THE UGANDA STOP MALARIA PROJECT YEAR 7 WORK PLAN September 30, 2014- March 27, 2015 USAID/JHU Cooperative Agreement No. CA 617-A-00-08-00018-00 Submitted 28 November 2014 Johns Hopkins Bloomberg School of Public Health Stop Malaria Project Center for Communication Programs Plot 30B Impala Avenue Plot 15 Binayomba Avenue Kampala, Uganda P.O. Box 3495 Tel: +256 0312-600-600 Kampala, Uganda Tel: 256 0414-250-192/183
Table of Contents Introduction... 2 IR 1 Malaria prevention programs in support of the national malaria strategy improved and implemented... 3 IR 1.1: Malaria related policies and guidelines operationalized... 3 IR 1.2: Access to IPTp increased... 4 IR 1.3: Access to LLINs increased... 5 IR 2 Malaria diagnosis and treatment activities in support of the national malaria strategy improved and implemented... 6 IR 2.1: Service providers capacity to manage severe malaria improved... 6 IR 2.2: Malaria diagnostic capacity and services improved... 7 IR 3 NMCP capacity to monitor and evaluate interventions strengthened... 7 IR 3.2: Collection, processing and use of data from districts and implementing partners improved. 8 Cross cutting activities... 9 A. Support supervision/quality improvement (QI) activities... 9 In addition SMP will Support MOH to develop IPT /MIP job aid for Health workers.... 13 B. Project monitoring and evaluation... 13 C. Documentation... 14 D. Management Information System (MIS)... 15 E. Coordination among key partners improved... 16 F. Project management and coordination... 16 Annex A: List of Year 7 project districts... 1 Year 7 Activity Implementation Plan... 4 The Uganda Stop Malaria Project Year 7 Work Plan i
List of Acronyms ACT Artemisinin-based Combination Therapy ANC Antenatal Care BCC Behavior Change Communication CCP Center for Communication Programs CDFU Communication for Development Foundation Uganda CPHL Central Public Health Laboratory DDU Data Demand and Use DHI District Health Inspector DHIS 2 District Health Information System 2 DHO District Health Officer / Office DHT District Health Team DLFPs District Laboratory Focal Persons DOTs Directly Observed Therapy - short course EQA External Quality Assurance GF Global Fund GFATM Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria GPRS General Packet Radio Service HA Health Assistants HCP Health Care Provider HIPS Uganda Health Initiatives for the Private Sector Project HMIS Health Management Information Systems HSD Health Sub District IDI Infectious Diseases Institute IEC Information, Education and Communication IMM Integrated Management of Malaria IP Implementing Partner IPTp Intermittent Preventive Treatment in pregnancy IR Intermediate Result ISS Integrated Support Supervision JHU/CCP Johns Hopkins University Bloomberg School of Public Health/Center for Communication Programs LLIN Long Lasting Insecticide Treated Net MC Malaria Consortium MCH Maternal and Child Health MDD Music, Dance and Drama MDGs Millennium Development Goals MEMS Monitoring and Evaluation Management Services MFPs Malaria Focal Persons MIP Malaria in Pregnancy MIS Malaria Indicator Survey MoES Ministry of Education and Sports MoH Ministry of Health MOP Malaria Operational Plan NMCP National Malaria Control Program NMS National Medical Stores PMI President s Malaria Initiative PMP Performance Monitoring Plan PNFP Private Not-for-Profit QI Quality Improvement The Uganda Stop Malaria Project Year 7 Work Plan ii
RBM RC MoH RDT RHD SDS SMP SP SURE TA TASO ToT UBOS UBTS UCSF UHMG UMIS USAID VHT WHO Roll Back Malaria Resource Centre of the MoH Rapid Diagnostic Testing Reproductive Health Department Strengthening Decentralization for Sustainability Stop Malaria Project Sulfadoxine-pyrimethamine Securing Ugandan s Right for Essential Medicines Technical Assistance The AIDS Support Organization Training of Trainers Uganda Bureau of Statistics Uganda Blood Transfusion Services University of California San Francisco Uganda Health Marketing Group Uganda Malaria Indicator Survey United States Agency for International Development Village Health Team World Health Organization The Uganda Stop Malaria Project Year 7 Work Plan iii
Executive Summary The Stop Malaria Project (SMP), funded by the U.S. President s Malaria Initiative (PMI), is managed by Johns Hopkins University Bloomberg School of Public Health Centre for Communication Programs (JHU/CCP), Malaria Consortium (MC), the Infectious Diseases Institute (IDI), and Communication for Development Foundation Uganda (CDFU). SMP is designed to assist the Government of Uganda in reaching the PMI and Roll Back Malaria (RBM) goal of reducing malaria-related morbidity and mortality by 70% by 2015 (MOP FY 2012), and subsequently contribute to the attainment of the Millennium Development Goals (MDGs). SMP works in 34 districts across the Mid-west, Central and Teso Regions of Uganda, supporting 1,117 public and private-not for profit health facilities across these districts. During Year 6, SMP consolidated achievements gained in previous four years of the project in providing the following key interventions to its implementation districts: The percentage of children under five with fever who received a diagnostic test (microscope and RDT at the health facility before treatment increased from 74% average of Year 5 to 80 % average of Year 6 against a target of 75% (HMIS Data 2014). Supported the Universal LLIN distribution, distributing over 22 million nets in Uganda. Submission of HMIS reports from the district to the national level that were timely (actual 94% target = 80%), and complete (actual = 99%: target = 98%) Data utilization at health facility level increased from 46% in Year 5, Quarter 3 to 57% in Year 6, Quarter 4. (HMIS 2013-2014) HMIS data accuracy increased from 71% in Year 5, Quarter 4 to 74% in Year 6, Quarter 4. Held a Project Close out Event of the Teso Region with NMCP, PMI, District Leadership and Implementers in attendance. SMP shared project achievements and sustainability plans. In this seventh year of implementation, SMP will continue to consolidate the achievements and lessons of the last six years, and work with the NMCP, districts, USAID/PMI and non USAID/PMI Implementing Partners (IPs) to support integration of activities in the districts in order to maintain the achievements and promote the sustainability of SMP activities after the project s end. Ongoing documentation and consolidation of project achievements, best practices, lessons learned will be completed in Year 7. These will be disseminated to NMCP and key stakeholders to inform future programming for malaria services in the country. The Uganda Stop Malaria Project Year 7 Work Plan 1
