REPUBLIC OF ZAMBIA

MINISTRY OF HEALTH

HIV AND TB
PIM
Provincial Level
Group

MUCHINGA
PROVINCIAL INTEGRATED MEETING AGREED
ACTIONS FOR IMPROVING PERFORMANCE
INDICATORS BY END OF 2019

15TH – 17TH MAY, 2019

22.05.2019

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 i. Introduction

The document was developed during the three days meeting held Zwangendaba Freshair Lodge
in Nakonde District. It was officially opened by the Provincial Health Director Dr. Neroh
Chilembo. The Director thanked District Health Director for managing health services during
financial drought. He thanked partners for their support to health sector and in particular for
support Provincial Integrated meeting.

During the meeting presentations were made on health indicators which were subjected to
analysis through group work. Members of management teams from Districts, General Hospitals
teams, Nursing School and Provincial Health Office participated in the process.

In order to meet the objectives of provincial integrated meeting, the team used participatory
approach through brainstorming in groups. Five groups were created to analyze issues
surrounding performance indicators and suggested actions towards improvement. Groups were
created according to the level of implementation as follows:
Group A; Community Level
Group B; Facility Level
Group C; District Health Office
Group D; General Hospital
Group E; Provincial Health Office
Members agreed to implement all the agreed action points to improve performance in 2019.

Table of Content
i. Introduction ……………………………………………………………………………… 2
1.0. Meeting Objectives and Action Point Report …………………………………… 4
2.0. Statement by the Provincial Health Director ………………………………………4

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2.1. PHD Presentation ………………………………………………………………………..5
3.0. Presentation by Public Health Specialist ……………………………………………6
4.0. Presentation by Technical Advisor for PATH……………………………………….. 7
5.0. Presentation by Districts ……………………………………...................................... 8
5.1. Observations from Presentations ……………………………………………………. 8
6.0. General Interventions …………………………………………………………………. 9
7.0. Performance Indicators………………………………………………………………. 10
7.1. Group Work ……………………………………………………………………………..11
8.0. PIM Agreed Action Points …………………………………………………………… 12
8.1. Community level ……………………………………………………………………… 12
8.2. Facility level …………………………………………………………………………….. 18
8.3. District level …………………………………………………………………………….. 29
8.4. Hospital level ………………………………………………………………………… ………….32

8.5. Provincial level ………………………………………………………………………… 39

9.0. Closing remarks ……………………………………………………………………….. 42
10. Annexes …………………………………………………………………………………. 43
Annex 1: Group Work Team Members…………………………………………………. 43
Annex 2: Presentations, discussions and updates …………………………………… 45
Annex 3: Annex 3: Attendance List …………………………………………………….. 61

1.0. Meeting Objectives

The Principle Planner led the house through the following meeting objectives:
 To review institutional program performance
 To share experiences on what works well
 To attract Partners Support in various program areas

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  To review strategic information by indicator performance
 To share policy / guidelines from the National Level

2.0. Statement by the Provincial Health Director

Immediately after the review of the previous discussion, the house was privileged to receive the
Provincial Health Director. The District Health Director for Chinsali District called upon the
Public Health Specialist to introduce and welcome the PHD to the house. The PHS
enthusiastically called for self-introductions from all the participants after which he was
privileged to call upon the PHD to address the participants.

In a humorous way, the PHD cautioned all officers introducing themselves as acting to stop,
instead just to mention their positions. He later took time to update the house on the changes that
have taken place within the province. He introduced new members of the provincial health Staff:
 Senior Accountant Benson Kapeso
 Accountant MwangoChungulo
 Senior Human R. Management Officer HabenzuFabian
 Principle Planner Miyanda Mussolini Mupimpila
 Planner Yonah Sakala

The PHD emphasized on the need of attaching great importance to the meeting as it provided an
opportunity to suggest solutions to problems being experience in the province. He was quick to
mention that PIM would not change indicators without proper strategies. In the same line of
thought, he encouraged all the districts to prioritise lifesaving and high impact interventions and
prioritize review of the action plans to suit the current situation.

Commenting on human resource, the PHD expressed his gratitude to the government of the day
under the leadership of His Excellence President Edgar ChagwaLungu for employing Nurses and
other professionals. He informed the house that the province had received 230 Nurses and
Midwives. To that effect he tasked DHDs to find means of taking care of the newly deployed
Staffs as they are not yet on payroll. He further reminded the DHDs with new infrastructure to
find ways of operationalizing them before 2021.

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Commenting on planning cycle, the PHD advised all districts to begin planning process as
enshrined in the planning handbook. He cautioned districts which were in the habit of doing
things haphazardly to change their way of doing of things. He encouraged all districts to do
things differently. The PHD concluded by appreciating the partners for the valuable support they
are rendering to the province and for supporting the provincial integrated meeting. With funding
challenges being experienced, the PHD called upon all the partners to support activities of such
nature so as to improve service delivery.

2.1. PHD Presentation on Maternal Death Surveillance

The PHD expressed his passion to see a province free of maternal death. He informed the group
that the province is making progress but maternal death are comparatively high. He challenged
the province to reduce maternal death from 398/100000 to 100/100000 live birth. In terms of
2019 target he mentioned that the province had already recorded 15 maternal deaths which is the
target for the entire year. He appealed to all health care workers to treat patients with dignity and
respect.
The PHD informed the house that he is the “lawyer” for vulnerable mothers who die while
giving birth. He shared with the house 5 maternal death which happened in the province this
year. It was heart-breaking to note that all the maternal deaths are attributed to staff negligence.
He later outlined measures to be taken:
 Station Ambulances at Strategic points to enhance referral system
 To ensure adequate supply of blood
 To improve on communication and consultations involving maternal issues
 Equitable distribution of HCW in facilities
 To charge all erring Staffs

3.0. Presentation by Public Health Specialist

After highlighting meeting objectives, the Principle Planner invited the PHS to guide in the
reviewing of the status of the action points implementation. In his presentation, the PHS

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reminded the participants on the importance of the meetings and encouraged participants to do
things differently. He stated that over the years the provincial integrated meetings had seen huge
investment while not much has been done to address the resolutions of the meeting. He attributed
it to the following reasons:
 Disjointed action points (not smart)
 No prompt review of actions upon dissemination by PHO
 Low implementation rate of the action points
The PHS informed the participants that holding a meeting in it-self would not change or improve
the performance indicators. Instead prompt implementation of the agreed action points would
help all institutions to be on course in meeting the national objectives of a having a health nation.
The Public Health Specialist (PHS) directed all Provincial Health Staff to move with action
points always when visiting districts a similar approach to be adopted by the Program Officers at
the District Health Offices. Commenting on the implementation status, the PHS informed the
house that Chama district was the only district which had managed to implement 80% of the
agreed action points while Nakonde and Isoka where the least with 55.7 / 55.6% respectively. On
average the general picture of the implementation was at 67.2%

4.0. Presentation by Technical Advisor for PATH

4.1. Malaria Scorecard Presentation
After action points review by the PHS, the Principle Planner invited Dr. Banda from the National
Malaria Elimination Centre to make a presentation on Malaria Scorecard.
The National Malaria Elimination Control Centre Advisor informed the house that Zambia has
set to increase the implementation rate of malaria interventions from 36% in 2015 to 95% at the
end of 2021. He informed the participants that the country has made steady progress in the
implementation status of malaria activities. He further informed the participants that one of the
recommendations was to develop a real time system for malaria monitoring, tracking, reporting
and decision making. He said that the system has been developed and currently being used to
truck performance and program implementation as a Nation, Provincial and District level. He
them introduced the National Malaria Elimination Website and requested that all participants to
log to www.malariascorecard.org the password was malaria2019.

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Commenting on the scorecard, the National Malaria Elimination Centre Adviser informed the
participants that the scorecard is a real time system that the country uses to report to the African
Union African Leaders Malaria Alliance. He later took through the group on how to effectively
utilize the malaria scorecard after logging in. He mentioned that in the interim the system can
only monitor programs and performance at National, Provincial and District level. He later
guided the group on the importance of business plan. He took the group through on how to make
a business plan. The business plan is targeting a population of 500 representing 1 community
health worker per 500 populations. The business plan would help track activity implementation
and lobby for financial support. He mentioned that all districts are requested to make and upload
the malaria business plan. He indicated that the using the malaria business plan, the community
and stakeholders would raise funds to support mass drug administration, Indoor Residue
Spraying (IRS) program.

5.0. Presentations by the Districts

Presentations were made on malaria, maternal health, child health, HIV and tuberculosis

5.1. Observations from presentations - Senior Health Education Officer

5.1.1. Malaria
 Inadequate CHWs trained in ICCM
 High malaria incidence (404/1000)
 Low suspicion index by health facility compared to community volunteers
 Low supply of commodities
 Health services accessed by people from other Countries
 Weak community structures
 ICCM not understood by some health workers
 Low engagement with traditional leadership
 Large water bodies for mosquito breeding in some areas
 Refusal of IRS
 Misuse of ITNs
 Malaria stratification not done

5.1.2. Maternal and Child Health

 IPTp data not reliable
 Weak community structures
 Inadequate supervision
 Inconsistency and unreliable HMIS data
 Increase still birth (fresh/macerated)
 Increase maternal deaths
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  Poor communication and coordination of maternal referrals
 Mismanagement of pregnant mothers resulting in maternal deaths
 Shortage of critical drugs
 Staff negligence and errors
 Increase on neonatal deaths
 Patograph either not used or used wrongly
 Inadequate space for waiting mothers
 Late referrals

5.1.3. HIV and TB

 Low uptake of VMMC
 Unreliable data
 Few trained HIV community counselors
 Few HEI tested at 12 and 18 months
 Attrition of TB Treatment supporters
 Shortage of commodities
 Loss to follow up
 Triple 90 not reached
 Shortage and expired blood
 Weak collaboration between TB and HIV
 Shortage of leprosy drugs

6.0. General Objectives and Interventions

6.1. Objectives
 Elimination of Malaria by 2021
 Reduce Maternal Mortality Rate (MMR) to less than 100 from 398 per 100 000 live
births and under-five child mortality from 75 to less than 35 per 1000 live births by 2021
 To reduce the incidence and prevalence of HIV and achieve HIV Epidemic Control, by
2021
 Halt and reduce non-communicable diseases by 2021
 To reduce the number of TB deaths in the population by 40% in 2021

