Malaria affects poor people the most

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PROGRESS WITH
ROLL BACK MALARIA IN THE WHO EUROPEAN REGION
Roll Back Malaria WHO Regional
Office for Europe Dushanbe, Tajikistan, 11 May,
2006
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Reported number of autochthonous malaria cases in
all countries of the WHO European Region,
1990-2005
RBM programme
Between 35 and 40 million people live in areas
at risk of malaria in the Region
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Countries with reported autochthonous cases of
malaria - 1980s, 1990s, 2000s
1980s (3)
2000s (10)
1990s (5)
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NUMBER OF AUTOCHTHONOUS CASES OF MALARIA IN THE
REGION, 1996 and 2004
2004
1996
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Current malaria situation in the WHO European
Region

• Countries where malaria remains a major public
  health problem TAJIKISTAN, TURKEY
• Countries where malaria epidemics have been
  contained and the results achieved need to be
  consolidated further TURKMENISTAN, AZERBAIJAN,
  ARMENIA, KYRGYZSTAN, GEORGIA
• Countries where sporadic cases are reported and
  the risk of further spread existsUZBEKISTAN
  RUSSIAN FEDERATION
• Countries free from autochthonous malaria or
  cases rarely reported ALL REMAINING COUNTRIES

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COUNTRIES OF CENTRAL ASIA

• AREAS OF CONCERN
• 14 MILLION PEOPLE OR 33 OF THE TOTAL POPULATION
  OF CENTRAL ASIA, LIVE IN AREAS AT RISK OF MALARIA
  
• THE TOLL OF MALARIA IS UNDERESTIMATED
• ESTABLISHMENT OF ENDEMIC MALARIA
• OCCURRENCE OF DRUG RESISTANCE
• UNSTABLE SITUATIONS IN BORDER AREAS
• MOST OF THE TERRITORIES, WHERE MALARIA HAD BEEN
  ELIMINATED, REMAINS HIGHLY RECEPTIVE TO A
  RESUMPTION OF MALARIA TRANSMISSION

• MALARIA SITUATION
• LARGE-SCALE EPIDEMIC OF MALARIA CONTAINED AT
  SUB-REGIONAL LEVEL
• THE SUBSTANTIAL REDUCTION IN THE INCIDENCE AND
  NUMBER OF ACTIVE FOCI OF MALARIA, PARTICULARLY P.
  FALCIPARUM
• THE TRANSMISSION OF P. FALCIPARUM MALARIA
  LIMITED MOSTLY TO AREAS BORDERING AFGHANISTAN

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Population at risk of malaria in countries of
Central Asia and Kazakhstan,estimated by WHO
4 500 000
2 500 000
5 600 000
4 500 000
1 000 000
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Areas with reported autochthonous cases of
malaria, Central Asia, 2004



AREAS WHERE AUTOCHTHONOUS CASES ARE REPORTED




AREAS WHERE AUTOCHTHONOUS CASES OF P. FALCIPARUM
ARE REPORTED



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THE CAUCASIAN COUNTRIES

• AREAS OF CONCERN
• 8.5 MILLION PEOPLE OR ALMOST 50 OF THE TOTAL
  POPULATION OF CENTRAL ASIA, LIVE IN AREAS AT
  RISK OF MALARIA
• THE TOLL OF MALARIA IS UNDERESTIMATED
• UNSTABLE SITUATIONS IN BORDER AREAS
• MOST OF THE TERRITORIES, WHERE MALARIA HAD BEEN
  ELIMINATED , REMAINS HIGHLY RECEPTIVE TO A
  RESUMPTION OF MALARIA TRANSMISSION

• MALARIA SITUATION
• LARGE-SCALE EPIDEMIC OF MALARIA CONTAINED AT
  SUB-REGIONAL LEVEL
• THE SUBSTANTIAL REDUCTION IN THE INCIDENCE OF
  MALARIA AND THE NUMBER OF ACTIVE FOCI OF P. VIVAX
  MALARIA
• IN GEORGIA, MALARIA EPIDEMIC CONTAINED, BUT
  MALARIA SITUATION REMAINS SERIOUS, PARTICULARLY
  IN AREAS BORDERING AZERBAIJAN

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Population at risk of malaria in Caucasian
countries and Turkey, estimated by WHO
2 000 000
Georgia
Armenia
1 500 000
Azerbaijan
5 500 000
Turkey
15 000 000
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Areas where autochthonous malaria cases reported,
TransCaucasian countries, 2004
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TURKEY

