RBM in EMR Achievements and challenges Dr' Hoda Atta

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RBM in EMR Achievements and challenges Dr.
Hoda Atta
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RBM EMR programme
Main directions

• Strengthen WHO capacity at RO and countries for
  provision of technical support to the countries
• Support inter-country action and inter-regional
  cooperation
• Support the countries in implementing effective
  interventions (RBM POAs)

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RBM STAFF AT EMRO AND COUNTRIES
Saudi Arabia STC

• Extend support to DJI
• strengthen it in PAK

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Foster inter-country action and interregional
cooperation
Expected results

• RBM partnership at regional level is maintained
  and advocacy is fostered and resources are
  mobilized
• technical standards developed and monitoring
  systems established
• The human capacities for planning and
  implementing RBM programme are strengthened
• Integrated vector control measures for malaria
  prevention are introduced
• Field applied research for evidence based
  decisions conducted
• Malaria programmes are revised, needs assessed
  and anti-malaria programmes along the border
  areas are coordinated

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RBM partnership and advocacy

• Support Advocacy events
• The Africa Malaria Day was celebrated in EMR
  African countries ( SUD, SOM, MOR), National
  Symposium on malaria in Sana'a, Yemen, 8-9
  October 2003
• Regular update of the EMR RBM web site
• Production of RBM advocacy documents summarizing
  the results of RBM evaluation in EMR and
  outlining future directions ( in process)

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Representation in RBM partnership board

• Identification of a board member for horn of
  Africa countries in the last RC meeting
  Undersecretary of health of Sudan Dr Abdulla
  Osman
• Participation in consultation meeting for board
  members and their constituent governments in
  Harare, board meeting in New York
• Identification of national focal points for RBM
  partnership

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Resource mobilization activities

• AFG , SUD, SOM,YEM, PAK have got approved
  proposals from GFATM
• GF money have been disbursed to YEM and PAK
• DJI , PAK, AFG, IRAN submitted proposals in 4th
  round
• Funds for malaria control in Afghanistan
  mobilised from USAID, another proposal submitted
  in 2004

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Ongoing actions for resource mobilization

• Proposal to the Global Environmental Facility
  (GEF) on strengthening national vector control to
  reduce reliance on, and prevent the
  re-introduction of DDT EMR
• Proposal to Arab Fund to strengthen malaria
  vector surveillance ad monitoring of insecticide
  resistance in SUD, DJI, YEMEN
• Proposal to AGFUND for HRD in EMRO
• Look for regional donors ---Visit to Islamic
  development Bank , Agfund, GCC ( RBM/HQ and EMRO
  ) for resource mobilization May 2004
• Regional proposal to USAID for ME

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Global Fund- malaria
 3rd round Pakistan MOH 1.548.636
2years
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• Technical documents
• In process
• Guidelines for establishing a system for quality
  assurance of malaria laboratory diagnosis
• ( DRAFT AVAIABLE FORCOMMENTS)
• Protocol for monitoring insecticide resistance

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HRD - Support Regional Courses

• 2003
• Regional training center in Iran
• 2 month Regional malaria planning course for MP
  Managers, Iran 2003
• 2 month Course for AFG, IRA in Farsi, Bandar
  Abbas Iran , 2004
• VMC Center in Tunis
• COMBI course in Tunis for SUD , AFG
• WHO Collaborating Centre Cairo
• Diploma on medical entomology in Ain Shams Cairo
  ( YEM, SUD, SAA)
• Short training for 3 Yemeni on medical entomology
  
• Training in Thailand on management of sever
  malaria ( SAA. SUD )

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HRD - Regional Courses Planned 2004-5

• DEPENDINNG ON AVAILBILITY OF FUNDS
• A course on monitoring insecticide resistance in
  WHO collaborating centre, Cairo
• Malaria Planning course in Iran
• IV workshop on QA of lab diagnosis ( Oman ???)
• IC course on IVM , BNRTI , Sudan
• ME workshop including Malaria surveillance ,
  Epidemic early detection
• GIS workshop in Arabic ( YEM, SYR, IRAQ, others
  )

