The recent episode of Malaria Routine Data in Action webinar series was hold on 18th October 2022 where we hosted NMCP representatives from DRC, Senegal and Zambia. We listened their experiences, recommendations and lessons learns on how data visualization inform decision making.
Webinar was moderated by Hannah Edwards
Presenters:
- Dr. Delille Lumbala,
- Dr. Hyacinthe Kaseya,
- Dr. El Hadji Doucouré,
- Mr. Ignatius Banda
Here are some key highlights from each of the country presentations:
- DRC, presented by Dr Hyacinthe Kaseya , Dr Delille Lumbala, , and Jicko Bondole:
In DRC, monthly malaria indicators are uploaded to a DHIS2 platform and visualized in online Tableau software. Use of a traffic light system enables easy and efficient visualization of how health areas, districts and provinces are performing against key malaria indicators. Weekly bulletins are automatically generated for each province with information on malaria cases and deaths. The system saves time through automatic analysis and graphing of key indicators and enables immediate identification of problems or outbreaks. There is also the ability to conduct cross analysis of different indicators, such as epidemiological indicators and malaria commodities data. Visualization of data allows for rational decision-making that takes into account a large amount of data, shortens the time taken to make decisions and allows decentralized access to data.
This system benefited from a co-creation approach under the leadership of the Programme National de Lutte contre le Paludisme (PNLP, the DRC Ministry of Public Health’s national malaria control programme) with feedback from key stakeholders at country level to ensure that key information was uploaded and visualized in the best possible way. Once the platform had been produced it was rolled out with a training of trainers approach led by the PNLP with training on data analysis and interpretation and use of the malaria dashboards. Peer-to-peer coaching improves use of the dashboards at each level of the health system, and quarterly (at national level) and monthly (at provincial and district levels) meetings are held on data visualization and analysis to ensure successful use.
A great example of the system in use can be seen through the experience in Ruashi health zone (at Haut-Katanga province) where outlet surveys showed an inequitable distribution of antimalarial drugs among the different health providers. In response, the central bureau changed the drug delivery strategy to send drugs directly to the different health facilities, leading to more equitable distribution.
2. Senegal: El Hadji Doucouré, Medoune Ndiop, Moustapha Cisse, Jean Louis
Routine epidemiological reporting changed from monthly to fortnightly reporting in high transmission zones and to reporting within 24 hours in certain low transmission zones. Entomological information is also reported on adult mosquito populations and larval habitats. Data is reported into DHIS2. Dashboards are used to visualize data quality indicators in graph form, including completeness and timeliness. Epidemiological and entomological data are visualized in the form of maps, showing data at national, regional, district and village health post levels. Geographic mapping allows stratification of the country by level of endemicity. The national stratification process uses different endemicity limits to those recommended by WHO in order to better separate the low-level transmission zones and aid toward elimination efforts. These different levels are then targeted with packages of interventions suitable to the local situation. Comparison of these stratification maps over time highlights areas in the country in which transmission is stable, and others in which the level of transmission fluctuates. Overlay of entomological information with epidemiological data identifies areas that are at risk of resurgence and highlights the interaction of vectors and human behaviour. For example, even though vectors are abundant in the east of the country, outbreaks are more common in the west due to the higher population density in this region.
There are many advantages to the current system, including visualization of data at different levels of the health system (regional, country, health post), monitoring of the changing epidemiology over time, visualizing the impact of certain interventions, and in combining different data sources for optimal analysis. Visualisation of data together with timely reporting allows detection of outbreaks in elimination zones. Outbreak investigations are mapped at a fine scale to show cases and presence of vectors. Specific dashboards can also be added, for example, a dashboard specific to the COVID-19 outbreak was developed to map cases across the country.
Deployment of this system of visualization has enabled identification of correlations between different data sources so that the best decisions can be made. However, having high quality data is essential and auditing of data quality ensures accurate decision-making. Finally, digitization of the reporting system is not easy or cheap, but has many benefits in timeliness and reach of reporting. Acceptability of digital tools by health providers is also an essential step for success.
3. Zambia: Ignatius Banda, Christopher Lungu
Zambia uses several visualisation tools depending on the type of data being used. In this webinar, focus was on data reporting and visualization from the community into Tableau for visualization and analytics. Zambia has an extensive network of over 17,000 community health workers, known as Community-based volunteers (CBVs) who report data monthly, and of 2238 health facilities that report weekly on malaria disease burden and associated logistics.
Data is uploaded into the system using mobile phones and visualized in Tableau dashboards. A data quality dashboard includes quality metrics from health facilities and communities, with graphing and colour-coded tables for easy visualization and to flag any problems or errors, for example if the number of cases exceeds the number of malaria tests conducted. A dashboard is also in place to visualize key indicators related to malaria cases for the Malaria Risk Overview (MRO), a process through which potential issues that could negatively impact the national malaria elimination strategic plan are analysed. A commodities dashboard shows information on the logistics related to CBVs, and an “inactive CBVs” dashboard indicates where there are CBVs not reporting for different periods.
The use of these visualization tools provides an opportunity to view data in real-time to monitor malaria trends. These data are used at various levels from national and international advocacy to district level planning of interventions, to community level review meetings where CHWs are empowered and feel more appreciated through understanding the impact of their work. The visualizations have enabled identification of low transmission areas suitable for case investigation and will lead into the process for malaria free zone certification. The success of the dashboards has been possible through good collaboration between the NMEC and MACEPA, as well as through robust data management trainings.