Local and International Malaria Control Programmes (past and present)

Local and International Malaria Control Programmes (past and present)

Outline

  • Background
  • Local Malaria  Control Programmes
  • International Malaria Control Programmes 

 

BACKGROUND

Today, half of the world’s population still live in endemic areas and are at risk of contracting the disease, in 2012 alone Malaria caused 627,000 deaths. While this number is much too high, a steady growth in control programmes and initiatives including the introduction of LLIN (long lasting Insecticidal nets) and the widespread adoption of the highly effective artemisine-based combination therapies (ACT)  has led to a great improvement on the situation of only a decade ago and, correspondingly, renewed levels of optimism that the disease can be beaten. 

 

The question remains, however as to how these programmes can collaborate most effectively to save more lives, not only from malaria and its effects, but from other causes too.

 

Malaria is a major public health problem in Nigeria, its endemic throughout the country with more than 90% of the total population at risk of stable endemic malaria (Netmark,2001). The Sahel regions and the high mountain area of the Plateau  experience slightly  lower rates of transmission. At least 50% of the population suffer from at least one episode of malaria each year(FMOH and NMCP,2009).

 

Malaria currently  accounts for nearly 110 million clinically diagnosed cases per year. An estimated 300,000 children die of malaria each year, and 11% of maternal related mortality  is related to Malaria in pregnant women. 

 

Malaria constitutes a major economic burden on endemic communities in Africa including Nigeria. In Nigeria, about 132 billion naira is lost to Malaria annually in the form of treatments costs, loss of work time.(FMOH and NMCP,2009)  Malaria is an important health and development challenge in Africa, where pregnant women and young children are most at risk. Each approximately 800,000 children die from Malaria.

 

Malaria in pregnancy contributes to a vicious cycle of ill-health in Africa, causing babies to be born with low birth weight (lbw),which increases the risk of newborn and infant deaths. As effective interventions exist to break this cycle, like insecticide treated bed nets (ITN) and intermittent preventive treatment of Malaria during pregnancy (iptp). In recent years, increased attention to and funding for Malaria control has resulted in a significant improvement in the coverage of Malaria interventions, particularly for children.  

 

LOCAL MALARIA CONTROL PROGRAMMES- NIGERIA (PAST AND PRESENTS)

  • Coordination of all malaria activities in Nigeria is the responsibility of the National Malaria Elimination programme(NMEP) with oversight function from the federal ministry of health .The state Malaria programmes provide leadership for state level coordination with support from NMEP while coordinating at the community and local levels is the responsibility of the primary health care department of the local government area.
  • The NMEP is mandated to formulate and facilitate policy and guidelines ,coordinate activities of partners and other stakeholder on Malaria control activities ,provide technical support to implementing bodies including state LGA’s and stakeholders,  mobilize resources, monitor and evaluate progress and outcomes in Malaria control effort .In order to fulfill its role NMEP is organize intro seven branches with other supporting unit and entities that provide financial ,technical and human resource support as maybe required.  

 

National Malaria Elimination Programme (NMEP) 

Goal; 

  • To reduce the Malaria burden to pre- elimination levels and bring malaria related mortality to zero. 

 

Vision ;

  • Malaria free Nigeria 

 

Mission;

  • Provide equitable ,comprehensive, cost-effective, efficient and quality malaria control services  ensuring transparency , accountability, client satisfaction , community ownership and partnership.  

 

NMEP OBJECTIVES

  • At least 80% of the targeted population utilizes appropriate preventive measures by 2020. To test all care seeking persons with suspected Malaria using RDT or microscopy by 2020.  T
  • To treat all individuals with confirmed Malaria seen in private and public facilities with effective anti-malaria drug by 2020.
  • To provide adequate information to all Nigerians such that at least 80% of the populace habitually takes appropriate malaria preventive and treatment measures as necessary  by 2020.
  • To ensure the time availability of appropriate anti malaria medicines and commodities required for prevention and treatment of Malaria in Nigeria wherever they’re needed by 2018.
  • At least 80% of health facilities in all LGA’s report routinely on malaria by 2020, progress is measured and evidence is used for programme development.
  • To strengthen governance and coordination of all stakeholders for effective program implementation towards an ‘A’ rating by 2017 sustained through 2020 on a standardized scorecard.  

 

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Roll back Malaria (Nigeria)

The Roll back Malaria(RBM) was founded in November, 1998 to mobilize resources and action against Malaria globally .Following the meeting of the African heads of state in Abuja on april,2001 and the pledge to halve Malaria burden in Africa by 2010 (Abuja declaration).  The RBM partners in Nigeria has provided significant financial resources, commodities and technical assistance in the national Malaria control program.  The RBM partners has supported Nigeria to develop fundable proposal and secure significant funding from global funds for AIDS , Tuberculosis and Malaria(GFATM),world bank, Presidential Malaria Initiative  (PMI-USAID),etc..  