6.2. Interventions on Malaria

 Surveillance
 Case management
 Entomology research
 Social Behavioral Change
 Vector Control
 Strengthening data quality

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6.3. Interventions on Maternal and Child Health
 Vaccinations
 Provision of EmONC Services
 Referral of maternal cases
 Social Behaviral Change
 Provision of FANC
 Nutrition
 IPTp
 Scale up family planning
 Strengthening Community Groups (SMAG)
 IMCI
 Strengthening data quality
6.4. Intervention on HIV and TB
 HTC
 eMPTC
 VMMC
 Viral Load sample analysis
 Contact tracing
 TB examination
 Monitoring
 Case management
 Social Behaviral Change
 Strengthening data quality

7.0. Performance indicator from January to March 2019

 Percentage of Clients accessing long acting reversible contraceptives 11.7

 Antenatal visits before 14 weeks 62.2%
 Pregnant women accessing at least 4 visits to ANC 48.1%
 Institutional deliveries 70.8%
 Malaria incidence 404/1000
 Deliveries by skilled personnel 69.4%
 Fresh still birth rate 51.1
 Postnatal care within 6 days 39.8
 Fully immunized 100%
 Antenatal 1st visit coverage 29.4
 Breastfeeding within an hour of birth 82.4
 Number of maternal death 11
 HIV tested positive 1923/62700
 Viral load progress 87%
 EID progress 5%
 TB mortality rate 12%

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7.1. Group Work

During the meeting, members were divided into 5 groups to analysis the performance and
developed interventions and activities to improve performance. Groups were divided according
to the following level of implementation:
 Community level
 Health centre level
 District level
 Hospital level
 Provincial level

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8.0. PIM AGREED ACTIONS

8.1. COMMUNITY LEVEL

8.1.1. MALARIA
INTERVENTIO ISSUES CAUESES SOLUTIONS / Activity RESPONSIBL DEADLI
N E NE
ITN provision  Poor record keeping  No standard registers at  Mobilize registers for CBVs NHC Q2, 2019
by CBVs during community level by June month end Chairperson
mass distributions  Lack of disposal  Bi-annual engagement of
mechanisms/ policy for local leaders on misuse of
 Abuse of ITNS at ITNS ITNS
community level  There is no proper  Exchange old for new ITNS
monitoring done on the at distribution time
 uncertainty on utilization of ITNS  Monthly Engagement of the
utilization of ITNS  Myths and community (IEC)
in the community misconceptions
IRS Not all eligible targeted  The chemicals are not  Lobby chemicals /funds HCC 3rd quarter
structures are sprayed received according to according to micro plans bi- Chairperson , 2019
micro plans submitted annually
 Refusal by the  Provide IEC monthly
community  Request for adjustment of
 Nomadic lifestyle spray when the people are
within the community
Larviciding Low sensitization  No funding at  Lobby for funding in HCC 3rd quarter
messages relating to community level on Larviciding at community Chairperson , 2019
larviciding at larviciding level by end of quarter 3,
community level 2019.
Case management Erratic supply of drugs  Inadequate stocks at  Monthly quantification at NHC Monthly
and RDTs facility level facility level to include Chairperson
 Inconsistent ordering by CBV’s stocks
the CBVs  Enhance supervision of CBVs
 Inadequate CBVs trained by health workers monthly Monthly
in ICCM  Lobby for training of more
CBVs in ICCM by end of
quarter 3,2019.

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 3rd
quarter,
2019
Malaria In Low IPT coverage (4+  Inadequate trained  Lobby to train more SMAGS NHC 3rd
Pregnancy (MIP) dose) SMAGs to refer Mothers by end of quarter 3, 2019. Chairperson quarter,
to health facilities  Increase outreach stations in 2019
the community
 Late first anti-natal  Supervise SMAGs
bookings  Conduct community
mobilisation Monthly

Parasite clearance Malaria cases are not  Too many carriers for the  Request for Bi-annual Mass NHC 3rd
reducing according to parasite drug Administration (MDA) Chairperson quarter,
the desired rate  Incomplete treatment in the community 2019
 Conduct community
mobilisation Monthly
Surveillance Some communities are Inadequate supervision by  Conduct supervision to all NHC Quarterly,
not reporting malaria health workers CBVs on a monthly basis Chairperson 2019
cases to health facilities Weak community structures  lobby for orientation of CBVs
on a monthly basis on surveillance by end of
quarter 3, 2019
 Lobby for the provision of
Phones/bicycles for CBVs by
end of quarter 3, 2019.
 Lobby for NHC training
M&E Lack of data reviews at No capacity to review data  Hold monthly data review NHC Monthly
Community levels meetings at community level Chairperson
 Plan to train/ orient NHCs in 3rd
basic M &E skills by end of quarter,
quarter 3, 2019. 2019
8.1.2. Maternal and Child Health
First ANC in first 62.2% of pregnant  Cultural issues and  Engage traditional leaders in 9NHC Q4, 2019
trimester mothers attend 1st ANC myths IEC to the community Chairpersons
within three months  Distance to facilities  NHC members to identify
 Few trained sites for outreach stations
CBVs/SMAGS  SMAGS to orient more NHC

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At least 8 ANC Only 48.1% pregnant  Late booking
visits mothers have at least 4  High dropout rate
ANC contacts  Community have no
information on 8 contacts
 Lack of accessibility to
services due to distance
and seasonality
FANC None of districts have  FANC services not
all health facilities known and the
providing FANC importance not
understood by
communities who utilize
ANC services
PNC within six 39.8% of mothers attend  Long distance to facility
days postnatal within 6 days
 Traditional myths
Provision of Late referral of mothers  Not recognizing danger
EmONC with danger signs from signs early
the community  Few trained SMAGS
 Lack of Male
involvement
members in SMAG activities
 Engage traditional leaders in 9NHC Q4, 2019
IEC to the community Chairpersons
 NHC members to identify
sites for outreach stations
 SMAGS to orient more NHC
members in SMAG activities
 SMAGs to provide HCC and NHC Q3 ,2019
information on FANC Chairpersons
services to the community in
order for them to demand for
the services during ANC
 NHC s monitor SMAGs NHC Q3,2019
strengthening IEC on the Chairpersons
importance of PNC 48hours
for mothers who stay far from
facility
 Involve local traditional
leadership during IEC in the
community
 SMAGs to conduct NHC Monthly
community mobilization on Chairperson,
danger signs in pregnancy, HCC and
labour and post delivery and headmen
work with traditional leaders
 Establish Communities
emergency response systems
to take clients to facility led
by men
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 Q3, 2019
Still births review High (51.1) still birth  Still births not regularly  All still births must be SMAGs and Monthly
rate reviewed to identify gaps reviewed starting from NHC
community level Chairpersons
 Community not involved
in the few still births  SMAGs to organize reviews
which are reviewed with Involvement of
Traditional leadership and
share minutes with facility
Provision of High antigens Drop Out  Long distance RHC  NHC to identify areas to open NHC June 2019
antigens more outreach sites Chairperson
 Lots of lost to follow up
tracers/CBV  NHC to use community
registers to track all children
eligible for vaccination in
each zone
IMCI services High number of child  Few trained IMCI  Request for training CBVs in HCC Q3, 2019
illnesses in the providers at CBV level community IMCI Chairperson
community

RED Strategy/ Absence of  Health facilities have not  Conduct head counts NHC Q3, 2019
EPI-Micro Plans consolidated EPI micro- prepared and submitted populations, proposed sites Chairperson
plans in all districts the micro plans to DHO for additional outreach posts
and strategy on drop out
children follow up to
respective facilities
IPT 4+ dose 0/9 districts had IPT  Importance of IPT not  SMAGs to provide HCC and NHC Monthly
coverage coverage of 4+ doses understood by information on IPT to the Chairpersons
communities who utilize community in order for them
ANC services to demand for the services
during ANC
Maternal and Non adherence to  Refusal by high risk  Engage traditional leaders SMAGs/NHC Quarterly,
Neonatal referral Maternal and Neonatal mothers to go to next when giving IEC to the Chairpersons 2019

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guideline referral guideline level of care Community on high risk
 Lack of knowledge on pregnancy
the dangers of risky  Traditional leaders to chair
pregnancy meetings for male
 Lack of Male involvement in health matters
involvement
8.1.3. HIV AND TB
eMTCT  Low numbers of  Inadequate knowledge on  lobby training of lay NHC Monthly
clients accessing transmission of HIV to counsellors Chairperson
HIV testing the unborn child  Hold community stakeholders
 Few numbers of HIV lay meetings
counsellors
 Low male involvement
HTCT  Low uptake of HIV  Inadequate knowledge on  Lobby for Lay counsellors NHC Q3, 2019
test transmission of HIV training Chairperson
 Few numbers of HIV lay
counsellors  Conduct community
mobilisation

VMMC  Low uptake of  Culture briefs on VMMC  Hold meetings with NHC Quarterly,
VMMC  Few numbers of traditional /religious leaders Chairperson 2019
community mobilisers in  Identify community
VMMC mobilisers and champions in Q3, 2019
VMMC
 Mobilise men for VMMC

Monthly
Viral Load sample  Low samples  Inadequate knowledge  Formation of support groups HCC Q4,2019
submission submitted for level on Viral load  Meetings with stakeholders Chairperson
analysis
Notification  Low TB notification  Low screening for TB at  Lobby for increase number of HCC Q4,2019
(DS/DR-TB) the community level. TB treatment supporters in Chairperson

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  Few TB volunteers in the the community
community  Conduct community
mobilization
 Supervise TB Treatment
Supporters
Gene x-pert Low utilization  Inadequate knowledge  Form and orient the members NHC Q4,2019
level on TB  Supervise TB Treatment Chairperson
 Inactive TB treatment Supporters
supporters  Meetings with stakeholders Monthly
to explain on sample referrals
and diagnosis

