THE UGANDA STOP MALARIA PROJECT ANNUAL PERFORMANCE REPORT
OCTOBER 1ST 2014 –MARCH 27TH 2015
Submitted to USAID on March 27th, 2015
USAID/JHU Cooperative Agreement No. CA 617-A-00-08-00018-00
1
Table of Contents
LIST OF ACRONYMS ...............................................................................................................................................3
EXECUTIVE SUMMARY .........................................................................................................................................5
BACKGROUND ..........................................................................................................................................................7
RESULTS FRAMEWORK ........................................................................................................................................8
PROJECT ACHIEVEMENTS ...................................................................................................................................9
IR 1.1: MALARIA RELATED POLICIES AND GUIDELINES OPERATIONALIZED........................................9
IR 1.3: ACCESS TO LLINS INCREASED ............................................................................................................. 12
IR 2: MALARIA DIAGNOSIS AND TREATMENT ACTIVITIES IN SUPPORT OF THE NATIONAL
MALARIA STRATEGY IMPROVED AND IMPLEMENTED ............................................................................ 13
IR 2.1: MALARIA DIAGNOSTIC TREATMENT AND REFERRAL SERVICES IMPROVED ........................ 13
IR 2.2: MALARIA DIAGNOSTIC CAPACITY AND SERVICES IMPROVED ................................................. 14
IR 3: NMCP CAPACITY TO MONITOR AND EVALUATE INTERVENTIONS STRENGTHENED .............. 14
IR 3.1: TECHNICAL RESOURCES AND SKILLS OF MONITORING AND EVALUATION (M&E) SUBUNIT IMPROVED ................................................................................................................................................. 14
IR 3.2: COLLECTION, PROCESSING AND USE OF DATA FROM DISTRICTS AND IMPLEMENTING
PARTNERS IMPROVED ...................................................................................................................................... 15
CROSS CUTTING ACTIVITIES ............................................................................................................................ 17
SUPPORT SUPERVISION .................................................................................................................................... 17
CREATING DEMAND FOR MALARIA SERVICES AND PRACTICES ........................................................... 17
PROJECT MONITORING AND EVALUATION ................................................................................................. 19
COORDINATION AMONG KEY PARTNERS IMPROVED .............................................................................. 20
LESSONS LEARNED ............................................................................................................................................... 20
CHALLENGES AND RECOMMENDATIONS .................................................................................................... 21
CONCLUSION .......................................................................................................................................................... 21
USAID/JHU Cooperative Agreement No. CA 617-A-00-08-00018-00
2
List of Acronyms
ACT
Artemisinin-based Combination Therapy
ANC
Antenatal Care
BCC
Behavior Change Communication
CDFU
Communication for Development Foundation Uganda
CHC
Communication for Health Communities
CME
Continuing Medical Education
DDU
Data Demand and Use
DHO
District Health Officer / Office
DHIS2
District Health Information System 2
DHT
District Health Team
DFID
Department for International Development in UK
DO3
Development Objective 3
DOTs
Directly Observed Treatment
EQA/QC
External Quality Assurance/Quality Control
GF
Global Fund
HMIS
Health Management Information Systems
IDI
Infectious Diseases Institute
IEC
Information, Education and Communication
IMM
Integrated Management of Malaria
IP
Implementing Partner
IPC
Interpersonal Communication
IPTp
Intermittent Preventive Treatment in pregnancy
IR
Intermediate Result
ISS
Integrated Support Supervision
JHU•CCP
Johns Hopkins University Center for Communication Programs
LLIN
Long Lasting Insecticide Treated Net
MC
Malaria Consortium
MCH
Maternal and Child Health
MDD
Music, Dance and Drama
MFPs
Malaria Focal Persons
MIP
Malaria in Pregnancy
MIS
Malaria Indicator Survey
MoH
Ministry of Health
MOP
Malaria Operational Plan
MPR
Malaria Program Review
MRS
Malaria Reduction Strategy
MTR
Midterm Review
mTRAC
Mobile Tracking of Essential Medicines
NDA
National Drug Authority
NMCP
National Malaria Control Program
NMRS
National Malaria Reduction Strategy
NMS
National Medical Stores
OPD
Outpatient Department
USAID/JHU Cooperative Agreement No. CA 617-A-00-08-00018-00
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PMI
PMP
PNFP
Q1
QI
QC
RBM
RC–MoH
RDT
SDS
SMP
SP
ToT
USAID
VHT
WHO
President’s Malaria Initiative
Performance Monitoring Plan
Private Not-for-Profit
Quarter 1
Quality Improvement
Quality Control
Roll Back Malaria
Resource Centre of the MoH
Rapid Diagnostic Testing
Strengthening Decentralized Systems
Stop Malaria Project
Sulfadoxine-pyrimethamine
Training of Trainers
United States Agency for International Development
Village Health Team
World Health Organization
USAID/JHU Cooperative Agreement No. CA 617-A-00-08-00018-00
4
EXECUTIVE SUMMARY
Stop Malaria Project (SMP) was designed to assist the Government of Uganda to reach the RBM
goal of reducing malaria morbidity and mortality by 70% by 2015. Project implementation
started in September 2008 with JHU.CCP, the lead partner, Malaria Consortium, the technical
lead, Communication for Development (CDFU) and Infectious Disease Institute (IDI).