Introduction The Stop Malaria Project (SMP), funded by the U.S. President s Malaria Initiative (PMI), is managed by Johns Hopkins University Bloomberg School of Public Health Centre for Communication Programs (JHU/CCP), Malaria Consortium (MC), the Infectious Diseases Institute (IDI), and Communication for Development Foundation Uganda (CDFU). The project is designed to assist the Government of Uganda, in particular the National Malaria Control Program (NMCP) and the District Health Teams (DHTs), to scale up proven interventions for malaria prevention, diagnosis, and treatment over a period of five years. SMP interventions are targeted to reach 85% coverage of children under five years of age, pregnant women and other vulnerable groups by improving diagnosis and treatment of malaria with Artemesinin-based Combination Therapy (ACTs), and by expanding prevention efforts through Intermittent Preventive Treatment of malaria in Pregnancy (IPTp) and Long-lasting Insecticide Treated Nets (LLINs). The project activities are designed to meet three intermediate results (IRs): IR 1 Malaria prevention programs in support of the national malaria strategy improved and implemented. IR 2 Malaria diagnosis and treatment activities in support of the national malaria strategy improved and implemented. IR 3 NMCP capacity to monitor and evaluate interventions strengthened. In this final year, SMP will work in 26 districts of Mid-west (5) and Central (21 districts), having phased out Teso (8 districts) Regions of Uganda on June 30, 2014. A list of these districts with population estimates and health facilities is attached in the annex A. The development of the Year 7 work plan was done in consultation with key partners. In a meeting with the National Malaria Control Program (NMCP), SMP shared the proposed activities for implementation in Year 7; NMCP provided in-put, and also endorsed the activities. SMP and its partners reviewed project performance during Year 6 and identified priority activities for SMP support during Year 7. SMP will also continue to focus on documenting and disseminating project best practices, success stories and lessons learned to inform future malaria activities in Uganda. SMP will work with the district authorities and the NMCP to integrate project activities into the district work plans in order to foster sustainability of services beyond the project lifetime. In particular, SMP will work with the districts supported by Strengthening Decentralization for Sustainability (SDS), a USAID implementing partners (IPs), and other USAID/PMI IPs to encourage the 26 SMP districts to plan and budget for activities currently supported by SMP, with SDS support. Year 7 activities are organized into four sections: by the three intermediate results (IRs) and crosscutting activities. In each section there is a brief review of the progress to date based on last year s achievements, lessons learned and remaining key issues which have informed the design of planned activities selected to be implemented in Year 7. During Year 7 SMP will continue to support malaria services throughout the current 26 SMP districts. The Uganda Stop Malaria Project Year 7 Work Plan 2
SMP will present to the Director General Health Services/Ministry of Health (MoH) the Letter of Agreement between SMP and NMCP, and copy of the PMI approved work plan for Ministry of Health endorsement. Once the Ministry of Health endorses the Letter of Agreement and the approved work plan, SMP will share these with each of the 26 districts. This work plan will form the basis of SMP s areas of support to the districts. The MoH endorsement of the approved SMP work plan will be taken as MoH commitment to implementation of the work plan. IR 1 Malaria prevention programs in support of the national malaria strategy improved and implemented IR 1.1: Malaria related policies and guidelines operationalized Progress to date Over the past six years, SMP has supported the NMCP in the development of various policy and strategic documents. These include Integrated Malaria in Pregnancy (MiP) Manual and ANC LLIN Distribution Guidelines, Integrated Management of Malaria (IMM) Training Manual, National Malaria Control Policy 2011, Malaria Program Review (MPR), NMCP strategic planning documents (Annual Work Plan 2011/12 and 2012/13, Strategic Plan 2010/15, M&E Plan 2010/15, Three-year Implementation Plan 2010/13), Data Quality Assessment Guidelines and Data Analysis and Use Training Manuals. In Year 5, SMP provided funding and participated in the workshop for the development of National Implementation Guidelines for Parasite Based Diagnosis of Malaria. In addition, SMP staff participated in a meeting convened by the NMCP to finalize the NMCP Strategic Plan 2010/15, M&E Plan 2010/15, and Three-year Implementation Plan (2010/13). Key Issues The National Implementation Guidelines for Parasite Based Diagnosis of Malaria was finalized but not yet approved by MoH. As such, the planned printing and launch of these documents was not done in Year 6. The National Implementation Guidelines for Parasite Based Diagnosis of Malaria is pending approval by the MoH Senior Management Committee. Planned Activities Activity 1.1.1: Print and disseminate guidelines Support NMCP to print and disseminate the National Implementation Guidelines for Parasite Based Diagnosis of Malaria. SMP will support NMCP to deliver copies of the printed documents to the 26SMP supported districts. Dissemination of these documents will be done during the planned quarterly Regional Review Meetings and district data use meetings. The Uganda Stop Malaria Project Year 7 Work Plan 3
