Proposed Malaria Surveillance System & Malaria Elimination Feasibility Study: Philippines

Lipa City, Batangas, Philippines10 – 18 February 2014

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

5,00010,00015,00020,00025,00030,00035,00040,00045,00050,000

34,96837,469

44,60539,946

46,342

35,40536,235

23,65519,95519,106

9,583 8,086

Figure 1. Annual Number of Malaria Cases in the Philippines, 2001-2012

Year

Num

ber

of M

alar

ia C

ases

Cases were reduced by 83% within a period of seven years, from 46,342 in 2005 to 8,086 in 2012.

Global Fund started

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

20

40

60

80

100

120

140

160

76

6254

150

122

73

56

2430

12 16

Figure 2. Annual Number of Malaria Deaths in the Philippines, 2002-2012

Year

Nu

mb

er o

f M

alar

ia D

eath

s

Global Fund started

Within the same period, deaths caused by malaria also declined by 89% from 150 in 2005 to 16 in 2012.

Programmatic Challenges

Palawan

Tawi-tawi

In 2012, 15 out of 80 provinces contributed to 99% of the reported 8,086 malaria cases; two provinces accounted for 85% - Palawan (51%) and Tawi-tawi (34%).

Progress in some provinces in the Mindanao (Southern) Region was erratic, most likely due to political and social instablity.

Enhanced Malaria Strategic Plan 2014 - 2020

Strategic Objectives1. To ensure universal access to reliable diagnosis, highly

effective and appropriate treatment and preventive measures.

2. To strengthen the capacity at all levels towards malaria elimination

3. To sustain financing of anti-malaria efforts at all levels of operations

4. To ascertain quality malaria services, timely detection of infection and immediate response and evidence-based enhancement of malaria elimination measures

2. Existing Malaria Surveillance

a. Phil. Integrated Disease Surveillance & Response (PIDSR)

Flow of Reporting

2. Existing Malaria Surveillanceb. Phil. Malaria Information System (PhilMIS)• An electronic information system that aims to

capture Malaria cases, deaths and vector control data;

• To be implemented across different health reporting units (BMMC/RDT sites, Hospitals, MHO, PHO/Ch-CHO, CHD);

• Allows analysis and use of data at different levels to effectively manage the Malaria Program.

Every 12th

day of thesucceedingmonth

Every 10th

day of thesucceedingmonth

Every 5th

day of thesucceedingmonth

Every 8th

day of thesucceedingmonth

Modified PhilMIS Reporting Flow

CHD

CH-CHOPHO DOH HOSPITAL

RHU/CHO HOSPITAL*

BRGY. FACILITIES

BRGY. FACILITIES

HOSPITAL**

CENTRAL OFFICE

PSFI-PO

PSFI-CH

*Municipal Hospital, District Hospital, Provincial Hospital, Private Hospital** Private Hospital, Clinics, Laboratories

Feedback MechanismReport Flow

What will be the role of the facilities?

• Fill-out Modified PhilMIS forms;• Consolidate and validate data;• Encode into the software of workstation;• Analyze data of workstation;• Provide feedback; and• Submit to next level

Modified PhilMIS FormsCASE REGISTRY FORMS VECTOR CONTROL FORMS

F1 Malaria Patient Registry Form

F6 Mosquito Net Distribution Form

F2 Monthly Malaria Report Form

F7 Mosquito Net Distribution Summary Form

F3 Malaria In-Patient Registry Form

F8 Indoor Residual Spraying Form

F4A Hospital Out-Patient Monthly Malaria Report Form

F9 Indoor Residual Spraying Summary Form

F4B Hospital In-Patient Monthly Malaria Report Form

F10 Mosquito Net Retreatment Form

F5 Active Case Detection / Mass Blood Survey Form

F11 Mosquito Net Retreatment Summary Form

Data can also be viewed in the website by implementers and

managers in the form of tables and graphical summaries.

Reports can also be sent to the implementers via email

During health emergencies (outbreak)

and special concerns (stock-out), System

Administrator of MTRS can contact local Implementers to

facilitate and coordinate activities.

A trained health

worker sends a Malaria

case report through SMS

Flow of Information in Malaria TXT Report System

Implementing partners/managers

at various levels

Malaria Diagnostic Facility

Malaria TXT Report System

5

The SMS is processed by the

MTRS software and the data is stored in a dedicated server.

