Jhpiego supports national malaria programmes (NMP) across 23 countries in sub-Saharan Africa to implement evidence-based malaria service delivery interventions in prevention, diagnosis, treatment, surveillance, monitoring and evaluation (SME). Priority interventions include insecticide-treated nets, intermittent preventive treatment in pregnancy (IPTp), seasonal malaria chemoprevention, malaria case management, and improving data recording and use at service delivery points to improve the quality of services. In alignment with WHO, donors and major stakeholders, Jhpiego supports national-level strategy, policy and guideline development, and at subnational level, strengthens health management teams and builds frontline health worker capacity to implement malaria interventions in line with recommended guidelines. As a service delivery partner, our malaria SME efforts in many countries center on technical assistance to NMP to improve data capture, quality and reporting at facility-level. We also coordinate with all national level SME partners directly, and through our presence on SME technical working groups, to develop and implement national, subnational, and facility-level data quality improvement and data use interventions, including malaria facility data dashboards, to promote health worker capacity in data analysis and use to improve malaria service delivery.
A notable and comprehensive SME achievement recently documented was through the Jhpiego-led Improving Malaria Care (IMC) project funded by the United States (US) President’s Malaria Initiative (PMI) through the U.S. Agency for International Development (USAID) in Burkina Faso and implemented across its 70 districts. The goal of the seven-year project (2013–2020) was to support Burkina’s National Malaria Control Program (NMCP) to meet its national malaria strategic plan objectives, which includes reducing the 2015 malaria morbidity and mortality rates by 50% by 2020. One of the intermediate results was “Improved national capacity to collect, analyze, and improve malaria data and the information management system”. At the onset of the project, a major challenge faced by the Burkina NMCP was poor data quality resulting largely from the fact that the malaria program operated a parallel data management system, with numerous data collection tools and reports, some of them being duplicates circulating outside of the national HMIS. As such, these created excessive burden on the health workers and gaps in malaria data capture at the facility-level. Consequently, malaria data verification, validation, reporting, and timeliness were suboptimal, and in most cases, absent, thus resulting in poor data quality. A malaria data quality audit (DQA) conducted in 2014, adapting the tools developed by the USAID-funded Measure Evaluation project, showed a low score for malaria data accuracy (43%), timeliness (36%), completeness (52%), consistency (51%).
To address this challenge, Jhpiego provided technical assistance to the NMCP to implement a series of data quality improvement interventions. First was to lead the integration of malaria data into the national HMIS (ENDOS-BF) housed on the DHIS2 platform – a key recommendation from the DQA findings. The objectives of the integration were to unify malaria data sources, reduce workload, strengthen data control, and have timely data for decision-making. The integration process included selection and operational definition of key malaria indicators to be integrated, revision of HMIS data collection and reporting tools, definition of malaria data validation rules and data elements, creating malaria module and setting up malaria data tables in DHIS2. Following the integration, IMC, in collaboration with WHO, supported NMCP and Health Sector Statistic Directorate (DSS) in the revision of the Health Information Management Procedure Manual on how to report monthly data at hospital, health centers, and community levels into DHIS2. This revision incorporated full consideration of malaria data aspects, data quality assurance process, use of newer technology approaches (e-health, m-health), and revision of the data dictionary to reflect the integrated system. This was followed by development and integration of an SME module into the national malaria training package. As part of the overall updating of the national malaria prevention and treatment guidelines based on the WHO recommendations, IMC supported NMCP to update the malaria training modules by appending a last module focused on data collection, review, analysis and use at facility level. Over 1,800 health workers across the 70 districts were trained on the malaria SME and the revised HMIS manual, with a focus on malaria data collection, analysis and use at varying levels of the health system. All data managers from the districts, regional directorates and hospitals, 65 professors from the national school of nurses and midwifery, and 40 SME leaders from national level (NMCP, malaria research institutes, Family Health Directorate and DSS) were trained. In addition to these trainings which created an extensive malaria SME knowledge and skills base nationwide, IMC supported NMCP and DSS to develop district-level malaria data review and validation procedures to foster district management capacity in assessing malaria data quality and promote data use.
This comprehensive suite of data quality improvement interventions enabled the Burkina Faso NMCP to strengthen its malaria SME system, produce better quality data for monitoring progress of malaria indicators and for decision making. The improvement in data quality was evidenced by the findings of the 2nd round malaria national DQA conducted in 2017, which revealed improved malaria data accuracy from 43% to 83%, timeliness from 36% to 86%, completeness from 52% to 78%, and reliability from 51% to 87% between the 2014 and 2017 DQAs. The Performance of Routine Information System Management (PRISM) assessment conducted by the Measure Evaluation project in 2019 confirmed the improvement in malaria data quality, with findings showing data accuracy above 90% for antenatal care (ANC) services (including IPTp) indicators and data completeness of 96% – 100% for the public health facilities. The established malaria data review and validation procedures, introduced at the district level, were scaled up to 56 of the Burkina’s 70 districts[1] in the last 3 years of the IMC project, and has continued to improve the quality of malaria data in those districts. By the end of the IMC project in 2020, the malaria database integrated into the ENDOS-BF continued to function optimally as the mainstay surveillance system for Burkina’s NMCP, and the established malaria data quality improvement systems remained functional. A follow-on USAID-funded five-year project – Integrated Family Health System (IFHS) – was recently awarded to Jhpiego in 2021 and will further strengthen the institutionalized infrastructure and improve malaria data quality and use.
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[1] The remaining districts were not reached due to security issues in the northern part of the country.