During the year, Stop Malaria Project (SMP) focused on three intermediate results:
1) Malaria prevention programs in support of the national malaria strategy improved and
implemented.
2) Malaria diagnosis and treatment activities in support of the national malaria strategy
improved and implemented.
3) NMCP capacity to monitor and evaluate interventions strengthened.
During the year, SMP made progress towards meeting Year 7 targets. These include:
IR 1: Malaria Prevention


SMP supported strengthening of health workers knowledge and skills of IPTp - DOTs and
interpersonal communication through support supervision and continuous medical
education. Over the years the proportion of pregnant women receiving two doses of
IPTp has increased from 39% in Year2, quarter 1 to 60 % in Year 7, Quarter 2.
SMP supported the NMCP to hold a stakeholders meeting to review the MiP
implementation policy guidelines in light of the new WHO MiP revised guidelines. The
guidelines await approval by top MoH management before they can be rolled out to
districts.
IR 2 Malaria treatment and referral services improved

the percentage of children under five who received a diagnostic test (either microscopy
or RDT) (Numerator = Tests done for children U5 and Denominator = Malaria cases of
children U5) at the health facility increased from 76% in Year 6, quarter 4 to 85% in Year
7, quarter 2.
IR 3: Strengthen the capacity of the NMCP M&E Unit to monitor and evaluate malaria
interventions.
 SMP supported NMCP to hold meetings for M&E technical working groups which
discussed the Malaria indicator Survey (MIS) analysis plan, the scope of work of the
technical working group, the NMCP Malaria bulletin.
5




Submission of HMIS reports from the district to the national level that were timely
(actual 94% target = 95%), and complete (actual = 99%: target = 98%).
Increase in data utilization at health facility level from 46% in Year 5, Quarter 3 to 53% in
Year 7 (HMIS 2014-2015).
Increase in Health Management Information Systems (HMIS) data accuracy from 74% in
Year 6, Quarter 4 to 79% in Year 7, Quarter 2.
Successful Project Close-out Event at the Golf Course Hotel in Kampala with the Minister
of Health, Mission Director, PMI/USAID, DFID, WHO, National Malaria Control Program
(NMCP), Implementing partners and District Leadership in attendance.
However, with all the gains that SMP has registered in the past years, it is not certain that these
gains will continue if some gaps are not addressed by the Ministry of Health. This includes
provision of the new revised HMIS tools, consistent support supervision to the health facilities
and provision of LLINS to pregnant women.
6
BACKGROUND
Stop Malaria Project (SMP) was designed to assist the Government of Uganda, in particular the
National Malaria Control Program (NMCP) and District Health Teams (DHTs), to achieve its goal
of reaching 85% of children under five years of age and pregnant women with proven
preventive and therapeutic malaria interventions, that include: Artemisinin-based Combination
Therapy (ACTs) for treatment of uncomplicated malaria, Intermittent Preventive Treatment
(IPTp) of malaria in pregnancy, and Long-lasting Insecticide Treated Nets (LLINs).
