 1 for additional detailed information regarding progress under each activity.

Figure 1. OMDM Results Framework

2 USAID Okoa Maisha Dhibiti Malaria Activity (OMDM), Year 1, Quarter 2 Performance Report

Table 1. Summary of progress during OMDM’s start-up period and Y1, Q2

OMDM Result Areas Summary of Progress Toward Achieving Year 1

Results OMDM start-up

Start-Up Activities • Home office technical and management staff traveled to Tanzania in January 2019 to participate in a kickoff meeting with the local OMDM team, key stakeholders, and USAID

• Initiated fixed amount awards (FAAs) to Muhimbili University of Health and Allied Sciences (MUHAS), University of North Carolina at Chapel Hill (UNC), and ZAMEP

• Finalized master service agreements (MSAs) with National Institute for Medical Research (NIMR) Mwanza and NIMR Amani

• Presented and discussed OMDM’s Y1 work plan with the NMCP and ZAMEP to ensure activities were well conceptualized by the partners and to forge a common way forward

• Provided an overview of OMDM’s Y1 work plan to USAID | Tanzania’s Agreement Officer (AO) and team

Result 1: Malaria surveillance is improved

Mainland Tanzania

Activity 1A.1: Engage in wider health management information system (HMIS)/ district health information system 2 (DHIS2) community

• OMDM was introduced to the Ministry of Health, Community Development, Gender, Elderly and Children’s (MoHCDGEC’s) Monitoring and Evaluation (M&E), Information and Communication Technology (ICT), and Epidemiology Units in Dodoma from March 7–8, 2019. These units supervise and manage HMIS data as well as the DHIS2 and electronic Integrated Disease Surveillance and Response (eIDSR) platforms on mainland Tanzania. This introductory meeting with Ministry leadership enables the OMDM to be recognized as a formal partner with the NMCP As the HMIS Unit is the custodian of all HMIS data and manages the ICT/HMIS/M&E technical working group (TWG), this formal introduction ensured OMDM is incorporated into the conversation around future updates of the HMIS, DHIS2, and eIDSR.

• OMDM participated in the March ICT, HMIS, and M&E TWG meeting and were invited by its leadership to join the TWG. In the meeting, the TWG agreed to develop a list of indicators to be included in program-specific and cross-cutting DHIS2 dashboards.

Activity 1A.2: Support HMIS/DHIS2, eIDSR, and malaria surveillance implementation

• From February 6–8, 2019, OMDM traveled to Morogoro with Swiss Tropical Public Health Institute (Swiss TPH) and Boresha Afya Lake Zone staff to support the NMCP to field test the newly-developed malaria services and data quality improvement (MSDQI) mobile application (app). The MSDQI app uses DHIS2 Touch and was developed by the University of Dar es Salaam; the app is being used by the NMCP and rolled out as their supervision tool. The app was tested in two health facilities and feedback was provided to UDSM for further refinement of the tool.

Activity 1A.3: Strengthen MoHCDGEC and NMCP outbreak response capacity

• Initiated detailed analysis of eIDSR to better understand trends around the completeness and timeliness of data submitted through the system. Data was stratified to ascertain its usefulness for malaria outbreak detection and case-based surveillance (CBS).

Activity 1A.4: Pilot malaria case notification (MCN) and reactive case follow-up in areas of pre-elimination

• Provided technical assistance (TA) to an NMCP meeting focused on CBS on mainland Tanzania. OMDM will host a stakeholder meeting in Q3 to further define the CBS implementation roadmap for mainland Tanzania.

ZANZIBAR

Activity 1B.1: Support ZAMEP to update and implement malaria surveillance strategy

• Continued providing TA to ZAMEP in the routine implementation of surveillance activities, analysis of existing data, support to the Malaria Epidemic Early Detecting System (MEEDS) and Malaria Case Notification (MCN; also known as Coconut Surveillance) platforms, and dissemination of bi-weekly reports to stakeholders.



Results • Supported ZAMEP to develop terms of reference (ToR) for the Malaria

Surveillance TWG; once functional, OMDM will also channel programmaticprogress and challenge updates through the TWG to assist ZAMEP andstakeholders to improve malaria surveillance in Zanzibar.

Activity 1B.2: Develop interoperability between key information systems

• Met with ZAMEP’s HMIS Unit and Directorate of Planning to address datainconsistencies between fragmented data collection systems—MEEDSand Integrated Diseases Weekly Ending (IDWE). The meeting led to anagreement being reached that all malaria data (e.g., cases, laboratorydiagnosis, long-lasting insecticidal net [LLIN] distribution, etc.) will bereported weekly through the national DHIS2 via laptops at the healthfacilities. OMDM will monitor the data throughout Y1 to ensure there are nodiscrepancies between system-based reporting before the plannedtransition from MEEDS to DHIS2 for weekly malaria case reporting.

Activity 1B.3: Enhance and strengthen MCN ICT architecture and sustainability

• Continued working with ZAMEP to enhance the MCN system through thedevelopment of an electronic outpatient department (OPD) malariaregister. Questions were finalized to be included in the user interface;these will be pre-tested in April 2019. RTI’s Senior Mobile ApplicationsDeveloper provided capacity building to OMDM’s Surveillance and MalariaAdvisor on system development and maintenance to facilitatetroubleshooting as issues arise.

Activity 1B.4: Support MCN implementation

• Continued providing logistical support (e.g., fuel, motorcycle maintenance,airtime, etc.) to ZAMEP’s field activities.

• Reminded and re-sensitized health workers on the importance ofaccurately documenting patient details, timely reporting, and consistentdata aggregation to reduce delays in patient follow-up and ensure weeklymalaria case aggregation is consistent with data reported in MEEDS andMCN platforms.

• Reviewed and provided feedback on MCN data recorded by DistrictMalaria Surveillance Officers (DMSOs); data utilized by ZAMEP to developweekly report disseminated to malaria partners.

• Negotiated agreement with Selcom to provide mobile services to DMSOsfor regular transmission of malaria data.

Activity 1B.5: Refine operational thresholds and triggers as MCN data is analyzed

• Participated in the Zanzibar Malaria Elimination Advisory Committee(ZMEAC), including discussions around operational thresholds and triggersas related to MCN data. Final recommendations from the ZMEAC report—anticipated in Q3—will be reviewed by ZAMEP to determineimplementation impact.

Activity 1B.6: Develop strategy and implementation plan to minimize malaria importation

• Planned for Q4.

Result 2: Entomological monitoring is improved

Activity 2.1: Compile and review entomological monitoring data

• Recruited entomology and therapeutic efficacy studies (TES) consultant toinitiate work under this activity; scope of work will begin in Q3.

• Discussed with ZAMEP the possibility of including routine entomologicaldata captured on field monitoring forms—retrospective and prospective—inMCN to feed into the DHIS2.

Activity 2.2: Conduct entomological monitoring planning and implementation

• Participated in NMCP TWG on February 6, 2019, to identify new indoorresidual spraying (IRS) districts for spraying and resistance study sites in2019.

• NIMR Mwanza assessed the quality of IRS operations in the Lake Zone aswell as continued monitoring the residual efficacy of clothianidin(SumiShield 50WG) in IRS districts; results indicate that mosquito mortalitypost-IRS exposure ranges from 70%–95% on days 1 and 2 and 100% onday 3, four months post-spraying.



Results • ZAMEP conducted IRS quality assessment in Zanzibar one-week post-

spray revealing 100% mortality rate for exposed An. gambiae sensu stricto(s.s.) on all surfaces tested in both Unguja and Pemba.

• ZAMEP conducted routine entomological monitoring activities across 10sites in Zanzibar—four in Pemba and six in Unguja.

Activity 2.3: Pilot and test new entomological monitoring approaches

• No activities planned for Y1.

Activity 2.4: Provide equipment and supplies for entomological monitoring

• OMDM procured entomological equipment and supplies procured onbehalf of NIMR Mwanza. All equipment and supplies for field work weredelivered; 85% of polymerase chain reaction (PCR) consumables andother reagents will be delivered by the second week of April.

• ZAMEP procured all supplies and equipment required to facilitateentomological monitoring activities in Unguja and Pemba.

Activity 2.5: Entomological investigation and response in hot spot areas/active foci (Zanzibar only)

• Planned for Q3.

Activity 2.6: Training of new entomological field team in new emerging hot spots (Zanzibar only)

• Planned for Q3 and Q4.

Activity 2.7: Strengthen national malaria vector control strategies, policies, and guidelines

• OMDM and vector control partners (e.g., Abt Associates (VectorLink),Johns Hopkins University Center for Communications Program(VectorWorks), and Swiss TPH) participated in TWGs providing inputs onIRS sites and resistance study selection sites.

Result 3: Drug efficacy monitoring is improved

Activity 3.1: Develop a TES toolkit

• The process to harmonize TES supervision tools developed by PMI, WHOand MUHAS began on March 29, 2019, during the TES TWG.

• Awaiting final report from March 2019 ZMEAC meeting to incorporate theCommittee’s recommendations before initiating TES in Zanzibar.

Activity 3.2: Plan, monitor, and implement TES

• Participated in TES TWG on March 27, 2019; selected sites for 2019study, including Igombe, Nagaga and Kyela. Chamwino will not beincluded in the 2019 study due to the low number of patients recruited inthe 2017/2018 rounds; the NMCP is working with MUHAS and OMDM toidentify an alternative.

Activity 3.3: Provide equipment and supplies for TES

• MUHAS procured the needed equipment and supplies for TES 2019 undertheir FAA with OMDM.

Activity 3.4: Test efficacy of new antimalarial drugs

• No activities planned for Y1.

Activity 3.5: Strengthen national malaria case management strategies, policies, and guidelines

• Planned for Q4.

Result 4: GOT’s evidence-based decision-making is improved

Activity 4.1: Strengthen Tanzania’s capacity for state-of-the-art (SOTA) analysis and interpretation of surveillance, entomological, and drug efficacy data

• Supported DHIS2 training during an HMIS capacity building workshop ledby the Ministry of Health (MOH) in Zanzibar.

• Discussed incorporating malaria data into the national DHIS2 system withZAMEP

• Met with Field Epidemiology and Laboratory Training Program (FELTP)organizers to discuss upcoming courses in 2019. Cohorts begin in Mayand August, 2019—OMDM is continuously working with the NMCP andZAMEP to identify course participants.



Results Activity 4.2: Conduct SOTA analysis and interpretation of surveillance, entomological, and drug efficacy data

• Facilitated the NMCP’s data review meeting (March 28–30, 2019) for 93regional and district personnel from the Tanga region to capacitate them toexamine, interpret and present malaria data on a routine basis (e.g.,monthly, quarterly, and annually); improve its quality; and improve demandand use for decision-making. Participants agreed to hold monthly districtdata review meetings, use the MSDQI tool in routine supervision, uploadresults in DHIS2, and use data to inform supervision visit planning.

Activity 4.3: Disseminate OMDM results through various channels

• Gave oral presentation (Case and foci investigation in the eliminationsetting of Zanzibar) at 7th East African Health and Scientific Conferenceon March 27–29, 2019, in Dar es Salaam.

• Drafted three abstracts to PMI for review prior to submission to theNovember 2019 Annual Meeting of the American Society of TropicalMedicine and Hygiene. Proposed abstract topics include Completeness ofmalaria reports submitted through the District Health Information Software2 (DHIS2) in 15 regions, 2013-2018; Electronic Integrated DiseaseSurveillance and Response (eIDSR) system completeness and timelinestowards malaria elimination in areas of very low transmission; and, Malariasurveillance in Zanzibar: patterns of case notification and investigation inline with WHO’s “1-3-7 days” approach.

Activity 4.4: Conduct study tours

• Zimbabwe study tour dates still pending confirmation from theMoHCDGEC.

Activity 4.5: Implement Learning Agenda

• Concept note submission planned for Q3.

2. Activity Implementation Progress

2.1 OMDM Start-Up

OMDM’s start-up activities were officially completed in Q2 with the onboarding and orientation of the full Activity team, including the hiring and transition of the Chief of Party (COP) role to on December 17, 2018. OMDM staff participated in several introductory meetings with key GOT stakeholders, in addition to hosting a kickoff meeting for internal and external participants. Additional start-up activities related to human resources (HR) and procurement were finalized in Q2. Start-up activity highlights are below.

