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Malaria Elimination Concepts, Strategic direction (2008-2010), Steps , Activities, Requirements

Malaria Elimination Concepts, Strategic direction (2008-2010), Steps , Activities, Requirements. Feedback on New Global “Malaria elimination” Initiative to NMCP 12 th November 2007 Morogoro. Contents of Presentation. Introduction The concept: towards malaria elimination

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Malaria Elimination Concepts, Strategic direction (2008-2010), Steps , Activities, Requirements

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  1. Malaria EliminationConcepts, Strategic direction (2008-2010),Steps, Activities, Requirements Feedback on New Global “Malaria elimination” Initiative to NMCP 12th November 2007 Morogoro Mkude.S (MD); NMCP/MoHSW

  2. Contents of Presentation • Introduction • The concept: towards malaria elimination • Strategic direction (2008-2010) • Steps & activities (Global level) • “Resource moderators” • Requirements for initiation of the process • Sub regional responsibility • Countries initiation process • WHO country office responsibilities & support to be given Mkude.S (MD); NMCP/MoHSW

  3. Introduction Mkude.S (MD); NMCP/MoHSW

  4. The Anatomy of Global Malaria initiative WHO DG WHO RBM Partners (Resource contributors) WHO GMP Technical Board Regional WHO WHO/AFRO HWG (Resource Moderators) Country WHO Offices Nairobi 2 in 1 Meeting HWG Nairobi Meeting 22nd-23rd October 2007 GMP Nairobi Meeting 24th- 26th October 2007 Mkude.S (MD); NMCP/MoHSW

  5. Introduction (1) • There is a Global movement which has created new “Malaria Elimination” initiative • The initiative is going to be in full scale within 6 months • It advocate rapid scaling of intervention to achieve RBM targets of universal coverage of 80% by 2010 (Intensive 36 months) • What is immediately required by donors community is to know the individual country needs (Needs Assessment) • Thereafter a business plan before February 2008 • The country Needs Assessment (NA) & Business Plan (BP) must be in line with (our) MMTSP Mkude.S (MD); NMCP/MoHSW

  6. Introduction 2 • The RBM Harmonization Working Group (HWG) will fill the gap of required resources • WHO will be the focal partner at country level • There was a 2 in 1 meeting (WHO GMP & RBM HWG) in Nairobi to initiate the process of country NA & BP • The meeting was attended by • NMCP’s PMs and their WHO Malaria NPO from selected 15 African countries • Representation from all WHO regional offices world wide • WHO HQ • RBM HWG members Mkude.S (MD); NMCP/MoHSW

  7. Introduction 3 • There was a request from participating countries for an official communication to Government Ministries of Health. • In principal we are “nominated” but we have to fulfil the requirements: • Initiate prescribed process in a tight framework of timelines • Centre to all is the re-orientation of Country Malaria STP Mkude.S (MD); NMCP/MoHSW

  8. The concept: towards malaria elimination Mkude.S (MD); NMCP/MoHSW

  9. The aims of the “new initiative” global fight against malaria • reduce the burden of malaria in endemic areas (rapid scaling up to 80% by 2010) • reduce the geographical extent of endemic areas (rapid scaling up to 80% by 2010) • Support elimination where feasible Mkude.S (MD); NMCP/MoHSW

  10. From malaria control to elimination Mkude.S (MD); NMCP/MoHSW

  11. The Origin of the idea: Traditionally 4 phases in malaria eradication WHO certification end of population-based interventions annual reporting to WHO Intense malaria IV Maintenance I Preparatory 1 year III Consolidation 3 years II Attack 4 years 3 years free of local transmission information collected, plan developed, systems ready, trained staff and resources in place Mkude.S (MD); NMCP/MoHSW

  12. Eligibility to “Malaria Elimination” • Cut of point of slide positivity rate <5% in fever cases as a criterion for initiation of elimination process • The minimum area is a district of about 100,000 population Mkude.S (MD); NMCP/MoHSW

  13. Mkude.S (MD); NMCP/MoHSW

  14. Definitions Malaria control: reducing disease burden to a level where it is no longer a public health problem Malaria Elimination: interruption of local mosquito-borne malaria transmission in a defined geographical area. Means zero incidence of locally contracted cases , imported cases will continue to occur. Continued intervention measures are required Eradication: permanent reduction to zero of the worldwide incidence of infection caused by a specific agent – i.e. Extermination of the infectious agent Mkude.S (MD); NMCP/MoHSW