2

The MTRS software sends

confirmatory SMS within minutes. It

can also send message for

announcements and special concerns

4

3

1

Framework of ESR

2. Exisiting Malaria Surveillance• Case Definition:

- case with fever/history of fever and manifest any of the following sign and symptoms: chills, sweating, headache, enlarge spleen and confirmed positive for malaria.• Laboratory Confirmation:– Microscopy– RDT

Barangay Microscopists

CHD/PHO ValidatorsRITM-NRL

RHU/CHO/hospital/laboratory

Microscopists

Slides for validation

Feedback, supervisionand remedial intervention

LEVEL 2 LEVEL 3

Proficiency Assessment

Slides for validation

Feedback, supervision and remedial intervention

National Core Group

of Trainers/ Validators (NCGT)

(composed of NRL staff and

CHD/PHO validators)

Training

Certification

National/ Regional

Slide Bank

World Health Organization

(WHO) Regional Slide Bank

Regional Accreditation and

EQA Program

LEVEL 1

RHU/CHOhospital/

laboratory/ BMMC microscopists

Basic Malaria Microscopy Training

Quality Control and Quality Assessment of Malaria Microscopy

• Validation of blood films- selection of blood films for validationControl Phase

Scheme 1

240 blood films – 30 blood films/quarter Scheme 2

200-240 blood films – submit all in a quarter Scheme 3

< 200 blood films – submit all blood films and validator sends panel of slide every year

Pre-Elim All positive slides and 10% of negatives

Elim PhaseAll positive slides, RDT positive to be confirmed by microscopy

- validation schedule and frequency

- feedback and reporting

Cross- checking

2. Existing Malaria Surveillance2.3. Personnel for case detection: a. Bgy/Village: Volunteer Bgy Microscopist,

Rural Health Midwives b. Municipality: Med. Techs., Rural Physicians,

Nurses, Malaria Personnel c. Hospitals: Med. Techs, Physicians (mun., district, prov, Cities) d. Private/NGOs, FBOs e. Provincial Health Teams (still existing in some provinces)

2. Existing Malaria Surveillance

• Laboratory Methods1. Microscopy2. RDT3. PCR - RITM

2. Existing Malaria Surveillance

• Methods of Reporting1. Submission of reports (hard and/or soft copy2. Program Implementation Reviews3. Field monitoring4. SMS (limited)

2. Existing Malaria Surveillance• Reports & Feedback Produced by Central Level– Quarterly, Semestral and Annual National Reports– Submits report to WHO - World Malaria Report– Program Implementation Review (twice a year)

3. Proposed Changes- Review of Malaria MOP and inclusion of the Elimination Chaptera. Case Classification– Local• Indigenous case• Introduced case

– Imported• Internal Imported• External Imported

– Induced cases

3. Proposed Changesb. Focus Classification- Stable Transmission – Endemic- Unstable - Active focus, Residual Active- Sporadic - New Potential- - Residual Non-Active- Malaria Free - Cleared - up

4. Proposed National Guidelines for Malaria Surveillancea. Case Definition:

- a case regardless of the presence or absence of clinical symptoms, malaria parasite have been confirmed by quality controlled laboratory diagnosis.b. Case Classification:

- Local: Indigenous, Introduced- Imported: Internal, External- Induced

c. Case Investigation: more active role in case investigation

4. Proposed National Guidelines for Malaria Surveillancec. Case Investigation: - Pre-Elimination/Elimination Areas: Immediate

case investigation- Investigation Teams: PHT, Provincial Malaria

Person, RHUs and Bgy. Health Worker- ACD/Focal Investigation

4. Proposed National Guidelines for Malaria Surveillanceb. Methods of Focus Identification, Delimitation & Classification:- Focus Investigation:

- Team: Trained Staff (Prov/Mun), Bgy Health Workers

- Map: breeding areas, houses, malaria case, Malaria Interventions

- Use of Malaria Focus Investigation Form

4. Proposed National Guidelines for Malaria Surveillance

c. Operational Implications of Different Types of Foci.

1. Foci maybe located in 2 or more boundaries:

human resourcesAllocation of commoditiessupervisionaccountability

Geographic Distribution Malaria Vector (2007-13)Source: RITM Entomology

Feasibility StudyA. Technical Feasibility1. Vectorial Capacity/ Receptivity– A. flavirostris- zoophilic but females can feed on both man

& animals– Breeds in man-made and natural breeding areas– Susceptible to current insecticides used– Generally dwellings with sprayable walls except in some IP

communities – Year round vs. seasonal transmission– Terrain: archipelago but generally good access to health

care services– Late evening activites

Feasibility Study

2. Duration of Infectivity:- P. falciparum (60 – 70%)- No drugs resistance reported, TES with RITM- Improved health seeking behaviour- Free health services - Expansion of health services to military, OFWs- Private Sector involvement in dx & tx

Feasibility Study3. Vulnerability- Significant population movement: OFWs, in-

country- Risk from neighboring countries is low except

to Students from endemic countries

-

Feasibility StudyB. Operational Feasibility- Political & social stability except in ARMM- Support from Executive Committee – DOH- Devolved Health Services – LGUs highly

accepts malaria elimination initiatives- MCP : Trained health workers but insufficient- Excellent Microscopy Services with functional

QAS- External Support: WHO, GF & Private Sector

Feasibility Study

Conclusion:- Malaria Elimination is Feasible in the

Philippines.- More work in Palawan & ARMM

Thank you!

Sample Report Generated (website view)

Sample Report Generated (website view)