2.1.1 Kickoff meeting

From January 21–23, 2019, OMDM staff hosted a kickoff meeting in Zanzibar and Dar es Salaam. The purpose of the meeting was to introduce the Activity’s vision, scope of work (SOW), objectives, and planned activities to internal and external stakeholders. From January 21–22, the OMDM team and representatives from RTI’s home office technical and management support team conducted an internal meeting to officially transfer the Activity’s history, scope, and vision to the local project team and to build the “one team” approach between local and home office RTI staff supporting OMDM. On January 23, external stakeholders were invited to the final day of the kickoff meeting to gain a deeper understanding of OMDM’s SOW and their role to ensure achievement across the Activity’s four result areas.

2.1.2 Formal Activity introduction to GOT partners

Work Planning Meeting with NMCP and ZAMEP

OMDM held a work planning meeting with the NMCP (February 21–22, 2019) and ZAMEP (March 13, 2019). Participants included representatives from the US President’s Malaria Initiative (PMI), NMCP, ZAMEP, MUHAS, NIMR Mwanza, Swiss Tropical and Public Health


Institute (Swiss TPH), and OMDM. OMDM provided a detailed explanation of activities planned for Y1; a significant focus was on the Activity’s support to existing NMCP and ZAMEP activities to identify timelines, deliverables, and forge a common way forward.

OMDM staff provided a brief orientation to NMCP staff on RTI’s funding and procurement requirements and procedures to ensure compliance with RTI and USAID regulations. Meeting participants also discussed the inability of the NMCP to receive and implement a FAA from OMDM due to structural challenges, which makes it difficult to facilitate funds disbursement for NMCP-specific activities. USAID | Tanzania and PMI agreed that OMDM will directly fund NMCP activities as opposed to issuing the FAA as originally intended.

Meeting with ZAMEP

In a meeting with ZAMEP on March 13, 2019, OMDM and ZAMEP agreed to revive the Malaria Surveillance TWG. The first meeting is anticipated for Q3; OMDM is currently reviewing the TWG’s ToR.

OMDM and ZAMEP staff discussed the need for an external audit due to the planned total disbursement of funds for Y1 exceeding $750,000. OMDM is investigating potential external audit firms and will coordinate with ZAMEP to finalize selection and confirm the audit dates.

HMIS/DHIS2 meetings in Dodoma

From March 7–8, 2019, OMDM staff traveled to Dodoma to meet with relevant HMIS and DHIS2 coordinating bodies. OMDM’s COP and ICT Specialist met with representatives from the President’s Office—Regional Administration and Local Government (PORALG), ICT, HMIS, and Epidemiology units within the MoHCDGEC. The aim of the visit was to formally introduce OMDM and discuss areas of collaboration to strengthen the GOT’s health information systems. The ICT and Epidemiology Units shared information on the eIDSR platform and challenges hindering its functionality, including infrequent system updates and enhancements, reliance on donor support to fund short message service (SMS) bundles for mobile data transmission, and inadequate staffing within the MoHCDGEC to support the eIDSR. The ICT Unit also requested that OMDM explore avenues to support improvements to the eIDSR—specifically requesting development of a mobile application to facilitate data collection and transmission from health facilities.

The PORALG requested support from OMDM to assist with analysis of short-term outcomes from a larvicide exercise completed by local governments in 2018 to understand the impact of the exercise on the number of malaria cases reported. OMDM agreed to schedule a follow-up meeting with senior leaders of the PORALG to introduce the Y1 work plan.

MSDQI meeting

On February 18–20, 2019, the NMCP led a meeting in Bagamoyo to share progress with partners on the status of the development of the MSDQI Mobile app to representatives from malaria partners including the World Health Organization (WHO), Boresha Afya, Tulonge Afya, Swiss TPH, UDSM, and the NMCP’s Epidemiology Unit. During this meeting, OMDM was provided the opportunity to introduce the scope of Activity and its four technical result areas.

OMDM overview to USAID | Tanzania’s Office of Assistance and Acquisition (OAA)

On March 12, 2019, OMDM presented the Y1 work plan to representatives from USAID | Tanzania’s OAA and PMI teams, including the Activity’s AO, Environmental Compliance Advisor, visiting PMI Advisor from Washington, DC, and local PMI team. The presentation provided an overview of OMDM, highlighting the Activity’s four result areas, planned activities, and anticipated outcomes over its lifetime. Discussions focused on risk mitigation, which is pertinent given that OMDM’s success largely depends upon the performance of the Activity’s numerous subrecipients. USAID | Tanzania recommended that future annual work plan presentations include only tangible outcomes for the year and reminded OMDM of the


importance of regularly including updates against the Activity’s Environmental Monitoring and Mitigation Plan (EMMP) in deliverable reports.

HR

In Q2, OMDM initiated recruitment of the Senior Technical Advisor position to lead activities under Results 2 and 3. Despite extensive negotiations, the preferred candidate did not join OMDM’s team. Due to the urgency of the position to assist activities with the NMCP and ZAMEP under Results 2 and 3, OMDM recruited a consultant to begin working with the project in Q3. We will continue our recruitment efforts to permanently fill this vacancy, with a goal of having the final candidate in place by Q4.

OMDM is also actively recruiting a driver; we anticipate this position will be filled in Q3.

Procurement

OMDM completed procurement of the Activity’s vehicle and minor equipment and supplies (e.g., laptops, monitors, workstations, etc.), and supported procurement of entomological equipment and supplies for subrecipient NIMR Mwanza. The COP underwent procurement training to receive official Delegation of Authority from RTI’s home office.

Memoranda of Understanding (MOUs) with GOT stakeholders

OMDM circulated draft MOUs between the Activity and GOT stakeholders, including PORALG, NMCP, and ZAMEP. Feedback from USAID | Tanzania and each stakeholder was incorporated into the final drafts. The Activity is waiting for the official modification updating its name change prior to finalizing the MOUs; it is anticipated the MOUs will be signed early in Q3.

Subawards

In Q2, OMDM initiated FAA subawards with MUHAS, UNC, and ZAMEP. The Activity issues letters of authorization (LOAs) to MUHAS and ZAMEP, which allow immediate initiation of work while MSAs for each were under development. The Activity is waiting to receive supporting documentation from UNC to finalize its FAA; we anticipate the LOA will be issued early in Q3. In the reporting quarter, MSAs were finalized with NIMR Mwanza Centre and NIMR Amani.

A second FAA for ZAMEP’s activities on case management and diagnosis is under development. OMDM requested approval from USAID for the second LOA totaling $200,000; it is currently pending approval by USAID. While awaiting approval, OMDM is directly funding activities on behalf of ZAMEP; discussions are ongoing around other funding mechanisms (e.g., cost reimbursable) given the ceiling thresholds of the FAA.

2.2 Result 1: Malaria Surveillance is Improved

Result 1 activities focus on the first major element of UTM’s Results Framework: disease

surveillance. In Y1 Q2, OMDM was formally introduced to the MoHCDGEC, M&E, ICT, and

Epidemiology Units on mainland Tanzania and MOH and ZAMEP in Zanzibar, in addition to

participating in key TWGs focused on Result 1 activities.

MAINLAND TANZANIA

2.2.1 Activity 1A.1: Engage in wider HMIS/DHIS2 community

Serve as members of and participate in relevant HMIS/DHIS2 coordinating bodies

Progress in Q2, Y1

On March 21, 2019, OMDM’s ICT Specialist participated in the M&E, ICT, and HMIS TWG organized by the MoHCDGEC. This was the first meeting of the TWG since November 2018. Representatives from the NMCP, PORALG, and other key stakeholders discussed M&E and ICT activities in malaria, HIV, and tuberculosis interventions. Management Sciences for


Health presented updates on the district health profile that was rolled out to 52 districts, including key messages on health sector and governance activities within each district. The TWG agreed that OMDM will participate in all future M&E and ICT TWG meetings.

Planned activities for Q3

In addition to OMDM’s continued representation in and contributions to quarterly M&E and ICT TWG meetings, the Activity will convene a stakeholders meeting with representatives from the NMCP and Epidemiology, HMIS and ICT units to discuss the repositioning of malaria within the eIDSR.

Support the NMCP in future review and updates of health sector strategic, policy, and technical documents

Progress in Q2, Y1

OMDM provided TA to support the NMCP in the review, modification, and integration of their general supervision checklists (e.g., logistics, antenatal care [ANC] tracker, LLIN distribution, Council Health Management Team [CHMT]/Regional Health Management Team [RHMT] checklists, etc.) with the MSDQI package to avoid effort duplication, reduce staff workload and improve the quality of data collected.


Although the majority of existing checklists were integrated with the MSDQI through TA provided in Q2, the process is ongoing. In Q3, OMDM will continue working with the NMCP and partners to finalize harmonization of supervision checklists by the end of the quarter.

2.2.2 Activity 1A.2: Support HMIS/DHIS2, eIDSR, and malaria surveillance implementation

Support HMIS/DHIS2 and eIDSR implementation by providing ICT support, as needed, in line with Tanzania’s eHealth strategy and inter-ministerial efforts for interoperability of systems

Progress in Q2, Y1

From February 6–8, 2019, OMDM participated in the NMCP’s orientation and field testing on the newly-developed MSDQI Mobile Application (app), developed by UDSM and linked to the DHIS2 Touch platform. During the orientation, OMDM and attendees from the NMCP, Boresha Afya, and Swiss TPH were provided with background on the current status of MSDQI implementation and the potential of electronic applications to improve supervision and data management for future MSDQI supervision visits.

Participants also reviewed and improved MSDQI checklists assessing malaria services across five areas: (1) OPD, (2) in-patient department (IPD), (3) ANC, (4) logistics, and (5) microscopy. OMDM and partners tested the app in two health facilities (Morogoro Regional Hospital and Saba Saba Health Center) and provided feedback to the developers on key system and performance issues.


OMDM will provide TA to the NMCP in coordination with other key implementation partners to finalize the MSDQI app, including conducting further field testing following phase 1 improvements to the app by UDSM. Field testing will be led by FHI360 with TA provided by OMDM.

Continuously engage with MoHCDGEC, NMCP, and other stakeholders to ensure HMIS/DHIS2 and eIDSR are functional and that data flow is adhered to in terms of timely collection and transfer of data, data completeness, and quality

Progress in Q2, Y1


OMDM discussed plans with the NMCP’s Surveillance, Monitoring and Evaluation (SME) Unit to reinstate the Malaria Surveillance TWG to support collaboration and discussions around the status of current malaria surveillance data sources and flow. OMDM determined that the TWG is still active, although scheduling challenges exist. Discussions between OMDM and the NMCP revealed that the SME Malaria TWG overlaps with the wider M&E and ICT TWG, which the MoHCDGEC convenes quarterly by the MOH, though both are necessary given their different areas of focus and participants. OMDM agreed to work with the NMCP to revive the SME Malaria TWG as it can dedicate more time and effort investigating current malaria surveillance activities.


In Q3, OMDM will work with the NMCP to facilitate an SME TWG meeting to review results from the eIDSR data analysis conducted by the Activity. The analysis aimed to assess eIDSR’s functionality in terms of completeness and timeliness of weekly malaria data reporting and understand differences in health facility reporting from districts with different malaria burden, identified through the NMCP’s malaria stratification maps. Initial findings show that in low malaria burden areas, weekly reporting is of higher quality than in districts with higher malaria burden. These findings will be used to determine how to best improve functionality of the eIDSR.

Facilitate monthly MoHCDGEC/NMCP data use workshops to review, analyze, and interpret epidemiological and programmatic data reported through the HMIS/DHIS2 and eIDSR, including pause and reflect sessions to identify trends, bottlenecks, and action items

Progress in Q2, Y1

OMDM, in collaboration with the NMCP and ZAMEP, identified priority topics for monthly data review workshops and developed a training plan and materials with a focus of building on and leveraging recently-developed DHIS2 dashboards reporting on programmatic malaria data.


The first monthly data review workshop is scheduled for April 3–4, 2019. It will focus on the Open Data Kit software for use in upcoming school malaria parasitemia surveys to allow the NMCP to transition from paper-based to electronic data collection. Future data review workshops on mainland Tanzania will include a review and analysis of data collected through the malaria dashboard to enhance the skillsets of the NMCP’s SME team in data demand and use.

Maximize the use of the recently developed malaria interactive dashboard within DHIS2 by improving its DHIS2 user-friendly interface and stimulating its use at all levels

Progress in Q2, Y1

In Q2, OMDM’s Surveillance and Monitoring, Evaluation, Research, Learning, and Adapting (MERLA) Director and OMDM’s Data Scientist received official access to the DHIS2 from the HMIS Unit within the MoHCDGEC. With this, the Activity can regularly review, analyze and discuss routine HMIS malaria-related data with the NMCP and other implementing partners.