IR 1.2: Access to IPTp increased Progress to date IPTp stock: During Year 6, in collaboration with the SURE project, SMP tracked stock levels of Sulfadoxine-pyrimethamine (SP), the drug used for intermittent preventative treatment of malaria during pregnancy (IPTp). SURE provided monthly updates of SP stock status at the national level, and SMP obtained SP stock levels at health facilities through integrated support supervision (ISS). SMP worked with the districts to relay this information to the NMCP to promote replenishment from National Medical Stores (NMS), or redistribution of SP within the districts. Over 90% of health facilities reached during ISS did not have any SP stock outs in Year 6 (HMIS data 2013/14). SMP held discussions aimed at identifying the most effective means through which the districts can track these items on their own, such as through mtrac (a government led initiative to digitize the transfer of Health Management Information System (HMIS) data via mobile phones) or DHIS 2 (district health information systems a computer based electronic HMIS system). IPTp uptake: IPTp2 uptake increased from 53% the previous year to averaging 58% during the year. While this reflects a significant improvement from 39% in Year 1, IPTp2 uptake remains below the SMP target 0f 60%, having stagnated around 51% at the end of Year 3 (HMIS data 2010/11). Key issues As mentioned above, although there has been progress in IPTp2 uptake by pregnant women in SMP districts from 39% in Q4 of Year 1 to 58% in Year 6. The Stop Malaria Project has done its best to improve the skills and understanding of health workers in administering IPTp through training on malaria in pregnancy in Year 2 and 3 of the project, and continuous emphasis on IPTp2 during support supervision. These activities should have addressed issues around inadequate staff numbers and skills, poor recording of SP administration in ANC registers, and myths about the safety of SP. SMP s provision of IEC materials and job aids on IPTp was also expected to improve uptake, along with provision of DOTs commodities and tracking of SP supplies. However, these have not succeeded in bringing rates of IPTp up to or beyond the target. Findings from a study under taken by Malaria Consortium; Assessing and Addressing Barriers to IPTp Uptake, revealed most of the barriers are on the supply side especially to do with recording and the workload for the ANC health workers leaving them with limited time to concentrate on IPTp. Planned activities Activity 1.2.1: Work with districts to track their SP stock in health facilities using ISS and mtrac SMP will continue to track stocks of SP and the availability of IPTp commodities in health facilities. In Year 7, SMP will increase its efforts to work with districts to take up some of these tasks through existing stock tracking mechanisms like ISS and mtrac. SM will encourage districts to regularly report on stock status which will be used to measure the extent to which the districts have taken up this task. The Uganda Stop Malaria Project Year 7 Work Plan 4
Activity 1.2.2: Conduct on-the-job mentoring during integrated support supervision to strengthen interpersonal communication of health workers with the clients Continue to conduct on-the-job mentoring during integrated support supervision to strengthen interpersonal communication of health workers with clients and reinforce the knowledge around IPTp DOTs and preventing malaria in pregnancy. Activity 1.2.3: Procure water purification tablets, additional cups and jerry cans to distribute to health facilities to ensure availability of safe drinking water for IPTp DOTs. Procure water purification tablets, additional cups and jerry cans to distribute to health facilities to ensure availability of safe drinking water for IPTp DOTs. Additional cups and jerry cans will replace those that have been damaged or lost. To promote continuity of IPTp DOTs services after SMP closure, a specific amount of IPTp DOTs commodities will be left behind with each district. IR 1.3: Access to LLINs increased Progress to date ANC LLIN distribution: During the year, the proportion of pregnant women attending ANC who received a net was 33%, average for Q1 to Q4 (range: 16% to 49%) [HMIS data 2013/14]. This was significantly below the year 6 SMP target of 95%. Over the year, SMP did not have ANC nets in its stores to distribute to the districts. PMI procured nets for SMP ANC distribution were channeled to fill the country gap for the mass campaign universal distribution in Kampala and Wakiso Districts. As such, the only nets which were available in the health facilities for ANC distribution were provided by The AIDS Support Organization (TASO) under the Global Fund Round 10 grant. Although TASO provided nets to health facilities, the quantities delivered were less than the need, and most health facilities had stock outs of nets over the year Key issues Planned activities Activity 1.3.1: Support the distribution of LLINs through ANC in collaboration with TASO in the 26 SMP districts. SMP will collaborate with TASO to continue supporting the ANC LLIN distribution in all 26 SMP in year 7. PMI nets are expected in the country in November to December but the timing will not be favorable for SMP to distribute the nets. The Uganda Stop Malaria Project Year 7 Work Plan 5
IR 2 Malaria diagnosis and treatment activities in support of the national malaria strategy improved and implemented IR 2.1: Service providers capacity to manage severe malaria improved Progress to date Support supervision: During Year 6, SMP provided on-job support and mentorship to health workers previously trained in integrated management of malaria (IMM). In health facilities reached during ISS, most health workers trained in IMM were found to manage malaria according to national malaria treatment guidelines; this was attributed to IMM training, regular ISS and clinical audits. However, there was massive recruitment of health workers across the districts and these are not trained in IMM. Clinical audits: SMP provided technical and financial support to district clinical audit teams to carry out clinical audits in 89 health facilities (35 hospitals and 54 HC IVs), and selected HC IIIs that manage severe malaria. Improvements in clinical practice relating to treatment of malaria were observed in most health facilities where clinical audits were conducted. For example, patients are fully assessed by clinicians and emergency cases attended to immediately with relevant laboratory investigations done (blood slide for malaria, blood sugar and haemoglobin). The quality of in-patient records has also greatly improved, e.g. filling relevant information in the patient observation forms including prescribed treatment, treatment outcomes as well as follow up notes. Availability of anti-malarial