1. Proposed Malaria Surveillance System & Malaria Elimination Feasibility Study: Philippines Lipa City, Batangas, Philippines 10 – 18 February 2014

2. Cases were reduced by 83% within a period of seven years, from 46,342 in 2005 to 8,086 in 2012. Global Fund started

3. Within the same period, deaths caused by malaria also declined by 89% from 150 in 2005 to 16 in 2012.

4. Programmatic Challenges Palawan Tawi-tawi In 2012, 15 out of 80 provinces contributed to 99% of the reported 8,086 malaria cases; two provinces accounted for 85% - Palawan (51%) and Tawi-tawi (34%). Progress in some provinces in the Mindanao (Southern) Region was erratic, most likely due to political and social instablity.

5. Enhanced Malaria Strategic Plan 2014 - 2020 Strategic Objectives 1.To ensure universal access to reliable diagnosis, highly effective and appropriate treatment and preventive measures. 2.To strengthen the capacity at all levels towards malaria elimination 3.To sustain financing of anti-malaria efforts at all levels of operations 4.To ascertain quality malaria services, timely detection of infection and immediate response and evidence-based enhancement of malaria elimination measures

6. 2. Existing Malaria Surveillance a.Phil. Integrated Disease Surveillance & Response (PIDSR)

10. 2. Existing Malaria Surveillance b. Phil. Malaria Information System (PhilMIS) An electronic information system that aims to capture Malaria cases, deaths and vector control data; To be implemented across different health reporting units (BMMC/RDT sites, Hospitals, MHO, PHO/Ch- CHO, CHD); Allows analysis and use of data at different levels to effectively manage the Malaria Program.

11. Every 12 th day of the succeeding month Every 12 th day of the succeeding month Every 10 th day of the succeeding month Every 10 th day of the succeeding month Every 5 th day of the succeeding month Every 5 th day of the succeeding month Every 8 th day of the succeeding month Every 8 th day of the succeeding month Modified PhilMIS Reporting Flow CHD CH-CHO PHO DOH HOSPITAL RHU/CHO HOSPITAL* BRGY. FACILITIES HOSPITAL** CENTRAL OFFICE PSFI-PO PSFI-CH *Municipal Hospital, District Hospital, Provincial Hospital, Private Hospital ** Private Hospital, Clinics, Laboratories Feedback Mechanism Report Flow

12. What will be the role of the facilities? Fill-out Modified PhilMIS forms; Consolidate and validate data; Encode into the software of workstation; Analyze data of workstation; Provide feedback; and Submit to next level

13. Modified PhilMIS Forms CASE REGISTRY FORMSVECTOR CONTROL FORMS F1Malaria Patient Registry Form F6Mosquito Net Distribution Form F2Monthly Malaria Report Form F7Mosquito Net Distribution Summary Form F3Malaria In-Patient Registry Form F8Indoor Residual Spraying Form F4AHospital Out-Patient Monthly Malaria Report Form F9Indoor Residual Spraying Summary Form F4BHospital In-Patient Monthly Malaria Report Form F10Mosquito Net Retreatment Form F5Active Case Detection / Mass Blood Survey Form F11Mosquito Net Retreatment Summary Form

17. Data can also be viewed in the website by implementers and managers in the form of tables and graphical summaries. Reports can also be sent to the implementers via email During health emergencies (outbreak) and special concerns (stock-out), System Administrator of MTRS can contact local Implementers to facilitate and coordinate activities. A trained health worker sends a Malaria case report through SMS Flow of Information in Malaria TXT Report System Flow of Information in Malaria TXT Report System Implementing partners/managers at various levels Malaria Diagnostic Facility Malaria TXT Report System 55 The SMS is processed by the MTRS software and the data is stored in a dedicated server. 22 The MTRS software sends confirmatory SMS within minutes. It can also send message for announcements and special concerns 44 33 11

18. Framework of ESR

19. 2. Exisiting Malaria Surveillance Case Definition: - case with fever/history of fever and manifest any of the following sign and symptoms: chills, sweating, headache, enlarge spleen and confirmed positive for malaria. Laboratory Confirmation: – Microscopy – RDT

20. Barangay Microscopists CHD/PHO Validators RITM-NRL RHU/CHO/hospital/labor atory Microscopists Slides for validation Feedback, supervision and remedial intervention LEVEL 2LEVEL 3 Proficiency Assessment Slides for validation Feedback, supervision and remedial intervention National Core Group of Trainers/ Validators (NCGT) (NCGT) ( (composed of NRL staff and CHD/PHO validators) Training Certification National/ Regional Slide Bank World Health Organization (WHO) Regional Slide Bank Regional Accreditation and EQA Program LEVEL 1 RHU/CHO hospital/ laboratory/ BMMC microscopists Basic Malaria Microscopy Training Quality Control and Quality Assessment of Malaria Microscopy