On March 27–30, 2019, OMDM provided TA to the NMCP to conduct a malaria data review meeting in the Tanga region for 90 participants, including RHMTs and CHMTs from all 11 councils. Participants were oriented on the updated version of the DHIS2 malaria dashboard, including navigating different tabs and filters, generating and downloading reports, and inserting charts to specific district profile templates designed by the NMCP. During the meeting, all the districts downloaded their data and populated their profile templates, after which CHMTs presented and discussed findings and interpretations in plenary sessions.


This hands-on exercise supported teams to review their district and regional data and use the findings to improve data quality reported and allow follow-up with health facilities reporting abnormal findings. For example, in Korogwe District Council (DC), health facilities reported more confirmed malaria cases than the test rate; CHMTs agreed to investigate the discrepancy. In Lushoto DC, one health facility had a higher artemether-lumefantrine dispensing rate than other facilities, prompting an investigation by the CHMTs in this district.


OMDM will continue supporting the NMCP to conduct data review meetings for other councils in six regions through the remainder of Y1.

Promote a malaria commodities accountability tool through the integration of the existing electronic logistic management information system (eLMIS) and service delivery information (HMIS/DHIS2)

Progress in Q2, Y1

During a meeting led by the NMCP in Bagamoyo on February 20, 2019, OMDM learned of the integration of the eLMIS and DHIS2 by the MoHCDGEC through deployment of the health information mediator (HIM), a third-party system allowing for integration of two other systems enabling them to “speak” to one another. Integration of eLMIS and DHIS2 is complete; final system activation is currently awaiting approval from the MoHCDGEC.

OMDM also learned during the meeting that PORALG is rolling out the GOT Hospital Management Information System, which collects health facility-level malaria data and is linked with the DHIS2. A formal data exchange is pending agreement between the MoHCDGEC and PORALG.

The head of the SME Unit agreed to collect and disseminate additional information about opportunities offered through the addition of these accountability tools.


OMDM will work with the SME team to explore eLMIS indicators selected for data exchange and compare them against existing accountability tools. Findings will be shared with the NMCP for discussion in relevant TWG in Q3.

Support the NMCP and other stakeholders in the implementation of the MSDQI framework by facilitating the interpretation and utilization of the outcomes of the routine supportive supervision activities

Progress in Q2, Y1

In addition to field testing the MSDQI Mobile App highlighted under activity 1A.2, OMDM participated in meetings to further refine the MSDQI checklists. Working with Swiss TPH, Boresha Afya, and the NMCP, OMDM modified questions in the checklists and improved the scoring mechanisms. The team also reviewed the MSDQI outputs within the DHIS2 malaria dashboard and suggested ways to improve the layout and presentation of findings for each service delivery point (e.g., OPD, IPD, ANC, microscopy, and logistics). UDSM is working to incorporate the proposed changes within the system and will share the updated app with the NMCP and other implementing partners before pre-testing.


In Q3, OMDM will pre-test the updated MSDQI Mobile App and continue supporting MSDQI supervision visits. Additionally, the Activity will promote additional discussions of MSDQI findings during council data review meetings.


Support the NMCP in data quality analyses (DQA) to identify data quality issues and support the routine supportive supervision and peer data review activities of region and district health management teams

Progress in Q2, Y1

DQA is currently well-captured within the MSDQI framework across all levels of health services. In collaboration with Boresha Afya, which conducts MSDQI in PMI-focused regions, the NMCP has increased its level of supervision to capture relevant information on services provided and data quality for non-PMI regions. With the finalization of the MSDQI App, electronic data capture from supervision visits to health facilities will greatly enhance the quality and timeliness of information generated and will allow for a national-level review of data based on elements recorded by health facilities in HMIS booklets and entered in DHIS2. In Q2, OMDM engaged with the NMCP to focus efforts to increase supervision visits and assess data quality based on health facility information.


OMDM will continue supporting the NMCP with MSDQI implementation and assess data quality assurance through results generated from supervisory visits. Outcomes will be formally documented in a DQA summary report highlighting key data quality findings. Additionally, OMDM will work with the PMI team to assess the quality of data recorded within the DHIS2 platform.

2.2.3 Activity 1A.3: Strengthen MoHCDGEC and NMCP outbreak response capacity

Support the MoHCDGEC/NMCP to define thresholds and triggers indicating malaria outbreak, including implementing them as predictors and automated notifications in eIDSR and DHIS2 and continuously monitoring and analyzing malaria data in the national DHIS2 system

Progress in Q2, Y1

During the feedback meeting in Bagamoyo on February 20, the NMCP provided updates on its current status. Although the eIDSR is now operating in 25 of 26 regions in mainland Tanzania, there are challenges related to the use of the system. For example, eIDSR fails to report abnormal events, despite being originally designed to do so; malaria indicators overlap with routine HMIS/DHIS2 reporting; the malaria component is not well-integrated in the standard eIDSR weekly reported conditions; and the outputs are not included in interactive DHIS2 malaria dashboards. The NMCP envisions improving the system by first repositioning malaria indicators within the weekly reports; improving alerts and notifications by ensuring the system actually responds to abnormal events of malaria cases reported by health facilities; and, within the eIDSR, develop a malaria case-based reporting system in low prevalence areas. Based on this feedback, OMDM has been discussing with the NMCP, Swiss TPH, and PMI the best ways to support the improvement of eIDSR.

In Q2, OMDM initiated a detailed review of eIDSR, with a specific focus on describing completeness and timeliness of data submitted through eIDSR stratified by malaria prevalence (very low <1%, low 1%<5%, moderate 5%<30%, and high >30%) and to ascertain its usefulness for malaria outbreak detection and CBS. Results from the review will align with the NMCP’s stratification and supplemental strategic plan and will be useful in decision-making around specific interventions. OMDM’s review and subsequent analysis of collected data will complement prior analyses completed by Tulane University under the MEASURE Evaluation.



OMDM will complete its review and analysis of the eIDSR and will convene the NMCP and partners to discuss ways forward, including the development of algorithms simulating thresholds and triggers based on defined epidemiological strata.

OMDM will also identify and work with other implementing partners responsible for system maintenance and mobile transmission of malaria case data from health facilities to ensure full functionality of the system and appropriate generation of alerts based on defined thresholds.

Determine potential linkages between DHIS2 and the Ministry of Education, Science and Technology’s School Information System (SIS) on malaria cases to confirm the timing and size of outbreaks

Progress in Q2, Y1

This activity was not planned / implemented this quarter.


In Q3, OMDM will engage key SIS stakeholders to assess the system’s functionality and determine its ability to track malaria-related data elements in support of NMCP interventions.

2.2.4 Activity 1A.4: Pilot MCN and reactive case follow-up in areas of pre-elimination

Share lessons learned from the MCN in Zanzibar and analyze technical alternatives in the Mainland context with the NMCP

Progress in Q2, Y1

In discussions with the NMCP and Swiss TPH, OMDM was made aware that mainland Tanzania is exploring opportunities to use eIDSR as the MEEDS and for CBS. The NMCP presented a diagram highlighting its intention to rollout the system in low prevalence areas earmarked for pre-elimination.

OMDM was advised by PMI not to engage with system development but instead provide TA to identify funding streams for the system’s eventual rollout and scale-up.


In Q3, OMDM will continue providing TA to the NMCP to determine how scale-up can be realized through funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria or other sources. The Activity will also continue our analysis of the eIDSR (see Activity 1A.2) and will share results with the NMCP and other malaria implementing partners to understand the system’s performance in different parts of the mainland based on the level of burden within districts. It is anticipated that the findings may help to determine optimal thresholds and triggers based on the epidemiological strata of the districts. The Activity will host a meeting with all stakeholders—PMI, NMCP, Swiss TPH and UDSM—to share findings and develop a roadmap for using the eIDSR platform and complement its use for proposed case-based surveillance currently under consideration by the NMCP for use in low malaria transmission settings.

Develop a protocol to pilot MCN in six Mainland districts, sensitize and collaborate with district-level CHMTs, and design a M&E approach to assess the feasibility and efficacy of MCN

Progress in Q2, Y1

This activity was not planned / implemented in the reporting period.


OMDM will provide TA to the NMCP to develop a protocol to use a case-based surveillance system in low malaria burden settings in mainland Tanzania. This action item is under


consideration by the NMCP, though current focus remains on analysis of eIDSR data and the development of algorithms sensitive enough to generate alerts based on the number of district cases.

Provide and support necessary hardware and software for MCN implementation, such as electronic tablets with open-source MCN software, and motorbikes, and train district-level health personnel in MCN use to fulfill the functions akin to those of DMSOs in Zanzibar

Progress in Q2, Y1



There are no activities planned for Q3. This activity will commence in Q4.

Provide supportive supervision to the NMCP and CHMTs during the implementation of MCN to resolve any operational issues

Progress in Q2, Y1




Support the NMCP to analyze the data of the MCN pilot, including assessing its cost-effectiveness for possible rollout to a larger operational scale

Progress in Q2, Y1




ZANZIBAR

2.2.5 Activity 1B.1: Support ZAMEP to update and implement the malaria surveillance strategy

Facilitate the creation of a Malaria Surveillance TWG to coordinate malaria surveillance and response system strengthening

Progress in Q2, Y1

In Q2, OMDM worked with ZAMEP to initiate the formation of a Malaria Surveillance TWG, including development of ToRs to guide the TWG, determine its constituency and frequency of meetings, and support its implementation.


The first Malaria Surveillance TWG meeting will occur in Q3, led by ZAMEP with TA from OMDM. During the first meeting, it is envisaged that participants will provide feedback on the draft ToR and identify agenda items for quarterly meetings through the remainder of Y1.

Work with the Malaria Surveillance TWG to develop a consensus strategy and phased implementation plan for strengthening the malaria surveillance and response system

Progress in Q2, Y1

OMDM works with ZAMEP to routinely implement surveillance activities, analyze existing data, and support MEEDS and MCN systems. Once the Malaria Surveillance TWG is functional, we will use it as a formal channel to disseminate progress and challenges


identified to support ZAMEP in managing all surveillance interventions. A priority area for close collaboration is the classification of malaria foci and response mechanisms based on meaningful thresholds for surveillance officers to further investigate cases.


In Q3, OMDM will continue providing TA to ZAMEP to enhance malaria surveillance systems and propose meaningful ways to respond to abnormal events. Specific focus will be given to data analysis to inform supporting increased resource allocations in higher transmission areas. Additionally, OMDM will provide TA to ZAMEP to conduct refresher trainings for district response teams and DMSOs, including training on the classification of malaria foci and response activities based on standardized thresholds.

Implement the plan and coordinate with other health information system strengthening efforts through the TWG

Progress in Q2, Y1

In Q2, OMDM reconciled malaria data collection parameters using the IDWE tool, the equivalent of eIDSR in Zanzibar. In collaboration with ZAMEP, the HMIS Unit, and the Directorate of Planning, Policy and Research within the Zanzibar MOH, OMDM worked to integrate malaria indicators within a weekly IDWE report. Malaria indicators on cases, LLINs, etc. will be recorded and entered directly into the DHIS2 platform by the health facilities. For example, health facilities previously reported malaria cases monthly through the HMIS and reported aggregated cases in MEEDS weekly, resulting in incomparable data within the two systems due to different reporting periods. By integrating malaria indicators into a weekly IDWE report, it is expected that malaria data quality and consistency will improve. If data quality and consistency improves, DHIS2 will make MEEDS redundant and could replace it in the future as the platform for weekly reporting of malaria cases.


In Q3, OMDM will continue providing TA to ZAMEP to compare DHIS2 outputs against current systems to ensure that once the change in reporting frequency is in effect, malaria indicators are reported as required and the data is of high quality.

Strengthen public and private sector facility malaria diagnosis capacity

Progress in Q2, Y1

In Q2, OMDM worked with USAID and ZAMEP to identify the appropriate funding mechanism to support ZAMEP’s case management activities. An FAA totaling $200,000 was submitted to USAID | Tanzania for approval in March 2019; OMDM anticipates that approval and the FAA will be finalized early in Q3. OMDM will directly fund ZAMEP’s activities in Q3 until approval is granted.


