RBM partnership

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RBM partnership
Afghanistan
Rolling Back Malaria in Afghanistan
Fourth Inter-country Meeting of National Malaria
Programme Managers, Isfahan, Islamic Republic of
Iran, 25 - 28 MAY 2004
Dr Abdul Wasi Asha President, Institute of
Malaria and Parasitic Diseases Ministry of
Health, Transitional Islamic Government of
Afghanistan
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RBM partnership
Afghanistan
AFGHNISTAN- A COUNTRY UNDER RECONSTRUCTION

• The World Bank, USAID and EU contract NGOs for a
  period of 3 years to implement a Basic Package of
  Health services (BPHS) at 4 levels I.e. HP, BHC,
  CHC, DH
• The BPHS includes
• Maternal and new born Health
• Child health and immunization
• Public nutrition
• Communicable diseases (malaria and TB)
• In the meantime, MOH assumes
• Stewardship
• Policy and planning
• Administrative and financial management

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Afghanistan
RBM partnership
Malaria Endemic provinces
Afghanistan
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RBM partnership
Afghanistan
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RBM partnership
Afghanistan
Total officially reported cases 591,441
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RBM partnership
Afghanistan
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RBM partnership
Afghanistan
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2003 Progress
Early diagnosis treatment
Malaria diagnosis

• Utilization of clinical diagnosis method
  (38 of total
• reported cases are clinically diagnosed)
• Improved and expanded light microscopy
  diagnosis
• (55 of total reported cases are
  microscopically
• diagnosed)
• Supplementation of diagnostic equipment and
  supplies
• for light microscopy to all functional
  facilities
• Introduction and utilization of RDTs in
  remote facilities
• without microscopic services

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Afghanistan
RBM partnership
2003
Updating treatment guidelines

• A new National Treatment Protocols for 2003
  developed and disseminated nationwide (limited
  copies available with AFG team)
• Introduction and adoption of ACT for the first
  time

Drug resistance

• Establishment of 4 sentinel sites to monitor
  antimalarial
• drugs resistance
• Evaluated the therapeutic efficacy of AQ, SP, AQ
  SP
• (results from 2 sites to be published soon)

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2003 Progress
Vector control
Insecticide treated materials

• Development of a national ITNs strategy for
  Afghanistan
• Formation of a national steering committee to
  oversee
• ITNs issues (MOH, WHO, UNICEF, HNI, PSI
  and USAID)
• Distribution of 103,221 and re-treatment of
  42,154
• conventional nets (HNI), 25,000 permanet
  (IMC and Malteser),
• 15,000 Olysets (WHO)
• Adoption of a social mobilization strategy
  based on
• COMBI approach and development of a
  COMBI plan to
• promote appropriate usage of ITNs

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2003
Other Vector control issues

• Multipartite community based project in
  the
• eastern region (HNI, WHO, WFP, MOH, GTZ)
• Health education
• ITNs re-treatment campaigns
• Targeted implementation of highly
• subsidized ITNs
• Larviciding operations
• Gambusia fish project
• Livestock sponging
• School HE program
• Swamps ponds drainage program
• Chadar/ curtain impregnation program

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2003
Epidemics and emergency situations
Experience with epidemic response in 2003-4
No malaria outbreak reported during 2003.
Early Detection Early warning System
Development of a National Guidelines on
Falciparum Malaria Outbreak to be field-tested
during 2004 transmission season
Malaria Surveillance
Inclusion of essential malaria information in the
newly established National Health Management
Information System (HMIS), including development
of standard case definitions
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2003
Malaria in pregnancy

• Pilot study (HNI, WHO, MOH and UNICEF) to
  establish
• the effectiveness of interventions for
  the control of
• malaria in pregnancy, delivered through
  the routine health
• system in Afghanistan
• Production of a 20 minutes film on the
  beneficial use of
• ITNs during pregnancy produced for
  mobile cinema
• caravans cover 160 malarious villages

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2003
Partnership Advocacy

• Established national and regional
  communicable diseases
• taskforces
• Administrative and community mobilization
  
• (Innter-sectoral collaboration (6
  ministries) for COMBI ITNs
• campaigns)

