Review efficiency of the teams in relation to overall assigned workload and provide technical assistance.
Overall, the three teams supervised were carrying out the tasks well including the interviews, testing for malaria and anaemia and treating of malaria and anaemia for those found positive. The smart phones were being used for listing of households using GPS in each cluster, from the listed households, the smart phone randomly selected 25 households and the teams then proceeded to do the interviews, testing and treatment of those found positive.
The teams was comprised of five members; two nurses, two lab technicians and one Geographic Information systems (GIS) Mapper. The work of the mapper was to lead the team in identifying eligible households in the cluster and map every household using Geographic Positioning system (GPU). On the days of listing the team worked collectively with a mapper and some community health workers to list all the households and then on subsequent days for the actual interviews and testing, two sub teams were formed comprising of a nurse, lab tech and a CHW and the two sub teams would share the 25 households in each cluster. The Survey was paperless exercise where questionnaires were filled out directly in the smartphones with touch screen capabilities. The smart phones were able to directly send data to the central database in real time when they are where there is mobile telephone network using Airtel as the service provider.
The following are the specific findings and challenges for each team
Team A Western: This team was to cover enumeration area aka clusters in Senanga 2, Mongu 3, Kaoma 2, Lukulu 1 and Kalabo 2 and comprised of 5 members all of whom spoke Lozi the local language spoken in western province. The team was only doing its fifth cluster out of 10 clusters despite having been in the field for close to a month at the time because it lost about 8 days arising from a vehicle breakdown they experienced. This vehicle was only replaced in the second week; the team also lost fuel as they had to use their fuel allocation to tow the broken down vehicle from Kaunga Lueti in senanga back to Mongu for repairs using another vehicle and also lost fuel as well because they had to send it back to Lusaka. The replacement vehicle was okay. The team was able to do 5 clusters in 16 days meaning they would need at least an additional week on top of the allocated 45 days. The distances they have to cover from Lukulu to Kalabo using the western bank of Senanga due to the floods in the plains also compounded the issue of time.
We spent 2 days observing and providing technical assistance to them. Though the team was doing well in the interviews, we noticed that they were not ensuring respondent confidentiality as they were interviewing the respondents in the presence and hearing of onlookers. Secondly, respondent comfort was not being assured as some interviews were being carried out directly under the sun and respondents had to endure the heat responding to a lengthy questionnaire that took in some cases 1 hour 20 minutes. Some women would even be nursing small babies in the process. We then advised the teams to ensure confidentiality by ensuring privacy as well as doing the interviews in the shade. We also reviewed the treatment protocols for anaemia and malaria using Folic acid and DHA-P respectively based on the 2014 malaria treatment guidelines.
We then submitted a request for additional fuel for the team based on the mileage covered and the outstanding distances to Kaoma, Lukulu and Kalabo via senanga westbank.
Team B - South Western: The team had 10 clusters to cover and at the time of visit, they were beginning the 9th cluster at the end of 4 about one month in the field. The clusters were in both southern and western provinces namely in Choma 1, Kalomo 3, Livinstone 2, Kazungula 1, Sesheke 2 and Shangombo 1. The team member composed of 5 members and only one spoke Lozi whilst 4 other members spoke Tonga. However, during our visit in Kaunga Mashi and Imusho, we realised that the locals use other local languages other than Lozi in these areas namely siKwamashi in Kanuga Mashi and siFwe in Imusho. The team had to use the CHWs as interpreters in all interviews but I could follow the proceedings because they are related to the ancient Luyi language. We joined the team when they had finished Kaunga Mashi and spent two day with them in Imusho. The team had completed 7 clusters in southern and one in shangombo and were in their 9th cluster in sesheke whilst remain another one in sesheke/mulobezi district. This team would make it to complete the work in the stipulated 45 days.