The project activities are designed to meet three intermediate results namely:
 Malaria prevention programs in support of the national malaria strategy improved and
implemented;
 Malaria diagnosis and treatment activities in support of the national malaria strategy
improved and implemented; and
 NMCP capacity to monitor and evaluate interventions strengthened.
The project activities are implemented in close collaboration with the NMCP and district local
governments including district health team. SMP will endeavor to seek avenues to engage the
Regional Performance Monitoring Teams (RPMTs). In Year 7, the project covered 26 districts in
Central (21 districts) and Mid-Western (Hoima) regions (5 districts). In Year 6, the project
phased out Teso Region, as a result of scaling down project activities in the final year of
implementation and change in regional focus by the donor.
Activities for Q1-Q2 were implemented in all 26 project districts. Activity implementation
during the year was based on the results framework below; the framework provides a
foundation for the expected project results and activities that contribute to the project
intermediate results.
7
RESULTS FRAMEWORK
Critical Assumptions
Availability of Funds
Health workers available at HF
Availability of drugs and nets
Development Objective 3: Improved Health and Nutrition Status in Focus Areas and Population Groups
Malaria related
policies and
guidelines
operationalised
Program Objectives 3.1.1: Reduce Malaria Mortality
IR1:
Malaria prevention improved
IR 1.1:
Malaria policies
& guidelines
operationalised
IR 1.2: Access
to IPTp ’
increased
IR 1.3:
Access to
LLINS
increased
.
Program Activities to affect the Results
IR2:
IR 2.1 Service
providers’
capacity to
manage severe
malaria
improved and
implemented
Print and disseminate guidelines
Program Activities to affect the
Results
IR 2.1
1.
2.
3.
4.
Track IPTp Commodities
Conduct ISS on IPTp
Print and distribute ANC cards
Provide water purification tablets, cups,
and jerycans
Print and distribute Cards
BCC to promote IPTp
IR 1.2
5.
6.
IR 1.3.
1.
2.
3..
4.
5.
Continue ANC LLIN distribution
Support Universal LLIN distribution
:
Promote Net Use
Print and distribute ANC LLIN
registers
Fund and participate in Integrated Vector
Management Technical Working groups
1.
2.
3.
4.
5.
6.
7.
2.
3.
4.
Crossing cutting program activities
1.
2.
3.
4.
5.
6.
7.
8.
Support NMCP to conduct ISS
Support districts to conduct ISS
Liaise with SDS to sustain ISS
Test, Treat and Track campaign
Net care and Repair campaign
Conduct Community Outreach activities
Conduct quarterly review meetings
Compile and share ISS reports
8
Technical
resources and skills
of M&E sub-unit
increased
-
.
IR 3.2
Collection,
processing and
use of data from
districts and
implementing
partners
improved
Program Activities to affect the
Results
IR 3.1
Conduct Clinical Audit in Hospitals
and HCIVs
Revise and produce job aids on
severe malaria -and uncomplicated
malaria
Support blood banks to increase
capacity for transfusion for severe
malaria
Track and when needed, redistribute
ACTs, RDTs and IV and rectal
artesunate
IMM training for new health facility
staff.
Reprint and distribute in patient
observation forms
Support review of HMIS tool to
facilitate capture of patients treated
with antimalarials who received a
diagnostic test and result of the
diagnostic test
IR2.2
1.
IR 3.1
IR 2.2
Malaria
diagnostic
capacity
and
,
services
improved
IR 1.1
1.
IR3:
NMCP Capacity streng t hened
Malaria diagnosis and treatment improved
Train Laboratory personnel on
malaria diagnostics
Strengthen NMCP capacity to
conduct EQA
Strengthen equipment maintenance
and supply
Strengthen supply of malaria
diagnostic consumables
1.
2.
3.