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Institutional development Upgrade/support
national training centres and WHO Collaborating

• Planned
• Evaluate/support the national training centres in
  SAA and PAK , SUD , Yemen
• Identification/support of regional centres of
  excellence in quality assurance of malaria
  microscopy ( Oman, Iran)
• Strengthen the Regional network for monitoring
  insecticide resistance ( Cairo, Iran)
• Support the regional training centre for IVM
  (Sudan)

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Support Integrated vector management

• IC workshop for IVM, Khartoum, Sudan January
  2003, Regional Strategic Framework for IVM
  developed
• STATREGY DOCUMENT PRODUCED
• Inter-country workshop on scaling-up ITN,  Abha,
  Saudi Arabia, 18-20 October 2003. National
  strategic plan for ITM implementation developed
  in 5 countries targeting ITN
• Introducing COMBI methodology and development of
  COMI plan in Sudan and AFG
• WHO/UNEP Workshop on Public Health Pesticide
  Management in EMR in the Context of the Stockholm
  Convention on (POPs) Jordan 7-11 December 2003

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Support operational research projects

• Under the annual EMRO/Small Grants Scheme about
  6-8 projects are funded annually
• Final Report Summaries for 1992-2000, projects
  published and posted in the web site
• Others
• An operational bed net project is being supported
  in Yemen to clarify issues related to use,
  distribution and financing mechanism
• Studies on impact of malaria in areas with
  unstable transmission
• Baseline Study Malaria in Pregnancy, HNI
  -Nangahar AFGHANISTAN 2003-4 at hospital
  facilities that provide antenatal and perinatal
  care in Jalalabad district

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Evaluation /Revsion of Mc Programmes and
Coordination at the Border Areas

• Done
• RBM evaluation - Report finalised October 2003,
  it is being published
• Annual programme manger meeting since 2001
• Border Coordination meetings under WHO support
• AFG, PAK, IRA
• Horn of Africa
• Border meeting March 2004 (SYR, Iraq, Turkey)
• YEM, SAA---periodic meetings
• Planned
• AFG, PAK, IRA ( AUG 04)-
• AFG, TAJ ( DEC 05)

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Support Country Actions- case management

• Distribution of WHO position statement on
  treatment of PF
• Technical support to 4 countries for updating the
  drug policy (Sudan, AFG , SAA, Iran )
• Policy has been updated , ACT adopted in 2
  countries
• (AFG, SUD Not yet implemented )
• The process of policy change toward CT is ongoing
  in SOM, S Sudan, Iran
• Update of the policy of treating imported P F
  cases in MOR ( Coartem ), UAE ( MEF AST )

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Support countries for monitoring drug efficacy

• 8 countries with local P falciparum in EMR
• Sentinel Sites have been established in 4
  countries ( SUD , YEM, SOM, IRA) data on 1st and
  2nd lines drugs are available , CT will be tested
  in 2004
• Technical support and training was provided in
  2003 to PAK, AFG for developing the sites
• Support a study in Afghanistan on therapeutic
  efficacy of CQ and SP in 2003 , Khanabad,
  north-eastern Afghanistan, in Collaboration with
  MERLIN and the Institute of Malaria and Parasitic
  Diseases
• No update information from DJI and SAA , support
  will be given in 2004

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Sentinel sites for monitoring drug efficacy in
Yemen
Bajil ACPR 58
Al Odein ACPR 61
W.Al Mesemeer ACPR 43,
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Sudan - sites for monitoring drug efficacy2002-3

• 4 sites in areas with Moderate transmission
• Failure by site
• Khartoum
• Gazera 36.3
• W. Nile 43.8
• B. Nile 42.4
• N. Kordofan 45.1

• 2 in areas with intense
• transmission
• CQ failure
• in Juba (83)
• in Malakal (78.3)

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Therapeutic efficacy of SP in Jamame, Jowhar, and
Janale sites in SCZ of Somalia
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HANMAT a network for HOA countries is being
established