Contact tracing  Clients are not being  NHCs not trained in new  Lobby for training NHCs NHC Q4,2019
followed guidelines /CBOs in new guidelines Chairperson
 Inactive TBTS Sensitize the community through
Drama and, radio Monthly
M&E  NHCs have no  No standardized data  Request standardized tools NHC Q4,2019
capacity to monitor collecting and reporting Chairperson
tools at community level  Lobby for training of
the activities
 Tools not provided NHCs /CBOs in monitoring
 NHCs not trained in and evaluation of activities
monitoring and
evaluation of activities
8.2. Facility Level
8.2.1. Malaria
IRS Non-involvement of  No information sharing  Health facility to know HC Q2, 2019
other Facility Members to facility staff eg number of structures to be In charge
in Planning Number of eligible sprayed HC In
structures to be sprayed.  Guidelines on provision of charge
 No communication chain information sharing to facility
from DHO to Facility
Staff
Targeting of few eligible  Pre-determined targeted  Facilities to identify eligible HC In Charge
Structures for spraying structures by Funders structure in there catchment HC In Charge
in Facility catchment areas

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 areas  To lobby for more structures
to be sprayed
Inadequate supervision  Non involvement of  Identification of supervisors HC Q2, 2019
during IRS Facility Staff in at Facility Level In Charge/
Implementation Supervising IRS EHT
Implementation
Inadequate Resources  Planning done centrally  Involvement of health facility HC In Q2, 2019
(Funds)to support the (District Level) in Micro-planning Charge
program  Lobby for funds from HC In
partners/DHO Charge

IRS Non-Involvement of  Non favorable criteria of  Develop an appropriate In-Charge/EHT Q2, 2019
Locals in spraying sprayer operators selection criteria suitable for
selection locals
LLINs Lack of monitoring of  Lack of community  Engagement of community HC In Q2, 2019
LLINs usage engagement in gate keepers charge/EHT
monitoring of LLINs  Develop Monitoring tools HC In
usage charge/EHT
 Lack of Monitoring tools
Poor facility  Less involvement of  Involvement of all staff in HC Q2, 2019
supervision/monitoring other staff in monitoring/ monitoring/ supervision In charge/ EHT,
of community based  supervision
distributors
ITNs Inadequate sensitization  Staff not trained in BCC  Train staff in BCC HC In Q2, 2019
on the proper utilization  Orientation of NHCs on charge/EHT,
(BCC) proper utilization.
LLINs Not all people are  Low number of Under  Head count population not HC Q2, 2019
receiving ITNs estimation of Head collected from NHCs In Charge
Count populations  Develop tools for Head Count
 Non standardized system activity
for conducting Head
Count population

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LLINs Misuse of ITN  No proper disposal of  Exchange of torn ITNs with HC In Q2, 2019
torn ITNs new ones charge/EHT
Case Management Few staff trained in  Inadequate resources to  Lobby for training from HC In Charge Q2, 2019
Malaria Case train staff partner. HC In Charge
Management and IMCI  High staff attrition  Lobby for more staff from
DHO
Unavailability of  Inadequate guidelines at  Request of guidelines from HC In Charge Q2, 2019
Standard malaria case facility level DHO
management guidelines
Case Management Stock outs of malaria  Late submission of  Improve logistic management In Charge Q2, 2019
commodities (Test kits reports
and antimalarial drugs)
Staff not adhering to the  Lack of knowledge  Lobby for mentorship from In Charge Q2, 2019
treatment guidelines DHO
IPT Not all Pregnant women  Inadequate drug due to  Improve logistic management HC In Charge Q2, 2019
are receiving fansidar late submission of
according to national reports
guidelines
Health Education Lack of effective  Inadequate IEC materials  Develop and print IEC In-Charge Q2, 2019
communication on the in local languages materials in local languages
dangers of malaria in  Lack of community with support from partners
pregnancy engagement
Health promotion Misuse of ITNs  Lack of community  Target critical audiences with HC In Q2, 2019
sensitization key messages charge/EHT
Refusals for IRS  Perception that chemical  Intensify SBCC HC In Q2, 2019
used brings about other charge/EHT
vemins
Surveillance, CHWs not trained/  Inadequate funds to train  Lobby for funds to train HC In Q4, 2019
M&E Oriented in malaria CHW CHWs in HMIS and malaria charge/EHT
surveillance surveillance
 Develop malaria business
plan
Surveillance, Inconsistency data  Lack of standard data  Consistent supply of updated HC In Q2, 2019
M&E capturing and reporting collecting and reporting data collecting and reporting charge/ EHT
tools tools HC In
 Lobby for trainings of staff in charge

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 surveillance
Surveillance, Non utilization of data  Lack of data ownership  To conduct routine review In charge Monthly
M&E for decision making at facility level meetings
Lack of data review  Not prioritized  To prioritized monthly data In charge Monthly
meetings reviews
8.2.2. Maternal and Child Health
st  Increasing number  Cultural and traditional  Engagement of Traditional In-charge 31st June
1 ANC in first
of Late booking’s beliefs and myths Leaders on Reproductive 2019
trimester
for ANC  Fear to be tested for HIV health ( meetings)
 H/C Staff not  Staff attitude  Mentorship to Health Centre
sensitising the  Lack of integration of Staff
community MCH services  Super market approach
 ANC services
limited to specific
days in a week
 Not conducting
ANC services in
outreach centres
At least 4 ANC  Increase in the  Cultural and traditional  Engagement of Traditional In-charge Q2, 2019
visits number Late beliefs and myths Leaders on Reproductive
booking for ANC  Fear to be tested for HIV health
 H/C Staff not  Staff attitude  Mentorship to Health Centre
sensitising the  Lack of integration of Staff
community MCH services  Super market approach
 ANC services  Incentivize the follow up
limited to specific visits
days in a week
 Not conducting
ANC services in
outreach centres
Provision of Non integration of  Limited transportation  To lobby for vehicle to In-charge Q2, 2019
FANC FANC Services during accommodate staff and
outreach logistics to use
Low no. of mothers  Long distance to facility  Provide Outreach services In-charge Q2, 2019
booking for A.N.C.

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  Inadequate knowledge on  Conduct SBCC to mothers
the importance of ANC
Poor monitoring of  Lack of knowledge on  Mentorship in Partograph In-charge Q2, 2019
labour partograph use and usage and interpretation
interpretation
Provision of Mismanagement of  Lack of protocols on  Source for protocols and In charge Q2, 2019
EmONC Services emergency obstetric management of guidelines
conditions emergency obstetric  Regular clinical meeting and
conditions mentorship
 Lack of understanding
and interpretation of
protocols
Vaccinations Unable to conduct  Inadequate transport for  Lobby for procurement of In charge Q2, 2019
extensive outreach outreach Motorbikes
services and reach out to
hard to reach areas
Unable to conduct  Inadequate transportation  To submit schedule to DHO In charge/ Q2, 2019
integrated outreach mode to carry more than and lobby for motor vehicle MCH
services 2 staff
Non availability of  Not utilizing the REC  Conduct mentorship and In charge Q2, 2019
inventory or database of concept to capture all supervision of CBVs on REC
under 2 children on children in the and how to use Community
vaccine schedule in communities registers
community
Vaccination Use of exercise books in  Unavailability/  Quantification and lobbying In charge
place of under 5 cards inadequate Under 5 cards for procurement of Under 5
at facility cards
 Poor recording and  Growth monitors not  Lobby for training of CBVs In charge Q2, 2019
tally of under under trained in Community integrated
5 cards registers
 Non-vaccination
follow ups
Compromised data due  Use of old/ un updated  To lobby for provision of In charge/ Q2, 2019
to using improvised tools updated new registers DHIO

20 | P a g e
 registers
Early Infant Low HIV testing of  Inadequate HIV test kits,  Improve logistic INCHARGE Q2, 2019
Diagnosis ANC mothers  Poor integration of management,
services in outreach,  Availability of HIV test kits
 Staff attitude during outreach,
 Provide mentorship in ANC
services
Low DBS collection of  Inadequate DBS cards,  Availability of DBS cards, INCHARGE, Q2, 2019
HEI  Staff lacking skills in  Train/orient staff in DBS MCH-CO-
DBS collection collection ORDINATOR
Poor data capturing in  Lack of skills in EID  Orient staff in data INCHARGE, Q2, 2019
the child mother follow data capturing and follow management on EID, MCH/DHIO
up registers ups,  Monthly data reviews
 Staff attitude
Early Infant Lack of data review on  Lack of prioritisation,  Hold facility data review INCHARGE, Q2, 2019
Diagnosis EID  Inadequate skill to meetings, MCH CO-
conduct EID data ORDINATOR
reviews
Poor courier system for  Lack of a system in place  Establish a system such as a INCHARGE Q2, 2019
DBS samples mwana program (mHealth)
Poor notification of the  Lack of Child-mother  Consistence child-mother INCHARGE Q2, 2019
care takers of the DBS follow ups, follow ups,
results  Lack of contact details  Updating of the child-mother
for care takers follow up register according
to standard guidelines
Follow ups not  Lack of utilisation of  Provide mentorship and MCH/INCHAR Q2, 2019
according to the data and standard orientation of the guidelines GE
schedules guidelines (6wks,
6mnths, 12mths)
IMCI Lack of implementation  Few staff trained in IMCI  orientation of staff in IMCI, In-charge Q2, 2019
of IMCI guidelines,  Mentorship in IMCI,
 Inadequate IMCI SOPs  Make available IMCI in
in facilities, SOPs
 Staff workload
8.2.3. HIV and TB
ANC Not all pregnant women  Stock out of test kits  Strengthening supply chain at In charge Q2, 2019