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2003
Capacity building

• Two-month fellowship course for 12 provincial
  directors on
• malaria control program management Bandar
  Abbas, Iran
• One-month course for 6 staff from the malaria
  institute on
• epidemiology, biostatistics and
  surveillance in Agha Khan
• University, Karachi, Pakistan.
• Training of master trainers (TOTs) on the
  management of
• severe malaria for 36 Professors and senior
  physicians (Prof.
• H. Gilles)
• The first phase of TOTs for 13 laboratory
  technicians (Prof.
• Natiqpour)
• Development and printing of standardized
  learning materials
• in two local languages
• Communication-For- Behavioural-Impact (COMBI)
  training
• workshop for 6 nationals (social
  mobilization plan for the
• usage of ITNs) in WMC, Tunisia

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2003
Capacity building contd

• Yearly national training activities (workshops
  and refresher
• training courses) for 166 doctors, 43
  microscopists and 140
• CHWs
• Development of a COMBI plan for scaling-up the
  usage of ITNs
• Provision of 14 cars, 30 motorbikes and 250
  bicycles
• Functional rehabilitation of 8 regional malaria
  reference centres
• Provision of computers and teaching aids
• Financial support (APWs) for 14 key provincial
  staff

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RBM partnership
Afghanistan
Teaching/Learning material for every category
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2003
Resource Mobilization

• Submission of proposals for funding to donor
  agencies (USAID GF)
• USD 3.1 million from GF (2nd round)
• USD 500,000 from USAID

Operational research
Conducted field studies to evaluate the
therapeutic efficacy of antimalarial drugs in 4
sentinel sites (results from 2 sites to be
published soon)
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2003
Monitoring Evaluation

• Inclusion of malaria indicators in the
  Procedures Manual of
• Health Management Information System (HMIS)
  to monitor the
• progress in the BPHS. A national taskforce
  is to workout
• evaluation mechanisms
• Routine monitoring and supervision activities
  carried out by
• senior staff at the central and provincial
  levels

Other issues
Establishment of 14 provincial malaria
directorates in 14 priority provinces that
harbour more than 95 of the malaria burden in
Afghanistan
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2004 Planned activities
1- Early diagnosis treatment

• Expansion of malaria microscopy network in
  targeted areas in line
• with the BPHS
• Establishment of functioning laboratory QC system
• Establishment of a national microscope
  maintenance unit
• Expand the utilization of RDTs in emergent
  situations
• Development of training modules for community
  health workers on
• the management of uncomplicated malaria /
  febrile illness in line
• with the national treatment protocol and the
  BPHS

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2004 2- Drug resistance
Maintenance of a functional network of 4 sentinel
sites for continuous monitoring of the
susceptibility status of parasites to drugs
3- Access to treatment and Home management
Development of a national COMBI plan aiming at
improving treatment seeking behaviors
4- Insecticide treated materials
Implementation of a plan to scale-up the usage of
ITNs in the northeast
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2004 5- Monitoring insecticide resistance
Establishment of entomology unit to be part of
the regional network for the monitoring of
insecticide resistance in at least one highly
endemic province and Entomological surveys and
insecticide resistance studies
6- Other Vector control issues

• Develop a national strategy for IVM
• Continue and expand evidence-based CBMCP

7- Epidemic preparedness and response
Establishment of EPR units in 14 priority
provinces
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2004
8- Malaria Surveillance

• Collection and analysis of epidemiological
  information from all
• health centers
• Utilization of GIS (eg Health Mapper)
• Mapping of malaria risk areas

9- Malaria in pregnancy

• Presentation of the 2003 study results and
  recommendations to
• MOH and other stakeholders for future work
• Continue showing the malaria film in malarious
  areas through
• mobile cinema and local TV

10- Partnership Advocacy

• Continue mobilize institutional, public and
  private sector
• partnership for malaria control
• Development of a multi-year strategic plan for
  Afghanistan

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2004
11- Capacity building

• Fellowships and study tours for key national
  staff
• 2nd phase of TOT for lab technicians
• Yearly national training activities

12- Operational research

• Continue monitoring the therapeutic efficacy
  of different
• antimalarial drugs in the 4 sentinel sites
• Consultancy to conduct a field study on
  treatment seeking
• behaviors

13- Monitoring Evaluation
Review of the early implementation of the
HMIS and develop monitoring and evaluation
mechanisms
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2004
Resource Mobilization

• A proposal of USD 10.6 million submitted to the
  4th round of the Global Fund
• A proposal of USD 500,000 submitted to USAID for
  the construction of the malaria institute

14- Other issues
Complete the restructuring of the program at the
national and sub-national levels as part of the
ongoing reconstruction of Afghanistan's health
sector process
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RBM partnership
Afghanistan
Thank you