• Interregional meeting in Cairo , March 2004
• Discussion toward establishing a network for
  monitoring antimalarial therapy
• Consensus on establishing a network for 6
  countries (Horn of Africa countries - SUD, SOM,
  DJI EMR and Ethiopia and Eritrea from AFR plus
  Yemen
• Chairman and focal points identified, meeting in
  July 2004 for finalising the structure and
  constitution of the network
• Another IC network is foreseen for PAK, IRA, AFG

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Malaria elimination efforts

• POA for malaria elimination in Morocco, Syria
• verification of malaria free status in UAE
  sero-epidemiological survey
• Strategy of malaria elimination in SAA finalised
  May 04
• Planned
• Consultation on certification/verification of
  malaria elimination planned in Dec 04 in
  collaboration with UAE other GCC countries

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Support specific projects in high burden countries

• Sudan
• Special project for Khartoum Gezira States,
  promising results documented
• Supported specific project on improving case
  management at hospitals
• A project for forecasting and early detection of
  malaria epidemic is supported in 5 epidemic prone
  states in Sudan
• Yemen
• Special project for Tihama and Socotra

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Epidemiological situation
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Group 1 Malaria eliminated

• Lebanon (1963)
• Palestine (1965)
• Jordan (1970)
• Qatar (1970)
• Libya (1973)
• Bahrain (1979)
• Tunisia (1979)
• Kuwait
• UAE

9 countries, 7 of the population
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Imported cases in last 5 years in malaria free
countries
UAE changed reporting in 2003
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Group 2 - Malaria under elimination

• Egypt
• Morocco
• Oman
• Syria

24 of the population
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Cases in group 2 in last 5 years
_at_introduced cases all cases are confirmed
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Group 3 Low/Moderate endemicity
Confirmed malaria cases only
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Significant increase in malaria cases in 2003
Cooperation with PAK, AFG is not functional
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Coordination with the northern GOVs Epidemic
preparedness are priority
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Data from routine surveillance only , Specific
Surveys introduced in 2003
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Pakistan Access to and utilization of diagnostic
services ratio of reported total slides examined
(TSE) through passive cases detection to reported
clinical malaria cases 2002
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Rough estimation of malaria burden in Pakistan
Surveillance is incomplete , incomprehensive

• The total number of confirmed cases recorded for
  2001 was 111,110.
• If the SPR of the remaining clinical cases
  treated in the public sector was 7, then this
  would account for an additional 226,125 cases, So
  the total confirmed cases should be 337,235 .
• If this represents one fifth of the total cases,
  then a conservative estimation for 2001 would be
  some 1.5 million malaria cases

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Group 4 With intense malaria transmission
(chronic, complex emergencies)
16 of population 95 of the cases

• Afghanistan
• Djibouti
• Yemen
• Sudan
• Somalia

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Summary of the regional plan for 2004-5
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Summary Of RBM Regional Extra-Budgetary Plan of
Action 2004-5
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Summary Of RBM Regional Extra-Budgetary Plan of
Action 2004-5
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Summary Of RBM Regional Extra-Budgetary Plan of
Action 2004-5
EB Funds available in EMRO 800,000 GAP is
4,416,000 RB funds allocated to RBM at RO and
county level in 2004-5 1,687,000
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Challenges

• Weak ME
• Lack of data on coverage of RBM intervention
  access to effective treatment , ITN coverage ,
  MIP
• Proper estimation of Malaria burden at country
  level
• Will be useful for estimation of the needed ACT
• Epidemiological surveillance is still weak ,
  incomplete, not comprehensive
• National capacity for planning and evaluation in
  endemic countries is still weak

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Challenges in relation GFATM

• Slow release of funds
• Constrained partnership for some countries
• No clarity about the role of WHO in
  implementation, monitoring of GFATM related
  activities in the countries.
• There is a need to maintain WHO RBM staff in
  country offices for technical staff cost be
  negotiated with GF

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More efforts for resource mobilization at country
level

• ENSURE SUFFICIENT NATIONAL FUNDING
• Mobilize resources at the country level
• Bilateral collaboration
• Best use of available resources
• Documentation of the successes and
  challengesSudan started
• Cooperation with other programmes EPI, STB, HIV