RBM coordination meetings
Financial and Technical support
to Malaria Technical Working
Groups
Support NMCP development of
Annual Work plan
IR 3.2
1. Conduct DQA and DDU
2. Fund Internet Subscriptions
PROJECT ACHIEVEMENTS
IR 1.1: MALARIA RELATED POLICIES AND GUIDELINES OPERATIONALIZED
During the year, SMP provided financial support for one RBM meeting, four M&E and three
Case Management Technical Working Group meetings. The RBM Meeting was held on 25th
February 2015 with 24 people in attendance. These included MoH staff, implementing partners
and representatives from the donor community. The key issues discussed in the meetings
included the net care and repair presentation by JHU staff. One of the notable achievements
registered in the year was the Mid-term Review (MTR) of the National Malaria Strategic Plan
2010/15, which was supported by SMP financially and technically.
IR 1.2: ACCESS TO IPTp UPTAKE INCREASED
During the year, the proportion of pregnant women attending first Antenatal Care (ANC) that
took two doses of sulfadoxine-pyrimethamine (SP) increased to 60% from 58% the previous
year (HMIS data Oct 2014 – February 2015). This year, data on health facilities reporting no SP
stock outs and proportion of health facilities equipped with IPTp commodities slightly increased
from 88% to 92%, while the latter decreased from 90% to 89%. However, during quarter 2 ISS,
SMP equipped health facilities with cups, jerrycans and Aqua Safe tablets since some health
facilities had worn out containers and stock-outs of Aqua Safe tablets.
SMP supported integrated support supervision (ISS) on IPTp to strengthen health workers
knowledge and skills of IPTp - DOTs and interpersonal communication of health workers with
clients. Most (71%) of health facilities reached during ISS and had at-least 2 health workers
trained in IPTp quality improvement approach, which was the same as Year 6. This may be
attributed to the fact the newly recruited health workers; were mentored at the time ISS was
being conducted. In addition, SMP supported districts to conduct continuous medical education
to improve health worker interpersonal communication skills for increased IPTp uptake.
During the year, SMP supported the NMCP to hold a stakeholders workshop to revise the
Malaria in Pregnancy Guidelines based on the new WHO guidelines; the revised policy
guidelines await approval from MoH top management. In addition, SMP in collaboration with
the Communities for Health Project supported a stakeholders meeting to review malaria in
pregnancy messages. As a result SMP supported the production of the messages, training and
distribution of the messages to the Village Health Teams (VHTs).
9
IPTp Uptake in SMP districts (2009-2015 HMIS Data)
100%
80%
60%
40%
84% 83% 85% 86% 85% 82% 83%
81%
76%
85% 83%
85% 84% 83%
81% 82%
78%
80%
67% 67% 66%
61%
59% 60% 60%
65%
54% 54% 53% 55% 53%
60%
60%
48%
57% 57%
40%
53% 52% 52%
50%
37%
48%
39%
39%
41%
IPTp 2 Target =
60%
IPTp1
20%
IPTp2
0%
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
Year1
Year2
Year3
Year4
Year5
Year6
Year7
Below is the indicator table for tracking progress for the year.
Indicator
Percentage of facilities
equipped with IPTp
commodities
Percentage of health
facilities with at least 2
health workers oriented in
IPTp quality improvement
approach
Data
Source
ISS
Target
Actual
95%
89%
Distribution of cups took place
during the last ISS in quarter 2.
ISS
75%
71%
Mentorship of newly recruited staff
was done during the last ISS in
quarter 2.
10
Comments
Indicator
Percentage of pregnant
women attending ANC who
received at least two doses
of SP
Percentage of health
facilities reporting no stock
out of SP
Data
Source
HMIS
Target
Actual
60%
60%
This achievement is an increase in
IPTp uptake from 58% in the
previous year.
ISS
96%
92%
This was an improvement from
88% from previous year.
11
Comments
IR 1.3: ACCESS TO LLINs INCREASED
ANC LLIN distribution
During the year, the proportion of pregnant women attending ANC who received an LLIN was
40%, an average for quarter 1 to 3 (range: 9% to 71%) (HMIS data 2014-15).
This was significantly below the year 6 SMP target of 95% but an increase from 33% the
previous year. Over the year, SMP received PMI ANC nets but due to late delivery PMI gave the
nets to JMS for distribution. Distribution by JMS is expected to begin next quarter. Distribution
by JMS coupled with TASO LLIN distribution is expected to increase LLIN access by pregnant
women attending ANC.
