Table 3 Outcomes from CQPI pilots in malaria programs in Eswatini, Namibia and Zimbabwe [21]

Eswatini, nationwide

2016-2017

Improvements in the reporting of malaria cases by health facilities and increased collaboration between the malaria program, schools, and community organisations. It also led to improved communication between leaders within the NMCP.

Zimbabwe, 2 Districts

2016-2018

Increase in the availability of malaria registers from 83 to 93% (25/30 health facilities to 28/30 health facilties) , a reduction in artemisinin combination therapy stockouts from 22 to 6%, and an increase in the timeliness of case investigation within three days from 55 to 65% (65 cases investigated out of 119 reported to 821 cases investigated out of 1,265 cases reported). A second year resulted in a further improvement in the timeliness of case investigation to 92%, together with better interprovincial collaboration, and the initiation of meetings to harmonize surveillance.

Zimbabwe, 11 Disticts

2017-2018

In Matabeleland North, one year of implementation resulted in an increase in the administration of primaquine from 63% (90 cases treated/142 RDT positive cases) to 75% (76/101), an increase in slide examination rates from 81 to 89% (115 slides examined/142 RDT positive 142 cases to 90/101), an increase in fully investigated cases from 88% (125 cases fully investigated out of 142 RDT positive cases) to 98% (99 cases fully investigated out of 101 RDT positive cases), the development of a system to reduce stockouts of drugs and diagnostics that resulted in an improvement from 50 to 70% stock, and the increased disbursement of LLINS from 37 to 98% (14,535 to 38,499 out of 39,285 LLINs) by moving distribution centers closer to villages. In Midlands, operational improvements included an increase in the correct treatment of confirmed malaria cases from 93 to 100% in one district and an increase from 89 to 100% in another district and an improvement in case investigation rates from 80 to 100%. Qualitative results for this season in Matabeleland North, included: increased collaboration with partners involved in malaria activities and improvements in staff motivation and accountability. In Midlands province, outcomes included: improvements to data quality, completeness, and timeliness; increased community engagement activities; and improved communication, ownership, and teamwork. More importantly, participants across all provinces reported an increased ability to analyze problems, act on solutions, and measure performance.

Namibia, 2 Districts

2019-2020

40% increase in reporting (60% complete, timely reports to 100% (4131/4131) in both districts), a 32% average increase in cross-border reporting and tracing of malaria cases (41 to 79% (55/70) in Nankudu and 20 to 45% (41/91) in Rundu), and a 10% average increase in improved management of malaria cases (89 to 100% (2778/2778) in Nankudu and 89 to 98% (1326/1353) in Rundu), integration of malaria activities into the operational plans of local platforms, an elevated profile for malaria among other infectious diseases, and increased access to subnational resources, including vehicles, fuel, and radio spots. The programme was institutionalised into existing structures within the health system, and participants have integrated the relevant skills and approaches in their respective roles, providing evidence of sustainability beyond the programme period.