Establishing National Intersectoral Coordination:

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• Establishing National Inter-sectoral
  Coordination
• Policy and Institutional Frameworks
• 5th intercountry meeting of national malaria
  programme managers countries free from malaria
  or with residual transmissionDamascus, Syria
  A.R., 21-23 June, 2005

Jacob E. Williams Malaria Strategy and Policy,
RBM Cluster on HIV/AIDS, TB Malaria, WHO/HQ
Geneva
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Challenges to vector control

• Multivariate multi-sector driving forces to
  local burden
• Natural and manmade
• Diminishing resources (significantly limiting
  management technical scope of country
  programmes)
• Inadequate technical capacities
• Limitation to the implementation of
  cost-effective sustainable intervention
  (chemical non-chemical)
• Diminishing arsenal of cost-effective PH
  pesticides
• Increasing disease burden in some local areas

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Challenges to vector control
CONSEQUENCE

• Effective vector control requires a
  multi-sectoral approach to the implementation of
  locally appropriate and cost effective
  interventions
• Need to address vector carrier of disease
• Need to address human target of disease
  (individual and community)
• Require some socio-economic, socio-political
  reconstruct
• The requirement for effective control clearly
  extend beyond the mandate of the health sector

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Integrated Vector Management

• A process of evidence-based decision making
• procedures aimed to plan, implement, monitor and
• evaluate targeted, cost-effective and sustainable
  
• combinations of regulatory and operational vector
  
• control measures, with a measurable impact on
• transmission risks, adhering to the principles of
  
• subsidiarity, intersectorality and partnership

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Integrated Vector Management

• A public health regulatory and legislative
  framework
• Collaboration within the health sector with
  other public and private sectors whose actions
  impact on vectors
• Empowerment and involvement of local communities
  and other stakeholders
• Methods based on knowledge of factors influencing
  local vector biology, disease transmission
  morbidity
• Use of a range of interventions, often in
  combination and synergistically

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Intersectoral collaboration

• Bedrock
• - A conducive policy environment
• - A conducive institutional framework

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Intersectoral Collaboration

• APPROPRIATE POLICY TO REQUIRE
• Accountability from actors/sectors impacting VBD
• Action or inaction
• HIA of development project
• inclusion of safeguards
• Require inter-sectoral action

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Development policy and health
Health Policy
DevelopmentPolicy
Social determinants
Environmentaldeterminants
Healthcare
Poverty
Health
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Intersectoral Collaboration

• Appropriate institutional framework
• To facilitate collaboration
• Ensure utility/added value for all stakeholder
  sectors
• Facilitate joint planning/budgeting
• Enable comprehensive policy evaluation and review

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Intersectoral Collaboration

• Sectors
• reflects societal vested interests able to
  mobilise sufficient political clout to ensure a
  territorial niche in a governance structure
• "intersectoral collaboration" is therefore a
  contradiction in terms (Degeling et al. 1991)
• Need for deliberate efforts

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INSTITUTIONAL ARRANGEMENTS
Intersectoral Collaboration

• First, look at existing intersectoral structures
• National Economic Planning Council
• Environmental Protection Agency
• Science and Technology Council

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INSTITUTIONAL ARRANGEMENTS
Intersectoral Collaboration

• Next, consider desirable intersectoral
  arrangements
• With the Environment Sector - a strategic
  alliance
• With the Development Sectors (Agriculture,
  Energy)
• With institutes involved in Science and
  Technology
• With the Ministry of Finance

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THE NATURE OF A STRATEGIC ALLIANCE SHOULD
Intersectoral Collaboration

• Overcome the obstacles of vested interests
• Have tools to resolve potential and real
  conflicts
• Ensure greater combined output than the sum of
  individual outputs of partners (added value for
  ALL through economies of scale and other
  synergies)
• Ensure agreement on a number of principles
• Enable rational process of Integration based on
  agreed criteria and common goals
• Enable custom-designed and effective mechanisms
  to meet needs at different levels (decentralized
  environment)
• Be solidly anchored in the overall governance
  structure

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Intersectoral Collaboration

• HEALTH SECTOR FUNCTIONS
• Periodic eco-epidemiologic evaluation
  Surveillance,
• Document and disseminate lessons
• Update the agenda of priority RD needs
• Establish and update institutional and
  operational frameworks
• Harmonize relevant sectoral policies and
  legislation
• Evaluate policy, institutional and operational
  framework
• Sector-specific VC measures and QC of VC
  activities
• Monitoring compliance
• Capacity building

