Maayaa City Health Office Malaria Elimination program Supportive

Supervision Checklist as Four month of 2016.

Part I: - Background – District Health Office level
1. Total Population of the District, 2016 ____________Total Kebeles___________Total malarious
Kebeles__________Total HC______Total in malarious area_______ Total HP ___ HP in malarious
area_______
2. Total active foci_______ Total residual non active foci______ Total cleared foci _____
3. Mosquitos breeding sites in number / (m2) _______/_____
Permanently______(______M2),Temporary________(_______M2)

4. Total lab professionals in this district catchments ____Total HCs__ total microscopy in these HCs_.
II-Malaria Elimination Program Activities
5. Is there malaria elimination plan in your district? Yes/No_______ If yes, does it contain all
activities (as per elimination phase activities)? _________
6. Does malaria elimination task force committee performing regular meeting on elimination activities
on monthly bases? Yes/No If yes, on what issues_______________________________________If
no why-----------------------------------------------------

III: Malaria Epidemic Monitoring and surveillance activities

7. Is there Malaria Epidemic preparedness plan? Yes/No______. If Yes, does the plan include malaria
Supplies? Yes/No ______. Does the plan include human resources? Yes/No_____. Does the plan
include resources of budget? Yes/No_____.
8. Is there malaria surveillance chart in woreda Health office (Yes/No) ______2. If yes, have they
updating regularly Yes/No ______
8.1. Did the case trends cross over the threshold level? Yes/No_____. If yes what action
taken____________________________________________________________
IV: Malaria Case Management
9. Do all facilities manage Malaria cases as per updated national malaria guideline? Yes/No_____.
10. Number of total tested suspect cases as this District (2016) Total test ______ # of total confirmed
positive cases______: PF______, PV ______, Mixed____________.
11. This year cases( four month2016) Total positive_______PF_______,PV_________ and
Mixed__________

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11.1. Total number of cases treated by preimaqiun? _____: PF_______, PV______, Mixed______,
cases treated with single dose_______, treated with Radical cure________ (check availability of
Premaquine utilization follow up registration book)
11.2. Malaria Test Positivity Rate (TPR) _____%. If TPR >5%, why _________________________
11.3. Do you have the five years malaria cases data? From 2010- 2015 EFY
Years 2016 2015 2014 2013 2012 2011 2010
Total malaria cases
per year

V. Malaria supplies/ commodities available in the District

Malaria Commodities Requested Received Used Expired Expired Remaining

SN
by RRF amount Date
6x1
6x2
1 AL ( Co-artem tabs) dose
6x3
6x4
2 Chloroquine Tins of 100 tab
3 Artesunate 60mg injection vials (Vial)
4 Artesunate 50mg suppository
5 Quinine 300mg of 100 tabs
6 Quinine injection of 300mg
7 Primaquine of 7.5mg tabs: Strip of 10 tabs
8 Primaquine of 7.5mg tabs: Tins of 100 tabs
9 Rapid diagnostic kits (RDT) of 25 tests
10 Giemsa solution of 1liter

12. Is there malaria commodities transfer/exchange mechanism to reduce expiry? (yes/no)______. If

yes, see the evidence what available __________________________________________________.

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VI. Active case search and Foci investigation (Focus Test and Treat- FTAT)

S.N Summary of FTAT Interventions

1 Total confirmed malaria cases

2 Number of confirmed malaria cases within HP catchment by HEW

3 Number of confirmed malaria cases notified by catchment HC/Primary Hospital

4 Number of index malaria cases eligible for investigation

5 Number of index malaria cases investigated

6 Number of households eligible (delineated) for investigation
7 Number of households investigated
7.1 Number of household members listed
7.2 Number of household members eligible for investigation (other than index cases, < 6 months infants,
sever cases)
7.3 Number of household members tested
8 Total number of positive secondary cases
8.1 PF
8.2 PV
8.3 Mixed
8.4 Imported cases (Cases with travel history)
8.5 Indigenous or local cases (Cases without travel history)
9 Targeted FOCI
10 Investigated and responded FOCI /See GPS Captured