medicines: During quarterly integrated support supervision conducted with the district teams, SMP tracked availability of ACTs. These were generally available in 88% of the health facilities reached during ISS. SMP relayed information about the stock levels to the districts to ensure timely requests to National Medical Stores (NMS) as well as redistribution within the districts. Key issues A number of districts have recruited new health facility staff that have not been trained in IMM. Due to competing LLIN distribution activities, SMP managed to train 1,156 out of the 2,260 new health workers recruited that needed to be trained in IMM. In addition, the clinical audit tool reviewed with the NMCP and other stakeholders needs to be field-tested prior to finalization, so that a robust tool is availed to the NMCP and partners. Planned activities Activity 2.1.5 Conduct IMM training for newly recruited district health workers and post training follow up to reinforce knowledge and skills on job. Conduct on job mentorship of health workers in IMM for all cadres of staff (nurses, clinical officers, doctors, laboratory staff, records officers) at HC II, HC III, HC IV and hospitals in SMP districts during integrated support supervision. The Uganda Stop Malaria Project Year 7 Work Plan 6
Activity 2.1.1 Provide financial and technical support to district and health facility teams to carry out clinical audits at hospitals and HC IVs. SMP will provide financial and technical support to district clinical audit teams to conduct clinical audits in hospitals and HC IVs. SMP will print the revised clinical audit tool endorsed by MoH and distribute to the districts and health facilities. The health facilities should be able to reproduce and use this less bulky clinical audit tool in order to continue with clinical audits in the health facilities after end of SMP support. During clinical audit, follow up health facilities on the use of IV Artesunate for treatment of severe malaria. IR 2.2: Malaria diagnostic capacity and services improved Progress to date To date, SMP has trained 1,493 laboratory healthcare workers including 176 trained last year. (143 ToT and 1,350 cascade). This has been achieved through building teams of trainers in each of the 34 SMP implementation districts who have in turn carried out cascade training within the districts. To support laboratory diagnosis of Malaria, SMP has also procured and distributed a total of 48 microscopes and has piloted a continuous external quality assurance processes in over 170 health facilities. The number of people being tested for malaria has gone up averaging over 90% In June 2014, SMP closed IDI the subcontractor for malaria diagnosis as a result no activity is planned for in year 7. IR 3 NMCP capacity to monitor and evaluate interventions strengthened IR 3.1: Technical resources and skills of M&E unit improved Progress to date To support NMCP s role in coordinating the Roll Back Malaria (RBM) Partnership, SMP funded quarterly RBM meetings. Three meetings were held in Year 6. The RBM partnership meetings provided a forum for update and review of malaria control interventions in the country by NMCP and partners. Key issues SMP plans to support the NMCP in revitalizing the different Malaria Technical Working Groups, it is hoped that this will lead to robust discussion and action in implementing the Malaria Reduction Strategy. Planned activities The Uganda Stop Malaria Project Year 7 Work Plan 7
Activity 3.1.1: RBM Coordination meetings Coordination of malaria partners is crucial for streamlining malaria interventions in the country. SMP will continue to provide financial support to NMCP for coordination of this activity. In this final year, we will work with NMCP to transition SMP support to another RBM partner to ensure continuity of the RBM coordination mechanism when SMP ends. Activity 3.1.2: Malaria Technical Working Groups SMP will provide financial and technical support to the different technical working groups (TWGs) (e.g. case management, malaria in pregnancy, integrated vector management, research monitoring and evaluation, and social and behavior change) to hold quarterly meetings with the aim of having vibrant and coordinated malaria interventions. TWGs provide a forum for providing technical support to the NMCP for quick decision making. IR 3.2: Collection, processing and use of data from districts and implementing partners improved Progress to date In Year 6, SMP supported all the 34 districts to conduct data quality assessment in selected health facilities. The Data quality assessment involved selected indicators (malaria cases, Malaria tests done and ACT balances). RC-MoH was also supported financially to provide technical support during DQA exercise. The M&E SMP team, RC-MoH and DHT also provided mentorship on proper recording and tallying to the facility health workers during the DQA exercise. SMP also supported districts to conduct data use meetings. These meetings provided an opportunity for different cadres (facility in-charges, nurses, midwives, records and laboratory personnel) from health facilities to participate. The purpose of the meetings was to give feedback regarding the performance of their different health facilities HMIS/mTrac indicators and to suggest ways of further improvement of data quality and data utilization. The meetings were also used as opportunity for health workers to share experiences on data issues. Key issues Although there s significant improvement in the quality of data from 37% (HMIS 2009) to 74% (HMIS 2014), it has not reached the desirable level. Lack of primary data collection tools at health facility level continues to be a challenge and this affects the quality of data. Planned activities Activity 3.2.1: Provide technical and financial support to districts to conduct 2 rounds of DQA & DDU meetings In order to improve data quality, management, analysis and utilization at district and health facility levels, SMP will provide technical and financial support to districts to conduct 3 rounds of DQA & The Uganda Stop Malaria Project Year 7 Work Plan 8