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Intersectoral Collaboration

• OTHER SECTOR FUNCTIONS
• Include health criteria in sectoral operational
  frameworks and procedures
• HIA for new development projects
• VC measures in line with sectoral mandates
• Participate in joint activities of an integrated
  nature
• Inform health sector on new technical
  developments

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2nd Presentation
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• Vector Control Needs Assessment
• (VCNA)

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Country Scenario on Vector Control

• 2 general categories
• Countries with ongoing organized VC services
• Need to strengthen VC to improve
  cost-effectiveness, sustainability and impact
  will involve recalibration of program objectives
  and operations
• No organized VC services (ad-hoc localized)
• Need to establish boundaries and goals for (new)
  cost-effective and sustainable national vector
  control

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Vector Control Needs Assessments (VCNA)

• Objectives
• Develop or improve VC policy and strategy
• Identify and prioritize intervention options and
  deployment regimes
• Establish appropriate management/operational
  systems to sustain deployment
• Provide basis for evaluation of VC impact

IVM
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VCNA Guidelines

• Objectives
• Provide a framework for assessing needs for
  introducing or improving VC programmes
  (cost-effective, locally appropriate)
• Propose a methodology, procedures and tools for
  the needs assessment.
• Provide guidance on the use of assessment
  outcomes for improving VC programmes.

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VCNA Guidelines

• Intended Users
• Government officials normally charged with
  planning and design of health sector programmes
• VCNA Assignment
• Design, commission, evaluate the VCNA
• Ensure mechanisms to monitor compliance with
  assessment recommendations
• VCNA to be done in close consultation various
  stakeholders.

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VCNA Guidelines

• 1. Proposes assessment procedure
• Framework for
• Conducting assessment
• Stakeholder consultations
• Achieving consensus on outcomes products
• Follow up activities for the development of IVM
  strategies and national pans of action on
  implementation

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VCNA Guidelines

• 2. Proposes assessment tools and methods
• Suggests primary assessment areas and information
  requirement
• Evaluation tools
• Indicative questionnaire tool
• Situation analysis, including problem analysis
• Identifying and prioritization of major
  constraints
• Determining the root causes of the major
  constraints identified
• Determination of the needs and opportunities for
  establishing or strengthening vector control
• 3. Suggest products of the assessment

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Steps in VCNA
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Steps in VCNA
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Steps in VCNA
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Contextual Analysis(Problem analysis)

• scope of problem(s) limiting the achievement of
  set VC objectives
• Identification of the root causes of the
  constraints
• Are we realizing our goals in reducing burdens ?
• If not, why not ?
• What can be done ?
• What will it require ?
• How can it be accomplished (plan of action)

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Data Collection

• Locally appropriate methodologies should be used
• Questionnaire, focus group discussions, desk top
  study, field observation etc.
• Indicative questionnaire proposed - to guide
  country specific questionnaire development

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Problem analysis
1. Identification of constraints
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Problem analysis
2. Root cause analysis ("fish bone" analysis)
PROGRAMME GOAL
START POINT
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Identification of constraints(example)
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Identification of constraints(try-out example)
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National MVC Capacity Problem Analysis
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Situation Analysis

• Output
• Detailed profile of the major vector borne
  diseases in the country
• For countries with formal VC programs
  information on all aspects of the program is
  derived, including a prioritized list of the
  current major constraints faced and root causes
  of the constraints

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ID of Needs Opportunities for VC improvement

• Output of situation analysis used
• For countries with formal VC programs
• Establishment of boundaries and goals for a new
  and cost-effective national vector control.
• For countries with formal VC programs
• Recalibrate program objectives and operations
  to increase cost-effectiveness and facilitate
  achievement of maximum sustainable benefits
  (reducing VBD burden)

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Steps in VCNA
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Products

• Actual VCNA process
• A situation analysis report providing
• Comprehensive evaluation of the current
  vector-borne situation in the country
• Performance of the vector control program,
  constraints and causes of constraints
• A needs assessment report detailing requirement
  and opportunities for strengthening or
  establishing vector control
• A functional stakeholder forum for developing
  national consensus on VC
• Consensus on national vector control strategy and
  implementation, and partnership roles.
• A functional intersectoral arrangement for
  effective collaboration on VC

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Products

• Completion of recommended follow-up Activities
• A national strategy and plans of action for the
  implementation of cost-effective and sustainable
  IVM complimentary strategy on resource
  mobilization.