• AREAS OF CONCERN
• 15 MILLION PEOPLE OR 23 OF THE TOTAL POPULATION
  OF CENTRAL ASIA, RESIDE IN AREAS, WHERE MALARIA
  IS ENDEMIC
• THE EXTENT OF THE MALARIA PROBLEM IS MUCH LARGER
  THAN THE INCIDENCE REPORTED, PARTICULARLY IN THE
  SOUTH-EASTERN PART OF THE COUNTRY
• THE ENDEMIC MALARIA IS FOCAL PROBLEM THERE
• MOST OF THE TERRITORIES, WHERE MALARIA HAD BEEN
  ELIMINATED, REMAINS HIGHLY RECEPTIVE TO A
  RESUMPTION OF MALARIA TRANSMISSION

• MALARIA SITUATION
• LARGE-SCALE EPIDEMIC OF MALARIA CONTAINED
• THE SUBSTANTIAL REDUCTION IN THE INCIDENCE OF
  MALARIA AND THE NUMBER OF ACTIVE FOCI OF P. VIVAX
  MALARIA

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Areas where autochthonous cases of malaria
reported, Turkey 2004
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Programme Achievements
RBM ISSUES REMAIN HIGH ON THE WHO AGENDA
THROUGHOUT AFFECTED COUNTRIES
1999 THE DEVELOPMENT OF THE REGIONAL STRATEGY TO
ROLL BACK MALARIA AND SUCCESSFUL IMPLEMENTATION
OF THIS PROGRAMME IN OUR REGION 2002 THE
ENDORSEMENT OF THE REGIONAL RESOLUTION SCALING
UP THE RESPONSE TO MALARIA IN THE EUROPEAN REGION
OF WHO BY ALL MEMBER STATES 2005 THE REGIONAL
DECLARATION ON THE MOVE FROM MALARIA CONTROL TO
ELIMINATION IN THE WHO EUROPEAN REGION IS BEING
DISCUSSED
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Programme Achievements
STRENGTHENED NATIONAL CAPACITIES AND CAPABILITIES
TO COPE WITH MALARIA
MALARIA PROGRAMMES DRIVEN BY KNOWLEDGE AND
EXPERIENCE THE FORMULATION OF GOALS, OBJECTIVES
AND TARGETS BASED ON THE COMMITMENTS AND
CAPABILITIES OF AFFECTED COUNTRY THE CORE
GROUPS OF ADEQUATELY TRAINED PROFESSIONALS WITH
NECESSARY EPIDEMIOLOGICAL EXPERTISE AND
COMPETENCE SEP UP AND FUNCTIONAL