DDU meetings. DQAs provide opportunity for mentorship and support, while performance review meetings are essential for feedback and experience sharing among DHT and health facility staff. Activity 3.2.2: Provide financial support for GPRS internet modems subscription to districts until UNICEF takes over in providing internet services to districts. Continue to provide subscription for district GPRS internet modems until UNICEF provides internet access to all districts in Uganda. SMP will collaborate with UNICEF to strengthen MTRAC & DHIS2 reporting through provision of Broadband Internet services at district level, even when the districts consume all the broadband width, access to mtrac and DHIS2 will be unlimited throughout the year. This will ensure sustainability for HMIS report submission to the national level even after SMP closes. Cross cutting activities A. Support supervision/quality improvement (QI) activities Progress to date During Year 6, SMP provided funding and technical support to districts to conduct integrated support supervision focused on IPTp, ANC LLIN distribution, diagnosis and treatment, health education, community mobilization, malaria commodities management and HMIS. In districts where SMP overlaps with SDS, funding for district teams was provided by SDS. Implementation of ISS was combined with Data Quality Assessments (DQAs) and Data Demand & Use (DDU) meetings. The aim of ISS was to improve performance of health facilities in the delivery of malaria prevention and treatment services. The activity was conducted in Q1, 2 &4; no ISS was conducted in Q3 because focus of districts and NMCP was on completion of the universal LLIN distribution campaign. Health facilities mainly targeted for ISS were: all hospitals and HC IV, about 80% of HCIII and a few HC II. District ISS teams made on-site observations using the standard ISS tool, and provided on-job mentorship to the health facility staff to strengthen their skills in malaria control. The ISS district teams then worked together with facility staff to develop facility own actions to address the gaps identified in the ISS tool. Facility action plans form the basis for tracking of progress on previously agreed actions within the health facility. Key issues The national support supervision guidelines require districts to conduct ISS at least once every quarter to the health sub-districts/health facilities as well as NMCP to districts. However, SMP s experience is that neither the districts nor NMCP are able to execute this mandate (especially ISS focused on malaria services) without SMP funding, which poses a big challenge to the sustainability of this valuable activity after SMP s closure. There is a need to advocate to NMCP to include malaria specific ISS to districts within their annual work plans and budgets. The Uganda Stop Malaria Project Year 7 Work Plan 9
At the facility level internal support supervision is not routinely conducted which is a vital approach for the facilities not only to identify and address their own performance gaps but it also provides an opportunity to ensure that action plans made by the external supervision teams (DHTs) are actually implemented. Planned activities Activity ISS 1.2: Provide financial and technical support to districts to conduct quarterly ISS to health facilities Provide technical and financial support to districts to carry out quarterly support supervision to hospitals, HC IVs and HC IIIs using the standard ISS tool (ISS tool focuses on key malaria control interventions: ANC LLIN distribution, IPTp, diagnosis and treatment, health education, community mobilization, management of malaria commodities and records). SMP will also provide support to district teams to carry out ISS to selected HC IIs. Creating demand for malaria services and practices Progress to Date Promotion of LLIN use and care During Year 6, SMP supported NMCP to prepare for the UC LLIN national Campaign and actively participated in all distribution related activities including actual distribution. SMP is an active member of the BCC TWG and is one of the key partners that rolled out the LLIN Distribution communication support activities in the country. Electronic media (mostly radio) was utilized to increase awareness about the program, registration, distribution schedules and distribution points as well as promoting usage, care and repair of nets among the communities. A total of 174,143 radio spots were aired, 337 radio talk shows on 64 radio stations were conducted and a total of 12 TV talk shows were aired to support the activity. Promotion of T3 test, treat and track SMP supported NMCP to implement communication activities aimed at increasing uptake of malaria diagnostic services and improving provider competences regarding adherence to malaria test results. Communication materials targeting caregivers of children aged five and below, and health providers were developed and are being disseminated. SMP supported NMCP to design training and job aid support materials for integrated interpersonal communication training for health providers. Using a cascade approach, SMP partnered with Malaria Consortium to train 13 National Master Trainers. Participants in trainings so far conducted have felt the training improved their trust in RDT and microscopic tests, increased their appreciation of the The Uganda Stop Malaria Project Year 7 Work Plan 10
importance of client-provider communication and adherence to malaria test results, especially negative test results. A total of 14,236 radio spots and 258 radio talk shows were aired. Community outreach SMP provided technical support to 122 Health Assistants (HAs) in ten districts to conduct community outreach activities in schools, health facilities and households to encourage adoption of malaria control practices. The engagement of HAs in community education interventions has greatly enhanced their visibility and usefulness at district level. The education sessions conducted by HAs on malaria and related topics have been strengthened through 60 community dialogue meetings. The dialogue meetings brought together the local council leaders, health facility in charges, and management committees, VHTs and members from the community. This offered a platform for the beneficiaries to interact with the service providers and come up with solutions to address the malaria related challenges with in the communities. As a result of this platform Stop Malaria in Your Community the project witnessed the communities initiating and implementing by laws (such as compelling any community member to buy a replacement net in the household if found