Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Strengthening SME System for National Program Moving from Transmission Reduction to

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand

Strengthening SME System for National Program Moving from Transmission Reduction

to Elimination PhaseThailand

21 August 2015


Introduction


Map Showing Areas for Control/Reduction Transmission and Elimination Areas, 2014

Elimination and Prevention of reintroduction areas

API=0

Pre-EliminationAPI >0 ; <1/1,000

Control/reduction transmission Area

API > 1/1,000


69 D. (7.4%)

199 D.(21.4%)

33 D.(3.6%)

(Draft) Area Phasing for Malaria Elimination, 2015

627 D. (67.6%)

Indigenous case +

API>=1/1000

Indigenous case +

API <1/1000

NO Indigenous case within 1-3 yrs.

NO Indigenous case > 3 yrs.

Control/reduction transmission Area

Pre- Elimination Area-1

Elimination Area Prevention of reintroduction areas

Unit=District


Number of Districts Targeted for Malaria Elimination, Thailand

Remark: 2014 is the baseline data, 660 districts with no indigenous cases


1.Review Current SME System, Make Informed Decision to Strengthen Relevant SME Areas

Strength Weakness Staff: Skillful malaria staff for SME at provincial level

Staff: Inadequate number of skillful malaria staff for SME at district level and some will be retired within 5 years; Data assistant are contracted and paid by GFATM (which will be finished at 2016). Sustainability is doubtful

System:• Surveillance system has been well established and updated; • computerized data has been used by national, regional levels for 2 decades; • ‘Malaria web-based’ system established in 2012 and used by all levels except communities

System:• Data from private sector & NGOs are not included• Data from other institutes outside VBDs and non-health sectors are not included• Data of non-Thai cases are included but not complete, its pop is unknown.• Case investigation rate is some 60%


Purpose Surveillance SystemAll Disease Including Malaria in the ME Strategy

Surveillance worker at

sub-district

Existing SRRT

Tasks• Case investigation• Foci investigation• And Response

Members;• Epidemiologist• Entomologist• Microscopist/

blood taker• VC staff• Representative

LAO

Existing SRRT Existing SRRT

At Sub-district level

At District level

At Provincial level

Tasks• Case investigation• Foci investigation• And Response

TasksCase investigation• Foci investigation• And Response

Enter data and

notify

Request for assistant

Request for assistant



LAO



LAO


2. Guidelines and SOPs

Types of Guidelines and SOPs Currently available Need to be refined for elimination area

PCD and ACD Yes Yes ACD will be encouraged by

using RDT/PCRCase investigation Yes Yes, as it is complicated so

need to be simplified for GHS staff

Foci identification, investigation and response

Yes Yes and need to be adjusted according to new WHO

definitionQA diagnosis Yes Yes

Data management and reporting Yes Yes and to be handed over to PHO/GHS

Supervision Yes Yes


3. Job descriptions of Surveillance Staff (ME)

Job descriptions• Monitor and analyze malaria situation (web-based program)

• Respond to local malaria case notification

• Notify (calling) to chief of SRRT whenever one or more local cases

reported

• Join SRRT for Foci identification, investigation and response

• Compile and produce monthly/quarterly and annually report to upper

level

Surveillance staff is a public health personnel at health center (GHS) and is computer literate with some analytical skills


4.Human Resource Planning

Categories of People Involved for SME

Training Required for ME

1. Surveillance staff (@HC, DHC)

• Malaria epidemiology • Situational analysis and report• Foci identification, investigation and response• Submission of data through Malaria online system

1. Surveillance staff is a public health at health center (GHS)2. SRRT consists of health staff and staff of local administrative organization (sub-district, district and provincial levels)


Categories of people involved for SME

Training required for ME

2. SRRT members Epidemiologist (GHS) Malaria epidemiology , Foci identification,

investigation and response;Malaria online system

Entomologist (VBDC) Refreshing on foci classification

Microscopists (VBDU)/Blood takers (GHS)

