Table 4.

Matabeleland North Year 1 challenges

Challenge	Solution	Year 1 change from baseline to endline
Regular review of malaria case investigation data and data management	Identify focal persons to be point of contact and follow up for surveillance related work, provide mentoring and supportive supervision visits on how to use DHIS2 tracker (malaria elimination surveillance system) to the focal persons, regular onsite data verification and data cleaning, initiation of regular surveillance meetings	8% increase in malaria slide examination rates of confirmed cases (81% to 89% or 115/142 to 90/101 slides examined out of total positive cases) 10% increase in fully investigated cases (88% to 98% or 125 cases investigated out of 142 RDT + cases to 99/101) Weekly disease surveillance reports shared with province: 1 out of 5 districts; quarterly district review meetings conducted: 2 out of 5 districts; quarterly provincial meetings conducted: 2 Improvements to data discrepancies and timeliness (no quantitative data available to support)
Implementation of new treatment guidelines	Mentoring of health workers and VHWs, refresher trainings, setting up a help line	12% increase in the administration of primaquine (63% to 75% or 90/142 to 76/101 cases administered PQ/total positive cases) Refresher trainings ongoing but all five eliminating districts have conducted post-training follow-up visits and VHWs now trained
Coordination across departments	Map stakeholders, attend district and provincial social services and local governance meetings, develop service improvement plan	Target achieved at district level for external coordination. See Box 2. Improvements to internal coordination were in progress
Lack of ownership and accountability	Conduct team building, award best performing district, provide peer support visits	Peer support visits implemented in 2 of 5 districts. Other activities were in progress
Malaria commodity stockouts	Create reporting template for tracer commodities, supportive supervision visits to improve stock management, redistributing excess commodities to other districts, supply VHWs with essential commodities	20% improvement in medicine stock status (50% to 70%)
Larval source management	Order biolarvicide, map active breeding sites, train environmental health practitioners in LSM, use standardized bio larviciding reporting form	1 of 5 districts have completed mapping. Training in 2 of 5 districts conducted
Poor quality IEC materials, unknown effectiveness of SBCC activities	Identify translators and correct malaria messages, evaluate impact of activities	Work in progress