Right Place, Right Time: Adapting End-use Verification Surveys for Seasonal Malaria Transmission

Feb 2019
Humphrey Chiwariro district pharmacy manager, Edson Muchemwa, essential medicines logistics officer, and sister Neddy Chikomo conduct an EUV survey in Nyikavanhu. Photo credit: GHSC-PSM

Zimbabwe is making big changes to the way it collects data. End-use verification (EUV) surveys provide a snapshot of how health facilities are managing malaria. Do they have enough medicine? Are stocks being replenished in time? Are medicines at risk of expiring? Since 2012, when Zimbabwe became a President’s Malaria Initiative (PMI) focus country, quarterly EUV surveys conducted in a random sample of the country’s health facilities have helped answer these crucial questions.

Yet surveying a health facility in peak malaria season in Zimbabwe (November to May) is very different than surveying in the off-season. And different areas of the country have different levels of malaria transmission, distorting the results of random sampling. PMI wondered if adapting EUV survey methods would provide more accurate results.

Through the USAID Global Health Supply Chain – Procurement and Supply Management (GHSC-PSM) project, PMI and the Ministry of Health and Child Care changed EUV survey frequency and timing, adjusted the sampling strategy, and introduced customized questions.

What changed?

Instead of quarterly EUV surveys, Zimbabwe now conducts semiannual surveys: once in November at the beginning of malaria season, and again in April when it peaks. This is when health facilities must treat the most people—and when the impact of any issues will be greatest. EUV surveys provide quick, actionable information to mitigate challenges and ensure that health facilities are prepared and functioning.

Instead of sampling that ignores local transmission levels, districts are allocated into one of three transmission categories (high/medium, low, and pre-elimination) based on parasite prevalence. With the available budget, 40 high/medium, 20 low, and 10 pre-elimination sites are randomly selected per round, which achieves a 90 percent statistical confidence level. This way, transmission areas’ unique differences can be accounted for. For example, local facilities in high-transmission areas may need more stock on hand; low-transmission areas may be vulnerable to expiries if they over-order; and pre-elimination zones carry unique medicines such as primaquine.

In addition to existing survey questions, new questions solicit information on critical issues for Zimbabwe’s supply chain system, including handling of expiries and accounting for commodities issued to village health workers.

The result?

The revised EUV survey approach, with its larger samples in high-burden regions, improves understanding of local facility needs. Further, its well-timed surveys provide data on how facilities prepare for and cope during malaria season. With more specific and reliable information, decision-makers can rapidly deploy targeted solutions and improvements within Zimbabwe’s malaria supply chain. The Ministry and PMI have already started implementing the revised EUV survey, but real success will come from harnessing these data to beat malaria.

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