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Improved Performance of the Malaria Surveillance, Monitoring, and Evaluation System from 2015 to 2018 in Madagascar

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Poster presentation from ASTMH 2019.

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Improved Performance of the Malaria Surveillance, Monitoring, and Evaluation System from 2015 to 2018 in Madagascar

  1. 1. Improved Performance of the Malaria Surveillance, Monitoring, and Evaluation System from 2015 to 2018 in Madagascar Conclusions MEASURE Evaluation’s support in strengthening malaria SME in Madagascar has likely contributed to significant improvements in malaria and overall IDSR data reporting, both at facility and community levels, from 2015 to 2018. The improvements span various areas, such as the availability of guiding documents and improvements in data quality in terms of increases in completeness and timeliness of reporting and data accuracy at the health facility and community levels. MEASURE Evaluation’s support has also contributed to establish a culture of data dissemination and use at the operational level by skilled professionals who have benefited from the project’s country-specific malaria SME training workshops. The observed trends need to be maintained and improved, especially because Madagascar has started strategies for progressive geographical elimination. Background Malaria poses a public health challenge in Madagascar, where the entire population is at risk, especially in epidemic-prone areas. Given that malaria cases and deaths reported through the national health management information system between 2003 and 2013 have decreased, Madagascar is considering pre-elimination strategies. This requires an effective surveillance system to monitor cases, detect potential epidemics, and investigate cases and foci as appropriate. Starting in 2015, after conducting a baseline assessment of key malaria surveillance indicators in the national integrated disease surveillance and response (IDSR), MEASURE Evaluation, funded by the United States Agency for International Development (USAID), has worked with the National Malaria Control Program (NMCP) to strengthen malaria surveillance in Madagascar with support from the U.S. President’s Malaria Initiative (PMI) and partners. In 2018, the project conducted a follow-up survey to measure and document improvements in the performance of the malaria surveillance, monitoring, and evaluation (SME) system in the country to inform future support to the NMCP. Jean-Marie N’Gbichi,1 Maurice Yé,1 Alain Rakotorisoa,2 Léa Randriamampionona,2 Solo Harimalala,3 Andriamananjara N. Mauricette,3 Laurent Kapesa,4 Yazoumé Yé1 1 MEASURE Evaluation, ICF; 2 Direction de la Veille Sanitaire, de la Surveillance Epidémiologique et Riposte, Ministry of Public Health, Madagascar; 3 National Malaria Control Program, Ministry of Ministry of Public Health, Madagascar; 4 President’s Malaria Initiative/United States Agency for International Development, Madagascar Acknowledgments—This publication has been supported by the President’s Malaria Initiative (PMI) through the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AIDOAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of PMI, USAID, or the United States Government. For information, contact: JeanMarieNGbichi@icf.com https://www.measureevaluation.org/ Methods Similar to the 2015 baseline assessment, the 2018 follow-up survey covered national, regional, and district levels. It consisted of a desk review of existing malaria SME and IDSR documentation in the 22 regions and 114 districts of the country through a self-applied data collection form. Data quality checks were performed in a randomized sample of health facilities, in which community-based data reporting was assessed in the facilities’ catchment areas. The performance of the system was evaluated in terms of data quality (data accuracy, timeliness, and completeness of reporting), data dissemination and use, and staff capacity in SME and IDSR. Data accuracy was assessed by comparing data reported to data recounted and re- aggregated from health facilities’ registers with a 95–105% percent validity scale. Timeliness of reporting was assessed by comparing the number of reports submitted on time to the total number of reports expected. Completeness of reporting was assessed by comparing the number of reports submitted to the total number of reports expected. For comparison of 2015 and 2018 data, the z-tests for proportions from two samples were estimated, and p-values were calculated. Differences were considered significant if p<0.05. Results 2015 2018 Malaria data quality assurance protocol No Yes Malaria data analysis and presentation protocol No Yes Malaria SME training curricula No Yes IDSR training curricula No Yes Malaria quarterly bulletin No Yes IDSR monthly bulletin Yes* Yes * A template for the IDSR bulletin was observed but has not been finalized and disseminated Table 1. SME guiding documents and data dissemination tools at national, regional, and district levels In the 2015 baseline assessment, the Madagascar malaria SME system lacked primary documents, such as the malaria data quality assurance protocol, malaria data analysis and presentation protocol, malaria SME training manuals, and a malaria bulletin. These documents were present in 2018. 