Once the FAA between OMDM and ZAMEP is in place, the following activities are planned for Q3:

▪ Conduct a 1-day training for 160 nurses and clinicians from Zanzibar’s main hospitals on proper blood smear preparation to equip staff with an understanding of standard procedures prior to sending slides to the laboratories for microscopic diagnosis;

▪ Conduct a comprehensive microscopy refresher training for 40 laboratory technicians from public health facilities;

▪ Provide routine supportive supervision at health facilities using malaria rapid diagnostic tests (mRDTs) to ensure compliance with diagnostic standard operating procedures (SOPs); and


▪ Support the procurement of PCR and enzyme-linked immunosorbent assay (ELISA)laboratory equipment and supplies.

Strengthen public and private sector facility malaria treatment capacity

Progress in Q2, Y1

This activity was not implemented in Q2 due to delays finalizing the FAA between OMDM and ZAMEP for case management activities.


Once the agreement between ZAMEP and OMDM is in place, the following activities are planned for Q3:

▪ Provide training to public and private health workers on Zanzibar’s 2018 MalariaTreatment Guidelines;

▪ Support the development of simplified job aides for clinicians and the community tosensitize case management interventions;

▪ Conduct supportive supervision visits at public and private health facilities;

▪ Conduct feedback meetings with District Medical Officers (DMOs), District LogisticsOfficers, and DMSOs; and

▪ Analyze availability, coverage, and rational use of primaquine in public healthfacilities.

Strengthen health facility and community social behavior change communication (SBCC) capacity

Progress in Q2, Y1/Planned activities for Q3

ZAMEP implemented a number of SBCC activities in Q2, as highlighted below.

• Technical meeting to review SBCC materials: ZAMEP conducted a 5-day meeting(March 11-15, 2019) for SBCC technical staff, including district authorities and stafffrom the Health Education Unit. The objective of the meeting was to review andupdate SBCC materials to incorporate recommendations from prior surveysconducted by ZAMEP and inputs from routine SBCC monitoring and supervisionactivities. Reviewed materials included posters, animated messages, standingbanners, traveler’s guide books, radio spots, and television public serviceannouncements.

In April 2019, ZAMEP will pre-test the first draft of the updated IEC and SBCCmaterials through TA from USAID’s Tulonge Afya project.

• Meetings with influential community leaders from informal seaports:Community leaders play a significant role supporting malaria elimination campaignsgiven their connections within their local communities. ZAMEP’s SBCC Unit hosted aseries of one-day meetings between March 4-15, 2019 for 240 community leadersacross Unguja and Pemba to update them on the implications of malariatransmission via informal seaports and to discuss malaria prevention methods amongtravelers. Participants represented seaports with high malaria prevalence and hotspots. ZAMEP requested participant support for existing malaria campaign activitieswithin their communities in addition to support identifying all informal seaports withintheir regions to district fisheries officers.

In Q3, ZAMEP’s SBCC Unit will produce and distribute SBCC materials to affectedseaports to increase awareness on malaria prevention with specific messages aimedat local travelers.

• Quarterly monitoring and supervision of LLIN distribution at health facilitiesand ANC clinics: In Q2, ZAMEP conducted monitoring and supervision visits at 63


health facilities and 83 shehia across four districts (Central, South, Micheweni, and Wete) to assess progress in the delivery of SBCC messaging and continuous net distribution within health facilities and communities. ZAMEP noted that all health facilities were implementing SBCC and net distribution activities as directed. Nets were in place with no risk of stockout, health education sessions were routinely conducted before the delivery of services, and net distribution was documented at the community level.

During these monitoring and supervision visits, ZAMEP identified that LLIN coupons for community members were not issued by Assistant Shehas in a few communities despite clear requirements from the MOH and ZAMEP. OMDM also observed that community members were delayed in collecting LLINs even after receiving coupons. Both challenges were discussed in feedback meetings following monitoring and supervision visits between ZAMEP, health facility staff, and Shehia leadership. As a result of these discussions, Shehia leadership committed to ensuring timely provision of LLIN coupons to eligible members. Community leaders agreed to further emphasize the importance of early LLIN collection at health facilities to community members. In Q3, ZAMEP will follow-up with health facility and Shehia leadership to measure changes in net distribution due to the recommitment of both groups to improve messaging around LLINs to community members.

• Malaria sensitization meetings to special institutions facing risk of malaria infection (boarding schools, military barracks, fishing camps, etc.): ZAMEP invited 269 participants from 11 districts to participate in dialogue meetings to discuss a wide variety of topics including malaria prevention among travelers, continuous net use, and ensuring cleanliness of living and working spaces to eliminate mosquito breeding sites. Participants included Shehas from hot spot areas and their assistants. Two key messages were shared for onward dissemination to participants’ respective communities: (1) use of LLINs is one of the most important things you can do to protect yourself from malaria, and 2) LLINs are safe and do not pose a health risk.

• Quarterly feedback meetings with district SBCC rapid response teams: In Q2, ZAMEP hosted 240 SBCC rapid response team members, including Shehas from 11 hot spot districts in Zanzibar, to share information on the status of SBCC activities and discuss specific interventions design to reduce malaria transmission in these areas. Participants requested that district health promotion officers make an extra effort to ensure that IEC materials are distributed to target audiences in a timelier fashion.

In Q3, ZAMEP will continue SBCC work through its SBCC Unit, including plans to disseminate IEC materials targeting community members in April 2019. This will be in addition to closely monitoring and following up on the overarching SBCC SOW approved within ZAMEP’s Y1 work plan under OMDM.

2.2.6 Activity 1B.2: Develop interoperability between key HIS

Complete ongoing electronic interoperability efforts between MCN and DHIS2 to enable ZAMEP to compare, analyze, and visualize data from multiple sources in DHIS2, including the ability to automatically generate necessary program and data elements in DHIS2

Progress in Q2, Y1

In Q2, OMDM continued providing TA to ZAMEP to improve the MCN platform. Although MCN is able to export data to the DHIS2, the team also explored possibilities to automate the upload of aggregated data directly into the DHIS2. However, Zanzibar’s DHIS2 platform is currently undergoing a significant system enhancement and upgrade with limited TA from OMDM. Once DHIS2 is stable, the Activity will collaborate with the HMIS Unit to determine appropriate sources for relevant indicators and ensure their inclusion and agreement with


other malaria data. OMDM will facilitate training to local ZAMEP and ICT and HMIS Unit staff to maintain MCN.


In Q3, OMDM will continue exploring possibilities to automate data into the DHIS2. RTI’s Senior Mobile Applications Developer will continue working with OMDM’s Surveillance and MERLA Advisor, ICT Specialist, and Data Scientist to transfer knowledge around MCN platform maintenance. OMDM will also facilitate training to local ZAMEP and ICT and HMIS Unit staff to maintain MCN.

Link facility-level, blood slide microscopy to cases in the MCN to improve ZAMEP’s ability to monitor rapid diagnostic test (RDT) results

Progress in Q2, Y1



Upon finalization of the FAA between OMDM and ZAMEP, TA will be provided to link facility-level data related to blood slide (BS) detected cases identified through the MCN to improve ZAMEP’s ability to monitor mRDT results.

Link Zanzibar’s Integrated Logistic System (ZILS) to DHIS2 to improve ZAMEP’s ability to monitor and manage the supply of antimalarial drugs, RDTs, and insecticide-treated nets to health care facilities and districts

Progress in Q2, Y1

In Q2, ZAMEP further defined the challenges working within ZILS to collect malaria data due to its fragmentation and lack of linkages to the broader logistics system within DHIS2 in Tanzania. Discussions with key stakeholders around these challenges and mitigation techniques are ongoing.


In Q3, OMDM will work with ZAMEP and other key stakeholders to identify key challenges and propose solutions to establish linkages between ZILS and DHIS2.

2.2.7 Activity 1B.3: Enhance and strengthen MCN ICT architecture and sustainability

Add IRS village-level threshold settings and associated data visualizations and alerts to the MCN and new focal area screen-and-treat data collection forms and reports to improve ZAMEP’s ability to implement, monitor, and adjust this protocol

Progress in Q2, Y1

OMDM recommended enhancements to MCN during discussions with ZAMEP in Q2, including the addition of IRS alerts.


In Q3 and for the remainder of Y1, OMDM will work closely with ZAMEP to review, discuss, modify, and implement recommended enhancements to MCN.

Integrate an advanced malaria transmission risk model with MCN through an application programming interface to enable ZAMEP to adjust malaria case response efforts using more recent and accurate transmission risk estimates

Progress in Q2, Y1





Continue to adapt and enhance MCN reports and data visualization to meet emerging ZAMEP needs, including determining whether concepts and lessons learned from implementing the NMCP Dashboard in DHIS2 on Mainland Tanzania could be transferred to Zanzibar

Progress in Q2, Y1

In Q2, ZAMEP and HMIS Unit staff were provided a demonstration of the existing NMCP Malaria Dashboards which outline programmatic and action-oriented data visualizations of key malaria indicators related to OPD, IPD, Reproductive and Child Health (RCH) and commodity management. With TA from OMDM, ZAMEP will adopt and transfer the NMCP Malaria Dashboard to the national DHIS2


In Q3, OMDM will continue providing TA to ZAMEP to adopt and transfer the NMCP Malaria Dashboard to the MCN platform of the national DHIS2 and implement recommended system enhancements to improve data visualization products. Proposed system enhancements include enhanced maps showing imported and local malaria cases; DMSO performance, including follow-up rates; and, case classification by district and Shehia. Specific focus will be on building ZAMEP’s capacity to continue implementing recommended enhancements to the MCN and DHIS2 systems and ensuring new changes are reflected in data visualization products.

Improve MCN sustainability by replacing MEEDS for new case notifications, update and improve MCN documentation for technical support and SOPs, transfer routine MCN technology support responsibilities to ZAMEP through mentoring, develop local MCN software development and support capacity, and transfer Tier 1 MCN software development and support responsibility to the HMIS Unit or a local private sector ICT service provider

Progress in Q2, Y1

OMDM met with ZAMEP, the HMIS Unit, and Directorate of Planning to develop strategies aimed to address data inconsistencies and how the MOH can do away with fragmented data collection systems (e.g., MEEDS and IDWE). All parties agreed that all malaria data (e.g., cases, laboratory results, LLIN distribution, etc.) will be reported weekly by health facilities through the national DHIS2. OMDM continues the development of new systems with a focus on local ownership to replace MEEDS,


OMDM and ZAMEP will continue monitoring weekly malaria data reported by health facilities to ensure there are no discrepancies between MEEDS and DHIS2 reporting before MEEDS is disactivated.

2.2.8 Activity 1B.4: Support MCN implementation

Provide software technology and equipment support to DMSO

Progress in Q2, Y1

In Q2, OMDM:

▪ Continued providing technology support and capacity building to ZAMEP to perform basic maintenance of MCN;

▪ Moved the MCN server to an upgraded service in a more secure facility, from Digital Ocean to Amazon AWS;


▪ Developed new interface for managing facilities and geographical hierarchy; OMDM had hoped this would come from DHIS2, but DHIS2 is not being updated quickly enough to meet ZAMEP’s needs;

▪ Fixed various bugs, including issues around new and existing DMSO user management; and,

▪ Finalized the agreement with Selcom to allow health workers to continue transmitting weekly aggregated malaria cases from health facility mobile phones.


In Q3, OMDM will continue providing TA to ZAMEP to maintain the MCN platform. Additionally, ZAMEP will procure equipment, including motorbike spare parts, tablets, mobile airtime, and internet data bundles for DMSOs to facilitate field case follow-up.

Discuss with ZAMEP how to mobilize additional resources during peak transmission season

Progress in Q2, Y1

In Q2, OMDM provided an analysis outlining gaps in DMSOs per district in Zanzibar, leading ZAMEP to recruit additional DMSOs to meet the goal of ensuring 90% of malaria cases are investigated and classified during peak transmission season.


OMDM will continue supporting ZAMEP to monitor the impact of additional DMSOs during peak transmission seasons and will provide feedback to ZAMEP to facilitate informed decision-making. It is expected that having additional DMSOs during peak transmission will improve client follow-up and reporting.

Continuously engage with ZAMEP and DMSOs to ensure MCN is functional and data flow is adhered to in terms of timely collection and transfer of data, data completeness, and quality, and that reactive case follow-up occurs within stipulated time windows

Progress in Q2, Y1

In Q2, OMDM continued providing TA to ZAMEP to monitor MCN and MEEDS data as part of the Activity’s efforts to ensure data completeness, accuracy, and timely submission was achieved. Q2 activities included the following:

▪ OMDM provided TA to ZAMEP to conduct an analysis of reporting completeness and timeliness using updated dashboards from MCN to all health facilities in-charge and DMOs during the MEEDS and MCN health facilities feedback meeting (March 23-24, 2019).

