1 / 34

Quality Assurance, Malaria Control Programme Challenges

Quality Assurance, Malaria Control Programme Challenges. NVBDCP, Orissa. Presentation by : Dr. Madan Mohan Pradhan. Malaria in Orissa,2008 Total population: 41 million (4%) of the country Total land area : 3% of the country. Total malaria cases around 3.7 lakh /years (24% of India).

bridgesd
Download Presentation

Quality Assurance, Malaria Control Programme Challenges

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Quality Assurance,Malaria Control ProgrammeChallenges NVBDCP, Orissa Presentation by : Dr. Madan Mohan Pradhan

  2. Malaria in Orissa,2008 Total population: 41 million (4%) of the countryTotal land area : 3% of the country Total malaria cases around 3.7 lakh /years (24% of India) Total malaria deaths 239/years (24% of India) Data source: Malaria surveillance in Primary Health Care System

  3. Malaria trend in Orissa Around 60% deaths in tribal blocks

  4. Epidemiological situation, 2004 to 2009

  5. 20 High Burden Districts

  6. Challenges • In Orissa more than 85% is Pf malaria • Orissa contributes 43% Pf malaria to India • Pf is resistant to Chloroquine • Large % of population : ST & SC and • more so in remote/ cut-off areas [ST + SC (22% ST and 16% SC) = 38%] • Relative lack of health sector human resources. --

  7. Challenges inDiagnosis at community level Diagnosis depends upon RDT and Microscopy • Use of RDT: So far 36340 ASHAs have been engaged which is expected to be 42000. • They will use RDTs, draw blood smears and fill up M1 form along with their other responsibilities • Use of microscopy: In Orissa microscopy clinics (MC) available upto Block level (Total 314 blocks) • To ensure diagnosis within 24 hrs MCs should be available at sector PHC level • There are around 1200 sector PHCs and accordingly trained LTs and microscopes are required

  8. Challenges:Microscopy - processes • All malaria microscopy centres send: • 10% of +ve and 10% of –ve slides to the state level laboratories • Central Lab under the National Control Programme under the state Govt and • Laboratory of RD, ROH & FW , GoI office Both these labs are meant for cross checking. Accordingly random end nos. are given by the Central Malaria Laboratory.

  9. Challengesin transportation of blood slides for cross checking • Blood slides for cross checking are transported from blocks to districts and then to state every month • Crosschecking labs at state level give feedback to the poorly performing labs • if discrepancy is > 2%, poor quality smear, delayed reporting etc., then feedback is sent to the districts for necessary action. • Poorly performing LTs are retrained at the Lab of RD,ROH & FW, GoI, BBSR.

  10. Microscopy Quality Monitoring

  11. Challenges:Monitoring the quality in microscopy • Desired numbers of slides are not received from MCs by the designated cross checking laboratories • Blood smears not received in time from a number of MCs • Defaulter MCs are alerted by letters from SPO and over telephone.

  12. Assessment of Laboratory Processes Initiatives taken: • Questionnaire designed for lab. Assessment and being used by trained LTs to collect information on lab. processes • Newly appointed LTs under the new projects have been trained • They will be assigned with the job of assessing the malaria microscopy using the questionnaires.

  13. Challenges with Diagnosis by RDT • Quality Assurance mechanisms not strongly established. • Guidelines for storage, transport and use of RDTs in the field has been sent to districts and district officials have been sensitized on the issue • Oriya pictorial information sheet developed to be used HW and ASHAs . • Possibilities of cross checking: • Sentinel site / block labs can be oriented to cross check RDTs comparing with microscopy

  14. Drugs &Treatment State procured Drugs: • Drugs procured using state funds come with a manufacturer’s testing certificate. • After receiving these drugs, Districts send random samples from each stock to State Drug Management Unit (SDMU) • SDMU forwards these drugs to certified National Accredited Biological Lab (NABL) for quality testing. GoI supplied drugs: No such procedure is followed for GoI supply drugs Treatment Audit: • Not yet implemented the prescription/treatment audits

  15. Surveillance- timeliness

  16. Vector Control Indoor Residual Spray (IRS) • Monitoring teams for IRS: • Both state and dist. teams are oriented before each round of IRS • A predesigned checklists is used for Monitoring • Entomological studies : • State has no functional entomological teams • Initiatives taken to make the three zonal teams functional • Entomological studies are done by ICMR institutes like NIMR/RMRC/VCRC

  17. IRS: Challenges Not done: • Insecticide quality testing is not done since insecticide supplied by GoI. • Spray quality testing – by bioassay / wall scrapings

  18. Monitoring and supervision for spray • Village level - MPW/ MTS/ MO I/c sector PHC • Recently GKS are involved – shows improvement • After Village committee/ GKS certification of completion of spray, wages are paid to SFW, IFW • Post cards are sent from the community where IRS is done • Display boards for IRS schedule/ areas at block PHC/CHC. • CHC/ PHC level - MPW/MTS/ ADMO/ MO PHC/ CHC • District level - Jt. DHS/ CDMO • State level - SPO, other staff at state NVBDCP

  19. Supervision report from ASHA & Sarpanch

  20. Monitoring : Treatment of nets by insecticides • Govt supplied bednets/ community bednets are treated with deltamethrine ( SP flow) • Treatment is done by govt. staff/ NGO/ CBOs/ volunteers. • Supervision by govt. staff is done during the insecticide treatment. • Treatment is done at a common place in the community so that people can see and adopt later. .