misusing the net) to reinforce proper and consistent usage of the long lasting insecticide treated nets. Key Issues To a certain extent, the message of net care and repair campaign was contradicted by the promotion of universal LLINs distribution. Some people do not perceive the need to repair their old nets since they are anxiously waiting for the new ones from government. SMP will address this issue by integrating messages on net care and repair in the distribution efforts of the new nets. During the previous year, there were staff turnovers among HA and in the schools. However through the support supervision activities, the new staff was oriented so as to ensure continuity of the community outreach activities. The Test and Treat campaign implementation efforts have been challenged by RDT stock outs in some health facilities. Attempts to address this problem include working with DHOs to encourage facilities with more stock and possibly less patients to share with those experiencing stock outs. VHTs in many districts are dispensing ACTs but without RDTs, which compromise both the message of testing before treating malaria as well as the faith in the services offered by VHTs. Despite NMCP s desire to provide RDTs to these VHTs, it has still not happened. Planned Activities Activity CDM 1.1: Promote LLINs distribution, net use, care & repair The Uganda Stop Malaria Project Year 7 Work Plan 11
In year 7, SMP will continue to work with partners mainly CHC to support NMCP to implement activities that increase awareness among communities on issues concerning registration, acquisition and proper usage of the free LLINS under universal LLIN distribution campaign. Mass media activities include radio talk shows and radio spots to articulate the key issues regarding registration, acquisition and proper usage of the LLINs. In addition to the above, the messages incorporate net care and repair messages. Media services. This will be done in 26 districts in Central region only. The mass media activities are relying on the support of the interpersonal communication activities conducted by community leaders through community mobilization meetings, dialogues and other IPC activities targeting VHT, HA and community members. Activity CDM 1.2: T3 Conduct Health provider trainings in IPC for test, treat and IPTp and 3 monthly CME sessions at participating health facilities for test, treat & track promotion This year, SMP will continue to support NMCP to implement communication to promote testing before treatment of malaria messages targeting care takers and givers of children aged five and below. The overall aim of the caregiver component of the campaign is to increase uptake of malaria diagnostic and treatment services. Further, SMP will continue to support and ensure health providers are not assuming that every fever is due to malaria are adhering to negative test results. In year 7, as part of the efforts to improved provider-client relations and greater adherence to test results and improved IPTp 2 uptake, SMP will train 108 health providers from 18 districts on how to; Communicate the importance of testing malaria before treating Communicate effectively about the negative test results and support care givers to seek further management of the fever. Refrain from treating children who test negative to malaria. In addition, CMEs will be conducted and these will provide an opportunity for SMP and the district team to supervise and provide mentorship to the health providers in order to promote the test and treat policy. During year 7, the project seeks to promote three behavioral change messages to intensify change and maintain positive behaviors through a combination of mass media and community outreach activities. This will be done in the 26 districts in the central and mid western Regions of Uganda. Under mass media activities, radio will be used as the main channel for talk shows and spot adverts. SMP will adapt the radio messages developed over the 6 years of the project to promote LLIN use, care, repair, Test and Treat. In August 2014 SMP carried out a post campaign evaluation to determine the impact of the campaign on levels of adherence to malaria test results as well as the effect on provider competence for managing fevers among children aged five and below in 18 SMP districts. Data on knowledge, attitudes and The Uganda Stop Malaria Project Year 7 Work Plan 12
practices has been collected from health providers, VHTs, and caregivers on aspects of testing and treatment for malaria. The post campaign evaluation included a control district where the campaign was not implemented. Collected data will be analyzed and findings will be shared with all malaria stakeholders during the December 2014 RBM meeting. Activity CDM 1.3: Support VHTs to conduct Community mobilization activities for IPTp and LLIN usage, care and repair During Year 7, SMP will continue to strengthen the community mobilization activities in 10 participating districts. The project will collaborate with the ANC department/ in charge (in the facility where the VHT is attached) to ensure monitoring of the VHTs. A total of 140 VHTs will be trained and monitored to ensure they are carrying out the following activities; Household visits to encourage utilization and repair of the LLINs, PW get all the IPTP doses Community dialogue meetings are held to reinforce messages from HWs, VHTs and radio and this will provide a platform to address related issues that directly affect them. SMP will print a comprehensive VHT mobilization material (job aid) and will provide financial support for ANC provider to supervise VHT activities in the communities. Activity CDM 1.4 Support the development of Intermittent Presumptive Treatment job aids. SMP will support stakeholders meeting to review revised Map documents to ensure they are in line with WHO updates. This is to ensure all stakeholders have input before documents are taken up the hierarchy at MOH for ratification, dissemination and publication. In addition SMP will Support MOH to develop IPT /MIP job aid for Health workers. B. Project monitoring and evaluation Progress to date SMP has continued to follow up districts to report complete and timely HMIS data to the national level through email and phone call reminders. Feedback was continually provided by SMP to all districts and with emphasis on poor performing districts. SMP continued to track project performance by analysis HMIS and ISS data, quarterly and ISS reports were shared with PMI, NMCP, districts and other stakeholders like SURE project. The Uganda Stop Malaria Project Year 7 Work Plan 13