The team failed to interview two households in Imusho because the respondents were in the fields guarding millet from birds (Kulita mauza). The other selected 23 respondents were successfully interviewed. Some of the noted discrepancies in this group was that one of the CHWs who acted as an interpreter used to coerce the respondents to give the answers he wanted to hear from the respondents while the interviewer could not understand what he was saying to the respondent. We guided them that the survey was about the knowledge and practices of the respondents and not the interviewer so they should not ask leading questions where the questionnaires do not require them to do so. E.g Question: in your opinion, what causes malaria? Answer from Respondent: ‘drinking dirty water from the river’. Interpreter (without relaying the answer to interviewer): ‘uuh you, don’t bites from mosquitos cause malaria?’
The other challenge noted was people’s refusals to be tested for malaria and anaemia because of fear of Satanism. They would agree for oral interviews but refuse to give blood despite being explained to. Other issues were that people wanted to be given food instead of mosquito nets or ‘these malaria things’ because they experienced low harvests due to bad rains and crop destruction by elephants (Imusho borders Sioma-Ngwezi national Park and Angola country).
Team C Southern: This team had 9 clusters and were in their 7th cluster after being in the field for over a month. At this rate, they would finish all the 9 within the 45 days. All the 5 member of this team spoke Tonga the local language in Southern province. The team spent two days with them in the field in Upper Kaleya of Chikankata area of Mazabuka district. During the TA, we noted the issues of confidentiality and respondent comfort which were addressed. The other issue noted was that since the interviewers all spoke Tonga, for one reason or another the CHWs would remain behind and the team proceed without a local CHW, however, the people would refuse to be interviewed by these strangers because of fears of Satanism ‘how can we give our blood to strangers’. It was emphasised that local CHWs should always accompany the teams to avoid this. The other issue of ‘parroting answers’ was also noted during the women’s questionnaires which is quite comprehensive, we noted that a husband or family member would be the one responding to the questions as they were being asked and expecting the actual respondent to just repeat them to the interviewer a phenomenon called parroting in social research. This was addressed and emphasised that only the respondent needed to independently answer the questions.
Other Challenges and Recommendations:
Fuel shortages, some distances were under estimated and there is need to give the teams additional money for them to complete the work in the field.
The teams did not have the formal communication to the district concerning the MIS and as such some districts were not even aware that there were teams coming to do the MIS. In the process, some teams lost a day or two because the DMO refused them access to the communities e,g the case of Chirundu district. This was communicated to NMCC who shared with us the said communication and we shared with all the teams.
Late TA visits, the teams felt that the TA visits were conducted a bit late when they were in their 7 or 8th clusters instead of earlier own so that they could not have carried own with some of the things they may have taken for granted e.g. the issue of parroting.
Publicity of the on-going MIS was very limited such that some districts and communities were not aware. e.g Stigma, some people felt that after the whole community listing, only those that have ‘HIV’ were being selected for interviews and testing.
Delays in payments of some team members through the bank transfer modality. This demotivated them a lot.
The paperless use of smartphones, GPS and real time transmission of data was very effective as there was minimum chance of faking data, eliminates issues of data entry later and allows central level people to monitor the process in real time.
Testing for malaria using RDTs and anaemia using hemocues was very effective within the field as treatment was instituted for those testing positive.
Outcomes/Key lessons learnt:
Time was spent in the field with the data collectors and UNDP was able to provide technical assistance as was needed and appreciation of their successes and challenges.
Resource utilisation by the team is consistent as the teams are keeping receipts and entering the mileages accordingly, however, distances were underestimated or some field logistical challenges will necessitate additional logistical resources for the teams to complete the work.
It is clear the teams are doing a good job and some teams would finish on time while other will not due to some logistical challenges. In the cases where the teams do not finish on time, this will be justified on a case by case basis.
The team also took slide carriers and lancets as well as collected Malaria Parasite Slides, Dried Blood Spots and slide schedules from the team in Western and brought it safely to NMCC for further analysis whilst team still in the field.
Continue to monitor progress through the online database