 

NATIONAL MALARIA STRATEGIC PLAN (A STRATEGIC PLAN TO ROLL BACK MALARIA)

A national Malaria situation analysis was conducted  in 2000, following series of meetings at national and zonal levels ,the FMOH produced a ‘strategic plan for rolling back Malaria  in Nigeria (2001-2005).This strategy was updated for the period of (2006-2009). 

 

GOAL; 

  • To reduce 50% Malaria related morbidity and mortality in Nigeria by 2010 and minimize socio economic impact of the disease.

 

VISION; 

  • Malaria free Nigeria. 

 

ROLL BACK MALARIA  (2009-2013)  

Objectives; 

  • To nationally scale up for impact (SUFI) a package which include appropriate measures to promote positive behavior change, prevention and treatment of malaria.
  • To sustain and consolidate these efforts in the context of a strengthened health system and create the basis for the future elimination of Malaria in the country.   

 

CORE INTERVENTIONS 

  • Prevention of Malaria transmission through IVM strategy, universal access and use of LLINs,selective use of Indoor Residual Spraying(IRS) and reducing breeding sites.
  • Prompt diagnosis and adequate treatment of clinical cases at all levels and in all sectors of health care. 
  • Prevention and treatment of Malaria in pregnancy (IVM,early recognition and treatment ,IPT all embedded with focused Ante-Natal care(FANC). 

 

MALARIA ACTION PROGRAM FOR STATES (MAPS) (NIGERIA)

  • MAPs was a comprehensive five year malaria program to improve Malaria control in Nigeria, the USAID  focuses on improving primary health care  services and management by filling gaps  in capacity, building on institutional strengths  and improving  each household’s ability to protect and promote its own health .Maps currently covers the Nigerian states of Benue, Cross river , Ebonyi, Kogi ,Nasarawa,Oyo,Zamfara , Akwa ibom and Kebbi.
  • The consortium was led by FHI 360 in partnership with health partners international (HPI) and Malaria consortium.
  • The main aim of the program was to increase coverage and use of  life saving malaria interventions in support of the Nigeria National Malaria Strategic plan and NMEP  

 

MAPS

  • The main outputs  of the program focus on pregnant women and children under 5 years of age and includes; 
  • Supporting the scale up of proven Malaria interventions including   
  • Attaining and maintaining a high level of insecticide treated bed nets.  
  • Improving malaria case management at facility and community level.  
  • Expanding use of diagnosis. 
  • Providing consistent delivery of intermittent preventive treatment to pregnant women.   
  • Strengthening the management capacity of the State Ministry Of Health and LGA health personnel to provide oversight of malaria interventions  

 

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Support to the National Malaria programme (sunmap2)

  • SuNMap 2 is a UKAID-funded program that worked with NMEP to harmonize donors efforts and funding agencies .
  • SuNMap has improved national, state ,local government level capacity for policy development ,planning and coordination , in addition to improve population coverage of effective measures for the prevention of Malaria and access of the population to effective treatment for Malaria follow-up. It  support government efforts to further reduce Nigeria’s malaria burden. 
  • From 2008 to 2016, Malaria consortium delivered the UKAID-funded support to the national malaria programme in Nigeria (SuNMap). This programme focused on scaling up Malaria programme interventions in an effort to achieve universal coverage of antimalarial commodities and services for the prevention and treatment of Malaria. Between 2010 and 2015, national Malaria prevalence among children aged six to 59 months decreased from 42 to 27 percent, reaching an average of 21 percent in SuNMap supported states. 
  • SuNMap 2 is a performance-based programme, with robust monitoring, evaluation, accountability and learning components. It aims to improve the planning, financing and delivery of sustainable Malaria programmed across 165 local government areas in six states of Nigeria: Jigawa, Kaduna, Kano, Katsina, Lagos, and Yobe.  

 

Objectives 

This programme aims to:  

  • Reduce Nigeria's all-cause under five mortality rate from 128 per 1,000 live births in 2013 to 85 per 1,000 live births by 2022 
  • Reduce the proportion of children aged six to 59 months that are infected with malaria parasites from 27 percent in 2015 to 16 percent by 2020. 

 

To achieve this it will: 

  • Strengthen national and state government stewardship and increase the proportion of total annual Malaria expenditure that comes from domestic sources 
  • Increases the availability of antimalarial commodities, so that 70 percent of the population has access to and sleeps under an insecticide treated net  
  • Contribute to more efficient and equitable malaria prevention and treatment service delivery, so that: 
    • 70 percent of eligible children receive seasonal malaria chemoprevention .
    • 40 percent of febrile children aged six to 59 months receive a diagnostic test. 
    • 50 percent of children under five that have been treated for Malaria receive artemisinin-based combination therapy
  • Ensure that citizens and institutions are informed of Malaria prevention and treatment services and all other programme interventions 
  • Embed an evidence-based learning environment in the national Malaria elimination programme and state malaria elimination programme. 

