FIFTH INTERCOUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS

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Progress of RBM Implementation in Afghanistan

• Dr. Najib Mahboob
• NMLCP Kabul

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Updates on Malaria Burden

• Afghanistans officially reported malaria cases
  during 2004 were 261,270
• P.f represented 4 of the total cases
• With the implementation of the Essential Package
  of Hospital Services, the HMIS is expected to
  start collecting data on malaria deaths

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Updates on case management - drug efficacy
studies , drug policy

• Malaria case management is integer part of the
  Basic Package of Health Services (BPHS)
• To promote the ACT, the malaria multi-year
  strategic plan advocated the expansion of
  laboratory services to include the BHCs in 14
  priority provinces.
• RDTs proposed to be used in emergent situations
• Referral of severe malaria cases will be part of
  the referral system proposed in the Essential
  Package of Hospital Services (drafted in 2004)
• 4 sentinel sites continued to monitor the
  therapeutic efficacy of the AMDs in the national
  treatment guielines

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Drug Policy

• Based on the evidence of drug efficacy studies,
  MoPH has adopted in 2003 a new national
  treatment guidelines
• First line treatment for laboratory confirmed
  falciparum cases ASSP
• Second line treatment for laboratory confirmed
  falciparum cases Quinine
• Clinically diagnosed cases to be treated with
  SPCQ
• Confirmed vivax malaria CQ
• Severe cases are to e treated with Quinine.

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Updates on vector control interventions and
inter-sectoral coordination for vector control at
country level

• 98,351 ITNs (conventional and LLINs) were
  distributed nationwide during 2004
• According to the multi-year strategic plan, IRS
  and insecticide treated materials (Chadors,
  blankets, etc) can be considered for control of
  focal epidemics when applicable
• MoPH in collaboration with WHO and Lewis Pasteure
  institute Iran, plan to initiate entomological
  surveillance during 2005

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Epidemics control

• Development of a National Guidelines on
  Falciparum Malaria Outbreak
• Translation into Dari and printing of the malaria
  field guide for malaria epidemic assessment and
  reporting
• Training of 14 provincial teams (2 each) on
  malaria EPR.
• Pre-positioning of contingency supplies in 14
  provinces during 2004 transmission season
  (including ACT RDTs).
• No malaria epidemics were reported during 2004.

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Updates on strengthening malaria ME and
surveillance system

• Overall responsibility for ME in Afghanistan is
  the MoPH/ME Unit.
• MOPH nominated a national malaria ME team
  comprised from MoPH/GFMU/ME and NMLCP/ME focal
  persons to coordinate and oversee the monitoring
  of progress and evaluation of national malaria
  strategies.
• MOPH,WHO and USAID REACH are planning the
  establishment sentinel surveillance system in 2
  provinces during 2005
• The newly established GFMU sub-national offices
  will further strengthen coordination and
  information sharing between MoPH, NMCLP, PMLCP
  and WHO and other implementing agencies.

10
Partnership, resource mobilization and advocacy

• Formation of a National Malaria Task Force
• Funds from GFATM R2 to support the capacity
  building of the MOPH
• Submission for the 5th round of GFATM is underway
• USAID Supported the construction of the malaria
  institute as well as incentive support to the
  NMLCP staff ( 500,000). Another proposal
  (700,000) submitted to consolidate the RBM
  strategic plan
• ECHO Supported the risk mapping project
• EC Funded HNI MLCP
• PSI Participated in ITNs project.
• A National Malaria Advisory Board is planned for
  2005 to promote inter-sectoral collaboration

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Review of the progress on the malaria border
coordination

• In accordance with the multi-year strategic plan,
  Afghanistan is in the process to establish border
  coordination mechanisms with the neighboring
  countries (Pakistan, Iran and Tajikistan)

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Human Resource Development

• Main key activities
• A national workshop standardized the malaria
  training curriculum for all categories of health
  workers in the BPHS
• Fellowship training course currently ongoing in
  WHO regional training center, Bandar Abbas, Iran
  for 15 key staff from NMLCP and partner NGOs

13
Operational research

• Malaria and pregnancy (still running).
• Malaria Lap dap study (still running).
• Risk mapping project (Still running).

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Conclusion

• Achievements
• Development of a multi years strategic plan for
  RBM
• Standardization of malaria training curricula
• Approval of the NMLCP structures at the central
  and provincial levels
• Intensive Fellowship training program for all
  NMLCP staff

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• Challenges
• Evolving healthcare delivery system (BPHS EPHS)
• Many stakeholders
• Weak coordination
• Poor procurement and logistic systems
• Haphazard private sector
• Security !

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Ways forward

• Mobilize resources for, and Implement the
  multi-year RBM strategic plan