  21. Challenges :in treatment of plain net • Monitoring of re-impregnation of nets after each six month is a difficult task • Gaps in supply of nets: When GoI supply nets are inadequate and not supplied in time, it becomes difficult to mobilse community nets to give >60% household coverage in a high burden areas. Due to this it becomes difficult to utilise SP flow in time.

  22. NGO/PPP involvement • 40 NGOs have been involved in IRS, especially in difficult to reach areas- they are monitored by health personnel in 8 districts. • ITN impregnation – NGOs involved in large numbers • Corporate sectors involvement started • Kalyani clubs, other CBOs • GKS, CBO and community based monitoring ongoing in a number of places

  23. Training and Capacity building • Pre and post training test questionnaires are a part of all trainings conducted by the State VBDCP unit. • Assessment of staff competencies done during field visits. • It has been planned to have KAPB assessment of field level service providers – • MTS will conduct the study.

  24. IEC/ BCC – QA assurance • IEC material being centrally developed to ensure standardisation and correct, to-the point messages. • Pictorial messages for lower literacy groups • Electronic media messages from state level to ensure uniformity • Greater focus on IPC for behavioural change. • Monitoring through field visits, documentation, photographs. • Issue based, area specific and outcome oriented IEC packages. • Use of multimedia approach for message dissemination

  25. Indirect quality assurance mechanisms • Program checklists/ Supervisory checklists for ADMO-PH/ DMOs and CDMO, state officials and consultants • VBD consultants have recently joined in World Bank districts, who would be directly responsible for Quality Assurance in their districts.

  26. Indirect quality assurance mechanisms • MTS submit monthly performance to district program officers using the designed checklist. • Communication from state NVBDCP to MTS over phone • District Collectors have been requested by Commissioner cum Secy, Health & FW to review malaria control program - Checklist provided. • Review by Secy Health in each month

  27. Proposed Lot Quality Assurance Sampling (LQAS)

  28. Lot Quality Assurance Sampling (LQAS) • LQAS is being planned for quality assurance for ITN/LLIN, RDT use, treatment, drug supply at the level of ASHAs/ FTDs • Technical support is being provided by The Liverpool School of Tropical Health & Hygiene • Preliminary round of training has been completed for core stakeholders like State NVBDCP, RMRC, and Medical college (SPM Deptt), T&MST • Questionnaires have been developed in the context of Orissa

  29. What is LQAS? (1) • LQAS is a method of rapid assessment of interventions/ collecting baseline information for any programme. • Monitors progress towards targets and objectives set forth by the state. • Decentralized measurement of outcomes at district and PHC levels to support local decision-making and provide objective monitoring to the central level

  30. What is LQAS? (2) • LQAS method uses a very small sample size of 19* in a supervision area/management unit • Supervision area/ management unit is a block PHC in our case. • LQAS can estimate with >90% accuracy whether a pre-established target is being reached or not. • Selection of villages and household • * 19 villages in a Block are selected randomly using a software. • From each village 1 household is selected randomly and interviewed. • From the same village one ASHA is also interviewed.

  31. Plan in Orissa • To be piloted in 3 World Bank supported dists, in 2009 i.e. Mayurbhanj, Sundargarh and Nawarangpur • The first round of data collection is planned for Oct. 2009 (to capture data during a high transmission season) • Data collection to be done through MTS and other field staff in malaria control • Training before data collection • T&MST (OHSP) is coordinating implementation.

  32. Small surveys for quality assurance • Community based survey in Mayurbanja and Sundargarh to assess the treatment seeking behaviour (with ACT) , coverage and use of ITN and IRS is being done in Sept- October,09 • Questionnaires developed and field tested • Such studies will be conducted for to assess the KAPB of filed level service providers ( ASHA, HW, MOs)

  33. Other mechanisms to improve the quality assurance mechanisms • Capacity building and ensuring regular analysis on QA of blood slides and feedback to dist/ PHCs • Ensuring submission of blood slides to the designated laboratories within the fixed time period • Improving capacities of LTs in poorly performing districts. • Integrating QA into the M & E mechanism. • QA for treatment protocol after training of Medical officers • QA for vector control processes.

  34. Thanks

More Related