SMP through ISS continued to encourage health workers to provide interpersonal
communication with pregnant women so that pregnant women consistently sleep under the
bed net received by universal net campaign every night during pregnancy and after delivery
along with their babies. Interpersonal communication messages also involved advising pregnant
women to care for and repair their bed nets so that the bed nets can last for a long time.
Performance
Indicator
Number of LLINs
distributed to ANCs in
districts from SMP
Kampala stores
Data
Source
SMP
Records
Number of ANC
clients receiving free
ITNs
Proportion of
pregnant women
provided with LLINs
through ANC
distribution
Proportion of ANC
clinics distributing
LLINs
Target
Actual
Comments
493,632
0
HMIS
Data
493,632
85,534
No ANC nets were available in the
SMP stores for ANC distribution.
PMI ANC nets arrived in December
2014 and were given to JMS for
distribution since SMP was
winding up implementation
This data was drawn from national
HMIS database. (DHIS2)
HMIS
Data
95%
40%
ISS Data
100%
30%
12
Numerator 85,534 (Pregnant
women (PW) who received LLINs
as reported in DHIS); denominator
213,835 (PW attended ANC 1st
visit in SMP districts as reported in
DHIS2).
308 out of 1025 health facilities
distributed LLINS. The rest had no
nets for distribution.
.
IR 2: MALARIA DIAGNOSIS AND TREATMENT ACTIVITIES IN SUPPORT OF THE NATIONAL
MALARIA STRATEGY IMPROVED AND IMPLEMENTED
IR 2.1: MALARIA DIAGNOSTIC TREATMENT AND REFERRAL SERVICES IMPROVED
During Year 7, SMP provided technical and financial support to district teams to carry out
clinical audits at 59% (43/72) hospitals and HCIVs reaching. Clinical audits were conducted by
district and health facility clinical audit teams using the revised clinical audit tool. District teams
have found the revised clinical audit tool easier to use as it provides simplified instructions on
how to administer the tool and provide feedback to health facility staff.
During ISS, SMP worked with districts to track the availability of ACTs and other anti-malarial
commodities in health facilities to ensure constant availability of these medicines in the health
facilities. In health facilities with higher stocks of these commodities, SMP worked with districts
to redistribute ACTs from these facilities to those with inadequate stocks. The proportion of
supervised health facilities experiencing no ACT stock outs was 97% which was higher than the
SMP target of 95% and achievement of 91% in Q1 of year 6 (SMP ISS).
SMP also participated in the malaria case management technical working group (TWG) meeting
with NMCP and other partners to review status of diagnostics commodities, treatment
commodities including IMM training of health workers in integrated management of malaria
and iCCM implementation under the GF grant and definition of diagnostics indicator for the
quarterly NMCP malaria bulletin and routine reporting. The meeting provided a forum for
discussion of these key case management issues and action points to ensure effective malaria
case management in the country.
13
IR 2.2: MALARIA DIAGNOSTIC CAPACITY AND SERVICES IMPROVED
SMP closed IDI at the end of Year 6. However, SMP continued to support on-the-job mentorship
of lab health workers through support supervision.
During the year, the percentage of children under five who received a diagnostic test (either
microscopy or RDT) (Numerator = Tests done for children U5 and Denominator = Malaria cases
of children U5) at the health facility increased from 76% in Year 6, quarter 4 to 85% in Year 7,
quarter 2.
Percentage of children under five who received a diagnostic test
(Microscope and RDT)at the health facility before treatment
(HMIS 2010-2015)
100%
72%
80%
38%
40%
58%
57%
60%
84%
71% 73%
78%
74%
81%
85%
76%
46%
44%
56%
69%
62%
Actual
42%
Target
20%
0%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
Year3
Year4
Year5
Year6
Year7
IR 3: NMCP CAPACITY TO MONITOR AND EVALUATE INTERVENTIONS STRENGTHENED
IR 3.1: TECHNICAL RESOURCES AND SKILLS OF MONITORING AND EVALUATION (M&E) SUBUNIT IMPROVED
SMP provided financial support for the Monitoring and Evaluation Technical Working Group
meetings held on a monthly basis. The meetings discussed the NMCP malaria quarterly bulletin,
and the malaria indicator survey analysis plan.