▪ ZAMEP provided bi-weekly feedback to DMSOs and supported troubleshooting efforts to resolve data cleaning challenges observed in the field.

▪ Under their FAA with OMDM, ZAMEP conducted supportive supervision visits to households that had been previously visited by DMSOs to address issues around loss-to-follow-up during case investigation. The primary reasons for loss-to-follow-up include poor documentation, unavailability of people, and incorrect addresses provided. Other challenges noted included DMSO’s late reporting of identified malaria cases, delayed case notifications, and untimely case investigations. Faulty equipment (e.g., phones and tablets) was also listed as a factor in the observed late reporting.

Challenges related to poor documentation will be addressed by ZAMEP during future supervision visits during which health facility documentation will be reviewed and feedback provided to the DMSOs, including reiterating the importance of their


review of case notification documentation to ensure notification of all malaria cases. ZAMEP’s SBCC Unit will add messaging around the importance of clear and accurate documentation in their messages to the community; to this end, two radio spots were aired in February and March 2019 to raise awareness on the importance of follow-up in two districts. Faulty equipment was replaced during feedback meetings held in March involving ZAMEP, DMSOs, lab personnel, DMOs, private boards, and the HMIS Unit in Unguja and Pemba.


In Q3, OMDM will continue providing TA to ZAMEP to support analysis of MCN and MEEDS data, timely data delivery, completeness, and consistency. ZAMEP will lead capacity building efforts with TA from OMDM to improve data analysis techniques among SME Unit staff. Data from DMSOs will be verified through separate field and household visits.

Facilitate monthly ZAMEP data use workshops to review, analyze, and interpret epidemiological and programmatic data reported through DHIS2 and MCN

Progress in Q2, Y1

ZAMEP, with TA from OMDM, conducted a monthly data use workshop in Pemba. The workshop was facilitated by OMDM staff and ZAMEP’s Pemba-based SME team, and was attended by 8 DMSOs in Pemba. OMDM took advantage of USAID’s scheduled visit to Wete hospital on March 20, 2019 and invited the DMSOs to ZAMEP’s Pemba office in Wete to assess data collected using MCN’s analytics dashboard. Although case follow-up has improved despite existing issues with MCN (e.g., missing notification to DMSO mobile phones, case identification conflicts, etc.), other challenges were identified. These included a high number of loss-to-follow-up due to incorrect address information provided by patients and aged equipment used by the DMSOs (e.g., motorcycles, tablets, phones, etc.).


In Q3 and through the remainder of Y1, OMDM will continue providing TA to ZAMEP to conduct monthly data use workshops and resolve identified challenges. The next 2-day workshop is scheduled for the first week of May 2019 and will focus on the use of geographic information systems for ZAMEP’s SME staff to equip the team to map malaria cases for dissemination in weekly reports circulated to program staff and key stakeholders.

2.2.9 Activity 1B.5: Refine operational thresholds and triggers as MCN data is analyzed

Use MERLA approach to continuously support ZAMEP to assess sensitivity and specificity of thresholds and triggers, and change and adapt, as appropriate, to further increase interventions’ programmatic effectiveness

Progress in Q2, Y1

OMDM acknowledges the need to revise existing operational thresholds to sensibly trigger response activities; the team awaits ZMEAC’s recommendations to identify a clear path forward.


Upon receipt of the final ZMEAC report expected by May 20, 2019, OMDM will provide TA to ZAMEP to establish foci definitions and databases and conduct analyses to generate sensitive thresholds reflecting different levels of malaria transmission settings to help the country implement effective response activities and help drive malaria elimination.


Collaborate with ZAMEP, PMI, and stakeholders to update, as necessary, guidance and intervention strategies to prevent and respond to the emergence of case clusters at village or Shehia level

Progress in Q2, Y1



Upon finalization of the ToR to revise the Malaria Surveillance TWG (anticipated in Q3), OMDM will collaborate with other key stakeholders to operationalize ZMEAC recommendations and determine strategies and interventions to respond to emerging case clusters at the foci level.

Conduct active case detection (ACD) and foci investigation

Progress in Q2, Y1

In Q2, ZAMEP conducted ACD in three locations: Kiponda in Urban district, North A, and Shumba in Pemba. ZAMEP chose these locations based on their increased reporting of malaria cases following a lack of cases in the previous year. Results follow in Table 2.

Table 2. Active Case Detection Results, January–March 2019

District Shehia/Village Target Total

Screened Positive

Magharibi A Bumbwisudi 185 183 1

Kati Uzini 179 167 1

Mjini Haile Selassie School 100 98 0

Chake Ndagoni 501 495 4

Shungi 251 221 2

Total 1,216 1,164 8


ZAMEP continues to actively verify village lists for existing data (ongoing since 2013) and will engage community leaders to conclude this activity in Q3. Verification is required to facilitate accurate identification of malaria foci for targeted interventions. Once completed, OMDM will provide TA to ZAMEP to identify and classify all malaria foci to strengthen the implementation of response activities.

2.2.10 Activity 1B.6: Develop strategy and implementation plan to minimize malaria importation

OMDM did not initiate the proposed tasks under Activity 1B.6 during Q2, Y1. Per the Activity’s approved Gantt chart in our Y1 work plan, activities will be initiated in Q4.

2.3 Result 2: Entomological Monitoring is Improved

Entomological monitoring activities continued in Q2 Y1, led by NIMR Mwanza and NIMR

Amani in mainland Tanzania and were initiated by ZAMEP in Zanzibar following the

February 2019 IRS campaign. An entomology and TES consultant was identified by OMDM

and will begin supporting the Activity in Q3.


2.3.1 Activity 2.1: Compile and review entomological monitoring data

Carry out a desk-based review of all entomological monitoring efforts in the past decade in Tanzania

Progress in Q2, Y1

In Q2, OMDM identified a local consultant to initiate work under this activity. The consultant’s SOW includes conducting a desk-based review of entomological monitoring efforts in Tanzania in addition to compiling and organizing available historical and current data, including that collected during the OMDM proposal effort and under the Tanzania Vector Control Scale-up Program.


The consultant will begin this SOW in Q3.

Review entomological monitoring sites and their current operational and analytical capacity to successfully conduct entomological monitoring

Progress in Q2, Y1



This activity will commence in Q4.

Provide TA to NMCP for entomological monitoring and data analysis

Progress in Q2, Y1



Work under this activity will commence in Q3 with the support of OMDM’s Entomology and TES Consultant.

2.3.2 Activity 2.2: Conduct entomological monitoring planning and implementation

Entomological surveillance, including Anopheles mosquito vector distribution, density, seasonality, biting behavior, human blood index, sporozoite rate, and entomological inoculation rate

Progress in Q2, Y1

NIMR MWANZA. Anopheles mosquito vector distribution and density. NIMR Mwanza collected 1,989 female Anopheles mosquitoes between January and February 2019. Of these, 1,345 (67.9%) were morphologically identified as An. gambiae complex; 500 (25.3%) An. funestus complex; and 135 (6.8%) as An. coustani. Observed An. coustani (n = 135) were from Chato (n = 28), Missenyi (n = 52), Bukoba rural (n = 17), Magu (n = 20), Buchosa (n = 5), and Kakonko (n = 13). A total of 1,057 (53.4%) of the female Anopheles collected were captured using CDC light traps (CDC-LT); 195 (9.8%) using Prokopack aspirator; 229 (11.6%) by clay pot; and 499 (25.2%) from CDC-LT with bottle rotator. An. gambiae complex was the most abundant vector species sampled via all collection methods in each district.

Sporozoite rates. Overall, sporozoite rates were found to vary across sentinel districts, ranging from 0% to 3.3%, with a mean sporozoite rate of 1.1% in study areas. The sporozoite rate was considerably lower at 0.5% (95% CI: 0.2-1.1; 6/1,151) in the sprayed sites vs. 2.3% (95% CI: 1.2-3.9; 13/571) in non-sprayed sentinel sites (p = 0.0007). An. funestus s.s. had a higher sporozoite rate at 2.8% (95% CI: 1.4-4.9; 11/398) followed by An. gambiae s.s., at a rate of 1.1% (95% CI: 0-5.8).


Biting behavior. There was a general decrease in indoor biting rates in Chato and Missenyi following IRS conducted between October 2018 and February 2019; however, indoor biting rates significantly increased in Kakonko, reaching 10.5 bites per person, per night between December 2018 to February 2019. The remaining IRS districts reflected low indoor biting rates throughout Q2. In unsprayed sites, indoor biting rates for both An. gambiae s.l. and An. funestus s.l. increased across all sites. In Biharamulo district, there was a slight decrease in the biting rate of An. gambiae s.l. from December 2018 to January 2019, as compared to that of An. funestus s.l. Moreover, an increased indoor biting rate for An. funestus s.l. compared to An. gambiae s.l. was noted in Biharamulo and Kibondo districts between January and February 2019.

The An. gambiae s.l. biting rate was generally higher outdoors than indoors, both pre- and post-IRS in sprayed sites. In unsprayed sites, both indoor and outdoor biting rates were fairly consistent.

Please refer to the Entomological Monitoring Report Y1, Q2, submitted under separate cover.

ZAMEP. Under their FAA with OMDM, ZAMEP conducted entomological monitoring in Q2 at all 10 sites (4 in Pemba and 6 in Unguja) where 119 and 129 An. gambiae s.l. were captured using man-landing catches (MLC), pyrethrum spray catches (PSC), pit trap collection catches (PTC), and light trap catches (LTC). Table 3 identifies species and location data for mosquitoes captured across the various methods.

Table 3. Vector species and location data, ZAMEP entomological monitoring

Island Vector

Species

MLC PSC PTC LTC Total

Indoor Outdoor Pemba An. gambiae s.l. 31 65 0 23 0 119

Unbuja An. gambiae s.l. 12 32 0 85 0 129

Total An. gambiae s.l. 43 97 0 108 0 248

Tables 4 and 5 highlight malaria vectors collected between January and March 2019 per method and sentinel site in Zanzibar. The low numbers collected were influenced by dry seasons on the islands.

Table 4. Malaria vectors collected in Pemba

Island Vector

Species


Indoor Outdoor Uwandani An. gambiae s.l. 0 0 0 0 0 0

Bopwe An. gambiae s.l. 16 60 0 10 0 86

Tumbe An. gambiae s.l. 15 5 0 13 0 33

Wambaa An. gambiae s.l. 0 0 0 0 0 0

Total 31 65 0 23 0 119

Table 5. Malaria vectors collected in Unguja

Island Vector

Species


Indoor Outdoor Mwera An. gambiae s.l. 0 2 0 85 0 87

Bumbwini An. gambiae s.l. 0 3 0 0 0 3


Island Vector

Species


Indoor Outdoor Stonetown An. gambiae s.l. 0 0 0 0 0 0

DongeMcangani An. gambiae s.l. 1 13 0 0 0 14

Muyuni An. gambiae s.l. 0 0 0 0 0 0

Cheju An. gambiae s.l. 11 14 0 0 0 25

Total 12 32 0 85 0 129


In Q3, both NIMR Mwanza and ZAMEP will continue with comprehensive entomological surveillance activities as per their respective work plans.

Quality assurance and insecticide residual efficacy monitoring following IRS

Progress in Q2, Y1

In Q2, OMDM participated in an NMCP-organized meeting with vector control partners to identify new IRS districts to be sprayed in 2019. Participants selected the following districts: Kasulu, Kibondo, and Kakonko (Kigoma region); Geita DC (Geita region); Rorya (Mara region); Biharamulo (Kagera region); and Ukerewe (Mwanza region). The TWG also selected 22 new insecticide resistance study sites within the new districts in a follow-up meeting on March 26, 2019.

NIMR MWANZA. In Q2, NIMR Mwanza continued insecticide residual efficacy tests to evaluate clothianidin (SumiShield 50WG) for potential use in future IRS operations. Preliminary tests were conducted between January and February 2019 at 11 field sites on mainland Tanzania, seven of which were sprayed and four of which were control sites. Clothianidin continued to show efficacy on sprayed surfaces. Please refer to the Entomological Monitoring Report Y1, Q2, submitted under separate cover.

NIMR AMANI. In Q2, NIMR Amani developed training materials in collaboration with the NMCP for a planned refresher training for District Vector Control Officers to conduct insecticide resistance monitoring. Special focus was placed on harmonizing field methodologies/SOPs to equip fieldworkers with the necessary knowledge and skills for insecticide resistance monitoring.