 

GLOBAL MALARIA PROGRAMMES(gmp)(2016-2030)

  • The WHO Global Malaria programme (GMP) is responsible for coordinating who's global efforts to control and eliminate malaria. Our work is guided by the Global Technical Strategy for Malaria 2016–2030 (GTS) adopted by the world health assembly in may 2015. 
  • Beginning in 2010, the Global Malaria Programme initiated an extensive review of WHO’s policy-making process for Malaria control and elimination. The aim was to establish a more rigorous, efficient, and transparent process that would allow for timely responses to the ongoing challenges faced by national Malaria programmes. 

 

Following the recommendation of an external advisory group, the Malaria Policy Advisory Committee (MPAC) was established in 2011 to provide independent advice to WHO on all policy areas relating to malaria control and elimination.

  • In the 2014–2015 biennium, the MPAC guided the development of the global technical strategy for malaria 2016–2030 and provided strategic advice on a range of technical issues, from recommendations on the use of mass drug administration to the risks associated with vector-control scale back. 
  • The global Malaria programme works closely with all major partners in the global Malaria community with endemic country governments and regulatory authorities, united nations agencies, inter-governmental organizations, private-public partnerships and campaign groups. The department also participates in all major inter-agency task forces, and in multi-partner and multi sectorial initiatives on malaria. 
  • The global technical strategy provides a technical framework for all Malaria-endemic countries working towards malaria control and elimination. It sets ambitious but attainable global targets for 2030, including:
  • Reducing Malaria case incidence by at least 90%
  • Reducing Malaria mortality rates by at least 90%
  • Eliminating Malaria in at least 35 countries
  • Preventing a resurgence of malaria in all countries that are malaria-free
  • The timeline of 2016–2030 is aligned with the 2030 agenda for sustainable development, endorsed in 2015 by all united nations member states.
  • The WHO global Malaria programme is committed to supporting member states to achieve the global technical strategy targets through:
  • Setting and disseminating global guidance and policies on Malaria control and elimination;
  • Supporting countries as they adapt, adopt and implement WHO global norms and standards for Malaria control and elimination;
  • Assisting countries as they formulate national Malaria strategic plans;
  • Helping countries develop robust Malaria surveillance systems;
  • Responding to requests from countries to address biological and operational emergencies and bottleneck issues.
  • As part of its core mandate, the global Malaria programme keeps independent score of global progress in the fight against Malaria. Its flagship annual publication, the world Malaria report, contains the latest available data on the impact of Malaria interventions around the world. 

 

PRESIDENT MALARIA INITIATIVE (PMI)

The PMI is a U.S government initiative designed to drastically reduce Malaria deaths and illnesses  in target countries in sub – Saharan African with a long term vision of a world without Malaria. 

The initiative was announced on June30,2005 when President Bush pledged to increase U.S funding of Malaria prevention and treatment in sub Saharan Africa by more than $1.2 billion over 5 years(2006-2010).

 

PMI developed a strategy to achieve Africa wide impact by halving the burden of Malaria in 70% of at risk populations in sub Saharan Africa, or approximately 450 million people. The strategy was updated (2015-2020). 

 

PMI  objectives   

The updated strategy sets out to meet the following three objectives by 2020; 

 

Reduce Malaria mortality by one third from 2015 levels in PMI supported countries , achieving a greater that 80% reduction from PMI original 2000 baseline levels. 

 

Reduce Malaria morbidity in PMI supported countries by 40% from 20154 levels.

 

Assist at least five PMI supported countries to meet WHO criteria for national or sub national pre-elimination.  

 

PMI focus

To achieve these objectives,PMI emphasizes five areas of strategic focus:

  • Achieving and sustaining scale of proven interventions
  • Adapting to changing epidemiology and incorporating new tools
  • Improving countries’ capacity to collect and use information
  • Mitigating risk against the current Malaria control gains
  • Building capacity and health systems 

 

PMI INTERVENTIONS

PMI works to scale up access to and use of key proven intervention: 

  • Long lasting insecticide treated nets.
  • Case management including appropriate use of diagnostic tools and acts
  • Intermittent preventive treatment for pregnant women
  • Indoor residual spraying with approved insecticide, where appropriate
  • Seasonal malaria chemo-prevention,where appropriate       

 

REFERENCES

  • National population commission, national malaria control programme, and ICF international. Malaria indicator survey 2010. Abuja, Nigeria: NPC, NMCP, and ICF international; 2012. Available from: here
  • National malaria elimination programme, national population commission, national bureau of statistics, and ICF international. Nigeria malaria indicator survey 2015: key indicators. Abuja, Nigeria, and Rockville, Maryland, USA: NMEP, npopc, and ICF international; 2016. Available from: here
  • World health organization. World malaria report. Geneva: world health organization; 2018. Available from: here
  • National population commission and ICF international. Nigeria demographic and health survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF international; 2014. Available from: here
  • A road map for malaria control in Nigeria, abridged version; Federal Ministry Of Health ,National Malaria Control Programme Strategic Plan;2009-2013.
  • Draft internal report to NMCP –data collection and synthesis for NMCP; AKINTOLA Oluseyi Abiodun;march2010.
  • Report of Malaria communication harmonization stakeholders [to NMCP and SuNMap];John Dada and Kirsten Bose; Nov. 2009.

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