SMP supported NMCP Staff to attend the Central regional review meeting that brought
together district health team members and the political leadership together last year in
December. The meeting discussed project performance, sustainability issues and
recommendations to MoH on scaling up malaria efforts in the country.
14
IR 3.2: COLLECTION, PROCESSING AND USE OF DATA FROM DISTRICTS AND IMPLEMENTING
PARTNERS IMPROVED
SMP continued to support districts to submit their HMIS reports to Resource Centre of the MoH
(RC-MoH) through DHIS2. There is a tremendous improvement in the percentage of districts
submitting HMIS data to the national level on time from 81% in Year 5, Quarter 4, to 95% in
Year 7, quarter 2 compared to 80.9% at national level. Complete data submission to national
level was maintained at 99% at the end of Year 7 compared to 86% at national level.
Percentage of SMP supported districts submitting complete
and timely reports to the national level (HMIS 2010-2015)
120%
100%
97%
95%
87%
96%
80%
78%
97%
95%
85%
98%
97%
96%
100%
98%
97%
98%
86%
84%
82%
72%
99%
99%
94% 92%
99%
99%
94%
92%
95%
83%
83%
68%
60%
Completeness
60% 61%
Timeliness
40%
45%
20%
0%
Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
Year3
Year 4
Year 5
Year 6
Year7
Utilization of HMIS data by the facilities increased from an average of 52% at the end of Year 5
to 53% average at the end of Year 7. The indicator was calculated based on the presence of
data analyzed with recent charts printed on the wall for health worker reference, especially
during the planning period and quantification of drugs.
15
HMIS data accuracy increased from 74% in Year 6 to 79% in year 7. The numerator is the
number of districts providing accurate data (accurate data means the summary of the data at
the health facility should match the data in the district HMIS data that was submitted to the
National level with an allowable variance of +-5) out of the 26 districts in the SMP project area.
The increase in the indicator was due to SMP support to districts to conduct data quality
assessments (DQA) in health facilities. During DQAs, the district teams provide mentorship on
how to improve the quality of data. During Year 7, SMP supported districts to conduct 2 rounds
of data quality assessments in all the 26 districts.
SMP recommends that RC-MoH in collaboration with partners to print and distribute the new
revised HMIS tools and conduct a comprehensive HMIS training based on the revised tools. The
training should target all health workers involved in recording any form of data in the health
facilities and consequently providing them with revised HMIS tools. This will go a long way in
improving data accuracy at health facility level.
Performance Indicator
Percent of SMPsupported districts
that provided
complete data on
malaria indicators to
national HMIS
database
Percentage of districts
submitting HMIS data
to the national level
on time (before the
28th of the following
month)
Proportion of health
facilities utilizing data
for decision-making.
Data Source
HMIS
Target
98%
Actual
99%
Comment
As per the Annual Health Sector
Performance Report 2010-14,
complete HMIS reporting is higher
in SMP districts at 99% compared
to 85.9% for national level.
HMIS
70%
95%
ISS
50%
53%
Number of Roll Back
Malaria
partner
meetings
Project and
Partners
records
1
1
At national level, timely reporting
of HMIS data stands at 80.9%
compared to 95% in SMP districts.
Improvement may be due to
continuous follow up and feedback
by SMP.
Numerator = number of health
facilities in SMP-supported
districts visited by ISS team with
evidence of plotting trends on key
malaria indicators and using the
data for planning in the quarter.
Denominator = the number of
health facilities visited by the ISS
team during the same quarter.
. The meeting was held on 25th
February 2015 at Kati Kati
restaurant
16
CROSS CUTTING ACTIVITIES
SUPPORT SUPERVISION
During Year 7, SMP provided funding and technical support to districts to conduct integrated
support supervision - ISS focused on IPTp, ANC, LLIN distribution, diagnosis and treatment,
health education, community mobilization, malaria commodities management and HMIS. In
districts where SMP overlaps with Strengthening Decentralized Systems (SDS), funding for
district teams was provided by SDS. Implementation of ISS was combined with Data Quality
Assessments (DQAs) and Data Demand & Use (DDU) meetings. The aim of ISS was to improve
performance of health facilities in the delivery of malaria prevention and treatment services.
