Transcript Document

Roll Back Malaria and Cutaneous
Leishmaniasis Control Program for
Afghanistan
Inter-country Workshop on Scaling-up
ITN Implementation for Control of Malaria
and other Vector-Borne Diseases in
Countries of EMR
Abha, Kingdom of Saudi Arabia
18-20 October, 2003
Dr Abdul Wasi Asha
President, Institute of Malaria and Parasitic Diseases
Ministry of Health, Transitional Islamic Government of Afghanistan
Afghanistan’ ITNs Strategy
(2004-2008)
Challenges
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Delays in establishing the proposed primary health care system. 65% of
the population have limited or no access to formal health care
Logistic barriers including limited road access to many parts of the
country
Confusion over the integration of a historically vertical programme into
community-based and district health care services
Bias towards curative care delivery by health services and decision
makers
Health services are supported by a multitude of partners, creating
occasional difficulties for coordinated approaches
Low incentives for government staff forcing competent staff to
supplement their income through private practice or seek employment in
the private, NGO or UN sectors where income is higher
Limited mobility of women (as health workers, household decision
makers, and patients)
Challenges
(cont’d)
• Limited data for planning and monitoring purposes (the national
Health Information System has not operated since 2001)
• Limited knowledge and understanding of malaria among some
sections of the population (including some health workers)
• Low purchasing power among some population groups with
regard to ITNs
• Absence of private sector participation to expand ITN sales
• Ongoing insecurity and political instability in some areas.
• Ongoing population and health worker preference for indoor
residual house spraying and other chemical methods of vector
control other than ITNs for malaria prevention.
• Scale of input (material, financial and technical) to achieve
coverage is large.
Afghanistan’ ITNs Strategy
(2004-2008)
Assumptions:
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That security in Afghanistan will steadily improve, and that
political stability will be attained.
That there will be continued external support to Afghanistan
over the next 5 years. Support includes material, financial and
technical and comes from a variety of sources including
bilateral donors, multilateral agencies and international
NGOs.
That supply of WHOPES approved LLINs will meet the global
demand by the end of 2003
Afghanistan’ ITNs Strategy
(2004-2008)
VISION:
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At least 60% of the target population in Afghanistan sleep
under insecticide-treated nets during the transmission
season by the end of 2008, resulting in reduction of malaria
and anthroponotic cutaneous leishmaniasis transmission.
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In urban areas, the majority of the target population will
purchase ITNs and home treatment kits from the
unsubsidized commercial market, and vulnerable groups will
obtain subsidized ITNs and home treatment kits from the
public sector and NGOs.
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In rural areas ITNs be promoted and distributed using
community mobilisation strategies, closely linked to the
implementation of community-oriented primary health care
system. ITNs will be made available to all affected members
without attempt at full cost recovery, and distribution should
be highly subsidised or free of charge where appropriate.
Afghanistan’ ITNs Strategy
(2004-2008)
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External support including donor funding will be sought to assist in
achieving coverage amongst vulnerable and rural communities, as
well as pump-priming the private sector.
Recognizing the country’s current weak health infrastructure, the
implementation of this strategy at the grass-root level will depend to
a large extent on the NGO’s network through an established National
Steering Committee (Chaired by the MOH) as well as the
mobilisation of the local community. As the health infrastructure and
security improves, attempts will also be made to strengthen the
capability of the public sector (MOH) to play a leading role especially
in providing a conducive environment and in addressing issues of
equity.
Afghanistan’ ITNs Strategy
(2004-2008)
GOAL:
Contribute to the reduction of malaria and
anthroponotic cutaneous leishmaniasis disease
burden in Afghanistan
STRATEGIC OBJECTIVES:
Increased use of ITNs by all household members in targeted
areas endemic for malaria and anthroponotic cutaneous
leishmaniasis
Afghanistan’ ITNs Strategy
(2004-2008)
PRODUCTS and ACTIVITIES
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Outcome 1: 60% of target population will be protected by ITNs
through adoption and implementation of effective strategies by the
end of 2008
• Mechanisms for identifying target population are developed.
• Public/private, private/private partnerships are built.
• ITN distribution systems and mechanisms are established.
• ITN promotion plan is developed, using communication for
behavioural impact (COMBI) methodology.
• Models and guidelines for targeting subsidies are established.
• Procurement strategies are developed.
Afghanistan’ ITNs Strategy
(2004-2008)
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Outcome 2: 80% of nets used by target populations are effectively
treated with insecticides by the end of 2008
• Initial treatment is ensured.
• Accessible and functional treatment / retreatment centres are
established.
• Treatment and re-treatment promotion plan using COMBI
methodology is developed.
• Distribution mechanisms/systems for free insecticides are
developed.
• Distribution mechanisms/systems for individual use
(treatment kits using social marketing or private marketing)
are developed.
