In the past decade, Tanzania has emerged as a national success story in malaria prevention and control. Between 2005 and 2016, nearly all malaria indicators for Tanzania improved. Efforts to control malaria in Zanzibar, a semi-autonomous archipelago that is part of Tanzania, have returned particularly dramatic results: In 2011, malaria prevalence reached near-elimination levels of less than 1 percent, and has been maintained at low levels ever since.
However, malaria remains the leading communicable disease in Tanzania, with 93 percent of the 60 million population at risk. Challenges today include increased disease burden in adolescents and adults, mounting insecticide resistance, weak malaria commodity procurement supply chain, and uneven technical and program management and implementation capacity at national, regional and district levels.
In 2018, the U.S. Agency for International Development (USAID) launched Okoa Maisha Dhibiti Malaria (OMDM)—Save Lives, End Malaria with funding from the U.S. President's Malaria Initiative to promote programmatic integration, local ownership, capacity strengthening, and maximize data for decision-making to reduce the overall burden of malaria and move Tanzania closer to elimination. The program builds on successes of the USAID-supported Tanzania Vector Control Scale-up Project, implemented by RTI from 2010–2016.
Through direct support to mainland Tanzania’s National Malaria Control Program (NMCP) and the Zanzibar Malaria Elimination Program (ZAMEP), OMDM’s activities focused on:
- Sustaining results through programmatic integration, local ownership and capacity strengthening;
- Maximizing data for decision making;
- Integrating gender into our technical and management approach; and
- Leveraging national and global knowledge and networks.
Data Integration for Improved Decision-Making
The Zanzibar Malaria Elimination Program relied on three different platforms to track malaria surveillance data: the District Health Information Software (DHIS2), which aggregates data on a monthly basis and is the government standard for public health data collection, including malaria; Coconut Surveillance, a mobile software application developed by RTI that uses Short Message Service (SMS) to capture and track malaria cases in real-time at the individual and household level; and the Malaria Early Epidemic Detection System (MEEDS), which captured new case notifications and weekly summaries of malaria cases at the facility level using mobile phones. These three tools all collected distinct information that is critical for malaria control and elimination; however, the systems operated separately, which made it challenging to view data on malaria cases that were being tracked, tested and treated in one place and gain a full picture of the malaria burden.
While the DHIS2 is the most widely used and preferred platform, it doesn’t include malaria cases at the household level. As Zanzibar moves toward elimination, Coconut provides the capacity for timely information and reporting on individual and household malaria cases, as well as the ability to track how quickly malaria surveillance officers are investigating cases.
OMDM worked alongside ZAMEP to streamline the data from these parallel systems into one integrated system that is owned and managed by the Ministry of Health of Zanzibar, in order to enable better data for programmatic decision-making. To do this, OMDM synced data indicators from Coconut and MEEDs into the main DHIS2 system and replaced MEEDS with a web-based system that stores its data on a ZAMEP server, allowing ZAMEP full access to data on facility level malaria case notifications that were previously hosted on an external server.
Thanks to these integrations of data systems, malaria decision makers can now view all data in one place, obtain a more accurate total count of cases at a lower cost, and better target and treat specific communities where transmission is most likely to occur.
Building Local Capacity and Ownership
Coconut has been used to strengthen malaria control and elimination in Zanzibar since 2012, helping surveillance officers respond to more than 60,000 reported cases of malaria, complete nearly 31,000 household visits, test more than 70,000 household members, and identify and treat more than 4,600 previously unknown cases. ZAMEP is committed to sustaining Coconut in the long term, as it generates important reports that enable operational decision making.
OMDM, with support from experienced software developers at RTI, provided online courses for staff from ZAMEP and the Ministry of Health, meeting once a week to provide mentorship, guidance and training on how to manage the Coconut database and keep it up to date. This included developing training resources and a curriculum that ZAMEP can use to continue to train its staff going forward. It also included migrating Coconut to the local Ministry of Health data server so that ZAMEP can have full access and ownership of the database moving forward. This will help ensure the sustainability of the malaria surveillance system and contribute to Tanzania’s journey to self-reliance.