Longitudinal evaluation of routine data from a malaria outreach training and supportive supervision program in Tanzania–January 2019-November 2022

Abstract Outreach training and supportive supervision (OTSS) are used to improve malaria case management in many countries in sub-Saharan Africa. Data on coverage and effectiveness of these programs are limited, and this report describes longitudinal coverage and changes in outpatient malaria case management performance from a large malaria OTSS program in mainland Tanzania. Data from Tanzania’s Malaria Service and Data Quality Improvement program (MSDQI) outpatient department (OPD) module from January 2019 through November 2022 were used. Six OPD indicator scores (0–100%) were calculated based on survey questions assigned point values on a variety of topics including clinical observation performance and register review. Associations between scores and covariates (facility size, malaria burden, and whether implementation was conducted by US President’s Malaria Initiative [PMI] implementing partners) were assessed using generalized linear regression. Among 8997 eligible health facilities in mainland Tanzania, 3609 (40.1%) had data from ≥ 1 OPD module; 58.2% of health facility visits had all 6 OPD indicator scores. Among visited facilities, 1574 (43.6%) had data ≥ 2 visits. Facilities in PMI-supported regions (OR 4.83 [95% CI 3.54–6.70]) and larger facilities compared with dispensaries had higher odds of receiving a follow up. Among facilities with multiple visits and initial clinical observation scores below 50% or between 50 and <75%, scores increased significantly on the second visit (40.3% [30.3–50.4%] and 16.4% [13.5–19.3%], respectively). Overall, < 50% of facilities completed a MSDQI visit with an OPD assessment; repeated MSDQI visits were more likely to occur in regions with PMI support. Performance improved between visits for low performing facilities and remained stable for high performing facilities. Further investigation is needed to identify the drivers of score improvements across visits. (health center: 1.47 [1.08–2.00], hospital: 2.50 [1.51–4.18]).