Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Strengthening SME System for National Program Moving from Transmission Reduction to Elimination Phase Thailand 21 August 2015

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Introduction

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Map Showing Areas for Control/Reduction Transmission and Elimination Areas, 2014 Elimination and Prevention of reintroduction areas API=0 Pre-Elimination API >0 ; <1/1,000 Control/reduction transmission Area API > 1/1,000

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 69 D. (7.4%) 199 D. (21.4%) 33 D. (3.6%) (Draft) Area Phasing for Malaria Elimination, D. (67.6%) Indigenous case + API>=1/1000 Indigenous case + API <1/1000 NO Indigenous case within 1-3 yrs. NO Indigenous case > 3 yrs. Control/reduction transmission Area Pre- Elimination Area-1 Elimination AreaPrevention of reintroduction areas Unit=District

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Number of Districts Targeted for Malaria Elimination, Thailand Remark: 2014 is the baseline data, 660 districts with no indigenous cases

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 1.Review Current SME System, Make Informed Decision to Strengthen Relevant SME Areas StrengthWeakness Staff: Skillful malaria staff for SME at provincial level Staff: Inadequate number of skillful malaria staff for SME at district level and some will be retired within 5 years; Data assistant are contracted and paid by GFATM (which will be finished at 2016). Sustainability is doubtful System: Surveillance system has been well established and updated; computerized data has been used by national, regional levels for 2 decades; ‘Malaria web-based’ system established in 2012 and used by all levels except communities System: Data from private sector & NGOs are not included Data from other institutes outside VBDs and non-health sectors are not included Data of non-Thai cases are included but not complete, its pop is unknown. Case investigation rate is some 60%

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Purpose Surveillance System All Disease Including Malaria in the ME Strategy Surveillance worker at sub-district Existing SRRT Tasks Case investigation Foci investigation And Response Members; Epidemiologist Entomologist Microscopist/blood taker VC staff Representative LAO Existing SRRT At Sub-district level At District level At Provincial level Tasks Case investigation Foci investigation And Response Tasks Case investigation Foci investigation And Response Enter data and notify Request for assistant Members; Epidemiologist Entomologist Microscopist/blood taker VC staff Representative LAO Members; Epidemiologist Entomologist Microscopist/blood taker VC staff Representative LAO

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 2. Guidelines and SOPs Types of Guidelines and SOPsCurrently availableNeed to be refined for elimination area PCD and ACDYes ACD will be encouraged by using RDT/PCR Case investigationYesYes, as it is complicated so need to be simplified for GHS staff Foci identification, investigation and response YesYes and need to be adjusted according to new WHO definition QA diagnosisYes Data management and reportingYesYes and to be handed over to PHO/GHS SupervisionYes

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 3. Job descriptions of Surveillance Staff (ME) Job descriptions Monitor and analyze malaria situation (web-based program) Respond to local malaria case notification Notify (calling) to chief of SRRT whenever one or more local cases reported Join SRRT for Foci identification, investigation and response Compile and produce monthly/quarterly and annually report to upper level Surveillance staff is a public health personnel at health center (GHS) and is computer literate with some analytical skills

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 4.Human Resource Planning Categories of People Involved for SME Training Required for ME 1. Surveillance staff DHC) Malaria epidemiology Situational analysis and report Foci identification, investigation and response Submission of data through Malaria online system 1. Surveillance staff is a public health at health center (GHS) 2. SRRT consists of health staff and staff of local administrative organization (sub-district, district and provincial levels)

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Categories of people involved for SME Training required for ME 2. SRRT members Epidemiologist (GHS)Malaria epidemiology, Foci identification, investigation and response; Malaria online system Entomologist (VBDC)Refreshing on foci classification Microscopists (VBDU)/Blood takers (GHS) Parasitological methods e.g. RDT and blood collection for PCR Vector control staff for IRSRefreshing on vector control methods --VBDU, VBDC; Workshop on vector control methods -- health staff from GHS Representative from local administrative organization Malaria epidemiology, Foci identification, investigation and response; Malaria online system 4. Human Resource Planning (Cont.)

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 5. Indicators of SME Performance No.Surveillance IndicatorsNumeratorDenominator 1ABER by Dist. And focus detected passively and actively No. of blood Slide Examined Pop at Risk (PAR) 2% of confirm case fully investigated within 24 hours No. of Investigated case No. of case 3% of Foci fully investigatedNo. of Investigated Foci No. of Foci (Occurred) 4Time from positive test results to notification of the national program (1 day by malaria online) (Symptomatic) No. of pos. test results notify to the National program within 1 day No. of pos test results notify to the National program

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand LevelSub districtDistrictProvincialRegionalNational CollectionYesNo AnalysisYes ValidationYes UseYes FeedbackNoYes to sub district level Yes to district level Yes to provincial level Yes to regional level BySurveillance worker Junior Epidemiologist EpidemiologistSenior Epidemiologist 6. Electronic-based Data Management

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Organogram of the flow of data, supervision and coordination MINISTRY OF PUBLIC HEALTH Department of Disease Control Vector-borne Diseases Office for Disease prevention and Control CENTRAL LEVEL DISTRICT LEVEL PROVINCIAL LEVEL SUB-DISTRICT LEVEL Provincial Public Health Vector-Borne Diseases Center Vector-Borne Diseases Unit Malaria Clinic District Public Health Hospitals Health Promotion Hospital REGIONAL LEVEL Other Diseases Other Departments Epidemiology Permanent Secretary ReportingSupervisionCoordination Malaria post /Border malaria post 7. Flow of Data, Supervision and Coordination Data entry SOP and checklist will be modified from GFM guideline

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 7.Malaria Online : BI system Developed by BIOPHICs, Mahidol University under GFM-R10 Support Features/ productions malaria cases by areas, health facilities, case detection activities, parasites species, trends, sex, occupations

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 8. Evaluation of SME System Performance Assessment of SME system performance on quarterly basis with identified indicators Evaluation of SME system will be carried out in 2016 as a baseline then every 2-3 years

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 10. Establish National ME committee Candidates should be (independent) –Former dean of Tropical Medicine Faculty, Mahidol University –Retired (malaria) epidemiologist –Lectures (Epidemiology, entomology, program evaluation)from universities –Retired malaria directors TOR: to review/verify malaria case report in elimination areas to determine if it is local case or imported case, and if the area is active focus, to recommend if ME verification is to be put on-hold, or withdrawn to make proper recommendations

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 11. Updating Legislation, as Part of Enabling Environment Process to make ‘malaria is a notifiable disease’ is currently on the way

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand 12. Involves Private Sector Private sector will be informed and involved for malaria elimination; they should comply to national guidelines and recognize that malaria cases must be reported to health authority Training on malaria detection and treatment will be provided for private hospitals and clinics Supporting supervisory visits to private sector will be provided on the agreed schedules

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand

Diagram Consolidation Malaria database BOE BVBD Conversion to the same structure across system BVBD Conversion to the same format BOE Conversion to the same format Join 2 Malaria Database Consolidation Malaria Database Deleted Duplicate Malaria Database Display on Intelligence Malaria Surveillance Web-based Standard WHO Suggestions Fuzzy Logic