21 | P a g e
 are tested at first ANC  Testing only done at facility level to improving on In charge
Non adherence to the static sites reporting In charge
ART guidelines with  Lack of updated job  To integrate testing in Incharge
regard to Viral load four Aids, Knowledge gap in outreach activities.
weeks before delivery the eMTCT guidelines  Facility to make a job aid
from the eMTCT guidelines
 Onsite mentorship/
orientation of all MCH staff
on the consolidated
guidelines
Labour and No DBs being done at  Knowledge gap in staff  Onsite mentorship to all staff In charge Q2, 2019
Delivery birth at the facility in labour ward on Option B+ In charge
 Non adherence to  Conduct monthly supervision In charge
current eMTCT to staff on eMTCT guidelines In charge
guidelines due to lack of  Hold clinical Meeting at
supervision facility
 Lack of DBs Kits  Facility to submit accurate
reports and place emergency
orders
PNC Low number of infants  Lack of standardised  Lobby for SMART CARE In charge 31st May
tested at 12/ 18 months trucking system for HEI system deployment at facility In charge 2019
 Knowledge gap on the from DHO. In charge Weekly
importance of testing at  Continuous IEC to mothers starting :
12 months after the six on the importance of testing. 21st May
months by mother’s  Lobby for register from 2019
regardless of results. DHO. 31st May
 In adequate data 2019
collection tools/ register
Low yield below 5%  Not conducting  Implement PNS/ Index In charge 1st June
prevalence rate for PNS/Index testing testing on : All new HIV/ In charge 2019
Province .  Non utilization of Positive clients, all clients 1st June
Screening tools with unsuppressed viral load, 2019
 All lost to follow clients
 Facility to utilize screening
tools


22 | P a g e
 Low number’s of clients  Inadequate human  Lobby for training of New In charge Q2, 2019
during the off campaign resources to conduct MCs provides from DHO In charge
periods VMMC  Engagement of Community/ In charge
 Non- involvement of Traditional
traditional leaders in  leaders
community mobilization  Lobby and develop a VMMC
 Lack of financial business plan
support to community
mobilisers
VMMC Mostly done during None prioritization of the Enhancing VMMC activity all In-Charge Monthly
Campaign periods activity during off campaign times
periods
Myths/Misconceptions Inadequate knowledge on the SBCC on benefits of VMMC In-Charge Monthly
of VMMC Procedure/Benefits of
VMMC
Inadequate/No VMMC Few/No providers trained per Lobby for training of more In-charge Q2, 2019
Providers Facilities VMMC providers through DHO
HTC Low number of people  Inadequate Community  Train more community in-charge 31.12.201
knowing their HIV Counselors. Myths and counselors 9
status and low number misconceptions
of circumcised men (manhood becomes
weak)  Quantify and order more HIV
 Shortage of testing kits kits
 Conduct outreach HTC Monthly
 Conduct community
engagement activities
Lack of integration of  Fewer staff conducting  Facility to request for support In-charge Monthly
HTC services in other outreach services due to from DHO
services inadequate fuel

Stock outs of logistics  Poor quantification of  Use of consumption rates in In-charge Monthly
(test kits) HTC logistics relation to quantification of
logistics
Lack of implementation  Staff attitude,  Hold meetings to discuss In-charge Q3, 2019

23 | P a g e
 of new HTC policy  Staff overwhelmed with HTC,
a lot more services,  Recruit more lay counsellors,
 Fewer HTC logistics,  Use of consumption rates in
 Fewer trained relation to quantification of
counsellors. logistics,
 Intensify HTC services in
outreach
Low TB Low suspicion index  Knowledge gap in TB  Onsite mentorship and In charge Monthly
notification rate at from staff Screening by staff orientation of staff
facility level
Gene-Xpert, Low utilisation  Low index of suspicion  Onsite mentorship and In-charge Quarterly
utilization of TB by facility staff, orientation of staff starting
 Not all facilities have  Lobby for Gene- Xpert quarter 2
Gene-Xpert machines Machines from DHO 1st May
2019
Gene-Xpert, Low utilisation  Long distances to referral  Lobby for a courier system In-charge 1st May
utilization facilities with Gene- for transportation of sample 2019
Xpert machines referral
Contact tracing Limited time to follow  Lack of integration of  Integrate contact tracing into In - charge Monthly
up clients TB activities other outreach programmes starting
 Poor attitude by facility June
staff
Monitoring & Non correlation of data  The data collecting tools  Lobby through DHO for the In charge 1st June
Evaluation elements in data not to speed with new provision of updated tools 2019
collecting tool HIV/AIDS Guidelines
(Registers ) and
reporting tools (HIA2)
Incomplete report on  Lack of knowledge on  Lobby for trainings/ In charge Q2, 2019
HIV/AIDS and TB the data elements to orientations on HIV/AIDS
program collect and report data collecting and reporting
tools
M/E Incomplete report on  Lack of knowledge on  Lobby for trainings/ In charge/ 1st June
HIV/AIDS and TB the data elements to orientations on HIV/AIDS DHIO 2019
program collect and report data collecting and reporting
tools

24 | P a g e
M/E A lot of gaps and  Inadequate/non  To lobby for the standardized In charge/ 1st June
Inconsistency of data availability of standard tools from District level DHIO 2019
and reports on data collecting and
HIV/AIDS reporting HMIS tools
8.3. District level
8.3.1. Malaria
IRS  Late commencement  Late disbursement of  Lobby for early disbursement DHD Q2, 2019
of IRS funds of funds through PHD by End
 No bi-annual action  Late receipt of June, 2019
plan for IRS commodities  To prepare bi-annual IRS by
 DHO not aware of the the end of June, 2019
policy directive
Case manage  Poor case  Inadequate logistics  Order enough supplies on Laboratory Q2, 2019
management (RDTs, antimalarials) time starting first week of Technologist/
 Inadequate mentorship June 2019 Pharmacist
and supervision of  Intensify TSS to HCWs by
HCWs the end of May 2019
 New staff not trained in  Train/orient new staff in
malaria case malaria management by end Planner
management of Q3, 2019

CCO
MIP  Low coverage of  Inadequate supply of SP  Order enough supplies on Laboratory Q2, 2019
IPT time starting first week of Technologist/
June 2019 Pharmacist
Parasite clearance  No MDA  Inadequate commodities  Order enough supplies on Laboratory Q2, 2019
time starting first week of Technologist/
June 2019 Pharmacist
SBCC  Inadequate/Ineffecti  Inadequate community  Organize and conduct Health June 2019
ve SBCC engagement and community mobilization Promotion
mobilization monthly Officer
 Hold quarterly meetings with
traditional leaders
Surveillance Current reporting • Delay in response due to  Strengthening the systems of Surveillance Q2, 2019

25 | P a g e
 not responsive delay in reporting at HF surveillance by end of June Officer/Health
2019 Promotion
Officer
M&E  Poor data quality  Lack of understanding of  DHO to provide TSS to HFs DHIO Q2, 2019
indicators  Conduct monthly data review
 Inconsistent data reviews  starting end of May, 2019
8.3.2. Maternal and Child Health
1ST ANC in first  Threat of not  Ceasation of RBF  strengthening community HPO/MCH Q2, 2019
Trimester sustaining good support engagement starting 27th
performance on the May, 2019
indicator
At least 8 visits  Inconsistent TSS  Lack of integration of  Integration of activities HPO/MCH Q2, 2019
 Knowledge gap activities starting 20th May, 2019
among  Inadequate funds  Orient all HCWs by 30th
HCWs/Community  Lack of orientation of June, 2019
HCWs/Community  Conduct radio sensitization
programs 20th May, 2019
FANC  Low FANC  Stock out of FANC  DHO to Improve timeliness Pharmacist/Lab Q2, 2019
coverage commodities of reporting on 10th of each oratory
month Technologist
 DHO to provide TSS to
challenged HFs starting by
20th May, 2019
Postnatal within 6  Low postnatal  Long distances from  DHO to provide MCH Q2, 2019
days coverage facility TSS/mentorship to HFs on
 Myths regarding new domiciliary visits
born  Engagement of traditional
leaders by 31st July, 2019
Provision of  Failure to identify  Failure to adhere to  DHO to provide MCH Q2, 2019
EmONC services maternal, newborn referral guidelines TSS/mentorship HFs 27th
complication on  Inadequate skills to May, 2019
time identify obstetric
emergencies
Still births review  Inconsistence review of  Submit review forms to MCH Q2, 2019

26 | P a g e
 still births DHO Coordinator
 High antigen  Absence of EPI micro  DHO develop micro plans by  MCH/EPI Q2, 2019
dropout rate plans 30th June, 2019 technician
Vaccination
 Inconsistence in outreach
services
IMCI services  High under five  Poor case management  DHO to train/mentor HCWs CCO/MCH Q3, 2019
mortality  lack skills in IMCI in IMCI by 30th June, 2019
 Poor attitude
8.3.3. HIV AND TB
eMTCT  Few HEI tested at  Loss to follow up  DHO to provide MCH/DHIO Q2, 2019
12 and 18 months TSS/mentorship to HFs on
documentation and client
 Inadequate DBS testing locator starting 31st may
kits 2019 Laboratory
 Order enough supplies on Technologist/
time starting first week of Pharmacist
 Inadequate skilled staff June 2019
in DBS sample collection  To train/TSS staff in DBS MCH
sample collection by Q3, Coordinator
2019
HTC  Wastage of test kits  Low indexing  Provide TSS/mentorship on HIV/TB FP Q2, 2019
causing shortages  Lack of adherence to indexing and use HIV testing
HIV testing screening screening guidelines starting
guidelines June, 2019
VMMC  Low number of  Traditional beliefs and  Engagement of key VMMC Q2, 2019
VMMC done myths stakeholders e.g. tradition Coordinator
 Inadequate resources leaders by end of Q2, 2019 DHD
 Integration of activities
starting end of June 2019
 Lobbying for more resources
for field staffs starting Q3,
2019
ART client  Low VL sample  Ineffective sample  DHO to come up with a SCO-TB/HIV Q2, 2019