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Programme Achievements
BROAD PARTNERSHIP ACTION WITH CONSIDERABLE
FINANCIAL ASSISTANCE TO ROLL BACK MALARIA
A HIGH LEVEL ADVOCACY FOR ACTIONS AGAINST
MALARIA RBM PARTNERSHIP MOVEMENTS FUNCTIONAL AT
COUNTRY AND INTER-COUNTRY LEVELS AND RBM
INTERVENTIONS COORDINATED AMONG ALL PARTNERS
CONCERNED INCREASED ASSISTANCE FOR MALARIA
CONTROL FROM GFATM CROSS-BORDER COOLABORATION
STRENGTHENED BETWEEN NEIGHBOURING COUNTRIES AND
REGIONS
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Programme Achievements
UPDATED KNOWLEDGE AND ENHANCED SKILLS ON
MALARIA AND ITS CONTROL AND PREVENTION
DECISION-MAKING BASED ON UPDATED KNOWLEDGE OF
MALARIA AND THE PLANNING OF MALARIA
CONTROL TRAINING PROGRAMMES CONSTANTLY ADAPTED TO
APPROPRIATE IMPLEMENTING STRATEGY A NUMBER OF
REVISED TECHNICAL MANUALS, PRACTICAL GUIDELINES
AND INNOVATIVE TOOLS PUBLISHED AND DEVELOPED
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Programme Achievements
IMPROVED CAPACITIES FOR DISEASE MANGEMENT AND
PREVENTION, AND EPIDEMIC CONTROL
A SYSTEM FOR EASY ACCESS TO EARLY/RELIABLE
DIAGNOSIS AND PROMPT/ADEQUATE TREATMENT IN
MALARIA-AFFECTED AREAS ESTABLISHED AND FUNCTIONAL
IN MOST COUNTRIES IN MOST SITUATIONS, VECTOR
CONTROL GUIDED BY CONSIDERATION OF TECHNICAL AND
OPERATIONAL FEASIBILITY AND EFFECTIVENESS A RAPID
RESPONSE CAPABILITY TO COPE WITH EMERGENCY
SITUATIONS BUILT IN ALL EPIDEMIC-PRONE COUNTRIES
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Programme Achievements
STRENGHTENED EPIDEMIOLOGICAL SERVICES AND
OPERATIONAL RESEARCH CAPABILITIES
IMPLEMENTATION OF MALARIA PROGRAMMES ADJUSTED TO
EPIDEMIOLOGICAL PATTERNS, THE EXISTING TOOLS AND
RESOURCES AVAILABLE REINFORCED SURVEILLANCE
MECHAMISMS AND INFORMATION SYSTEMS CAPABLE OF
PLANNING, MONITORING AND EVALUATING CONTROL
INTERVENTIONS THE CREATION OF A REGIONAL NETWORK
OF MALARIA-ORIENTED RESEARCH RESEARCH OUTCOMES
USED TO MAKE MALARIA CONTROL MORE EFFECTIVE
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Programme Achievements
INCREASED COMMUNITY AWARENESS AND PARTICIPATION
IN MALARIA PREVENTION
RAPID ASSESSMENTS ON PRACTICES OF RECOGNITION AND
TREATMENT OF MALARIA AND PERSONAL PROTECTION TO
DEVELOP EFFECTIVE IEC STRATEGY CONDUCTED
STRENGTHENED COMMUNITY AND FAMILY CARE AND
PREVENTION PRACTICES THROUGH DEVELOPMENT OF
TARGETED IEC MATERIALS, AWARENESS SESSIONS,
COMMUNITY SUPPORT, SKILLS BULDING AND MASS MEDIA
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Regional Roll Back Malaria Objectives and Goal

• Programme objectives are
• TO PREVENT DEATHS DUE TO MALARIA
• TO PREVENT LARGE-SCALE MALARIA EPIDEMICS
• TO CONTAIN MALARIA OUTBREAKS
• TO REDUCE FURTHER THE INCIDENCE AND PREVALENCE
  OF MALARIA
• TO PREVENT THE RE-ESTABLISHMENT OF MALARIA
  TRANSMISSION AND MAINTAIN THE
  MALARIA-FREE STATUS IN COUNTRIES AND TERRITORIES
  WHERE MALARIA HAD BEEN ERADICATED

The ultimate goal is TO INTERRUPT P.FALCIPARUM
TRANSMISSION AND ELIMINATE P. FALCIPARUM MALARIA
IN CENTRAL ASIA (BY 2010) TO INTERRUPT MALARIA
TRANSMISSION IN AFFECTED COUNTRIES OF THE REGION
(BY 2015)
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Main ConstraintsRoll Back Malaria in the WHO
European Region

• The limited financial resources invested in
  malaria control by Governments
• All national malaria control programmes in
  affected countries are chronically dependent on
  external support
• A positive response from the international
  community only after malaria epidemics have
  occurred in affected countries
• Donor response rarely sustained longer than 3
  years
• Partner response has been traditionally weak in
  situations of small-scale outbreaks, occurrence
  of sporadic cases and high risks of malaria
  resurgence

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Main ChallengesRoll Back Malaria in the WHO
European Region

• How to sustain the donor interest in situations,
  where epidemics of malaria have curbed, but
  malaria is still a public health problem, and
  there is a risk of explosive resurgence of
  malaria transmission, which could lead to
  outbreak situations exist
• How to attract the donor interest towards
  supporting the new malaria elimination initiative
  

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Roll Back Malaria Programme Regional Outlook

• THE DEMONSTRATED FEASIBILITY OF MALARIA
  ELIMINATION IN THE PAST
• THE VISIBLE IMPACT ON MALARIA OF RBM
  INTERVENTIONS AT PRESENT
• THE STRONG POLITICAL COMMITMENTS TO ACHIEVE A
  GREATER IMPACT ON MALARIA SITUATIONS AT NATIONAL
  LEVEL
• THE AVAILABILITY OF EFFICACIOUS TOOLS TO CONTROL
  AND ELIMINATE MALARIA IN THE REGIONAL CONTEXT
• HAVE CREATED A UNIQUE OPPORTUNITY AND A SOLID
  EVIDENCE TO MOVE FURTHER FROM CONTROL TO
  ELIMINATION

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THE END