2015 2018 p-value National Quarterly malaria data discussion meetings held in the last two years 0% (0/8) 100% (8/8) p=0.00060 Monthly IDSR data discussion meetings held in the last two years 0% (0/24) 79.1% (19/24) p<0.00001 Regional  Health regions that received a malaria quarterly bulletin each quarter in the last two years 0% (0/10) 81.8% (18/22) p<0.00001 Regions that received an IDSR monthly bulletin in the last six months 0% (0/10) 86.3% (19/22) p<0.00001 Regions that held malaria data discussion meetings in the last six months 0% (0/10) 77.2% (17/22) p<0.00001 District Districts that received a malaria quarterly bulletin each quarter in the last two years 0% (0/44) 85% (97/114) p<0.00001 Districts that received an IDSR monthly bulletin in the last six months 0% (0/44) 64% (73/114) p<0.00001 Districts that held malaria data discussion meetings in the last six months 0% (0/44) 80.7% (92/114) p<0.00001 Table 3. Data use by levels None of the 2 national directorates (NMCP and the Direction de la Veille Sanitaire, la Surveillance Epidemiologique et la Riposte [DVSSER]), 10 regions, and 44 districts assessed reported holding data discussion meetings in 2015. In 2018, the NMCP reported holding 100 percent of the quarterly malaria data discussion meetings in the last two years, and the DVSSER reported holding 79.1 percent of the monthly IDSR data discussion meetings in the last two years. In addition, 77.2 percent of the 22 regions and 64 percent of the 114 districts reported holding malaria monthly data discussion meetings in the last 6 months (p<0.00001). In 2018, the malaria quarterly bulletin was disseminated to 81.8 percent of regions and 85 percent of districts, and the IDSR monthly bulletin was disseminated to 86.3 percent of regions and 64 percent of districts (p<0.00001). Table 2. Data quality (completeness, timeliness of reporting, data accuracy) Table 4. Capacity building   2015 2018 p-value Completeness and timeliness at health facility level       Completeness 62.2% (821/1,320) 73% (998/1,368) p=0.00044 Timeliness 48.3% (638/1,320) 68.3% (935/1,368) p<0.00001 Completeness and timeliness at community level Completeness 8.6% (225/2,616) 94.3% (18,920/20,064) p<0.00001 Timeliness 5.2% (136/2,616) 55% (11,035/20,064) p<0.00001 Data accuracy at health facility level 73% (964/1,320) 87% (396/456) p<0.00001 Completeness of routine IDSR data reporting, including malaria, by centres de santé de base (CSB) health facilities was significantly higher in 2018 (73%), compared to 2015 (62.2%) (p=0.0044). Timeliness of CSB reporting was 68.3 percent in 2018, compared to 48.3 percent in 2015 (p<0.00001). Completeness of community-based reporting was significantly higher in 2018 (94.3%), compared to 2015 (8.6%) (p<0.00001), and timeliness was 55 percent in 2018, compared to 5.2 percent in 2015 (p<0.00001). Data accuracy, the comparison of data from weekly reporting forms to weekly malaria data in registries, was at 87 percent in CSB in 2018, compared to 73 percent in 2015 (p<0.00001).   2015 2018 p-value  National   NMCP SME unit technical staff trained in malaria SME 25% (4/12) 93.3% (14/15) p=0.00024 DVSSER technical staff trained in IDSR 33.3% (3/9) 79.1% (15/17) p=0.00386  Regional   Regional directors trained in malaria SME 50% (5/10) 95% (21/22) p=0.00228  District   District directors trained in malaria SME 34% (15/44) 99.1% (113/114) p<0.00001 At the national level, 93.3 percent of the NMCP SME unit technical staff were trained in malaria SME in 2018, compared to 25 percent in 2015 (p<0.00001); 79.1 percent of DVSSER technical staff were trained in IDSR in 2018, compared to 33.3 percent in 2015 (p<0.00001). At the regional level, 95 percent of regional directors were trained in malaria SME in 2018, compared to 50 percent in 2015 (p<0.00001). At the district level, 99.1 percent of district team leads were trained in malaria SME in 2018, compared to 34 percent in 2015 (p<0.00001).

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