27 | P a g e
monitoring submission referral system /transport
challenges
Management of  Low notification  Inadequate diagnostic
TB (DS/DR-TB) equipment (Gene-expert
machine
 Low Gene-Xpert,  Ineffective sample
utilization referral system /transport
challenges
Contact tracing  Low contact tracing  Inactive TB treatment
supporters
Monitoring &  Unreliable data  Irregular data audits and
Evaluation reviews
 Disparities in data  Weak collaboration
for HIV/TB between HIV & TB
programs
8.4. Hospital level
8.4.1. Malaria
ITN provision Low utilization of ITNs  Not every single hospital
for in-patients in the bed has an ITN Hanging
wards  Poor attitude of Health
workers and inpatients
towards ITN use
 ITNs are not well
maintained, in Some
cases, ITNs may be dirty
or torn (compromised
quality)
IRS  Hospitals buildings  No clear policy on
not sprayed during implementing IRS in
IRS implementation hospitals (Wards with
period patients)
schedule for VL sample
collection
 Lobby for gene expert DHD Q2, 2019
machine
 Starting Q3, 2019
 DHO to improve on TB SCO-TB/HIV Q2, 2019
sample referral system end of
Q2, 2019
 Strengthening community HPO/SCO- Q2, 2019
structures TB/HIV
 Strengthen data audits and SHIO Q2, 2019
reviews through program
integration starting 30th June,
2019
 Strengthening collaboration
of HIV & TB programs
through data sharing starting
end of May, 2019
 Provision and installation of Done all Q2, 2019
ITNs on every hospital bed hospital beds
by quarter 2 2019 have been
 Sensitization on importance provided with
of ITN Use to patients and ITNs
care givers by Quarter 2 2019
 Formulation of hospital
policy on ITN Use by Quarter
2 2019
 Poor storage/negligence on
maintenance by June 2019
 Engage PHO to avail and done Q2, 2019
clarify policy and modalities
of carrying out IRS in
hospitals especially
28 | P a g e

Larviciding Breeding sites  Allow stagnant water
Case management  High malaria Case  Poor adherence to
Fatality Rate in standard treatment
hospitals guidelines on
complicated malaria
cases by health staff
 Lack of mentorships on
Malaria Case
 Poor index of
management
malaria suspicion by
 Lack of experience in
clinicians management of severe
cases by new staff
 Erratic supply of
commodities from MSL
 Poor logistic
management of
commodities at hospital
level
 Stock outs of
commodities such as
RDTs and anti-
malarial for severe
malaria
MIP  IPT not given to  Stock out of SP
waiting mothers  Poor SP quantification
 Poor SP logistic
management
admission wards and other
sensitive areas by end of
quarter 2 2019.
 Burry and clear breeding sites done Q2, 2019
in hospital premises
 Provision of standard CCO Q2, 2019
treatment guidelines at all
treatment points by quarter 2 CCO
2019. HPO
 Conduct OTSS on malaria
case management to health CCO
staff end of June 2019.
CCO
 Intensify mentorship to newly
deployed staff routinely.
MS/MOIC
 Engage PHO/PP/MSL to
ensure availability of
commodities like RDTs and
Anti-malarial by end of
quarter 2 2019
 Pharmacy and end user MOIC/MCH 05,2019
departments to improve on Coordinators
SP logistic management and
reporting.
 PHO to place emergency
orders for SP at MSL
immediately
29 | P a g e
Parasite clearance High numbers of malaria  Drugs not completed  Conduct OTSS MOIC
carriers
SBCC  Inadequate IEC  IEC biased towards  Provide IEC to all clients HP Q2, 2019
given to caregivers curative and neglecting attending at the hospital NO
and Patients health promotion during admission and before
discharge
Surveillance  Poor data capturing  No designated Hospital  Lobby for creation of HRMO/MOIC/ Q2, 2019
Information Officer at Hospital Information Officer DHD
hospitals  Train COs on correct data
 Clinicians in OPD not capturing
oriented on Malaria data
capturing
M&E  No ICT equipment  ICTs not prioritized  ICT equipment to be given MOIC Q2, 2019
 Lack of necessary  Officers assigned to priority for M&E
M&E Skills leading handle hospital  Provide routine orientation
to poor data information are and mentorship
capturing, storage appointed on adhoc
and analysis arrangement
8.4.2. Maternal and Child Health
At least 8 ANC  Pregnant Women  Late booking and referral  Engaging DHO to ensure done Q2, 2019
visits with maternal from the health centers complicated maternity cases
complications  Non adherence to the start ANC early at the
designated to do new ANC guidelines for hospital by end of second
ANC at the hospitals complicated pregnancies quarter
having less than 8  Poor data capturing for  DHO to disseminate,
ANC visits during hospital ANC Women implement and monitor new
their pregnancy ANC guidelines by end of
second quarter
 Provide ANC data capturing
tools to the hospitals by end
of June
Provision of  Few hospital staff  Luck of prioritization of  Revision and Prioritize done Q2, 2019
EmONC Services trained in EmONC EmONC Trainings by EmONC trainings from the
districts COC Plans under G2G
Support, by quarter 2 2019
Still births  High number of still  Late referrals from the  Provide technical support to Done birth still Q2, 2019

30 | P a g e
Review births recorded at facilities
the hospital  Inadequate skills in
 Not all still births monitoring mothers in
are revealed labour and in new born
resuscitation at the
hospital
 Still births review not
prioritized
Non adherence to  Non adherence to  Poor staff attitude
MN referral referral guidelines towards the
guideline  MN referral implementation of new
guidelines not MN referral guidelines.
readily available at  Distribution and
service delivery orientation of staff on
points MN referral guidelines
not done at hospitals
8.4.3. HIV and TB
eMTCT  Stock out of DBS  Poor quantification of
Cards DBS.
 Low DBS  Late reporting for the
Collection at Birth DBS logistic system.
from labour ward by  Skill: staff not oriented
staff. on DBS Collection.
 Weak courier system  Skill not oriented on new
of DBS from the DBS collection
hospital Guidelines.
 Donor dependent courier
system, luck of
institution ownership
HTC  Not everyone  Opt out of some clients.
attending hospital  Few counsellors to do
services is routinely HTC
the facilities quarterly review are done
 Provide mentorship to facility
and hospital staff quarterly
 Put in place systems for still
birth review as soon as they
occur, by end of May
 Conduct routine counselling MOIC/CCO/N Q2, 2019
and mentorship of staff O/In-charge
 Conduct orientation on MN
referral guidelines to all staff
working in labour ward at the
hospitals by Quarter 2 2019
 Improve on DBS done Q2, 2019
quantification and reporting
at service delivery points by
1st week of every month.
 Timely reporting of DBS
logistics by all end users by
5th of every month.
 Orientation of staff on new
EID (DBS) Collection
guidelines by 2nd Quarter
2019.
 Planning and budget for DBS
courier system by the
institutions.
 Strength the implementation Done Q2, 2019
of Hospital HTC guidelines
by 2nd Quarter 2019.
31 | P a g e
 tested for HIV  Poor quantification of
according to the HIV test kits
national guidelines
 Stock outs of some
test kits.
VMMC  Few Mens  VMMC not done
Circumcised in everyday, done on
Muchinga scheduled days and
campaigns
 Few trained providers
 Cultural and traditional
belief
 Limited and Luck of
conducive VMMC space.
 Stocks out of VMMC
logistics.
 Inadequate financial
resources for VMMC
outreach
Viral Load sample  Not all ART patients  Transport challenges
submission have a viral load taking samples to
done according to Chinsali Viral load
guidelines. laboratory
 Health workers not
following the HIV new
guidelines regarding the
viral load when
managing ART clients.
 Only one viral load
 Train more counsellors for
HTC by 2nd quarter of
quarter 2
 Improve on HIV Test kits
quantification and reporting
at service delivery points by
1st week of every month.
 Timely reporting of HIV test
kits logistics by all end users
by 5th of every month.
 Make VMMC a routine done Q2, 2019
facility service
 Training of more VMMC
providers
 Health education and
Sensitization, SBCC.
 Creation of separate VMMC
Spaces by 4th Quarter 2019
 Mobilization and Main
streaming of VMMC as a
routine service at Facility.
 Strengthen the courier system PHD Q2, 2019
currently supported by MS
EQUIP HCC
 Orientation and technical HIV FPP
support to health workers on
viral load
 Lobby for setting up another
viral load machine in Mpika-
Chilonga General Hospital
32 | P a g e
 machine in the province
Notification  Low notification of  Challenges of DR TB  Mobilization of partner MS Q2, 2019
(DS/DR-TB) DR-TB at the sample referral from the support for DR TB to CDL. MOIC
hospital hospital Laboratory to  Mobilizing resources for DR- TB Focal
Chest Disease TB referral to CDL
Laboratory (CDL) in
Lusaka.
Gene-Xpert,  Very low utilization  Low index of suspicion  Orientation and Mentorship Done Q3,2019
utilization of Gene Xpert at of TB by health workers of Health workers and TB
diagnostic sites. at facility and treatment supporters in TB
 Stock out of Gene X community (TB Notification and sample
pert Treatment supporters). referral by 2nd quarter 2019.
 Poor Gene Xpert logistic  Strengthen logistic system for
quantification Gen Xpert immediately
Contact tracing  Inadequate TB  Few trained TB  Train more TB Treatment TB FFP Q3, 2019
treatment supporters Treatment supports. supporters at community Health
at community level  Low TB Index of level. promotion
for tracing patients suspicion by health  Orientation and Mentorship officer
 Weak Sample workers on TB Care Community
referral from Engagement
community/Facility Officer
to the TB Diagnostic
sites
Monitoring &  Weak M and E for  No update registers for  Mobilization and supply of done Q3,2019
Evaluation TB Program TB new TB registers to facilities.
 Lost to follow ups of  Strengthen TB DQA in
TB/ART patient facilities
8.5. Provincial Level
8.5.1. Malaria
M&E  Data inconsistencies  Lack of malaria data  Monthly Malaria data Review SHIO Q3, 2019
between levels review meetings meetings
(District/Provinces)  Lack of support to the  Conduct Quarterly malaria
focused malaria data

33 | P a g e
  Inadequate malaria audit data Audit
Data Audits
ICCM  Inadequate(691/943(  Inadequate financial  Lobby for financial support CEHO Q3,2019
73%) active CHWs Resource to conduct from Partners for ICCM
of the trained in ICCM training Training
ICCM  Develop a malaria business
plan
Supply of  Low supply of  De-linkages between  Orient pharmacy staff in Principle Monthly
commodities commodities demand and commodity logistical focasting Pharmacist
supply  Redistribution of
 (80% of Facilities commodities across Districts
stocked out of (excess stock)
Fansidar )
Provision of  Low community  Lack orientation to the  Orient community SHEO Q3, 2019
SBCC engagement 691/943 newly appointed leaders Engagement officers in their
(73%) of the roles and responsibilities
reporting CHWs  Facilitate creation of health
corners in churches (IEC
Points)
Larviciding Large water bodies for  Limited of alternative  Provide on IEC on Malaria SHEO Monthly
mosquito breeding in intervention of vector  Provision of LLIN to
some areas (15% control Districts CEHO
covered by water
bodies)
8.5.2. Maternal and Child Health
1st ANC in first Low 1st ANC coverage  Non engagement of FBO  Create health corner in SHEO Q3,2019
trimester in ifirst trimester (62.2% and Traditional leaders, churches ,
ANC before 14 wks. )  Inadequate focused TSS  Province to facilitate
to DHOs engagement of traditional
 Non adherence to policy leaders
guidelines and SOPs  Provision of TSS to DHOs
 Provision of policy guidelines
with regards ANC
At least 8 ANC Low 8 ANC visits  Non adherence to the  Supervisory visits , spot PNO-MNCH Q3,2019

