Strengthening SME system for national programmes moving from transmission

reduction to elimination phase

Cambodia

Pailin Province- Capital: Pailin- Area: 803Km²- Total Pop: 102382- PAR: 74,124- 2 Administrative Districts- 1 Operational District- 4 Health Centers- API/1, 000: 5.04 (#374)- In western- northern, Border of Thailand

1. SME system and update

• PM endorsed National Strategic Plan for Malaria Elimination ( 2011- 2025)

• Strong commitment from Provincial Governor and Community participated

• Adequate health infrastructure • Established provincial malaria elimination

committee • Functional partnership

• Shortages of public health staff• Inadequate capacity building• Inadequate curative and preventive services

for MMP

1. SME system and update (cont.)

2. Develop / update relevant guidelines including SOPs

- National Strategic Plan for Malaria Elimination 2011-2025 (already endorsed and being implemented)

- Malaria Elimination Action framework ( MEAF) 2015-2019 (under development)

- SOPs for PCD and ACD (as a part of the new framework to be revised)

- Develop SOPs for Foci identification and investigation and response, QA diagnosis, data management and reporting and supervision for elimination phase

3. Job description for surveillance workersHealth Center:

– Case detection– Treatment– Follow up– Jointly with OD surveillance officer – case and foci

investigation– Reporting of cases and stock of commodities

3. Job description for surveillance workers (cont.)

Operational health district (OD):– Case detection– Case investigation– Foci investigation and Response– Analysis of data and feedback to HC– Collect data from private sector– Data entry– Reporting of cases and stock of commodities– Supervision

3. Job description for surveillance workers (cont.)

Provincial health department (PHD):– Case detection– Jointly with OD surveillance officer – case and foci

investigation and response– Outbreak investigation and Response– Data entry– Analysis of data and feedback to district – Supportive supervision– Communication with all sectors (meeting, advocacy)

HC OD PHD CNM

8 additional Staff * (Request MoH)**

6 additional staff * ** (3 group)2 in each group(Contract staff)

2 additional staff* (contract staff)***

5 additional**- 2 Data entry

specialist- 3 staff (Epi-

Unit )(Request MoH)

Human resource needed

Number of HC will be specified*Job description will be done in line with government’s policy for those to be recruited by MoH** Job description will be done in line with special requirements by CNM and international partners***

4. Human resource planning

Training, supervision, motivation

• Training: planning exercise to prepare plan with existing human resources, gaps and needs

• Supervision: guidelines, schedule, checklist, supervision team

• Motivation: Incentives in kind, study tours, awards, certificates

4. Human resource planning (cont.)

5. IndicatorsIndicator Definition Based-lines

20141 API/1,000 - Numerator: total of

parasite positive in the year- Denominator: Total PAR

5.45

2 Proportion of laboratory facilities with QA

HF lab participated with CNM/ total HF lab

Not Applicable

3 Proportion of health facilities reported on monthly basis

Number of HF monthly reported to CNM/total of HF

NA

4 Proportion of confirmed cases reported within 24 hours

# of confirmed cases report within 24h/ total confirmed cases

NA

12

Health Management Information System (HMIS)

Ministry of Health

Operational Health District Office (OD)

Malaria Information System (MIS) CNM

Health Centers (HC)

Cent

ral l

evel

Perip

hera

l lev

el

Malaria Workers (VMWs/MMWs)

Private Providers (part of PPM

network)

Military/Police

Referral Hospitals (RH)

Provincial Hospital

(PH)

HMIS information flowMIS information flow

Data collection (paper forms)

Electronic data entry

Database

PHD

6. Electronic based data management

Data Flow of MIS

National Malaria Control

Provincial Health Department

Operational District

Sender

Receiver Receiver

Operational District

Sender

National Malaria Control

SenderReceiver

Receiver Provincial Health Department/

Operational District

Day 0 Malaria Alert System

Sender

Data Flow of Day 0 Malaria Alert System

Village Malaria Worker

Health Center

• Revised SOP for monitoring and supervision• Check list for field trip• Set up supervision team

7. Field monitoring and supervision

- Baseline 2015: SME system is functional to report routinely on malaria indicators related to malaria control

- Mid-term: it is expected that SME system will be revised to reflect elimination challenges in 2017-2018

- 2020: it is expected that SME will be operational in all areas eligible for malaria elimination with immediate/mandatory reporting on all confirmed cases

8. Evaluation of SME System performance

9. Reporting

• Monthly report to higher levels • Realtime report for malaria case (SMS)• Feedback to lower level

• The establishment of the national committee on malaria elimination has been agreed with the Minister of Health.

• The TWG and STWG have been set up to guide this process

9. Establish a National Independent Malaria Elimination Monitoring Committee

11. Updating legislation– Malaria is notification disease

• Compulsory parasite based diagnosis (already in place);

• Private sector participation (not yet properly involved, but the private sector has to report to a public health facility on each confirmed malaria case);

• Appropriate treatment and follow up of confirmed cases (already in place); and

• Access to quality anti malarial medicines (not yet sure that all drugs are quality-assured in the private sector)

12. Involve private sector

– Training (already in place)– Support for referral is important (already in

place for severe and complicated cases)– to ensure all suspected cases are confirmed

by RDT (yes), – notified (not yet)

Thank you!