  15. Target audience: endemic country governments, programme managers, staff from partner agencies Purpose: provide the overall picture, point to more detailed information Current format: 96 pages total Malaria elimination: a WHO Field Manual Mkude.S (MD); NMCP/MoHSW

  16. GMP malaria elimination field manual • Clarity on malaria elimination concepts (for moderate-to-high transmission countries that consider moving towards elimination) • Clarity on WHO policies, procedures and reporting requirements (for countries that are near malaria elimination or have recently achieved it) Mkude.S (MD); NMCP/MoHSW

  17. Strategic direction (2008-2010) Mkude.S (MD); NMCP/MoHSW

  18. Strategic direction (2008-2010) • Develop scientific consensus on control strategy and business plan • Intensified implementation of national malaria programmes • Effective advocacy / resource mobilization Mkude.S (MD); NMCP/MoHSW

  19. Recommended (proven intervention) Malaria control package (1) • Diagnosis-based treatment • Diagnostic use • Treatment use • Prevention (LLITN + IRS) • Transmission control with ITNs • Transmission control with IRS • Monitoring and evaluation • Performance monitoring and impact evaluation • Insurance (protect effectiveness of current tools) • Operational research Mkude.S (MD); NMCP/MoHSW

  20. Malaria control package(2) • "Documentable" effective case management systems • National – District – Health facility, Community, Private Sector • Prevention • LLITN for community prevention, 80% coverage of total population at risk • IRS for community prevention as a supplement to LLITN, for epidemic preparedness, etc. Mkude.S (MD); NMCP/MoHSW

  21. Strategic direction (2008-2010) • Develop scientific consensus on control strategy and business plan • Intensified implementation of national malaria programmes • Effective advocacy / resource mobilization Mkude.S (MD); NMCP/MoHSW

  22. 2. Intensified implementation • Effective treatment and prevention coverage increased to 80% in 54 countries • Elimination / certification in 25 countries • More gradual scale up in 28 countries Mkude.S (MD); NMCP/MoHSW

  23. Intensified implementation • 57 Programmes*: support led by WHO • Endemic (10 in Africa; 22 in other regions) • elimination / certification: 25 • 22 Programmes* in Africa: support coordinated by RBM harmonization working group (which includes WHO) • 28 Programmes*: scaling up gradually, supported by WHO & other interested partners • Coordination with International Health Partnership on health systems strengthening (Burundi, Cambodia, Ethiopia, Kenya, Mozambique, Nepal, Zambia) * Proposed Mkude.S (MD); NMCP/MoHSW

  24. Proposed countries • Group A: Scaling up Malaria control to 80% (2008-2010) • Africa: Angola, Benin, Burundi, Burkina Faso, Cameroon, CAR, Chad, Congo, DRC, Equatorial Guinea, Eritrea, Ethiopia, Ghana, Guinea, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Niger, Nigeria, Rwanda, Sao Tome & Principe Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Uganda, Zambia, Zimbabwe • Latin America: Brazil, Colombia, Guatemala, Honduras, Nicaragua, Peru, Venezuela • Asia & Middle East: Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Laos, Myanmar, Papua New Guinea, Philippines, Thailand, Solomon Islands, Vanuatu, Vietnam, Yemen • Group B: Pre-elimination to elimination phase (2008-2010) • Algeria, Argentina, Azerbaijan, DPRK, El Salvador, Georgia, Iran, Iraq, Krygsztan, Malaysia, Mexico, Paraguay, Tajikistan, Turkey, Turkmenistan, Russia, Sri Lanka, Saudi Arabia, Swaziland • Group C: Certified Malaria Free (2008-2010) • Mauritius, Morocco, Oman, Armenia, Syria, • Group D: Gradual scale-up in remaining 28 countries Mkude.S (MD); NMCP/MoHSW

  25. Strategic direction (2008-2010) • Develop scientific consensus on control strategy and business plan • Intensified implementation of national malaria programmes • Effective advocacy / resource mobilization Mkude.S (MD); NMCP/MoHSW

  26. 3. Resource mobilization • Ensure investments and resource flows • More resources and effective, innovative implementation of investments: GF • More investments: PMI, WB, UNITAID, new bilaterals, new international NGOs • Increasing National investments • Resources mobilization – USD 6 billion (2008 -2010) • National programmes & commodities – 85 % • TA and Operational research – 15 % • Advocacy • In-country efforts • Individual (Ray Chambers) and institutional (WHO, WB, PMI, UNICEF, etc.) initiatives • UN Special envoy • Media campaigns (in-country and international) Mkude.S (MD); NMCP/MoHSW

