MT. MALARAYAT GOLF & COUNTRY CLUB LIPA CITY, BATANGAS, PHILIPPINES 10 TH TO 18 TH FEBRUARY 2014 MALARIA ELIMINATION SURVEILLANCE SYSTEM REVIEW

ELIMINATION OBJECTIVE: To achieve health systems related elimination criteria in pre-elimination provinces and to reach and maintain API <1/1,000 in elimination provinces (Temotu and Isabel) and to rollout to other provinces. The population of Temotu = 26,026 and Isabel = 28, 049

 ACD from MSAT/MBS data  PCD (MIC. + RDT) data from health facilities – MCMR is now rolled out to capture all this data in future INDICATORSISABELTEMOTU SPR (%) ABER (%) API (/1000)310 Diagnostic – MIC +RDT (%) Confirmed Cases (%)27100 IndicatorIsabelTemotu SPR (%) ABER (% of target villages)6784

 In elimination, a case of malaria = any case confirmed by quality controlled diagnosis to provide malaria parasite information (species, stages and density):  Demonstration of malaria parasites in Giemsa- stained blood films by light microscopy is the gold standard  Cases detected with RDTs only should also be investigated the same way as microscopy confirmed cases

 Laboratory Detection Methods ◦ Laboratory services are typically organized into 3 main levels (Peripheral (NAP/RHC/AHC/UHC), Intermediate (Provincial Hospital) and National (NRH). ◦ Microscopy is the gold standard ◦ Rapid diagnostic test (RDTs) are distributed to all health facilities  Case Detection personnel and stakeholders ◦ Malaria and other health officers including Malaria Elimination Officers (MEO) or Microscopists) for MSAT/MBS in the field. ◦ Nurse Aids and Registered Nurses at health facilities including Hospitals ◦ Malaria Microscopists in health facilities microscopes ◦ By affected family or other members of the communities  Detection Can be by either: ◦ Passive (detected when sick patient attend a health facility to seek treatment) or ◦ Active (detected at community or household levels when health workers screen for fever and/or parasites in target high risk populations

 Each notified case of confirmed malaria is investigated within 48 hours in the field. This involves obtaining and verifying of the case and ACD in populations likely to harbour parasites. The case is then classified into one of the following categories:  Local:  Indigenous = Case within the province (IP = 84 and TP = 263 in 2013). A case detected from a case investigation report in a village cleared of malaria for the past 2 years or more. Response must occur within 10 days of case reporting (Refer to SOP on Remedial Measures)  Introduced = Cases acquired from an imported case (first generation imported case or internally imported)  Imported or exotic: = Cases imported from other provinces/country (Need proper case investigation – within the past 3 months)  Induced: Congenital or contamination with infected blood (Hospital based)  Clinical: = Unconfirmed cases but treated by clinicians for malaria

 Every case should be confirmed by early laboratory examination (Microscopy) for species, density and presence of gametocytes in both public and private facilities  Cross Checking of slides  Done quarterly at provincial level during Supervisory visits (10% positives and 5% negatives). Slides are cross checked at the provincial level by a level 2 External Competency Assessed (ECA) Microscopist. This ECA is supported by WHO and is done annually at headquarters for selected Senior Malaria Laboratory officers from all provinces.  This is supplemented by an Internal Competency Assessment (ICA) at the provincial level, facilitated by a Senior Parasitologist from the programme headquarters (refer to SOP) as part of the annual refresher training for all microscopist.  Slide Bank is not yet well established

 FOCUS: - A defined, circumscribed locality currently or formerly in a malarious area with continuous or intermittent epidemiological factors necessary for malaria transmission.  Focus investigation identifies the followings: ◦ Mapping of geographical features: Location, Population at great risk (house holds) ◦ Vectors responsible for transmission (where they are & when they transmit)  Entomologist required for: ID breeding sites, mosquito collection and identification, malaria and vector control interventions  From the investigation, the focus can be classified into 6 types: ◦ Endemic, Residual Active, New Active, New Potential, Residual non-active, Cleared-Up

 Active foci - Rapid parasitological and entomological responses (Need to effectively control transmission)  Residual foci – Strong surveillance and timely reporting  Malaria Free – Strong surveillance system and case management capacity  Current Practice: ◦ Active foci - MSAT – Targeted ACD ◦ Residual foci – MSAT - Supervisory work ◦ Malaria Free – PCD  It is vital to track, review and update these foci classifications and investigation results periodically

 Data Collection and recording ◦ A systematic system of recording, reporting and analysis of elimination data and information needs to be exercised at the various levels of the health services from health facility, Field, Regional and National. ◦ Guidelines to ensure timely, completeness and quality of reports are achieved must be developed and applied with commitment.

 Reporting Methods (Programmatic and Financial) ◦ Hard copy and Radio (VHF) sent to Programme Manager at Provincial level from regions (health facilities) before 15 th of the following month ◦ Hard and Electronic copy to M & E Unit at Central level by 20 th of the following month ◦ Spatial Decision Support system (SDSS) is being introduced in elimination provinces and needs refresher trainings and updating and improvement to cater for appropriate information input and analysis. It also requires provision of adequate equipment to ensure the system is working at the provincial level  Reports and feed-back methods from Central Level (Programmatic and financial) ◦ Annual M & E Support trainings for provincial officers to improve timely, completeness and quality of reporting from provinces ◦ By weekly or Monthly phone calls and s to provincial level ◦ Quarterly Supervisory Visits to provincial level ◦ Quarterly Reports from M & E headquarters ◦ Annual Reports (National Annual Conference)

 Review, Update and Complete all SOPs and guidelines including Malaria treatment protocol for elimination provinces  Nurse Refresher Training on Management of Malaria  Recruit and train Surveillance Agents (Case Management)  Recruit Field and Monitoring Officers (PSD)  Review JDs for Malaria Elimination officers (MEO)  Plan for Malaria Elimination Training for health workers and stakeholders at provincial level  Training and coordination of Community Mobilization and engagement activities involving CBO/NGOs/private sectors including the development, distribution and utilization of IEC materials.