The activity was conducted in quarter 1 and quarter 2. Health facilities mainly targeted for ISS
were: all hospitals and HC IV, about 80% of HCIII and a few HC II. District ISS teams made on-site
observations using the standard ISS tool, and provided on-the-job mentorship to the health
facility staff to strengthen their skills in malaria control. The ISS district teams then worked
together with facility staff to develop facility action plans to address the gaps identified in the
ISS tool. Facility action plans form the basis for tracking the progress of previously agreed
actions within the health facility.
CREATING DEMAND FOR MALARIA SERVICES AND PRACTICES
During year 7 the key Behavioral Change (BCC) activities implemented included the Test and
Treat Campaign to promote malaria diagnostics services. Radio spots, radio talk shows and
health provider job aids were used to create demand and utilization of the malaria control
services.
a) Test and Treat
SMP supported NMCP to implement the media components of the Test and Treat
communication campaign. A total of 1,035 radio spots and 27 radio talk shows were
conducted on 9 FM radio stations during the reporting year. Messages were integrated with
a focus on LLIN usage, care and repair, test and treat and IPTp uptake among pregnant
women.
The Test and Treat health provider trainings were implemented in 14 Central region districts
to enhance health provider their competency in interpersonal communication and in
17
managing fever among children under five. The training focused on health providers from
health center III & IIs. Two hundred sixty (260) health providers benefited from the training.
Continuous Medical Education (CME) sessions were conducted to further mentor both the
trained and untrained health providers on the test and treat IPC skills on patient
assessment, differential diagnosis, testing and treatment. The CME sessions were an
opportunity to further discuss progress since the last training was conducted and how the
challenges have been addressed.
b) Village Health Team job aid
In order to strengthen the demand and motivation for Intermittent Preventive Treatment in
Pregnancy (IPTp) uptake, SMP trained 222 VHTs during year 7 on key malaria messages and
developed a job aid. The objective of the training was to equip the VHTs with knowledge on
key prevention messages including IPTP uptake, LLIN use, test and treat with a strong focus
on IPTp uptake among pregnant women within their catchment area. The VHTs will conduct
home visits to sensitize household members and follow up pregnant women that are due
for IPTp. An integrated job aid was designed to support VHTs with their activities. The job
aid focuses on Malaria in Pregnancy (MIP), LLIN use, care, repair, test and treat.
c) Health facility Intermittent Preventive Treatment (IPTp) job aid
SMP in collaboration with the Communication for Healthy Communities (CHC) project held
consultative and planning meetings on the development of the Intermittent Preventive
Treatment job aid for health providers. The job aid will support health providers improve
their IPC skills and streamline MIP information by the health providers. A stakeholder’s
workshop was held. Officials from MOH, implementing partners, midwives, clinicians,
nurses participated in the development of the MIP /IPTp job aid.
Performance Indicator
Number of radio talk shows on
IPTP uptake, Test and Treat and
LLIN usage, care and repair
conducted
Number of radio spots
broadcasted
Target
23
840
Actual
27 radio
talk shows
Comments
Media activity were approved and
commenced in the month of
December
1035
Media activity were approved and
commenced in the month of
December
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Performance Indicator
Number of health providers
trained
Number of health facilities
conducting CMEs
Target
216
108
Actual
260 health
providers
140
Health
facilities
Comments
More health workers were available
for training than initially projected
Some districts had more HC IIs and
IIIs. These include Rakai Mityana,
Buikwe, Mukono and Kalungu
PROJECT MONITORING AND EVALUATION
During the year, data entry into the HMIS database was done by the SMP M&E Team on a
monthly basis, which involved tracking timely and complete submission of reports from districts
to the national level. The SMP M&E team continued to provide feedback to districts on the
status of their reports in the District Health Information System (DHIS2), which contributed to
improved reporting (page 15).
