Table 3.

New Year 2 challenges for Matabeleland South province

Challenge	Solution	Year 2 change from baseline to endline
Village health worker (VHW) recruitment and retention	Lowered qualification requirements for VHW recruitment and provided VHWs with training and support to retain them	Beitbridge: 3% (87% to 90%)
		Gwanda: 5% (83% to 88%)
Lack of inter-provincial collaboration	Use available funding from the Elimination 8’s Global Fund grant to conduct a minimum of two peer to peer province and district learning visits. The meetings will enable harmonization of surveillance and response activities between provinces and create cross-border and inter-provincial linkages	Target achieved through initiation of inter-provincial (Matabeleland South-Masvingo) and cross border meetings (Zimbabwe- Botswana) and exchange visits)
Low IRS coverage in Beitbridge district	Conducted operational research and analysed results	Planned to implement recommendationsa in the 2018/19 IRS campaign
Failure to conduct entomological activities	Engage the national entomologist, conduct training on larval source management (LSM) to build the capacity of the EHTs	Beitbridge achieved target of 2 entomological activities (malaria vector bionomics investigation, bioassays for testing insecticide susceptibility and training of EHTs on LSM). Gwanda had not yet initiated entomological activities
Slow uptake of Public Finance Management System (PFMS) funds	Provided on the job training and telephone consultations	Efforts to improve use of the finance system despite internet connectivity challenges resulted in improvement in fund utilization
Failure to update slide results of RDT + cases in case-based surveillance records	Developed tool to track slides received from health facilities which will allow the microscopy center to update results on case-based surveillance and relay results back to health facility	Feedback loop between lab and health facilities will be closed with the introduction and training on this tool at health facilities

^aRecommendations from the operational research conducted to address low IRS coverage included increased community sensitization, development of IEC materials in local languages, including radio programs in local languages, recruitment of community mobilizers, early engagement and partnership of stakeholders, and better planning for IRS timing, resources, and supplies