SMP supported zonal quarterly review meetings with district partners and other stakeholders. The meetings targeted district political leadership and technical staff, these provided forum for SMP to disseminate project progress reports, reviewing district performance, soliciting ways of improving project implementation and dissemination of policy updates. Planned activities Activity: PME 1.1: Host quarterly review meetings SMP will continue to hold regional quarterly review meetings with district and other stakeholders. The purpose of this is to share project performance, and experiences for more effective project implementation, monitoring and dissemination of key project indicators. SMP will work with the DHTs to coordinate the quarterly review meetings. Production and dissemination of quarterly reports, annual reports and ISS reports to partners will continue. Activity: PME 1.2: Analyze data for Test and Treat campaign and write a report SMP will analyze the Test and Treat Evaluation study data and compile a report. The Assessment is intended measure levels of adherence to malaria test results as well as effect on provider competences for managing fevers among children aged five and below in 18 SMP districts. It is the first large scale campaign promoting adherence to test results and may prove to be a model to other settings. PME 1.3. Compile and share ISS reports In order to track project performance, SMP will continue to analyze HMIS and ISS data, compile quarterly and ISS reports to be shared with PMI, NMCP, districts and other stakeholders like SURE project. C. Documentation To demonstrate how the project has made a difference to malaria in Uganda and to malaria knowledge globally, SMP plans to continue documenting the voices and experiences of the beneficiaries, implementing team, and partners in multimedia formats and through technical channels. In addition, the lessons learned and challenges will help inform the next steps of malaria activities in Uganda. Planned Activities In Year 6, full documentation plan was developed with key products and dissemination plans to ensure effective knowledge sharing. The broad elements of the strategy are: Activity: D1.1: etoolkit: The Uganda Stop Malaria Project Year 7 Work Plan 14
An etoolkit is an online collection of resources which is easily accessed through the Knowledge4 Health (k4health.org) website. The Stop Malaria Project etoolkit will contain key documents, tools, and research studies that were generated during the Stop Malaria Project. The etoolkit will be linked with appropriate national and international technical entities as well as being shared widely with practitioners. Finally, considering that internet access in Uganda can be slow and intermittent, especially in rural areas, an offline version will be created and distributed. In Year 7, SMP will compile more project documents to be included in the etoolkit. Activity: D1.2: Finalize the compilation of the End of project report: The end project report is a reader-friendly summation of project achievements, challenges, lessons learned and recommendations. Although this will be disseminated during the final closing event, SMP embarked on developing this report in Year 5 and will continue till second quarter of Year 7, the report includes identification of best practices, gathering of stories, testimonies and case studies, as well as ensuring high quality and representative photographs and other visual representations. This booklet will help make the goals, achievements and lessons learned of the project easy to understand for anyone interested. Activity: D1.3: Short (5-10 min.) video documentary: As part of the final event, in order to more effectively share the processes of SMP, a short video documentary will help to ensure a wider audience understand the key aspects of SMP and what should be continued through the efforts of the various government structures and implementing partners. SMP will hire a local consultant to shoot the video. Activity: D1.4: End-of-project close out events: There will be one event in February 2015 in the Central region. The event will be an opportunity to showcase success, discuss next steps, share testimonies and symbolically handover all materials and activities. At the event, experiential displays that explain each concept, supporting research, photographs, training videos, related toolkits and BCC materials will be erected. There will also be a video documentary on achievements, challenges, lessons learned and recommendations. The video will make the impact of the project easy to understand. D. Management Information System (MIS) Progress to date Over the years, SMP routinely collected data through MoH HMIS, ISS and activity reports. SMP used the data collected to track progress on the project key performance indicators as well as preparing SMP progress reports on quarterly and annual basis to PMI, NMCP and other partners. Key issues The Uganda Stop Malaria Project Year 7 Work Plan 15
Although timelines and completeness of reporting has improved since project inception to date, some districts do not submit data timely. There is also a need to improve on the quality of data that is submitted. Planned activities The program monitoring and tracking of indicators at district level will be done by collecting information on activities implemented in each district. The SMP Technical Team Leaders (who are based in the regions/districts) with the support of the SMP M&E Team will routinely monitor the quality of information. In collaboration with RC-MoH, SMP M&E Team will also: 1. For each activity conducted, activity reports will summarize data on the program indicators and submitted to the SMP M&E desk for entry into the SMP database. HMIS and ISS tools will be used to track indicators in the PMP from the 3 regions on a quarterly basis. Monthly reports from the districts will be validated and then compiled for the quarterly data summaries. 