34 | P a g e
visits coverage (48.1% Q1 guidelines on 8 visits by checks, circulars
2019 for at least 4 visits DHOs
)
FANC 0/9 Districts conduct a  Inadequate FANC  PHO to direct on the PHD Q2, 2019
full complement of logistics I.E heamaques, provision of FANC logistics
FANC Services urine sticks, etc. by the Districts
PNC within 6 (32.2% Q1 2019)  Data capturing tools are  Lobby for the revision of SHIO Q2,2019
days Low PNC coverage deficient on PNC within Data capturing tools
within 6 days 48hrs
Provision of Low Provision of  Inadequate equipment for  Provision of equipment for SHRMO Q3,2019
EmONC Services EmONC Services EmONC service EmONC service
Across District  Staff attitude towards  Institute Disciplinary charges
EmONC on erring staff
Still births 51.1% Q1 2019 of FSB  Lack of leadership  Strengthen supervision on PNO-MNCH Q2, 2019
Review not reviewed DHOs /wards to account for
FSBs
 Facilitate for the training in
EmOC to DHO/ward staffs
IMCI Services Very few Health workers  Lack of resources to train  Lobby for the Training of CCS Q3,2019
trained in IMCI Services IMCI providers staff in IMCI
 Supportive supervision the
IMCI providers
Maternal 15 maternal Deaths in  Non adherence to MN  Strengthen supervision on PNO-MNCH Monthly
/Neonatal Deaths Q1 2019 referral guideline Early referrals
(High Maternal  Low implementation of  Provision of SOPs and
mortality) EmOC by guidelines
Districts/Hospitals  Strengthen interrogations /in
maternal & neonatal reviews
8.5.3. HIV and TB
eMTCT Increasing positivity  Commodity stock out  Ensure adequate stocks of Principal Q2, 2019
Rate (from 4% Q4 2018- (DBS cards ) Niverapine niverapine and DBS cards in Pharmacist
to 5% in Q1 2019) and Facilities /PBS

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  Data quality issues in SHIO
EID
VMMC Low coverage in  Cultural barriers  Province to facilitate SHEO/PHS Q2, 2019
VMMC service (53%  High attrition of VMMC engagement of traditional
2018) providers leaders
(17737/33220)  Demand creation for VMMC
through CEOs,
TB collaborative Low TB +ve clients  De-linkages in TB/HIV  Increased focused Supportive PHS Q2, 2019
service tested for HIV 74% in collaborative activities supervision for TB
Q1 2019  Data quality issues collaborative Activities
 DQA in TB HIV
collaborative activities
Monitoring & Data inconsistencies  Irregular DQAs across  Conduct Quarterly DQAs SHIO Q2, 2019
Evaluation across program lines program data elements across program data elements

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9.0. Closing remarks
In closing the meeting, thePHD stressed that the province was on course to serve its people in a
special. He said it was expected that people leave their work stations late for the sake of service
delivery; he asked if any of the District Heads were tired they would mention it in time so that
they could be replaced.

He further stressed that maternal deaths should be avoided at all costs, it was important that all
hospitals and DHOs put the people have the heart to serve the people. The PDH further added
that planning cycle had since started, he mentioned that the Planning unit has shared that
schedule of activities leading to the same, he emphasised that it was expected that all the District
training schools and Hospitals should do the obvious things so such as profiles etc., so as when
the planning figures are given during the planning update periods there would be less work to do
The PDH concluded by thanking the Planning Unit Staff and all the PHO staff that had put in
their efforts to see the PIM a successful endeavour.

He wished every one well and safe trips to all and closed the meeting at 19.23 hrs.
The prayer was given by Mr Muma DHD kanchibiya District.

10. ANNEXES
Annex 1: Group Work Team Members
Group 1: Community Level
 DHD – Chama
 DHD – Mafinga
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  Planner – Kanchibiya
 Planner – Shiwangandu
 MCH – Chinsali
 MCH – Mpika
 MISA – SARAI
 PNO-MNCH – PHO
 IA – PHO
 CDC – PAMO
 PFMS - SBH

Group 2: Health Centre/Post Level

 HMIS – SBH
 PNO - MP – PHO
 RHP – SARAI
 MS – Chinsali
 DHD – Isoka
 DHD – Nakonde
 Planner – Chama
 Planner – Mafinga
 MCH – Kanchibiya
 MCH - Shiwangandu
Group 3: District Level
 DHD – Lavushimanda
 Planner – Isoka
 Planner – Nakonde
 MCH – Chama
 MCH – Mafinga
 P. Tutor – Chilonga G. H
 RM – SARAI
 PP – PHO
 G2G Coordinator – PHO
 SO – PAMO
 Officer - JSI
Group 4: Hospital level
 SHRMO – PHO
 G2G FS – PHO
 Coordinator – AGIS
 MS – Chilonga
 MCH – Isoka
 MCH – Nakonde
 Planner – Lavushimanda
 DHD – Chinsali
 DHD – Mpika

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  TO – Care
 TO - EQUIP
Group 5: Provincial level
 DHD – Kanchibiya
 DHD – Shiwangandu
 Planner – Chinsali
 Planner – Mpika
 MCH – Lavushimanda
 P. Tutor – Muchinga N.S
 CEHO – PHO
 CCS – PHO
 Coordinator – PAMO
 PMS – SBH
 LS - ETB

Annex 2: Presentations, discussions and updates

9.2.1. Plenary – Malaria Score Card
There was concern that IRS was being done late and once a year, what measures were being put
in place to conduct it twice. Another participant wanted to find out what strategies Chama
District was using to achieve 80% of the planned activities and also what challenges where faced
by the Isoka and Nakonde for scoring the least.

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Responding to the issue over IRS being performed twice, the National Malaria Elimination
Adviser informed the group that the directive to conduct IRS twice was not new as it was first
made in 2017 during the launch of the Malaria Plan. Again it was reaffirmed in 2019 following
the high incidence of Malaria in the country. He said it was a ministerial directive to conduct IRS
twice. He further mentioned that the life span for the chemicals was about 4 month hence the
need to spray twice. He clarified that districts should not worry over funds but just to submit
malaria business plan to the National Malaria Centre.

Responding to the concerns attributed to Chama District Health Director, he informed the house
that Chama was doing well due to the following reasons:
1. Review and follow-up of status of action points during management meetings
2. Integration of activity during implementation
3. Forum for report. The development of report of activities done
The District Health Director for Isoka highlighted two reasons for not addressing the previous
PIM action points:
1. Inadequate funds to conduct trainings which were recommended
2. Some activities done but no proper reports were available

After tea break, Chama, Isoka, Lavushimanda and Shiwanga’ndu made their presentations on
malaria. The general picture was that the incidence for malaria all ages has gone up when
comparing Q 1 2018 and Q 1 2019. Further analysis showed that in some facilities within
districts malaria incidence had reduced while it was the opposite in other facilities. From the
presentation it was observed that malaria management in most districts had improved which
resulted in reduction of case fatality rates in the districts. This was attributed to availability of
supplies and improvement in case management as a result of OTSS and Mentorships which were
conducted by most districts. On the other hand Lavushimanda, Shiwangandu and Isoka attributed
the rise in incidence and case fatality in certain facilities due to:
 Large water bodies around the catchment areas
 Migration of population during certain times of the year
 Poor housing structures (IRS not possible)
 Misuse of ITNs by the community

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  Inadequate skills in case management due to Staff attrition
 More numbers due to foreigners accessing services

9.2.2. Plenary Session

After the presentations from the four districts, the chairperson invited participants to plenary
discussion and the following were the points of discussion:
 What proportion of foreign influence had contributed to increasing malaria incidence in
Chama? What strategies were being employed?
 How was the incidence rate for Lavushimanda calculated?
Responding to the issues attributed to Chama, the District Health Director informed the house
that his office had engaged the Malawian counterparts and found out that there were not
conducting IRS/ACCM approach. Commenting on the calculation of malaria incidence, the
Director informed the house that there was need to clean the data and also to conduct mapping of
areas and structures.

9.2.3. Second set of presentations

After the first set of presentations, Kanchibiya, Mafinga and Chinsali Districts made their
Presentations. The following are the observations from their presentations:

Mafinga district has seen reduction in incidence rate at district level for malaria all ages when
compared from Q1 2018 to Q1 2019. Further analysis showed that some facilities in Mafinga had
recorded a reduction while others had recorded an increase, Zumbe, Muyombe and
Schitabulehave seen an increase in malaria incidence all ages. A similar trend was observed for
Chinsali and Kanchibiya Districts.

9.2.4. Plenary
After the presentations, the Chairperson invited participants to plenary and the following were
the discussion points:
 Mafinga was asked what means of diagnosis was being done during the stock outs of
RDTs? How did the district managed to score fatality rate.
 With weak community structures, how do partners such as ROCS work?

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  Kanchibiya was asked why the incidence rate in Kanchibiya was high.

In addressing the issues attributed to Mafinga district, the District Health Director informed the
house that the district had lobbied for RDTs from neighbouring districts to ensure continuity of
care and proper diagnosis. The DHD further mentioned that they were working closely with the
partners such as ROCS to improve malaria activities in the district.

Kanchibiya District Health Director informed the house that the high incidence rate in his district
was attributed to large water bodies. However, he was quick to mention that the district had
intensified IEC among other interventions to increase awareness. After the plenary, the meeting
was adjourned.