  27. Phase 1(Strategic Direction): 6 months (Sep 07 – Feb 08) • Development of the plan • Consensus building • Endorsement and launch of the plan Mkude.S (MD); NMCP/MoHSW

  28. Steps & Activities(Global level) Mkude.S (MD); NMCP/MoHSW

  29. Global Key activities in Phase 1(strategic direction-Plans on proven interventions): 6 months (Sep 07 – Feb 08) • Gates Malaria Forum- Seattle, 16-18 October • Presentation of strategic direction by DG • Endorsement of strategy by key stakeholders (Tanzania attended with 4 other African countries) • Operational plans • Workshop to develop country plans - WHO supported national programmes, Nairobi, Kenya- October 22-26, 2007 (Tanzania attended) • Workshop to develop country plans: (?? deadline for in country process end of January 2008) – facilitated by RBM harmonization working group • Launch of the Business plan - High level forum, February 2008. • Endorsement of plan by Heads of State (US, UK, Canada, etc); endemic countries; and H8 group (WHO, World Bank, UNICEF, Gates Foundation, GFATM, GAVI, UNITAID, and UNFPA) • Launch of Intensified implementation towards a “malaria free world” Mkude.S (MD); NMCP/MoHSW

  30. Global Key activities in Phase 2: (strategic direction-Intensified implementation) 12 months (Mar 08 – Feb 09) • Intensified implementation • Roll-out of WHO's new case management cum disease surveillance strategy • Substantial strengthening of national malaria programme management (structure, logistics, etc) • Roll-out of WHO new country monitoring and evaluation system • Roll-out of WHO new ITN and IRS strategy • Establish commodity needs forecasting system (ACT & LLIN) • Negotiations with manufacturers • Establish ACT raw material buffer stock system • Expansion of LLIN production capacity • Documentation and Report Card • WHO Global Malaria Report (World Malaria Day in 2008) • Monthly information system (tracking commodity & progress) • Biannual performance report on GMP website • Analysis: impact, cost-effectiveness, success stories Mkude.S (MD); NMCP/MoHSW

  31. Global Key activities in Phase 2: (strategic direction-Advocacy) 12 months (Mar 08 – Feb 09) • Media Awareness campaign with regular events • Clearer policy/position on other interventions/tools (IPTp, IPTi, IVM, vaccine, etc) • Global consensus on priority research agenda • Consensus-based new estimates of Global Malaria Burden • Development of Plan Mar 2009 – Dec 2010 • Development of Plan for a "Malaria Free World" 2010 - 2015 Mkude.S (MD); NMCP/MoHSW

  32. “Resource Harmonization” Mkude.S (MD); NMCP/MoHSW

  33. RBM Harmonization Working Group (HWG) • Major financial and implementation support partners • Constituency Membership is decided by RBM Board • Membership includes: WHO (AFRO and HQ), UNICEF, World Bank, Global Fund, MACEPA, Bill and Melinda Gates Foundation, Malaria No More, UN Foundation, Johns Hopkins VOICES Project, Millennium Project, UNF, PSI • All RBM sub-regional networks and RBM Working Group Chairs Mkude.S (MD); NMCP/MoHSW

  34. Scaling-up for impact: • The Board has endorsed a new rallying cry at the core of Roll Back Malaria: • “Scale Up” • Existing full package of proven interventions • Nation-wide to high coverage • Rapidly • “For Impact” • Track action and document changes in coverage and benefits in human and economic terms • Moving from high coverage towards elimination as a public health problem and eventually eradication Mkude.S (MD); NMCP/MoHSW

  35. RBM Harmonization Working Group (HWG) • Coordinate a process to support the development of and adherence to the “3-ones” concept at country level • Assist countries to identify support needs for scaling-up through comprehensive gap analyses and needs assessment • Track and Facilitate resource flows from partners to countries • Harmonize partner efforts to fill country-identified gaps • Facilitate the development of a “rapid-response” mechanism to support countries to overcome implementation bottlenecks (reactively and proactively) • Secure additional resources from the Global Fund, PMI, World Bank and others in support of country scale-up Mkude.S (MD); NMCP/MoHSW

  36. But, 1st……Needs Assessments • Support >30 national programs to develop malaria needs assessments and business plans over the next 4-6 months that will result in achievement of 2010 RBM Goals (>80% coverage) • Plans will result in an improved understanding of country support needs (financial and technical/implementation support) and the resources and strategies required to fill them. • Present plansto a series of high-level donor meetings, as well as to individual partners, for immediate support Mkude.S (MD); NMCP/MoHSW

