By Elisabeth Wilhelm, Advocacy & Communications Officer with MACEPA and Global Health Corps Fellow.
Zambia has a long history of innovation in data collection and analysis, and was the first country to undertake a nationally representative household malaria survey in 2006, the Malaria Indicator Survey (MIS). But while MISs are useful for understanding malaria trends and planning for next steps, to achieve elimination of malaria, more precise, and timely information is required on malaria burden and interventions at the provincial, district, and health facility catchment area levels. This level of detail provides malaria programs with the data they require to be responsive to local needs. Enter DHIS2.
Since 2011, the National Malaria Control Centre, in conjunction with MACEPA and local partners, has pioneered the use of District Health Information Software, or DHIS, an open-source health management information system platform used in 47 countries to monitor health interventions, improve malaria surveillance, and speed up data access. (The “2” in DHIS2 refers to its mobile platform.) DHIS2 enables the Ministry of Health and the Ministry of Community Development Mother and Child Health to make strategic, data-driven decisions to improve service delivery. With the advent of data entry via mobile phones, reporting is more flexible and timely than ever.
In areas where malaria has been effectively controlled, the malaria parasite must still be stamped out with intensive, digitized, and focalized efforts toward elimination. Before, only paper records were used to collect information on malaria interventions and epidemiology, but this made it difficult to identify larger trends (e.g., a spike in malaria cases in a rural area). In over 300 health facility catchment areas, health facility staff and community health workers are now trained to test and treat community members for malaria symptoms and record results on their mobile phones, data which is then added to the DHIS2 database. This malaria rapid reporting and surveillance allows for closer-to-home malaria case detection and helps clear out infections before they are spread by mosquitoes to other community members.
In total, reporting is taking place weekly for 560 clinics and at community level, monthly reporting is taking place by approximately 2,500 community health workers. This rapid reporting system is being implemented in Eastern Province (1 district), Central Province (4 districts), Lusaka Province (3 districts), Southern Province (13 districts) and Western Province (16 districts). This system is in roughly 35 percent of the total districts in the country, where a community member’s malaria status and course of treatment can now be instantly recorded and transmitted.
The national health management information system (HMIS) in Zambia also uses DHIS2 as its backbone, with over 1,900 facilities reporting. All the malaria-related data collected in DHIS2 can be accessed and used by other national health programs linking into the same system. The simple but powerful interface ensures that the data is at the fingertips of district staff so that they do not need to wait on the National Malaria Control Center for actionable malaria information. Dashboards collate data at provincial and district level and allow for drill-down into health facility catchment area level. Data is also plotted using GIS on a map, allowing for accurate pinpointing of cases, facility and village locations, and determining where malaria “hotspots” are located.
The use of DHIS2 to capture malaria-related information has helped improve the country’s understanding of the link between malaria disease burden, rapid diagnostic tests, and anti-malarial drugs administered. Zambia is actively working with partners to build adoptable and adaptable strategies which have the potential to bring about the elimination of transmission and the clearance of parasites in people by using data and information generated by this system. Armed with high quality and rapidly reported data, Zambia’s Ministry of Health is moving more quickly and intelligently toward the goal of malaria elimination across the nation.