ZAMEP. ZAMEP, through support from the PMI VectorLink project implemented by Abt Associates, conducted targeted IRS in Zanzibar for 3 weeks beginning February 23, 2019, across 127 shehias—101 in Unguja and 26 in Pemba. ZAMEP conducted IRS quality assurance activities in Zanzibar during the first week of the spray (February 23–27, 2019) and after the spray concluded (April 13–17, 2019) to assess quality and spray team performance. Results from quality assessments across the six shehias sprayed in Unguja and Pemba revealed that all IRS-treated and tested surfaces observed high mosquito mortality (100%) after 24 hours, indicating a quality spray and high performance of spraying teams. Insecticide residual efficacy will be assessed monthly from the final day of spraying until mosquito mortality falls below 80%.


NIMR MWANZA. NIMR Mwanza will continue assessing insecticide decay rates post-IRS on mainland Tanzania through cone wall bioassays through Q3 and the remainder of Y1.

NIMR AMANI. NIMR Amani will host a 4-day training workshop for field entomologists between April 15–18, 2019 to equip fieldworkers with the necessary skills to conduct insecticide resistance monitoring.


ZAMEP. In Q3, ZAMEP will continue assessing insecticide residual efficacy monthly until mosquito mortality falls below 80%.

Insecticide resistance monitoring in selected sites

Progress in Q2, Y1

NIMR AMANI. In Q2, NIMR Amani procured the required entomological equipment and supplies to conduct insecticide resistance studies at selected sites (Table 4), including WHO test kits and insecticide-impregnated papers.

Training materials were developed in collaboration with the NMCP for a planned refresher training for District Vector Control Officers to conduct insecticide resistance monitoring.

NIMR Amani contributed to a March 27, 2019, meeting during which the sites listed in Table 6 were selected for resistance studies in 2019.

Table 6. Revised districts for fiscal year 2018/2019 insecticide resistance monitoring

S/N Region District S/N Region District

1 Tabora♦ Igunga♦ 12 Morogoro♦ Kilosa♦

2 Tabora♦ Sikonge♦ 13 Kigoma Kakonko**

3 Simiyu♦ Bariadi DC♦ 14 Mtwara♦ Newala♦

4 Simiyu♦ Meatu♦ 15 Mtwara♦ Tandahimba♦

5 Kigoma Kasulu** 16 Mara Rorya**

6 Kigoma Kibondo** 17 Pwani♦ Kibaha DC♦

7 Lindi♦ Kilwa♦ 18 Shinyanga♦ Shinyanga DC♦

8 Lindi♦ Nachingwea♦ 19 Shinyanga♦ Ushetu♦

9 Geita Geita DC** 20 Kagera♦ Misenyi♦

10 Ruvuma♦ Nyasa♦ 21 Kagera Biharamulo**

11 Ruvuma♦ Tunduru♦ 22 Mwanza Ukerewe**

Note: ♦ newly-selected districts; ** newly-selected IRS sites


NIMR AMANI. NIMR Amani will host a 4-day training for field entomologists between April 15–18, 2019 to equip fieldworkers with the necessary skills to conduct insecticide resistance monitoring. Field teams will be deployed immediately following training.

Species identification using PCR technique

Progress in Q2, Y1

NIMR MWANZA. NIMR Mwanza conducted PCR analysis for species identification and ELISA

for sporozoite detection of 1,722 female Anopheles mosquitoes. PCR results confirmed the

local vector population to be predominantly An. arabiensis (60%), An. funestus s.s. (23.6%),

An. gambiae s.s. (5.4%), and An. parensis (0.9%); 10.1% of the samples were non-amplified

by An. gambiae complex and An. funestus complex specific primers. Please note—species

morphologically identified as An. coustani were not involved in species identification by PCR

due to a lack primers.

Preliminary analysis indicates that, overall, An. funestus s.s. had a higher sporozoite rate at

2.8% (95% CI: 1.4-4.9; 11/398) followed by An. gambiae s.s. at a rate of 1.1% (95% CI: 0-

5.8). One sample that was sporozoite positive could not be identified by PCR to the species

level, but were morphologically identified as An. gambiae s.l.


Figure 2. Species Composition in Sprayed and Non-Sprayed Sites


NIMR Mwanza will continue entomological monitoring studies in selected sites in Q3 and through the end of Y1.

Maintain Anopheles colony in NIMR Mwanza and ZAMEP insectaries

Progress in Q2, Y1

Both NIMR Mwanza and ZAMEP continued maintaining its Anopheles gambiae s.s. (Kisumu strain) in Q2. Production of adult mosquitoes was increased in order to meet the demands of field activities (i.e. IRS quality assessment and residual efficacy testing).


Insectaries and Anopheles colonies will be maintained in Q3 by ZAMEP and NIMR Mwanza.

2.3.3 Activity 2.3: Pilot and test new entomological monitoring approaches

No activity anticipated in Y1.

2.3.4 Activity 2.4: Provide equipment and supplies for entomological monitoring

Progress in Q2, Y1

NIMR MWANZA. In Q2, OMDM procured entomological equipment and supplies on behalf of NIMR Mwanza. NIMR Mwanza received 100% of supplies to be used in the field; 85% of the PCR consumables and other reagents will be received by the second week of April 2019 (Q3).

ZAMEP. Upon receiving the initial disbursement of funds from OMDM in Q1, ZAMEP procured all equipment and supplies required to facilitate entomological monitoring activities in Unguja and Pemba.


In Q3, OMDM will finalize the procurement and delivery of all outstanding entomological monitoring equipment and supplies on behalf of NIMR Mwanza.

2.3.5 Activity 2.5: Entomological investigation and response in hot spot areas/active foci (Zanzibar only)

Progress in Q2, Y1

No activities implemented during this reporting period.

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In Q3, as hotspot areas/active foci are detected, ZAMEP will conduct hot spot investigation and response activities.

2.3.6 Activity 2.6: Training of new entomological field team in new emerging hot spots (Zanzibar only)

Progress in Q2, Y1

No activities planned / implemented during this reporting period.


In Q3, ZAMEP will identify training needs for new field teams in emerging hot spots in Unguja and Pemba. It is anticipated that training will be conducted in Q4.

2.3.7 Activity 2.7: Strengthen national malaria vector control strategies, policies, and guidelines

Engage with the respective subcommittees and TWGs

Progress in Q2, Y1

In Q2, OMDM participated in and provided support to two vector control planning meetings related to national malaria vector control strategies, policies, and guidelines. The first meeting resulted in the final list of IRS sites for the next spray, while the second finalized insecticide resistance study sites. No TWG meetings were held on Zanzibar in the reporting period.


In Q3, OMDM will continue supporting vector control activities and will work with the NMCP and ZAMEP to resume TWG meetings by which to update stakeholders on activities undertaken.

Review and update relevant policy and technical guidelines

Progress in Q2, Y1



In Q3, OMDM will support dissemination of the mainland Tanzania’s Supplementary National Malaria Strategic Plan 2018–2020. The plan was developed in an NMCP-led process in consultation with key stakeholders and finalized in November 2018. It has been formally approved and is expected to be launched during Tanzania’s World Malaria Day commemoration (April 25, 2019).

2.4 Result 3: Drug Efficacy Monitoring is Improved

In Q2 Y1, OMDM finalized our FAA with MUHAS to support initiation and implementation of

TES. OMDM contributed to the TES TWG and identified an entomology and TES consultant

to begin supporting the Activity in Q3.

2.4.1 Activity 3.1: Develop a TES toolkit

Conduct a desk-based review of TES protocol and supporting documents and support the compilation of a country-specific TES toolkit

Progress in Q2, Y1

In Q2, OMDM identified a local consultant to review supervisory checklists and assist in compiling historical TES data from all institutions that have managed TES. Materials and


data collected will form the foundation of the TES toolkit to be developed in Q3 and Q4 of Y1.


In Q3, under their FAA with OMDM, MUHAS will conduct trainings and supervision meetings and implement TES studies from April 26–July 31, 2019.

Enter all historical and future clinical data in a DHIS2 database

Progress in Q2, Y1

In Q2, OMDM identified a local consultant to conduct a desk-based review of historical clinical TES data.


Beginning in Q3 and through the end of Y1, the consultant will conduct a desk-based review of historical clinical TES data. All data collected will be entered into the DHIS2.

Review TES sites and their current operational and analytical capacity to successfully conduct TES

Progress in Q2, Y1

In the TES TWG held in March 2019, the Chamwino site was deemed infeasible to participate in future TES due its low caseload and insufficient client pool. OMDM is working with the NMCP to analyze DHIS2 data and propose an alternate site in the central zone.

Agreed upon sites for 2019 TES activities include Igombe (implemented by Catholic University of Health and Allied Sciences), Nagaga (MUHAS), and Kyela (Ifakara Health Institute).


In Q3, OMDM will work with the NMCP and MUHAS to identify the fourth site for the 2019 TES. The TES will be initiated in each of the four sites, as highlighted in Table 7 below:

Table 7. 2019 TES Schedule

Activity Kyela Igombe Nagaga TBD

Training start date April 26, 2019 May 10, 2019 May 24, 2019 TBD

Recruitment initiated

May 6, 2019 May 20, 2019 June 3, 2019 TBD

Expected end of recruitment period

May 6, 2019 July 20, 2019 August 3, 2019 TBD

Expected TES end date

August 6, 2019 August 20, 2019 September 3, 2019 TBD

Review current number of TES sites

Progress in Q2, Y1

No activities were planned / implemented in this reporting period.


This activity will be initiated in Q4.

2.4.2 Activity 3.2: Plan, monitor, and implement TES

Mainland Tanzania: Plan, monitor, and implement TES

Progress in Q2, Y1


2018’s TES results indicated that artemisinin-based combination therapy (ACT) efficacy remains high at 92%; these results were disseminated during a TES TWG held March 28–29, 2019. Discussions during the TWG also focused on the harmonization of TES supervision checklists. The TWG conducted a review of MUHAS, PMI, and WHO’s existing checklists and agreed that MUHAS will initiate exercises to develop one comprehensive tool. The draft comprehensive tool will be reviewed during the next TWG planned for July 2019.

In 2019, TES will be led by MUHAS under an FAA with OMDM. Upon signature of their FAA, MUHAS immediately began ethical research clearance processes through the Commission for Science and Technology and NIMR. Amendments to the protocol will be made and submitted to NIMR for clearance following the decision of a replacement site for Chamwino; TES preparations will continue as planned for three already-identified sites.


In Q3, under their FAA with OMDM, MUHAS will finalize the comprehensive supervision checklist to be utilized in the 2019 TES activities. Training of field data collectors and health care workers will begin in Kyela on April 26, Igombe on May 10, and Nagaga on May 24.

Zanzibar: Plan, monitor, and implement TES

This activity is planned for Y2.

2.4.3 Activity 3.3: Provide equipment and supplies for TES

Progress in Q2, Y1

Upon signing its FAA with OMDM in Q2, MUHAS finalized the procurement of needed equipment and supplies for the 2019 TES activities.


In Q3, MUHAS will distribute equipment and supplies to each study site to start TES activities.

2.4.4 Activity 3.4: Test efficacy of new antimalarial drugs

There are no activities anticipated in Y1.

2.4.5 Activity 3.5: Strengthen national malaria case management strategies, policies, and guidelines

Engage with the respective subcommittees and TWGs

Progress in Q2, Y1

No activities were planned / implemented during this reporting period.


In Q3, OMDM will participate in case management TWGs, as organized by the NMCP.

Review and update relevant policy and technical guidelines

Progress in Q2, Y1

No activities were planned / implemented during this reporting period.


As needed, this activity will be initiated in Q4 following the results of the 2019 TES activities in coordination with the NMCP and the TES and case management TWGs.

2.5 Result 4: GOT’s Evidence-Based Decision-Making is Improved

UTM will support the GOT on mainland Tanzania and Zanzibar to ensure progress on their

paths toward malaria elimination through the strengthening of the NMCP and ZAMEP’s


capacity to analyze and interpret data and use this data for evidence-based decision-

making.

2.5.1 Activity 4.1: Strengthen Tanzania’s capacity for SOTA analysis and interpretation of surveillance, entomological, and drug efficacy data

Provide and/or support attendance of short courses

Progress in Q2, Y1

In Q2, OMDM identified potential short courses for interested applicants from the NMCP and ZAMEP to participate in (1) the MEASURE Evaluation workshop on SME of malaria control programs scheduled for June 24–July 25, 2019 in Ghana and (2) DHIS2 Academy training planned from July 15–20, 2019 in Dar es Salaam.