  37. Process forNeeds Assessments • Develop common template for needs assessment and plan • Countries lead needs assessment and business plan development • Each country will be paired with one lead partner and additional supporting partners • Each country will be offered consultant support to assist in writing/documentation of assessment and plan • RBM will aggregate assessments and plans, and assist in the development of regional/cross-border investments/actions Mkude.S (MD); NMCP/MoHSW

  38. Mkude.S (MD); NMCP/MoHSW

  39. Process forNeeds Assessments & Business plan Needs Assessments: • Workshop (Nairobi), October 22nd -23rd , 2007 with initial 15 countries to be hosted by WHO • Template to be developed by MACEPA and revised by wider partnership • Consultants will be contracted to carry out the data collection and actual writing/filling-in of the template to ensure consistency Business Plans: • Template to be developed by MACEPA • Process for country level development to be managed by RBM HWG Task Force members with in-country presence, namely WHO, UNICEF, MACEPA, US PMI, and the World Bank, under the auspices of the RBM sub-regional networks. Mkude.S (MD); NMCP/MoHSW

  40. Requirements(Sub regional & Countries) Mkude.S (MD); NMCP/MoHSW

  41. Requirement (1): Sub regional Mkude.S (MD); NMCP/MoHSW

  42. 1st Nairobi workshop, October 22, 2007 with initial 15 countries • Adaptation of proposed initiation process to individual countries • Identification of key milestones in country • (Selection and) timing of consultants • Discussion on mechanism of in-country initiation of the processes (Need Assessment) (workshops/retreats) • Financial requirements Mkude.S (MD); NMCP/MoHSW

  43. Sub region requirements • HWG develop a template for business plan by end November • 2nd workshop for countries on business plan template (early February 2008?). • translation of needs assessment to business plan through in-country planning • Finalization (March) Mkude.S (MD); NMCP/MoHSW

  44. Sub region to facilitate • Global level synthesis (March) • High level donor/partner consultation (march) to mobilize necessary resources to meet identified needs: • financial • technical • implementation support Mkude.S (MD); NMCP/MoHSW

  45. INITIATION FOR RAPID SCALING OF MALARIA INTERVENTIONS IN TANZANIA Stepping in “Malaria Elimination” Initiative Mkude.S (MD); NMCP/MoHSW

  46. Contents • Where are we in line with what is required? • Key milestones (events)in the initiation process • Resources to support Focal Partner (WHO Country Office) • Some future implementation issues to be considered Mkude.S (MD); NMCP/MoHSW

  47. Where are we in line with what is required? Requirement 1: In each individual country Malaria Medium Term Strategic Plan (MMTSP) will be the referencedocument to the “Malaria Elimination” initiative • The current 2002-2007 Malaria MTSP is in its last days. • In the development process of the new MMTSP (2008-12) we are aware that: The context of malaria prevention and control has changed and a much more aggressive approach is needed Mkude.S (MD); NMCP/MoHSW

  48. Where are we in line with what is required? • At present the consensus on the framework of our new MMTSP (2008-2012) has been much influenced by GFR7 application, it is a right direction: • Concept part • Needs assessment/Gap analysis • Operational plan/Business plan (1 year roll out plan? Fixed .e.g. 3 yrs plan? .e.t.c.) Mkude.S (MD); NMCP/MoHSW

  49. Where are we in line with what is required? • In the meantime available needs assessment/Gap Analysis (NA/GA) have been calculated through different recent requested proposal (GF R7, IRS Master Plan, ITN “Sacchs”) based on the new strategies identified in the draft of 2008-12 MMTSP • Through different above proposals we have in place the patchy frame works for MMTSP Needs Assessment/Gap Analysis which will contribute to our MTSP Operational/business plan • The MMTSP (2008-2012) draft still needs developed/adoptation NA/GA from different recent proposal to contribute to operational/business plan (a resource moderation component of MMTSP) Mkude.S (MD); NMCP/MoHSW

  50. Where are we in line with what is required? • Mid of November 2008 there is an already planned NMCP workshop to finalize the draft of the MMTSP/dissemination • In principle, we have to review our Goals, Objectives & Targets in the concept part in the new MMTSP to address the high universal coverage (80% or above) concept to every intervention (SUFI). • The timing for the country initiation process of new “Malaria Elimination” with regard to MMTSP is perfect • Finalization of our MMTSP in November 2008 is now a must! It will in time(!) merge issues from the new Malaria Elimination initiative required to be reflected in MMTSP Mkude.S (MD); NMCP/MoHSW

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