9.2.5. Day one afternoon Session

We regrouped at about 14:30. The districts to present immediately after lunch were Nakonde,
Mpika and Provincial Health Office. The following are the observations made from the
presentations.

Like the case with other districts, it was observed that the Malaria incidence rate for Mpika
district was high. On the other hand, it was observed that Nakonde set targets had a vague picture
of what was achieved. It was further noted that Nakonde district had low numbers of Community
health workers.

Responding to the concerns attributed to Mpika district, the District Health Director informed the
house that they were working on scaling up malaria activities in the facilities as well as
mentorship on case management. Commenting on the vague targets, the District Health Director
for Nakonde informed the house that his team was working on cleaning their data. He further
informed the house that some of the Community Health Workers had left for school while few
had died. He was however quick to mention that the district with support from PAMO had
recently trained new Community Health Workers whom are expected to contribute in
spearheading the fight against malaria in their district.

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9.2.6. Malaria Group Work
The Senior Health Environmental Officer for Muchinga Province guide through the participants
in the group work. Following the presentations from the districts, he made the following
observations:

 Inadequate CHWs trained in ICCM

 High malaria incidence (404/1000)
 Low suspicion index by health facility compared to community volunteers
 Low supply of commodities
 Health services accessed by people from other Countries
 Weak community structures
 ICCM not understood by some health workers
 Low engagement with traditional leadership
 Large water bodies for mosquito breeding in some areas
 Refusal of IRS
 Misuse of ITNs
 Malaria stratification not done
After highlighting the challenges observed from the presentations, the SHEO grouped all
participants into five groups. He emphasized on the need of coming up with smart and attainable
actions which would in turn help in the fight against malaria in the province.

Day one was concluded by reviewing what the groups had worked on. While the groups had
come up action points, it was observed that they were not measurable and smart. All group
leaders were tasked to re-do the work and submit the following day. The closing prayer was
given by the DHD.

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9.2.7. DAY TWO – MATERNAL AND CHILD HEALTH
Day two started on a bright note. It was impressive to note that participants were punctual and
ready to start the day. Opening prayer was given by the District Health Director for Kanchibiya
and late the Chairperson for the day called upon the rapporteurs to give the recap for the previous
day. The recap was presented by the planner for Mafinga. He gave a well detailed report which
focused on malaria elimination activities.

9.2.8. Maternal and Child Health Presentation – Day Two

The first presentation was made by Chinsali District Health Director. It was impressive to note
that their immunization below one year was above 100% which was attributed to low CSO
population as compared to the headcount. ANC visit still low at average of 3 (Standard is 8
according to the new ANC guidelines). It was also observed that new family planning acceptors
were low.
The second presentation came from Kanchibiya District it was noted that fully immunised under
one year had improved from 65% - 80%, this was attributed to new motorbikes and improved
staffing levels in the facilities.
Mafinga’s ANC visits were at 1.7. it was also observed that the district had recorded high FSB
which was attributed to data issues.

9.2.9. Plenary Discussion

Chinsali DHO was asked on why Musanya and Kalela had recorded very low on RMNCAN
indicators. Mafinga was asked why they had recorded high cases of FSB. Kanchibiya was asked
why they had measles outbreak when they had improved their immunization coverage. Mpika
DHO was asked why they had recorded shortages of Under 5 cards.

In responding to issues attributed to Chinsali, the DHD informed the house that midwifes in the
two facilities were on leave during period under review and hence poor performance on
RMNCAN indicators. The DHD for Kanchibiya informed the house that his team was on the
ground and that they will increase outreach supervision activities in the district. Mafinga DHD
informed the house that the high numbers of FSB was attributed to data issues. He promised to
work on the data so as to have a clear picture.

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9.2.10. General Discussions
The Principle Pharmacist informed the house that the current shortages of RDT and Fansidar
were caused by districts due to late reporting and poor quantification. He informed the house that
an emergency order had been made and the drugs had been delivered. He urged districts to avoid
artificial stock outs in future. He mentioned that only Family Planning Commodities had stocked
out at the central level.The medical Superintendent for Chinsali General Hospital encouraged
districts to plan for High Dependency Units (HDU) which can improve maternal and Child
health outcomes.

9.2.11. Provincial Presentation on Maternal and Child Health

The Provincial Reproductive Maternal and Child Health Coordinator presented on behalf of the
province. His presentation was based on the maternal and child health score card. It was noted
that Mpika and Isoka were doing well in institutional deliveries and skilled deliveries. He
however pointed that Lavushimanda needed to do more institutional and skilled deliveries as
they were in red but the arrow going upwards and the trend needs to be maintained.
It was noted that Postnatal Care within 48 hours for Chama was doing well as they were in
green. The same was true for Shiwanga’ndu. On the other hand, Isoka was sited to be dropping
in the PNC within 48hours. It was observed that the province was in red for 1 st ANC for women
under 20 years.
Commenting on maternal death, the Coordinator informed the house that, obstetric haemorrhage
was singled out as the highest cause of maternal death, seconded by hypertensive disorders.

9.2.12. Plenary Discussion

Chinsali Planner inquired on the -3 Zscore which was in absolute numbers, hence difficult to rate
performance. Another member inquired as to how FBS was 100%. The PNO wanted to learn
from Chama as what was being done on the ADH activity implementation.
PHO acknowledged that the underweight slide was in absolute numbers and that future
presentations would be expressed in percentages. Commenting on the 100% FSB it was notes
that the calculation was to be considered as a rate and not a percentage. Chama DHD informed
the house that the district was working on improving ADH services in the district.

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9.2.13. Maternal and Child Health Group Work
Reactions to Group 5
 There was concern on whether the action points formulated were smart, the PHS inquired
as to whether could not identify more than one issue at the level and also to quantify the
coverage
 There was concern raised as to whether districts really needed a directive to implement
FANC or work on the procurement issues at district level
Reactions to Group 2
 There was concern on the solution of keeping mothers at the facility in relation to space
as it seemed to have been mixed with PNC within 48 hours and 6 days

Reactions to Group 1
 There was a concern on the solution that at community level, the team was guided to
bring out the role of the NHCs. It was also observed that NHCs were not well instituted.

9.2.14. End of Day Two Remarks

The PHS reminded the members of the meeting that agreed action points for day one on malaria
were supposed to have been submitted by 13:00. He requested to meet the team leaders of all the
groups meet and agree on the way forward.
Day one discussions were concluded by a prayer given by the Senior Human Resource
Management Officer at the provincial health office

9.2.15. HIV/TB Presentation - Day Threee

The house was called to order at 08:30 and a prayer was given by the Planner from Kanchibiya
District Health Office. The Chairperson reminded the house that the focus for the day was
TB/HIV. He then led the house into presentations from Isoka, Nakonde and Shiwangandu and
later on we had presentations from the Nursing Schools and from partners.

9.2.16. Plenary

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The first question came from the Medical Superintendent for Chinsali General Hospital who
wanted to find out why numbers of VMMC were low across all districts. It was stated that
cultural practices contributed most because the community don’t buy into the concept.
Muchinga Colleage of Nursing and Midwifery was asked on the strategies to acquire the
remaining books. The Principle Tutor informed the house that the school had engaged GNC to
assist with the books and also that ZICTA had set up optic fibre connection through internet.
The PHD was concerned on the pronouncement to reduce school fees in public institution. He
wondered whether this would be a threat and have a bearing on how the school would run. The
principle Tutor for Chilonga School of Nursing acknowledged that reduced fees would affect the
operation of the school especially that most of the activities are to be done in the field.
Muchinga Colleage of Nursing and Midwifery was asked on the modalities put in place to be
able to train Midwives. The Principle Tutor informed the house that they were working hand in
hand with the PHO to ensure that the training would start. He further outlined that selection of
models had been done.

The Principle Nursing Officer Practice and Management was asked on the neglected areas of
psychiatry and how clients are managed. He informed the house that no hospital had a psychiatry
unit at present. Commenting on the same the PHD informed the house that psychiatry was a
priority area and that the new General Hospital in Chinsali will have a psychiatry wing were
issues of rehabilitation will be handled by the end of the year.

9.2.17. Partners Presentations

After presentation by the School, it was time for the partners to make their presentations. The
first to present was System for Better Health, followed by Equip, CARE, SARAI and Global
Health Supply Chain Procurement and Supply Management.

9.2.18. Plenary
SBH was asked if they would manage to provide technical support to the district realising that
their project was coming finishing by June. The SBH team Lead informed the house that all
planned activities would be done before concluding the project ends.

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SARAI was asked whether new family planning acceptors were asked the history of use and
would they scale up in other districts. SARAI informed the house that they had discovered that
most facilities had no family planning cards and some health care workers were not taking
comprehensive history from clients due to work overload. On scaling up to other districts, it was
said that the facilities were they operate from were given by MOH and that 5 more facilities
would be included in other districts.

CARE International were asked on the logistical support being given to the facilities in terms of
height board and scales. The Team lead informed the house that they had provided both Ceca
and Salter scales in the facilities.
All partners were asked if they had a budget lline to support the Nursing Schools. Equip
responded that they had already started to support Nursing School. A case in point was Chilonga
School of Nursing and Midwifery were they were training students in HIV/AIDS.
The afternoon session proceeded from lunch and the participants went into various working
groups which were divided with particular focus on identified issues as follows, community,
Health facility, District health office, and Provincial Health office level respectively.
The mater of focus proceeded on the identified areas s in HIV/AIDS presentations that the
various working groups had presented in the morning session
And they were as follows
HIV
 Emtct
 HTC
 VMMC
 Viral Load sample submissions
Tuberculosis
 Notifications(DR/DR-TB)
 Gene Expert utilization
 Contact tracing
 M&E
The chairperson of the session asked that Group one (1), which looked at the issues above with
the community perspective, after whom groups 3, which looked at the matter with the

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perspective of the District health Office Perspective and group 4 presented which looked at the
identified issues with hospital perspective and group 5 which looked at the issues with the
Provincial perspective

9.2.19. Major discussions on the presentations

I. The presentation with the community perspective did not view the matter with the
community of view point but as though it was a health facility view Point ,
II. There was no statics on most of the issues that were raised under the community, the
claim was that most data had no baseline with the community but with the facility hence
the non-stating in the presentation.
III. DBS stock out was used by the group 5 as the reason for the increase in the positivity rate
(from 4%-5% of Q4 2018 and Q1 2019 respectively) , the house guided through Mr
Chimfwembe that it was not representative of the issues on the ground, but that the real
reason was inadequate testing of the children in the respective ages of 6,12, and 18
months of the exposed children.
9.2.20. General comments /discussions
 The Public Health Specialist (PHS) guided that going forward, HCC chairperson should
attend District Integrated Meeting (DIM) this arose after noticing that community data
was not represented in community based presentation.
 He further guided that, it was an expectation that PIMs should proceed DIMs and that
the data presented during PIMs should be that which was agreed upon from DIMs
 He also added that data from the Community should be authenticated by the Health
Facility In charges for onward transmission to DHOs
 Provincial Health Director Guided that most presentations did not identify real issues for
the realization of the Activities that would address the real issues in the Districts at
various levels, he added that the planning Unit should provide TSS in identification of
problem issues.