In Q3, OMDM will work with the NMCP and ZAMEP to finalize candidate selection for the Ghana SME Workshop and DHIS2 Academy training.

Support for Field Epidemiology and Laboratory Training Program (FELTP) trainees

Progress in Q2, Y1

In Q2, OMDM met with FELTP management and PMI to discuss training program options and potential support to be provided by the Activity. OMDM also engaged the NMCP and ZAMEP to identify potential trainee candidates for the FELTP.


In Q3, OMDM will work with the NMCP and ZAMEP to finalize the selection of FELTP candidates for the 3-month training beginning in August 2019. Additionally, OMDM will support one ZAMEP trainee to participate in the May 2019 FELTP.

Hold scientific stature/data analysis workshops

Progress in Q2, Y1



OMDM, in collaboration with the NMCP, will conduct a scientific stature, data analysis, and writing workshop from May 6–10, 2019. The Activity is taking advantage of the work initiated by Swiss TPH and the NMCP on malaria stratification and draft manuscripts. These scientific stature/data analysis workshops will additionally build the capacity of other staff from the NMCP and other implementing partners to write abstracts and use routine data to develop reports for further publication and dissemination.

Develop a malaria webinar series

Progress in Q2, Y1



In Q3, OMDM will initiate discussions on possible webinar series with key local partners and with support from RTI’s home office communications team.

Mentor and coach MoHCDGEC/NMCP and MOH/ZAMEP staff

Progress in Q2, Y1

OMDM has been providing continuous mentoring and coaching to the NMCP and ZAMEP through one-on-one engagements with team members, as well as through formal meetings


and workshops. With the initiation of monthly data use workshops, we hope to lend further support to the SME teams on both mainland Tanzania and in Zanzibar.


In Q3, OMDM will continue providing TA to ZAMEP for data analysis, interpretation, and use, as well as sharing surveillance reports through continuous review of DHIS2 data and MCN in Zanzibar.

2.5.2 Activity 4.2: Conduct SOTA analysis and interpretation of surveillance, entomological, and drug efficacy data

Progress in Q2, Y1

OMDM began work to establish a DHIS2 instance to monitor, manage and report out on Activity indicators, as identified in our Monitoring, Evaluation, and Learning (MEL) Plan. Discussions with RTI’s home office MERLA team advanced OMDM’s development of a Learning Agenda to identify key areas of support to the NMCP and ZAMEP, in addition to formulating key learning questions utilizing existing data for SOTA analysis.


In Q3, OMDM will complete the set-up of the Activity DHIS2 instance and begin populating it with key parameters, including entomological and TES indicators; the Learning Agenda be further refined with concept notes developed for OR addressing formulated learning questions

2.5.3 Activity 4.3: Disseminate OMDM results through various channels

Provide regular updates on SOTA analyses

Progress in Q2, Y1

Following receipt of official access to the DHIS2 in Q2, OMDM initiated an analysis of system data, including monitoring trends reflected in NMCP Malaria Dashboards.


OMDM is working with the NMCP and internally with technical staff to conduct a trend analysis of OPD, IPD and RCH malaria indicators reported between 2016 and 2018. Data will be downloaded from DHIS2 and formatted into posters for display during World Malaria Day celebrations on April 25, 2019.

Support drafting and disseminating programmatic updates

Progress in Q2, Y1

In Q2, OMDM provided support to the NMCP to develop, print, and disseminate the 2018 Malaria Surveillance Bulletin; this was the 7th issue of the bulletin, covering annual indicators between 2015 and 2018. The bulletin was designed by the NMCP to provide quarterly updates regarding malaria on mainland Tanzania. The bulletin targets health care providers and various malaria stakeholders and implementing partners.


In Q3, the NMCP will disseminate 10,000 printed copies of the 2018 Malaria Surveillance Bulletin to all regions, councils, malaria stakeholders, and implementing partners. OMDM will also share copies at World Malaria Day on April 25, 2019.

OMDM will continue supporting the NMCP and ZAMEP to draft and disseminate future Malaria Surveillance Bulletins.

Develop policy and advocacy briefs

Progress in Q2, Y1


This activity was not planned / implemented during the reporting period.



Linkages with data libraries

Progress in Q2, Y1



In Q3, OMDM will work with the NMCP and ZAMEP to explore linkages to vector control and other malaria data libraries to ensure the regular sharing of entomological and drug efficacy data with global malaria stakeholders, including through the WHO World Malaria Report, the African Network for Vector Resistance, the Worldwide Antimalarial Resistance Network, and the WHO Malaria Threats Map and IR Mapper database.

Attendance of national, regional, and international conferences and workshops

Progress in Q2, Y1

An abstract entitled “Case and foci investigation in the elimination setting of Zanzibar” was accepted for an oral presentation at the 7th East African Health and Scientific Conference on March 27–29, 2019, in Dar es Salaam. The abstract was submitted under sub-theme two of the conference: Technologies for Disease Surveillance, Disease Outbreak Detection and Response and Cross-border Mobility and Disease Tracking. Humphrey Mkali, OMDM’s Data Scientist, presented on behalf of OMDM.

For the American Society of Tropical Medicine and Hygiene Annual Meeting to be held in Washington DC in November 2019, OMDM initiated work to draft oral and poster presentation abstracts, as well as submitted a symposium concept on The Relative Importance of Migrant and Mobile Populations: a Challenge for Malaria Surveillance Systems and Intervention Targeting. Drafted abstracts (Completeness of malaria reports submitted through the District Health Information Software 2 (DHIS2) in 15 regions, 2013–2018; eIDSR system completeness and timelines towards malaria elimination in areas of very low transmission; and, Malaria surveillance in Zanzibar: patterns of case notification and investigation in line with WHO’s “1-3-7 days” approach) were submitted for review and clearance by NMCP, ZAMEP and PMI. Symposium concept includes a presentation by ZAMEP on The Role of Travel in the Context of Malaria Elimination in Zanzibar.


Following review and clearance by NMCP, ZAMEP and PMI, the three presentation abstracts will be finalized and submitted for the upcoming American Society of Tropical Medicine and Hygiene Annual Meeting scheduled for November 2019.

Manuscript submitted for peer-review

Progress in Q2, Y1




2.5.4 Activity 4.4: Conduct study tours

Progress in Q2, Y1

The NMCP’s plans for a study tour to Zimbabwe to review their routine malaria tracking practices and use of DHIS2 are on hold due to scheduling conflicts for Tanzania’s Minister of Health.



In Q3, OMDM will continue discussions with the NMCP to identify dates for the study tour to Zimbabwe.

2.5.5 Activity 4.5: Implement Learning Agenda

Progress in Q2, Y1

OMDM, in coordination with RTI’s home office-based MERLA team, began drafting the Activity’s Learning Agenda. Topics under consideration include travel-related malaria cases in Zanzibar, malaria mortality data discrepancies in reported versus actual deaths in Mainland Tanzania, eIDSR data completeness and timeliness and to ascertain its usefulness for malaria outbreak detection and CBS, and costing of operational elements of the MEEDS and MCN platforms.


OMDM’s MERLA team will finalize the Activity’s Learning Agenda in Q3. It will be shared with the NMCP, ZAMEP, and PMI for feedback.

3. Implementation Challenges

▪

▪ Senior Technical Advisor. OMDM’s preferred candidate for the Senior Technical Advisor position declined the RTI’s offer of employment, despite extensive negotiations. OMDM has identified a consultant to initiate activities under Results 2 and 3 while recruitment activities for the position continue in Q3.

▪ Systems performance in Zanzibar. Due to the restructuring of the administrative boundaries of MEEDS and MCN, data from some health facilities were not being registered by MCN at the beginning of Q2, limiting the ability of DMSOs to follow-up on identified malaria cases; this was immediately fixed once it was recognized. Additionally, poor network connectivity in some parts of Pemba further limited the ability to sync cases between those observed within health facilities and those reported via MCN.

4. Gender Considerations

4.1 Progress in Q2, Y1

, provided initial gender diversity and inclusion training for OMDM staff in January 2019.


OMDM also drafted the Activity’s Gender Action Plan with support from . The plan, submitted under separate cover

with this Q2 report, will be updated based on feedback from USAID | Tanzania.

4.2 Planned for Q3

In Q3 and through the remainder of Y1, OMDM will:

▪ Participate in additional diversity and inclusion trainings to be conducted by based on RTI’s corporate-level emphasis via their Diversity &

Inclusion Initiative; and,

▪ Work with USAID | Tanzania and key stakeholders to finalize and disseminate the Activity’s Gender Action Plan based on feedback from USAID | Tanzania.

5. Environmental Compliance

In Q2, no activities were implemented by OMDM that were directly applicable to our EMMP. With the initiation of TES in Q3, OMDM will closely monitor the use of personal protective equipment (e.g., laboratory coats, gloves, etc.) and use of sharps and biological sample waste bins for disposal of needles, test kits, and slides during supervision visits to TES sites.

6. MEL Plan: Progress on OMDM Performance Indicators

OMDM’s Performance Indicator Summary Table is attached as Annex 1. The table includes reporting on indicators for which quarterly updates are required. Annual and periodic indicators will be updated as proposed in OMDM’s MEL Plan.

7. Management

7.1 Collaboration with OMDM Partners and Stakeholders

There was significant collaboration among OMDM partners and stakeholders throughout this reporting period—largely comprising formal introductions to key implementing partners. OMDM staff have contributed to and participated in the partner and stakeholder meetings and events detailed in Table 8.

Table 8. OMDM Q2 collaboration with partners and stakeholders

Event Participants 2019 Q2

Dates Site visit from students and faculty from Warren Wilson College in North Carolina; overview of Zanzibar’s methods to identify, report, and monitor malaria

(OMDM) and students and faculty from Warren Wilson College

January 9, 2019

Meeting with ZAMEP’s Program Manager to discuss planned activities and the funding mechanism from OMDM

(ZAMEP), OMDM), and

(OMDM)

January 14, 2019


Event Participants 2019 Q2

Dates OMDM kickoff meeting (internal) OMDM local staff and RTI home office

leadership, management, and technical team

January 21–22, 2019

OMDM kickoff meeting (external) OMDM staff; OMDM’s home office leadership, management, and technical team; and representatives from USAID, PMI, NMCP, ZAMEP, NIMR Mwanza, NIMR Amani, MUHAS, UDSM

January 23, 2019

Meeting with MUHAS to discuss planned TES activities and the funding mechanism from OMDM

(MUHAS), (OMDM),

(OMDM), (OMDM), and (RTI)

January 24, 2019

Contractual kickoff meeting with USAID | Tanzania

Representatives from USAID’s OAA, PMI, OMDM staff, visiting RTI leadership and management staff

January 24, 2019

Meeting with the HMIS Unit and Directorate of Planning within Zanzibar’s MOH to address data inconsistencies among fragmented data collection systems

Representatives from OMDM and the MOH HMIS Unit

February 2–11, 2019

NMCP TWG to identify new IRS districts for spraying and resistance study sites

Representatives from OMDM, NMCP, Swiss TPH, Abt Associates (VectorLink), PMI, and NIMR

February 6, 2019

Meeting with VectorLink (OMDM) and (VectorLink)

February 6, 2019

MSDQI Mobile App orientation meeting

Representatives from OMDM, NMCP, (FHI360), and Swiss TPH


MSDQI meeting Representatives from OMDM, NMCP, (FHI360), Swiss TPH,

JHU/CCP (VectorWorks), PMI


NMCP work planning meeting Representatives from OMDM, NMCP, PMI February 21–22, 2019

Introductor meeting with the MoHCDGEC’s M&E, ICT, and Epidemiology Units

Representatives from OMDM and the MoHCDGEC’s M&E, ICT, and Epidemiology Units

March 7–8, 2019

Meeting with FELTP organizers Representative from OMDM, FELTP organizers, PMI

March 11, 2019

ZAMEP work planning meeting OMDM and ZAMEP staff March 13, 2019

ZAMEP’s data use workshop (Pemba)

Representatives from OMDM, ZAMEP’s SME Pemba team, DMSOs from PEMBA

March 20, 2019

PMI visit to Zanzibar Representatives from OMDM, ZAMEP, (FHI360), PMI

March 20–21, 2019

ICT, HMIS, and M&E TWG Meeting Representatives from OMDM, MSH, FHI360, ICT and HMIS Units from MoHCDGEC and PORALG, and Abt Associates (PS3)

March 21, 2019

ZMEAC meeting ZAMEP and ZMEAC invitees March 21–22,2019

Insecticide Resistance Management Site Selection Meeting

Representatives from OMDM, NMCP, NIMR, Swiss TPH, Abt Associates (VectorLink), PMI

March 27, 2019

TES TWG meeting Representatives from OMDM, NMCP, NIMR, MUHAS, PMI

March 28, 2019

NMCP’s malaria data review meeting (Tanga)

Representatives from OMDM, NMCP, and RHMTs and CHMTs from Tanga Region

March 28–30, 2019


7.2 List of All Documentation Submitted to the Development Experience Clearinghouse (DEC)

Work was initiated in Q2 to ensure the Q1 performance report met 508 compliance requirements in terms of redaction and readability to allow posting to the DEC; we anticipate posting the Q1 performance report to the DEC in Q3.