1- Did your HF notify the cases within 24hrs before undertaking FTAT to the
Zone/Woreda? Yes/No______. If no, what is the reason? ______________________________.
2-Is there not eligible cases registered? 1-Yes(_____ in number) 2- No If yes, do you notify to
respective district? See case notification format
VII- Anti-malaria school club activity

Number of Total anti Total anti Schools Schools not Facilitato Health
school malaria malaria reporting reporting rs Education
available school club school club anti malaria anti teachers participants
5-8 established with mini activities malaria
media activities
M F T

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VIII: Vector control Interventions
i. LLINs distribution and utilization
13. Have you done LLINs utilization status assessment in this (four month.)? Yes/No ____,if yes,
capture the result and advice on the assessment elements
14. Do you monitor LLINs utilization status? (Yes/No) _____. If yes, of LLINs distributed to
community, how many HHs utilizing it? _____, what is the actual utilization rate? _____, What is
the utilization rate for total sleeping places according to this woreda? ____.
15. If yes, on ques. No. 17, is there LLINs utilization mal practices in your woreda? Yes/No _____, if
yes, how many HHs engaged in mal practice of LLINs? _____, what is the mal practice actual rate?
______. What action taken _____________________________________________________.
ii. Environmental management activities
Table 1. Environmental management activities performed during the four month, 2016.

Achievement
Plan
SN Type of activities Available(m2) By Source By Abet
Total %
reduction chemical
1 Permanent breeding Site(m2)
2 Temporary breeding Site(m2)
3 No. of community participated
4 Health Education on malaria

1. In how many intervals time environmental management activities should be performed? ________

2. Do you have Abet chemical at hand now? Yes/No __, if yes, how many gallons______ /_______cc.

1. IX- Materials

S.No Name of Materials Total Total Total Total If gap

received distributed Available Available
and using but not
using
1 National malaria Guideline (2018)
2 Pocket Guideline
3 Hel-men Urine colour chart
4 Malaria OPD registration/see in all
OPDs/
5 Weekly case reporting PHEM pad
6 Malaria Monitoring Chart
7 Screening form
8 HH Track form
9 HH questionnaire

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10 Weekly FTAT report form
11 Supportive supervision check list
X. Monitoring and Evaluation Activities
16. Have you conducted malaria elimination review meeting in this four month? Yes/No_____, if yes,
how many participants participated in?______, if No, describe the
reason__________________________
17. Have you conducted Malaria specific supportive supervision in this four month? Yes/No_____ If
yes, would you provided feedback for HC or health post? Yes/No____.If no, describe the
reason___________________________________________________________________________
18. Do you have functional PMT at level? Yes___ No___, if yes see the evidence, if no list out the
reason__________________________________________________________________________
19. Do you monitor weekly malaria situation by kebele? Yes____ No___ If yes, Do you analyses and
provide feed-back and corrective action based on the evidence? Yes/No__(Place, Time and Person)
20. Do you compare DHIS2 & PHEM report and use the evidence for corrective actions? Yes/No _____
21. Allocated domestic budget in 2014____________Planned for 2015__________
22. Do you have proposal for allocated GF budget from zone.1-Yes 2-No If no
why-------------------------------------------------------------------------------------------------------------------
23. What are the strengths on malaria prevention and control activities
________________________________________________________________________________
________________________________________________________________________________

24. Weaknesses on malaria elimination activities

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
25. Any problems and challenges on malaria elimination activities;
________________________________________________________________________________
_______________________________________________________________________________
Note:-

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See the Availability, Completeness and Timeless of report in this four month.

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Action plan

SN Malaria related identified gaps Corrective Actions Time Responsible body

Name of supervisors Organization Responsibility Mobile Signature

1.____________________ _______________ _______________ ________

2.____________________ _______________ _______________ ________

Name of supervisee (respondents)

1.____________________ _______________ _______________ _________

2.____________________ _______________ ________________ _________

3.____________________ _______________ _______________ _________

4.____________________ _______________ ________________ _________