SMP held regional review and planning meetings with districts in all its regions of operation
(Central and Mid-Western). District participants included the political (Secretaries for Health of
different districts), administrative (Chief Administrative Officers) and technical leaders (District
Health Team members). The objective of the meetings was to share achievements, lessons
learnt and challenges, and sustainability issues. Districts appreciated SMP’s support in the fight
against malaria. For example, Dr. Okware, Luwero District Health Officer said, “Not only did the
project build the capacity of health workers in managing malaria cases, they also offered tools
to make it happen”. They appreciated the unique style of SMP of supporting the districts with
physical oversight done by SMP staff and district supervisors to ensure that guidelines are
followed to the dot.
SMP held a close out event on February 19, 2015 which was attended by various dignitaries
including the USAID Mission Director, the DFID Health Advisor and the Minister of Health as the
guest-of-honor. Other guests included Ministry of Health NMCP Staff, JHU Regional
Representative, SMP partners’ directors, district officials and implementing partners.
At the event SMP staff showcased the different activities that the project was engaged in right
from malaria prevention activities, policies formulated/updated, malaria treatment and
diagnosis activities, support to NMCP M&E unit, strengthening district HMIS and behavior
change communication.
During the event, the Chief-of-Party shared the project’s achievements, challenges and
recommendations to NMCP. In addition, certificates of appreciation and plaques were given to
districts and SMP partners, donors, NMCP and RC respectively. The event provided SMP with
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the opportunity to disseminate lessons learned and project materials and to show appreciation
to all who had supported it to attain its expected results.
The Minister of Health, USAID Mission Director and SMP Staff cut a cake
during the Close-out Event
COORDINATION AMONG KEY PARTNERS IMPROVED
SMP held quarterly meetings with NMCP to share progress and identify strategies to address
gaps identified during the course of implementation. A meeting with Malaria Consortium was
organized to discuss partner close-out on the SMP project.
SMP held several meetings with the Communities for Health Communication project (CHC) to
discuss collaboration in revising the NMCP Communication strategy, designing malaria
messages and development of the VHT job aid.
SMP supported NMCP to hold quarterly Roll Back Malaria meetings for malaria partners. The
meeting provided a platform to share research findings for the net care and repair survey
conducted in Uganda and Nigeria in collaboration with the Networks project.
LESSONS LEARNED

Consistent supply chain system from quantification, procurement, warehousing,
distribution, monitoring and reporting is necessary to maintain a well-designed ANC LLIN
distribution system
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
When both RDTs and microscopy are available in hospitals, HC IVs and HC IIIs, health
workers prefer using RDTs to microscopy indicating that RDTs are popular among health
workers largely attributed to ease of performing RDTs

ISS is a key activity for improving performance of health workers. ISS has positively
influenced malaria testing, IPTp2 uptake, and pre-referral treatment. ISS also provides an
opportunity for partners to interface with districts and discuss any bottlenecks and
implementation plans.
CHALLENGES AND RECOMMENDATIONS

Persistent stock outs of LLINs in health facilities for ANC distribution affected prevention
efforts among pregnant women. Although many pregnant women were covered under the
recently concluded mass campaign universal LLIN distribution, there is a need to ensure
consistent supply of LLINs for ANC distribution.

Most health facilities are now able to diagnose malaria using RDTs or microscopy; however,
some health workers still treat malaria presumptively contrary to national malaria
treatment policy. There is a need to monitor health workers practices and tracking of
malaria tests and treatment with regular feedback to stakeholders up to health facility level.
CONCLUSION
SMP has contributed the improvement of malaria services in Uganda through the different
activities implemented in the last six and half years. During Year 7, SMP registered significant
achievements. These included:
 Timely (actual 95% target = 95%) and complete (actual = 99%: target = 98%) submission
of HMIS reports from the district to the national
 Increase in HMIS data accuracy from 74% in Year 6, quarter 4 to 79% in Year 7, quarter
2.
 Increase in the proportion of pregnant women receiving two doses of IPTp from 39% in
Year2, quarter 1 to 60 % in Year 7, quarter 2
Increased diagnostic testing of children under five from 76% in Year 6, quarter 4 to 85% in Year
7, quarter 2.
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