The same steps will be taken to prepare this Q2 performance report for DEC posting upon receipt of approval from USAID | Tanzania.

7.3 Certification that all Participant Training Information has been Entered in the TraiNet Database

No participant trainings were conducted in Y1, Q2. OMDM will ensure timely updates to the TraiNet database as trainings occur throughout the life of the Activity.

8. Upcoming Events

Table 9 highlights planned events involving OMDM and key implementing partners in Y1, Q3.

Table 9. Upcoming events

Event Lead 2019 Q3

Dates Dissemination of IEC materials ZAMEP April 2019

Pre-testing of IEC and SBCC materials ZAMEP April 2019

Data review workshop NMCP April 3–4, 2019

Training of field entomologists on insecticide resistance monitoring

NIMR Amani April 15–18, 2019

World Malaria Day NMCP April 25, 2019

Initiation of TES in Kyela MUHAS April 26, 2019

Participation in FELTP course by ZAMEP participant MoHCDGEC-FELTP May 2019

Scientific stature, data analysis, and writing workshop NMCP May 6–10, 2019

PMI Entomology team visit PMI May 6–15, 2019

Initiation of TES in Igombe MUHAS May 10, 2019

Initiation of TES in Nagaga MUHAS May 24, 2019

Meeting with PORALG to introduce OMDM’s Y1 work plan

OMDM To be determined (TBD)

Stakeholder meeting to define roadmap for CBS implementation

OMDM TBD

SME TWG meeting to review results from eIDSR data analysis

NMCP TBD

Stakeholder meeting to develop a roadmap for MCN and reactive case follow-up

OMDM TBD

Malaria Surveillance TWG meeting ZAMEP TBD

USAID Umuhimu wa Takwimu za Malaria, Year 1, Quarter 2 Performance Report 37

Annex 1. Performance Indicator Summary Table

Annual and periodic indicators presented below have been shaded grey as quarterly updates are not applicable. Indicators with annual reporting frequency will be updated in OMDM’s Annual Report; indicators requiring periodic frequency will be updated on an ad-hoc basis.

Indicators Data Source

Disaggregation Reporting Frequency

Domain Baseline Q1 Q2 Q3 Q4 Y1

1a # of malaria-related deaths per year

HMIS/ DHIS2

Sex/District/ Regions/Mainland

Tanzania and Zanzibar

Annually

Mainland Tanzania

4,294

(2017)

1b Zanzibar 1

(2017/2018)

2a # of malaria cases

HMIS/ DHIS2



Annually

Mainland Tanzania

5,593,544

(2017)

2b Zanzibar 4,190

(2017)

3a Malaria prevalence rate among children aged 6‒59 months

Demographic and Health Survey/

MIS



Periodically

Mainland Tanzania

7.5%

(2017)

3b Zanzibar 0.2%

(2017)

4a Malaria prevalence in pregnant women attending antenatal clinics

ANC malaria testing reports



Periodically

Mainland Tanzania

6.7%

(2017)

4b Zanzibar 0.3%, N = 383 (2017/2018)

1.1a # of national meetings (TWGs, etc.) conducted with policy and decision makers

Reports Mainland Tanzania

and Zanzibar Quarterly

Mainland Tanzania

2

(2017) 1 1

1.1b Zanzibar 0

(2017/18) 0 1

1.2a # of districts implementing regular data review meetings for data analysis

Reports District/Mainland


Quarterly

Mainland TBD 0 11

1.2b Zanzibar 0

(2017/2018) 0 4





as a basis for sound planning

1.3

% of districts with copies of updated or new policy and technical guidance

Activity records

District/Mainland Tanzania and

Zanzibar Quarterly

Mainland Tanzania

Not applicable (NA)

0 100%

Zanzibar NA 0 100%

1.4

% of districts provided with monthly supportive supervision

Activity records


Zanzibar Quarterly

Mainland Tanzania

NA 0 0

Zanzibar NA 0 20%

1.5

% of districts using malaria dashboard based on DHIS2 and other local systems

Activity records


Zanzibar Quarterly

Mainland Tanzania

76.34 %

(2018) — 80%

Zanzibar NA — —

1.6

# of data use, pause and reflect meetings under NMCP/ZAMEP's leadership with meeting minutes distributed

Activity records

Mainland Tanzania and Zanzibar

Annually

Mainland Tanzania

NA

Zanzibar NA

1.7

# of GOT staff trained in HMIS/DHIS2 and MCN (cumulative)

Activity records

Sex/Mainland Tanzania and

Zanzibar Annually

Mainland Tanzania

NA

Zanzibar

1.8

# of GOT staff trained in data analysis and scientific stature (cumulative)

Activity records


Zanzibar Annually

Mainland Tanzania

NA

Zanzibar





1.9a # of staff trained in malaria surveillance and response at district level

Training records

Sex/District Annually

Mainland Tanzania

1,363

(2017)

1.9b Zanzibar 130

(2017/2018)

1.10a # of districts with trained malaria surveillance and response teams

District-level

registers

Districts/ Regions/Mainland


Upon establishm

ent of formal teams

Mainland Tanzania

0

(2017)

1.10b Zanzibar 11

(2017/2018)

1.11a % of outbreaks detected and investigated

Epidemiological

records

Districts/Regions/Mainland Tanzania and

Zanzibar

Upon every outbreak

Mainland Tanzania

NA NA

1.11b Zanzibar 16% (N = 12)a (2017/2018)

0

1.12a % of malaria outbreaks responded to by district councils within two weeks from onset

NMCP/Activity reports

Districts/Regions/Mainland Tanzania and

Zanzibar Annually

Mainland Tanzania

NA

1.12b Zanzibar 12% (N = 9)a (2017/2018)

1.13a # of rapid response guidelines and protocols

Draft guidelines/

SME records


Periodically

Mainland Tanzania

NA

1.13b Zanzibar 1

(2017/2018) 1

1.14 % of eIDSR reports submitted

Electronic reports/

case registers

Districts/Regions/Mainland Tanzania

Quarterly Mainland Tanzania

51.3%

(Aug 2018) 72.9% 63.9%

1.15 % of MEEDS (SMS) reports submitted

Electronic reports/

case registers

Districts/Regions/ Zanzibar

Quarterly Zanzibar 23.8%

(2017/2018) 98.6% 94.9%

1.16a

% of facilities reporting complete and accurate routine

HMIS/ DHIS2/

Electronic reports/

Districts/Regions/ Mainland Tanzania

and Zanzibar Quarterly

Mainland Tanzania

98%

(2017)

In-patient diagnosis

(IPD): 98.3%

IPD: 99.0%

OPD: 99.0%





malaria indicators quarterly1 and within a prescribed time period

case registers

Outpatient diagnosis

(OPD): 98.4%

ANC: 99.5%

ANC: 99.7%

1.16b Zanzibar 47%

(2017/2018)

IPD: 74.8%

OPD: 91.9%

ANC: 95.2%

Not available

1.17a % of health facilities conducting data quality assessments

DQA Districts/Regions/


Annually

Mainland Tanzania

NA

1.17b Zanzibar 55%

1.18

% of health facilities submitting eIDSR reports on time

Electronic and

supervision records


Quarterly Mainland Tanzania

40.9%

(Sept 2018) 42% 40.9%

1.19

% of health facilities submitting MEEDS [SMS] reports on time

Electronic and

supervision records

Districts/Regions/ Zanzibar

Quarterly Zanzibar 27%

(2017/2018) 72.7% 68.9%

1.20a

# of positive cases reported and investigated/ confirmed from health facilities

MCN

Sex/District/ Regions/ Mainland


Quarterly

Mainland Tanzania

NA NA NA

1.20b Zanzibar

4,106 cases notified; 2,997

cases investigated (2017/2018)

985 cases notified;

130 cases investigate

d

1,182 cases

notified; 988 cases investigate

d

1 Monthly data for DHIS2 is also available





1.21a % of districts conducting active CBS

Reports Districts/Mainland


Upon case detection

Mainland Tanzania

NA NA

1.21b Zanzibar 100%

(2017/2018)

1.22a % of notified cases that were fully investigated within specified time

Reports Districts/Mainland


Upon case detection

Mainland Tanzania

NA NA

1.22b Zanzibar 30%

(2016/2017)

2.1a % of entomological surveillance sites reporting timely on expected parameters

Entomological

monitoring reports

Mainland Tanzania and Zanzibar, by site

Annually

Mainland Tanzania

61%

(2017)

2.1b Zanzibar 100%

(2017/2018)

2.2a # of entomological monitoring plans developed and adopted

Entomological

monitoring reports


Annually

Mainland Tanzania

1

(2014)

2.2b Zanzibar 0

2.3a Vector susceptibility (% mortality of vector population)

Entomological

monitoring reports

Mainland Tanzania and Zanzibar, by

site, by insecticide Annually

Mainland Tanzania

Various

2.3b Zanzibar Various

2.4a Resistance among malaria mosquito hosts to current, recently used, and new insecticides for IRS and insecticide-treated nets

Entomological

monitoring reports


Annually

Mainland Tanzania

Various

2.4b Zanzibar Various

2.5a # of sentinel sites established

Program reports


Annually Mainland Tanzania

28

(2017)





2.5b

for monitoring insecticide resistance

Zanzibar 10

(2017/2018)

2.6a Malaria vector abundance and morphological characterization by species in selected sentinel sites

National malaria vector

surveillance (MVS) sites

Mainland and Zanzibar, by site

Annually

Mainland Tanzania

Various

2.6b Zanzibar TBD

2.7a Sporozoite rate among Anopheles spp

National MVS Sites


Annually

Mainland Tanzania

1.8%

(2017)

2.7b Zanzibar 0

(2017/2018)

3.1a % of patients with an absence of parasitemia on day 28 (day 42)

TES reports

Sex/Age, by TES site

Semi-annually

Mainland Tanzania

>95%

(2017/2018)

3.1b Zanzibar 100%

(2017/2018)

3.2a Therapeutic efficacy of the first-line and alternate ACT nominated by NMCP/ZAMEP for consideration

TES reports

District/Regions/ Mainland Tanzania

and Zanzibar

Annually for 4 out of 8

established sites

Mainland Tanzania

TBD

3.2b Zanzibar 97%

(2017)

3.3a # of patients enrolled in TES

TES reports

Sex/Age, by TES site

Annually

Mainland Tanzania

Various

3.3b Zanzibar 146

(2017)

4.1a % of interventions within the annual implementation plan that have been

NMCP/ ZAMEP/ Program reports


and Zanzibar Annually

Mainland Tanzania

25%

(2017)

4.1b Zanzibar 60%

(2018)





successfully implemented

4.2

# of GOT staff trained in data analysis and scientific stature

Activity records


Zanzibar Annually

Mainland Tanzania

NA

Zanzibar

4.3a # of evidence-based innovations for malaria control adopted or introduced

Reports Districts/Regions/


Annually

Mainland 2

(2017)

4.3b Zanzibar 1

(2017/2018)

4.4

National malaria strategies, policies, and guidelines reviewed, renewed, or updated

Activity records


Annually NA 0

4.5

# of operational research (OR) studies conducted with GOT collaboration

Activity records


Annually NA 0

4.6

# of presentations on OR study results given in partnership with GOT

Activity records

TWGs/Conferences Annually NA 0

4.7

# of peer-reviewed manuscripts published with NMCP/ZAMEP collaboration

Activity records


Annually NA 0





4.8

# of success stories and blog entries written in partnership with NMCP/ZAMEP

Activity records


Quarterly NA 0 0 0

USAID Umuhimu wa Takwimu za Malaria Malaria (OMDM)

Documents

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