Surveillance, Monitoring, Evaluation and Operations Research

Introduction

The prevalence of malaria in Kenya is estimated to be 6% and varies by endemic zones according to KMIS 2020. This variation in malaria burden demands for a rigorous surveillance system to collect high quality, complete and timely routine malaria data to enable tracking of the disease trends and employ effective interventions. Surveillance, monitoring, and evaluation 9SME) is largely guided by the malaria M&E plan and is anchored in the fifth objective of the Kenya Malaria Strategy (KMS) 2019 – 2023 that seeks to strengthen malaria surveillance and use of information to improve decision-making for programme performance. Surveillance data is collected through the integrated routine health information system that is supported by the Division of Health Informatics.

Partners

Implementation of the Malaria SME objective is supported by funding from Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Currently, the NFM III grant is operational. In addition, PMI has strongly supported DNMP both financially and technically through Measure Malaria and Impact Malaria Projects. Amref Health Africa has also been a key implementing partner, especially malaria SME at the community level. The DNMP continues to closely collaborate with the counties to implement the KMS 2019 – 2023. Other partners include KEMRI-Wellcome Trust in operations research and Africa Leaders Malaria Alliance (ALMA).

Achievements

In the first half of implementation of the KMS 2019 – 2023, the malaria surveillance curriculum was revised to incorporate the recommendations of Global Technical Strategy (GTS) and to align to the expressions of the KMS 2019-2023 to take on board use of routine surveillance data to track progress. The curriculum has been used to train 188 trainers and 7,600 healthcare workers across the 47 counties. Routine reporting tools have been revised to include reporting of IPTp3 data, and the country is now able to monitor the indicator routinely. There has been improvement in availability of inpatient data with 51% reporting rates in 2021 compared to 28% in 2018. This was because of enhanced capacity that was achieved through implementation of the programme’s roadmap. The supportive supervision manual was revised to incorporate a mentorship component and community aspects. It was also to align it to the new governance structures. Data quality assessments were undertaken across all 47 counties to identify and improve gaps in data quality and in addition corrective measures were initiated. There have been efforts to develop visualization tools including malaria scorecard, malaria bulletins, automation of epidemic monitoring dashboard in DHIS2, and the malaria program dashboard to enhance use of information at all levels. In addition, stratification using routine data is conducted annually and was used to recommend use of PBO nets during mass net distribution campaign in 2021.

The EPR guidelines were also revised to align to the new governance structures and to consider the changes in epidemiology. Consequently, an EPR curriculum was developed that will be used to build the capacity of the subnational level on EPR. Two rounds of EPR review and planning meetings for 128 sub-counties in 26 epidemic-prone counties were conducted.

The malaria indicator survey was successfully conducted in 2020 which provided information on impact and outcome indicators. Other surveys and studies included the PMLLIN survey, QoC, nationwide laboratory assessment, MFT study (ongoing), TES (ongoing), and HRP2 deletion study (ongoing) that were conducted in collaboration with the partners.

Entomological surveillance guidelines and SOPs were reviewed and disseminated. Entomological surveys were conducted in 44 counties during the first half of implementation of the KMS 2019 – 2023. The data from the surveys has been incorporated in the quarterly malaria bulletins and inform decisions in the implementation of program activities.

Constraints

Implementation of the Malaria SME objective is supported by funding from Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Currently, the NFM III grant is operational. In addition, PMI has strongly supported DNMP both financially and technically through Measure Malaria and Impact Malaria Projects. Amref Health Africa has also been a key implementing partner, especially malaria SME at the community level. The DNMP continues to closely collaborate with the counties to implement the KMS 2019 – 2023. Other partners include KEMRI-Wellcome Trust in operations research and Africa Leaders Malaria Alliance (ALMA).

Lessons Learnt

Conclusion

The good performance for this objective was made possible through the strong collaboration, coordination, and partnerships. Enhanced capacity for surveillance was realized following improvement of reporting tools and enhanced use of technology for data analytics and visualization. To strengthen data quality effectively and comprehensively, there is a need to invest in case-based digital surveillance solutions especially for inpatient data and for malaria elimination. Notably, Covid-19 impacted negatively on the rate of implementation and achievement of surveillance outcome targets. This was mitigated through use of technology and operating within protocols given by the Covid-19 inter-agency coordinating committee.

Future Strategic Direction