21. Validation of blood films - selection of blood films for validation Control Phase  Scheme 1 240 blood films – 30 blood films/quarter  Scheme 2 200-240 blood films – submit all in a quarter  Scheme 3 < 200 blood films – submit all blood films and validator sends panel of slide every year Pre-Elim All positive slides and 10% of negatives Elim Phase All positive slides, RDT positive to be confirmed by microscopy - validation schedule and frequency - feedback and reporting Cross- checking

22. 2. Existing Malaria Surveillance 2.3. Personnel for case detection: a. Bgy/Village: Volunteer Bgy Microscopist, Rural Health Midwives b. Municipality: Med. Techs., Rural Physicians, Nurses, Malaria Personnel c. Hospitals: Med. Techs, Physicians (mun., district, prov, Cities) d. Private/NGOs, FBOs e. Provincial Health Teams (still existing in some provinces)

23. 2. Existing Malaria Surveillance Laboratory Methods 1.Microscopy 2.RDT 3.PCR - RITM

24. 2. Existing Malaria Surveillance Methods of Reporting 1.Submission of reports (hard and/or soft copy 2.Program Implementation Reviews 3.Field monitoring 4.SMS (limited)

25. 2. Existing Malaria Surveillance Reports & Feedback Produced by Central Level – Quarterly, Semestral and Annual National Reports – Submits report to WHO - World Malaria Report – Program Implementation Review (twice a year)

26. 3. Proposed Changes - Review of Malaria MOP and inclusion of the Elimination Chapter a. Case Classification – Local Indigenous case Introduced case – Imported Internal Imported External Imported – Induced cases

27. 3. Proposed Changes b. Focus Classification - Stable Transmission – Endemic - Unstable - Active focus, Residual Active -Sporadic - New Potential - - Residual Non-Active -Malaria Free - Cleared - up

28. 4. Proposed National Guidelines for Malaria Surveillance a.Case Definition: - a case regardless of the presence or absence of clinical symptoms, malaria parasite have been confirmed by quality controlled laboratory diagnosis. b. Case Classification: - Local: Indigenous, Introduced - Imported: Internal, External - Induced c. Case Investigation: more active role in case investigation

29. 4. Proposed National Guidelines for Malaria Surveillance c. Case Investigation: -Pre-Elimination/Elimination Areas: Immediate case investigation -Investigation Teams: PHT, Provincial Malaria Person, RHUs and Bgy. Health Worker -ACD/Focal Investigation

30. 4. Proposed National Guidelines for Malaria Surveillance b. Methods of Focus Identification, Delimitation & Classification: -Focus Investigation: -Team: Trained Staff (Prov/Mun), Bgy Health Workers -Map: breeding areas, houses, malaria case, Malaria Interventions -Use of Malaria Focus Investigation Form

31. 4. Proposed National Guidelines for Malaria Surveillance c. Operational Implications of Different Types of Foci. 1. Foci maybe located in 2 or more boundaries: human resources Allocation of commodities supervision accountability

32. Geographic Distribution Malaria Vector (2007-13) Source: RITM Entomology

33. Feasibility Study A. Technical Feasibility 1. Vectorial Capacity/ Receptivity – A. flavirostris- zoophilic but females can feed on both man & animals – Breeds in man-made and natural breeding areas – Susceptible to current insecticides used – Generally dwellings with sprayable walls except in some IP communities – Year round vs. seasonal transmission – Terrain: archipelago but generally good access to health care services – Late evening activites

34. Feasibility Study 2. Duration of Infectivity: -P. falciparum (60 – 70%) -No drugs resistance reported, TES with RITM -Improved health seeking behaviour -Free health services -Expansion of health services to military, OFWs -Private Sector involvement in dx & tx

35. Feasibility Study 3. Vulnerability -Significant population movement: OFWs, in- country -Risk from neighboring countries is low except to Students from endemic countries -

36. Feasibility Study B. Operational Feasibility -Political & social stability except in ARMM -Support from Executive Committee – DOH -Devolved Health Services – LGUs highly accepts malaria elimination initiatives -MCP : Trained health workers but insufficient -Excellent Microscopy Services with functional QAS -External Support: WHO, GF & Private Sector

37. Feasibility Study Conclusion: - Malaria Elimination is Feasible in the Philippines. - More work in Palawan & ARMM

38. Thank you!

39. Sample Report Generated (website view) Sample Report Generated (website view)