2. The project will report to PMI by posting data into the IP reporting system through MEMS. Both quantitative data and the project narrative reports will be posted on the MEMS database. Updates of the PMP will be done at the end of this PMI year. E. Coordination among key partners improved Progress to date SMP held quarterly meetings with NMCP to share and plan activities. SMP helped fund the quarterly RBM partnership meetings. Planned activities 1. SMP will continue to have quarterly meetings with NMCP. This will keep NMCP/MoH updated on SMP activities and provide opportunities to seek their guidance and solutions to implementation challenges beyond SMP scope; as it was in Year 6, the focus for Year 7 will be on sustainability of activities supported by SMP. At the national level, the Chief of Party will work with the Senior Malaria Technical Advisor to represent SMP during coordination meetings. 2. At the district level, SMP will collaborate with other IPs (e.g. STRIDES, SDS) to support DHOs to ensure proper use of resources by coordinating activities. SMP Zonal teams will participate in malaria-related meetings organized by DHTs and other implementing partners. F. Project management and coordination SMP will continue to partner with stakeholders at national and district levels through the project offices based in Kampala and in the regions. The project s central office based in Kampala accommodates the Chief of Party (COP), Senior Malaria Technical Advisor, and a Finance Manager, a Deputy Chief of Party / M&E Manager, a Communication Officer, M&E Officer, Operations Officer, The Uganda Stop Malaria Project Year 7 Work Plan 16
and three Finance Officers. Also in Kampala is the Central Region team. The regional office is in Hoima. SMP s senior management team comprises the COP, Senior Technical Malaria Advisor, Deputy Chief of Party / M&E Manager and Finance Manager. The senior management team is responsible for overall management of the project and ensuring all deliverables are met. CCP will continue to provide technical, administrative and financial support to the team from its offices in Kampala and Baltimore. The Uganda Stop Malaria Project Year 7 Work Plan 17
Annex A: List of Year 7 project districts Central Region: DISTRICT Total Population (2013) [1] Women of Child Bearing age (0.202) Expected Pregnancies (0.05) Expected birth (0.0485) Children under 1yr (0.043) Children under 5yrs (0.202) Hospitals [2] HC IVs HC IIIs HC IIs PNFP Public TOTAL 1 Kayunga 356,316 71,976 17,816 17,281 15,322 71,976 1 2 8 13 7 17 24 2 Kiboga 176,194 35,591 8,810 8,545 7,576 35,591 1 1 10 15 8 19 27 3 Kyankwanzi 190,543 38,490 9,527 9,241 8,193 38,490 0 1 6 13 9 11 20 4 Luwero 432,212 87,307 21,611 20,962 18,585 87,307 1 4 22 42 30 39 69 5 Masaka 260,154 52,551 13,008 12,617 11,187 52,551 2 2 8 18 8 22 30 6 Bukomansimbi 157,582 31,832 7,879 7,643 6,776 31,832 0 1 11 4 10 6 16 7 Lwengo 258,500 52,217 12,925 12,537 11,116 52,217 0 3 13 9 13 12 25 8 Kalungu 183,225 37,011 9,161 8,886 7,879 37,011 1 2 9 8 11 9 20 9 Mityana 312,061 63,036 15,603 15,135 13,419 63,036 1 3 13 35 20 32 52 10 Mpigi 470,263 94,993 23,513 22,808 20,221 94,993 1 1 18 8 8 20 28 11 Butambala 101,879 20,580 5,094 4,941 4,381 20,580 1 0 8 14 10 13 23 12 Gomba 157,995 31,915 7,900 7,663 6,794 31,915 0 1 5 13 4 15 19 13 Mubende 585,864 118,345 29,293 28,414 25,192 118,345 1 2 14 39 6 50 56 14 Mukono 569,734 115,086 28,487 27,632 24,499 115,086 1 3 10 32 11 35 46 15 Buvuma 55,733 11,258 2,787 2,703 2,397 11,258 0 1 3 4 2 6 8 16 Buikwe 444,206 89,730 22,210 21,544 19,101 89,730 5 0 11 21 18 19 37 17 Nakaseke 184,672 37,304 9,234 8,957 7,941 37,304 2 3 6 11 4 18 22 18 Nakasongola 155,100 31,330 7,755 7,522 6,669 31,330 1 2 10 19 3 29 32 A-1
DISTRICT Total Population (2013) [1] Women of Child Bearing age (0.202) Expected Pregnancies (0.05) Expected birth (0.0485) Children under 1yr (0.043) Children under 5yrs (0.202) Hospitals [2] HC IVs HC IIIs HC IIs PNFP Public TOTAL 19 Rakai 482,775 97,521 24,139 23,415 20,759 97,521 2 1 23 69 29 66 95 20 Sembabule 218,071 44,050 10,904 10,576 9,377 44,050 0 2 7 14 4 20 24 21 Wakiso 1,303,771 263,362 65,189 63,233 56,062 263,362 4 5 36 59 40 64 104 TOTAL 7,056,850 1,425,48 4 352,843 342,257 303,445 1,425,484 25 37 241 448 254 522 776 Mid-west (Hoima) Region: District Total Population (2013) [1] Women of Child Bearing age (0.202) Expected Pregnancies (0.05) Expected birth (0.0485) Children under 1yr (0.043) Children under 5yrs (0.202) Hospitals HC IVs HC IIIs HC IIs PNFP Public TOTAL 1 Buliisa 83,547 16,876 4,177 4,052 3,593 16,876 0 1 3 6 0 10 10 2 Hoima 567,459 114,627 28,373 27,522 24,401 114,627 1 4 23 25 13 42 55 3 Kibaale 704,464 142,302 35,223 34,167 30,292 142,302 1 4 21 26 18 34 52 4 Masindi 364,382 73,605 18,219 17,673 15,668 73,605 1 1 9 23 3 31 34 5 Kiryandongo 328,295 66,316 16,415 15,922 14,117 66,316 1 0 8 10 5 14 19 TOTAL 2,048,147 413,726 102,407 99,335 88,070 413,726 4 12 62 95 39 134 173 [1] Source: UBOS Data, population projections for 2013 [2] Source: District Health Offices A-2
A-3
Year 7 Activity Implementation Plan In Year 7, SMP will focus on documenting and disseminating project best practices over the years, success stories and lessons learned to inform future program activities in the country. SMP will work with the district authorities and the NMCP to integrate the project activities into the district work plans in order to foster sustainability of services beyond the project lifetime. The project will collaborate with SDS and other USAID/PMI IPs to integrate malaria activities into district work plans and budgets. Activity Code Activity Description Indicators Annual s/key Outputs/Key Deliverables Q1 (July September 2014) Q2(October- December 2014) Q3(January March 2015) IR 1.1 Malaria related policies and guidelines operationalized Support NMCP to disseminate National implementation guidelines for parasite based diagnosis of malaria Number of copies printed 300 copies printed Proportion of districts provided with National implementation guidelines for parasite based diagnosis of malaria Proportion of districts provided with National implementation guidelines for parasite based diagnosis of malaria 300 copies printed IR 1.2 Access to IPTp increased Work with Proportion of districts to track health facilities their SP stock in with no stock health facilities out of SP using ISS and mtrac 96% of health facilities reporting no stock out of SP 96% of health facilities reporting no stock out of SP 96% of health facilities reporting no stock out of SP A-4