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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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
Introduction
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
Number of Districts Targeted for Malaria Elimination, Thailand
Remark: 2014 is the baseline data, 660 districts with no indigenous cases
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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%
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Members;• Epidemiologist• Entomologist• Microscopist/
blood taker• VC staff• Representative
LAO
Members;• Epidemiologist• Entomologist• Microscopist/
blood taker• VC staff• Representative
LAO
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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)
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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.)
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
11. Updating Legislation, as Part of Enabling Environment
• Process to make ‘malaria is a notifiable disease’ is currently on the way
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
THANK YOU FOR YOUR ATTENTION
Bureau of Vector Borne Diseases, Ministry of Public Health, Thailand
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
http://biopsds.biophics.org/sites/boe/Pages/Default.aspx