MALARIA SITUATION IN PAKISTAN

PROGRAMME GOALS AND OBJECTIVES

To reduce the burden of malaria by 50 percent by the year 2010 RBM Implementation all over the country by 2006

ELEMENTS OF NATIONAL RBM STRATEGY

Early detection and prompt treatment of malaria cases Multiple prevention measures including ITNs and focal spraying with insecticides Detection and control of malaria epidemics Operational research Viable partnerships with government, non-government and private sector partners

Malaria Occurrence in Pakistan: Annual Parasite Incidence/1000 population

5 4.5 4 3.5 Cases/1000 3 2.5 2 1.5 1 0.5 0 P S NW FA BAL Pak
0.12 1.08 1.32 0.8 4 4.7

Occurrence of Potentially Dangerous Malaria: Percentage of Plasmodium Falciparum

50 45 40 35 30 25 20 15 10 5 0
46.5 36.4 31.8

Percentage

20.5 10.4

19.2

NW

FA

BAL

PAK

2003 DATA - Malaria Control Programme

Annual Parasite Incidence API/1000 population

More than 3.5 1.6 3.5 0.5 1.5 Less than 0.5 No data available

2003 Data - Malaria Control Programme

Annual Falciparum Incidence API/1000 population

More than 3.5 1.6 3.5 0.3 1.5 Less than 0.2 No Data available

Districts with RBM in place

PUNJAB: Muzzafargarh, D.G. Khan, Rajanpur, Bhawalnagar, Jhang, Kasoor, Sailkot, Khenewal, Rahimyar Khan, Liayah Hyderabad, Mirpurkhas, Badin, Jacobabad Thatta D.I. Khan, Sawabi, Laki Marwat, Kohat, Karak, Bunner, Bannu, Malakand Pishin, Zhob, Kharan, Lasbella, Nasirabad

SINDH:

NWFP:

BALUCHISTAN:

Programme Expansion by Province(2002-2006)

RBM Expansion (Cumulative Number of Districts)
2001- 02 2002- 03 2003- 04 2004- 05 2005- 06

4 4 6 5 0 2 0

5 9 11 9 1 5 0 40

16 12 18 13 3 6 2 70

22 21 34 16 7 6 5 112

21

ACTIVITIES
DIPS IN 21 RBM DISTRICTS CAPACITY BUILDING CASE MANAGEMENT TRAINING OF MEDICS/PARAMEDICS TRAININGOF MICROSCOPISTS PROVISION OF LOGISTICS PROVISION OF ANTI MALARIAL DRUGS

ACTIVITIES (contd)

IRS FOCAL SPRAY IN SELECTED AREAS

PROVISION OF SPRAY EQUIPMENTS INSECTICIDES LARVECIDES ULV FOG GENERATORS (N.W.F.P)

VECTOR CONTROL

ITNS

Treatment & Diagnostic facilities

The district and sub-district hospitals and rural health centers (and few selected basic health units) work as microscopy centers. The primary health care facilities such as basic health units and dispensaries work as treatment centers. The Tehsil and district headquarter hospitals also provide specialist care to complicated/severe malaria cases.

EPIDEMIC CONTROL
Epidemics in district, Okara, Mirpurkhas Flood affected areas of Sindh and Balochistan WHO support in investigation & response

PROGRESS-1
National strategic plan developed. Federal and Provincial PC-1s approved. Case management guidelines and microscopy manual developed (local language). 21 districts initiated RBM activities, as per DIPs. Malaria early warning system (MEWS) drafted. TV, radio and print materials developed. GFATM support for programme strengthening

Capacity Building/ Advocacy and Communication

Revitalization of the former NIMRT Training to various levels of malaria workers National plan for advocacy & education in place Advocacy and mass awareness activities started

- TV: - Newspaper: leading News

500 400 Advertised in papers

-Radio messages:

Training of doctors and technicians

Province Punjab Sindh NWFP Baluchistan TOTAL Doctors Trained in Case Management 802 71 494 98 1,465 Technicians trained in Malaria microscopy 91 (further training in progress) 203 32 16 346

Specialized Courses Conducted

Course Conducted (duration) - Ento-tech course (3-weeks) - Junior Mal. Course (06 weeks) - Senior Mal. Microscopy Course (06 weeks) - Insect collector course (1 week) - Entomology Course (3 weeks) Number trained 29 25 18 16 22

Provincial/District Strengthening through Federal PC-I

ITEMS SUPPLIED
Vehicles Insecticides Larvicides: Fenthion/Temephos Antimalarial Tablets Computers/printers Photocopiers Training equipment (Projectors) Blood Lancets

QUANTITY
25 22.6 M.Tons 116 M.Tons/1000 L. 6 million 55 7 46 2.2 million

PARTNERSHIPS

International & National partnerships-1

WHO

JPRM: US$ 72,000 (02 yrs.) Tech Officer (RBM): 01 Further commitment for TA
GFATM

Grant Round 2 : US$ 4.4 Million Strengthening microscopy in 23 districts

Enhanced case management capacity in 23 districts Design and implement BCC strategy Promote the use of ITNs in 11 pilot districts through public-private partnership

International & National partnerships-2

GFATM Round 3:
Proposal approved by Tech Rev Panel (TRP) Total grant approved: US$ 1.5 million

DFID
DFID-NHF to provide TA and budget support to the MCP for strengthening RBM expansion.

TA includes:
- Human resource - Provincial level strategic planning and PC-1 revision. - Development of training materials and manuals

International & National partnerships-3

The programme is piloting implementation of ITNs in 11 districts in partnership with following NGOs: Health Net International Peshawar National Rural Support Programme/ Association for Social Development greenstar

IMPLEMENTATION
Drug resistance sentinel sites needs functional , trainings has been completed & implementation will start shortly. Sentinel sites for recording and reporting of severe malaria morbidity & mortality identified workers are trained, tools for data collection provided & the sentinel sites will be functional in next quarter of this year.

OPERATIONAL RESEARCH
Drug resistance studies carried out in 12 districts. Research study on care providers and community perspectives (contracted to IPH Lahore)

Assessment of public & private sector health care delivery capabilities and potential for malaria control Assessment of community perceptions and practices regarding malaria and its control

STRENGTHENING OF FEDRAL DIRCTORATE

IN PROCESS A. DFID 1. INTERNATIONAL ADVISOR 2. PROGRAMME OFFICERS 3. EPIDIMIOLOGIST 4. DEVELOPMENT OF GUIDELINES B. GFATM ROUND-II 1. PROJECT COORDINATOR (FIELD) 2. M/TECHNICIANS FOR NIMRT 3. M/REPAIR TECHNICIANS 01 02 01

01 02 05

STRENGTHENING OF FEDRAL DIRECTORATE

C.GOVERNMENT OF PAKISTAN 1.COMPUTOR PROGRAMMER 2.MEDICAL OFFICER 3.SCIENTIFIC OFFICER (NMIRT) 4.ADMIN OFFICER AND SUPPORT STAFF.* * Advertisement made 01 01 01 01

ISSUES & CHALLANGES

ISSUES
Need for provincial and district level strategic planning Need for strengthening supervision and monitoring at provincial and district level Sub-optimal use of malaria human & other resources Inadequate field cost (TA/DA) for malaria staff Involvement of private sector in malaria control

ISSUES
Drug resistance

RII level to chloroquine Resistance is now on increase

Insecticide resistance

Two primary malaria vectors are resistant to Organochlorines (DDT, BHC, Dieldrin) and Organophosphates (Malathion)

ISSUES
National Policy on the vector control (rational use of insecticide) National Malaria Treatment Policy to be in line with WHO ACT Integration of MCP activities with EPI and MCH Uncontrolled private sector

THANK YOU