Afghanistan’ ITNs Strategy
(2004-2008)
The Partnership Development Process
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Establishing a National Steering Committee for ITN implementation:
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Chair: MOH
Members: HNI, UNICEF, WHO, PSI, USAID
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Invited members: Ministry of Education, Ministry of Information, Chamber of commerce,
Ministry of Finance, Ministry of Agriculture, Provincial MOH representative (1).
Terms of reference
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Identify target population
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Coordinate ITN programming and implementation
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Create strong political support
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Advocate for resource mobilisation and soliciting human and financial resources
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Lobby for the removal of tax and tariff barriers
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Coordinating ITN promotion
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Plan mechanisms for targeting subsidies
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Monitor and evaluate implementation for continuous improvement
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Set priorities for operational research
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Establish a network of provincial coordinating committees
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Develop detailed yearly implementation plans specifying targets, indicators, and partners
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Present recommendations and progress reports to Country Coordinating Mechanism for GFATM
Afghanistan’ ITNs Strategy
(2004-2008)
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Establishing or reinvigorating the provincial coordination mechanisms
The National Steering Committee should ensure the establishment of
the provincial coordination mechanisms
Provincial coordinating mechanisms should build on existing
coordination mechanisms where possible, such as sub-national CCMs
of the GFATM, health coordination committees, and malaria
working groups
Provincial coordinating mechanisms should be inclusive of all
partners working or potentially working in malaria control,
including for example WV, IMC, Malteser, Merlin, SCA, MSF, Ibn
Sina, AMI, Mercy corps
Afghanistan’ ITNs Strategy
(2004-2008)
• Partners:
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Alongside the MOH, UN agencies and HNI, a further 22
partners have been, are, or will be involved in
implementation of ITNs in Afghanistan:
Swedish Committee of Afghanistan (SCA); Hewad; QLC;
ORA; MCI; ISRA; Ibne Sina; IAHC; Aryan; Habitat;
DAC; ATA; ARCS; AMI; AHDS; TODAI Japan; World
Vision; Save the Children – US; Merlin; Malteser; and
Population Services International (PSI).
Afghanistan’ ITNs Strategy
(2004-2008)
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Roles of
a. Public sector
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the partners:
Create enabling environment for all partners
Mobilise resources
Promote generic demand through use of a variety of approaches and
channels
Coordinate and chair the ITN steering committee and the
involvement of partners in scaling-up coverage
Agenda-setting for operational research, through the steering
committee
Set standards and norms for ITNs and insecticides, monitor and
regulate their quality
Ensure equitable distribution and access to ITNs
Coordinate, through the IEC department of the MOH, an effective
national social mobilisation and communications for behavioural
change programme to ensure correct utilisation and monitor usage
of ITNs
With partners, monitor and evaluate efforts to scale up effective ITN
coverage
Afghanistan’ ITNs Strategy
(2004-2008)
b. Private sector
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Create awareness and demand for branded net and
insecticide products
Improve product image and acceptability through consumer
research
Surveillance and monitoring of the commercial market
Supply, in a sustainable manner, ITNs and insecticides for net
re-treatment
Equitable distribution of ITNs, including through targeted
subsidies for those most vulnerable to malaria in accordance
with the National Steering Committee recommendations
Execution of social marketing schemes to generate demand
for generic net and insecticide products
With partners, monitor and evaluate efforts to scale-up
effective ITN coverage
Afghanistan’ ITNs Strategy
(2004-2008)
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c. Non-governmental Organizations (NGOs)
and civil society
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Equitable distribution of ITNs, including through targeted
subsidies for those most vulnerable to malaria in accordance
with the National Steering Committee recommendations
Execution of social marketing schemes to generate demand
for branded net and insecticide products
With partners, execute a programme of communication for
behavioural impact for correct usage of ITNs
With partners, monitor and evaluate efforts to scale up
effective ITN coverage
Conduct of operational research in line with priorities set by
the National Steering Committee
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Afghanistan’ ITNs Strategy
(2004-2008)
d. Multi-lateral agencies and donors
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Provision of technical support for development of guidelines
and standards
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Advocacy for prioritisation of ITN programmes for the
prevention of malaria and other vector-borne diseases within
the health sector
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Resource mobilisation
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Capacity building of MOH
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Advocate, internationally, for the removal of taxes
Afghanistan’ ITNs Strategy
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Operational research.
To ensure the evidence base of the ITN strategy, several areas are
identified for operational research:
Consumer preference studies.
Polyethylene Olyset® net effectiveness in preventing anthroponotic
cutaneous leishmaniasis (ACL).
Epidemiological impact evaluation.
Cost-effectiveness of ITN programme implementation.
Socio-economic burden of malaria..
Level of ITN coverage needed to achieve public health impact.
Market surveys.
Update of important vectors of malaria.
Health worker and household case management
Afghanistan’ ITNs Strategy
(2004-2008)
THANK YOU