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Monitoring and Evaluation of Integrated Campaigns. Measles-Malaria Partnership Meeting Mac W. Otten, Jr., MD MPH Global Immunization Division Feb. 2007. M&E Integrated Campaigns. Campaign itself During campaign Survey: immediate, dry season Survey: wet season Post-campaign ITN use
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Monitoring and Evaluation of Integrated Campaigns Measles-Malaria Partnership Meeting Mac W. Otten, Jr., MD MPH Global Immunization Division Feb. 2007
M&E Integrated Campaigns • Campaign itself • During campaign • Survey: immediate, dry season • Survey: wet season • Post-campaign ITN use • Post-campaign routine ITN distribution
Six Sigma for Child Survival Kaizen for ITN Use Creating 50,000 Conversations for Malaria Control Improving Measurement and Management for ITN Use
Issues • 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
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
Public health management:minimal information package • Minimal package • Inputs (stock) • Coverage • Impact (surveillance) • Use of data
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
Am. J. Trop. Med. Hyg., 68(Suppl 4), 2003, pp. 137–141 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
Can this be done? Monthly measurementat Health Facility & District Levels
Measurement itselfas an intervention • 50,000 conversations per month about ITN use • Communication, marketing, advocacy tool • Benin – MOH/CDC study
Integration • Building on successful management paradigm • Polio-Measles-Routine success story • De-centralized measurement & problem-solving • New anti-malarial drugs (ACTs) • Child survival interventions
Scale • Small pilots • Design & cost between small pilots and nationwide scale are different
Impact • Why do we need impact measurement? • Can’t we just use coverage?
Burkina Faso Namibia South Africa Malawi Ethiopia Benin Niger Rwanda Uganda Kenya Zambia Angola Benin DRC Sierra Leone Tanzania For measles, impact does notmatch coverage
Proposal: Achieve >80% ITN useat 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
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