9.2.21. Provincial Health Office Updates

Weekly Report
 District Report Period: Tuesday (W1) – Tuesday (W2).

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  District Report Time: Close of Business (not later than 17:00 Hours) on Tuesday of every
week.
 Province Report Period: Wednesday (W1) – Wednesday (W2).
 Province Report Time: Close of Business (not later than 17:00 Hours) on Wedn of every
week.
Human Resources & Administration
 Medical Superintendent and DHD’s to submit documentations for contract normalization
for those that are not normalized and also all contracts that needs to be normalized.
 All acting on promotion with a view for substantive promotion should send documents by
Tuesday 21 / 08/ 19
Clinical Care Unit
 Establish QA/QI Teams at District and General Hospitals levels.
 Submit feedback as per correspondence to PHD by Friday 17th May, 2019
 Attach Schedules (Gantt chart) for trainings of their respective Staff.

Maternal, Child Health Adolescent & Nutrition

 Safe motherhood Week – 2019 Commemoration, 13th – 18th May 2019, detailed reports
will be expected within two week after completion of the activity.
 Child Health Week & HPV Vaccine Scale Up - 24th to 29th June, 2019.
 Commodities available at PHO (CHWk)
 HPV Orientation in Mpika – 20 th to 21st May, 2019 (DNO, DHIO & HP) arrival
date 19th May, 2019.
 EPI Micro plans (RED Strategy Micro-plans)
 To compile monthly Adolescent Sexual and Reproductive Health Activities and submit to
DHO in each district they are supporting – Partners.
 At each quarter Partners to Submit ASRH activities to PHO by 8th of every month
 Contact Number: 0977869211
 Email: bsmutale@gmail.com
Communicable & Non-communicable Diseases
 Global Funds support for TB/HIV and Malaria Work Plans for 2019 have been signed
and submitted to MOH-HQ, awaiting disbursement of funds.

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  Malaria Electronic Plans for the remaining districts (except Chinsali) will be rolled out
within the first two weeks of June, 2019.
 All districts have by now received LLINs for Continuous Distribution. Please ensure that
proper documentation is adhered to both at district and facility levels.
Beneficiaries
 1st ANC visitors – Regardless of the period
 Children upon receiving MR1
Note: To have two separate registers at the point of issue to beneficiaries. One for pregnant
women and another one for Children.
Ensure that data is transferred into safe motherhood registers as well as Child Health Register
respectively.
Environmental Health
Water quality monitoring
All Districts are supposed to buy Laboratory Reagents for Portable Laboratories.
Internal Audit Unit
 Delayed/No responses to internal audit queries at DHOs and Health Facilities.
 Accounts Departments at District and Hospital level do not submit monthly/quarterly
reports to PHO.
 Weak supervision of Revenue collections in Hospital causing audit queries.
Accounts & Procurement Unit
 G2G – USAID Disbursement for 2019 Work Plan dependent on liquidation of the
remaining funds – status report as at 30th April, 2019 and liquidation plan.
Planning, M&E and Infrastructure Unit
Provincial Health Office disseminates technical updates to
1 3rdweek, Apr
DHOs, hospitals and training institutions.
DHO meets with hospitals providing first level referral services
2 to negotiate bed purchase and agree on the terms of the 4th week, Apr
Memorandums of Understanding (MoUs).
DHO brief first level hospitals, health centre/health post in-
3 1st week, May
charges on programme and any planning updates.
4 DHO meets with health centres and hospitals to draft plans. 3rd wk. Jun
5 Hospitals/Training school departments draft their plans and 3rd wk. Jun

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 submit to hospital core planning team.
6 First level hospitals submit completed plan to DHO. 4rd wk. Jun
Training Institutions, 2nd/3rd level hospitals present their plans
7 to the Provincial Office; first level hospitals present their plans 3rd wk. July
to their DHO.

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Annex 3: Attendance List
S/N NAME DESIGNATION INSTITUTION PHONE #
01 Standford Chulu MCH Coordinator Mafinga DHO 09772550272
02 Aggray Ngambi CCO Mafinga DHO 0977418846
03 Timothy Mbewe Planner Mafinga DHO 0977982160
04 Bernard Mwansa CEHO PHO 0977210673
05 Bornface S. Mutale PNO PHO 0977869211
06 Malema Malama P/Pharmacist PHO 0977408526
07 Sydney Mushiki Capacity Development Officer PAMO 0977679186
08 Patrick Kalenga Surveillance Officer PAMO 0962123605
09 Fiona Nkweto Daka Internal Auditor PHO 0978217641
10 Royce S. Phiri MIS SBH 0968573766
11 Joy Walubita PFMS SBH 0968575319
12 Mwango Chungulo Accountant PHO 0963731313
13 Jesse Shimungalu Planner Chinsali DHO 0964880718
14 Dr. David Silweya District Health Director Chinsali 0966936733
15 Andrew Chulu Clinical Care Officer Chinsali 0977580272
16 Kennedy Chinyama FSSO Chinsali 0975283299
17 Elizabeth Makasa NO-MCH Lavushimanda 0979520899
18 Martha C. Phiri Planner Lavushimanda 0979481912
19 Benson Kapaso Senior Accountant PHO 0979545860
20 Roseline Chisanga RM SFH 0979320204
21 Doris Mwape RM SFH 0977695387
22 Felix Chola SHEO PHO 0977913966
23 Peter S. Phiri Principle Tutor Muchinga College of 0977724023
Nursing
24 Miyanda M. Mupimpila Principle Planner PHO 0977452886
25 Augustine Chinyama Coordinator PAMO 0977331776

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26 Nicholas Malapa Development Coordinator Care (Shiwangandu 0978411694
27 Alister Kandyata Manager GHSCPSM 0966715975
28 Miranda Kazembe PMS SBH 0968575060
29 Kelvin Bwalya Ag. Senior Nursing Officer Chinsali General 0976378418
Hospital
30 Dr. Willies Silwimba Medical Superintendant Chinsali General 0976939330
Hospital
31 Richard Chimfwembe PC-RMNCAH&N PHO 0977212855
32 Chali Mumbi PFD-G2G PHO 0977594193
33 Dr. Philimon Kapesa CCS PHO 0978798469
34 Kay Silulapwa PLSSS USAID GHSC - PSM 0962172427
35 Maxwell Chongo MCH – Coordinator Shiwangandu 0978463291
36 Scheswayo Ngosa Planner Shiwangandu 0961749717
37 Dr. Webster Kambinga District Director of Health Shiwangandu 0977801951
38 Dr. Rodrigue Kamunga District Director of Health Isoka 0966582082
39 Mwila Mwaba Planner Isoka 0971825509
40 Pauline Namposya MCH – Coordinator Isoka 0977354561
41 Nicodemas Kalasani Planner Kanchibiya 0979207824
42 Cornelius Mwansa MCH – Coordinator Kanchibiya 0978722463
43 Gillan Banda Team Lead Discover Health 0966830408
44 Yonah Sakala Planner PHO 0977459667
45 Hastings Mono MISA-FSH SFH 0976921523
46 Michael Phiri Ag. DHD Chama 0974471363
47 Lottie Hara MCH – Coordinator Chama 0978782474
48 Grace B. Botha Ag. Planner Chama 0979256929
49 Sr. Rosemary Kabonga Principal Tutor Chilonga NS 0977711180
50 Dr. Kalengayi M.Jean Medical Superintendent Chilonga G. Hospital 0972408763
51 Patience M. Kunda PNO - MCH PHO 0977861278
52 Gladys Nanyangwe NO -MCH Nakonde DHO 0977171052
53 Mukile Njovu Planner Nakonde DHO 0977663477
54 Rawlings Milimo M&E Equip 0979935350
55 Mulinda Phiri DTO Equip 0969962877

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56 Featherstone Mangwe PTO Equip 0977237473
57 Moses Bwanga Planner Mpika DHO 0977534831
58 Stephen Silomba MCH- Coordinator Mpika DHO 0979649853
59 Joe Chinkont Ag. DHD Mpika DHO 0977275442
60 Terrel Kalumbi DHD Lavushimanda DHO 0977654702
61 Paul Muma DHD Kanchibiya DHO 0978486602
62 Dr. James Banda Senior Advisor NMEP 0965436129
63 Dr. Chola Kaunda DHD Nakonde DHO 0965694233
64 Fabian Habeenzu SHRMO PHO 0977360799
65 Dr. Charles Chungu PHS PHO 0977398262
66 Dr. Neroh Chilembo PHD PHO 0978303199
67 Victor Kamanga Planner PHO 0962502714
68 Charles Muwowo Driver PHO 0976450436
69 Benard Chileshe Driver Kanchibiya DHO 0971701717
70 Kedwn Simwalala Driver Shiwangandu DHO 0976006219
71 Boas Sichalwe Driver PHO 0976585806
72 Batra Kasongola Driver SFH 0977953582
73 Peter Phakati Driver SBH 0966167792
74 Emmanuel Mayaka Driver Isoka DHO 0978114537
75 Robert Chewe Driver PAMO Lusaka 0978313897
76 Elisha Siame Driver PHO 0975229222
77 Justine Mwila Driver PHO 0976569991
78 Alex Chomba Driver PHO 0978563590
79 Nachan Chisalima Driver Muchinga N. School 0978393715

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