Parasitological methods e.g. RDT and blood collection for PCR

Vector control staff for IRS Refreshing on vector control methods --VBDU, VBDC;Workshop on vector control methods -- health staff from GHS

Representative from local administrative organization

Malaria epidemiology, Foci identification, investigation and response;Malaria online system

4. Human Resource Planning (Cont.)


5. Indicators of SME Performance

No. Surveillance Indicators Numerator Denominator

1 ABER by Dist. And focus detected passively and actively

No. of blood Slide Examined

Pop at Risk (PAR)

2 % of confirm case fully investigated within 24 hours

No. of Investigated case

No. of case

3 % of Foci fully investigated No. of Investigated Foci

No. of Foci (Occurred)

4 Time from positive test results to notification of the national program (1 day by malaria online) (Symptomatic)

No. of pos. test results notify to the National program within 1 day

No. of pos test results notify to the National program


Level Sub district District Provincial Regional National

Collection Yes No No No No

Analysis Yes Yes Yes Yes Yes

Validation Yes Yes Yes Yes Yes

Use Yes Yes Yes Yes Yes

Feedback No Yes to sub district level

Yes to district level

Yes to provincial level

Yes to regional level

By Surveillance worker

Junior Epidemiologist

Epidemiologist Senior Epidemiologist

Senior Epidemiologist

6. Electronic-based Data Management


Organogram of the flow of data, supervision and coordination

MINISTRY OF PUBLIC HEALTH

Department of Disease Control

Vector-borne Diseases

Office for Disease prevention and Control

CENTRAL LEVEL

DISTRICT LEVEL

PROVINCIAL LEVEL

SUB-DISTRICT LEVEL

Provincial Public Health

Vector-Borne Diseases Center

Vector-Borne Diseases Unit

Malaria Clinic

District Public HealthHospitals

Health Promotion Hospital

REGIONAL LEVEL

Other Disease

s

Other Departments

Epidemiology

Permanent Secretary

Reporting SupervisionCoordination

Malaria post /Border malaria post

7. Flow of Data, Supervision and Coordination

Data entry

SOP and checklist will be modified from GFM guideline

MIS


7.Malaria Online : BI system Developed by BIOPHICs, Mahidol University under

GFM-R10 SupportFeatures/ productions

malaria cases by areas, health facilities, case detection activities, parasites species, trends, sex, occupations


8. Evaluation of SME System Performance

• Assessment of SME system performance on quarterly basis with identified indicators

• Evaluation of SME system will be carried out in 2016 as a baseline then every 2-3 years


10. Establish National ME committee

Candidates should be (independent)– Former dean of Tropical Medicine Faculty, Mahidol University– Retired (malaria) epidemiologist– Lectures (Epidemiology, entomology, program evaluation)from

universities– Retired malaria directorsTOR: to review/verify malaria case report in elimination areas to determine if it is local case or imported case, and if the area is

active focus, to recommend if ME verification is to be put on-hold, or withdrawn to make proper recommendations


11. Updating Legislation, as Part of Enabling Environment

• Process to make ‘malaria is a notifiable disease’ is currently on the way


12. Involves Private Sector

• Private sector will be informed and involved for malaria elimination; they should comply to national guidelines and recognize that malaria cases must be reported to health authority

• Training on malaria detection and treatment will be provided for private hospitals and clinics

• Supporting supervisory visits to private sector will be provided on the agreed schedules


THANK YOU FOR YOUR ATTENTION


Diagram Consolidation Malaria database

BOEBVBD

Conversion to thesame structure across system

BVBD Conversion to the same

format

BOE Conversion to the same

format

Join 2Malaria

Database

ConsolidationMalaria

Database

Deleted DuplicateMalaria

Database

Display on Intelligence Malaria Surveillance Web-based

StandardWHOSuggestions

Fuzzy Logic

http://biopsds.biophics.org/sites/boe/Pages/Default.aspx




Documents

Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand Strengthening SME System for National Program Moving from Transmission Reduction to