Transcript Monitoring and Evaluation of Integrated Campaigns Measles-Malaria Partnership Meeting

Monitoring and Evaluation of
Integrated Campaigns
Measles-Malaria Partnership Meeting
Mac W. Otten, Jr., MD MPH
Global Immunization Division
Feb. 2007
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M&E Integrated Campaigns
• Campaign itself
− During campaign
− Survey: immediate, dry season
− Survey: wet season
• Post-campaign ITN use
• Post-campaign routine ITN distribution
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Six Sigma for Child Survival
Kaizen for ITN Use
Creating 50,000 Conversations for
Malaria
Control and
Improving
Measurement
Management for ITN Use
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Issues
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Great progress: 5% to 55%
~45% children not under ITNs
One-third not using ITN
How to address?
− Distribution: increase to >90%
− ITN use
− Distribution of ITNs at routine antenatal
and EPI visits
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ITN Use, <5 yo children
Countries with MM Partnership SIAs
ITN use, <5 yo
Zambia: 4 rural districts
56
Togo: nationwide, SIA Dec 2003
54
Kenya, 2006
52
Tanzania: 2 prov.; July-Aug 2005
Ghana, 1 district: Dec 2002
Niger: nationwide, SIA Dec 2004
Mozambique: 2 provinces, 2005
Non-SIA ITN program
Zambia, survey May 2006
21, 55
71
56
59, 62
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Take-Home Messages
• Reach >80% ITN use by improving ITN use &
routine ITN distribution
• Modern management paradigm
− Continuous measurement
− De-centralized measurement
− De-centralized problem-solving
• Scale
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Public health management:
minimal information package
• Minimal package
− Inputs (stock)
− Coverage
− Impact (surveillance)
• Use of data
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Measurement tools
• Inputs (Stock): ITNs
• Coverage
− Ask about ITN use at EPI contacts
• Impact
− WHO Integrated Disease Surveillance
monthly form
− <5-year-old in-patient malaria cases/deaths
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De-centralized problem-solving
• Why do we need?
− Behavioral change related to ITN use may
be complicated
• Fits with known community
development and behavior change
theory
• Reaching Every District meetings
between community and health facility
staff
Am. J. Trop. Med. Hyg., 68(Suppl 4), 2003, pp. 137–141
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Can this be done?
Monthly measurement
at Health Facility & District Levels
EPI
Malaria
Inputs
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Coverage
+++
Impact
+++
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Measurement itself
as an intervention
• 50,000 conversations per month about
ITN use
• Communication, marketing, advocacy tool
• Benin – MOH/CDC study
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Integration
• Building on successful management
paradigm
− Polio-Measles-Routine success story
• De-centralized measurement & problemsolving
− New anti-malarial drugs (ACTs)
− Child survival interventions
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Scale
• Small pilots
• Design & cost between small pilots and
nationwide scale are different
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Impact
• Why do we need impact measurement?
• Can’t we just use coverage?
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For measles, impact does not
match coverage
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Burkina Faso
Namibia
South Africa
Malawi
Ethiopia
Benin
Niger
Rwanda
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Uganda
Kenya
Zambia
Angola
Benin
DRC
Sierra Leone
Tanzania
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Proposal: Achieve >80% ITN use
at scale in 3 countries in 2007
• Example: Sierra Leone
− Using all ANC and EPI contacts, mothers
− Train health facility staff to facilitate behavior
change discussions with community and
political leaders, especially males
− Link with NGOs
 Red Cross system - 50% chiefdoms
− Measurement of stock and coverage in all
health facilities and districts every month
− Evaluation
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Summary
• Address ITN use & routine ITN
distribution
• Modern management paradigm
− Continuous improvement
− De-centralized problem-solving
• Make progress at scale in 2007
• Attempt to reach >80% ITN use
coverage in 3 countries in 2007
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End
TM