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RBM Progress 2002

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RBM Progress 2002 Powered By Docstoc
					          RBM in EMR
          Achievements and
          challenges
          Dr. Hoda Atta



WHO EMRO, Dr Hoda Atta , RBM, May 2004
             RBM EMR programme

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


WHO EMRO, Dr Hoda Atta , RBM, May 2004
 RBM STAFF AT EMRO AND COUNTRIES



                                   VC                                       RA                                       STP

                                                                       Countries




           Sudan                           Somalia                          Pakistan                   Afghanistan                    Yemen



RBM coordinator, STP ( North)       Medical officer , STP         1 national focal point ( SSA)   technical officer ( STP)   Malariologist ( YEMEN RB)



 Medical offcer, STP (south)    4 National focal points ( SSAs)                                                                 Entomologist (STP)




                                                                                                     Saudi Arabia
                                                                                                        STC


           •Extend support to DJI
           • strengthen it in PAK
 WHO EMRO, Dr Hoda Atta , RBM, May 2004
    Foster inter-country action and
    interregional cooperation
Expected results

    1.       RBM partnership at regional level is maintained and advocacy is
             fostered and resources are mobilized
    2.       technical standards developed and monitoring systems
             established
    3.       The human capacities for planning and implementing RBM
             programme are strengthened
    4.       Integrated vector control measures for malaria prevention are
             introduced
    5.       Field applied research for evidence based decisions conducted
    6.       Malaria programmes are revised, needs assessed and anti-
             malaria programmes along the border areas are coordinated
WHO EMRO, Dr Hoda Atta , RBM, May 2004
              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)
WHO EMRO, Dr Hoda Atta , RBM, May 2004
                  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

WHO EMRO, Dr Hoda Atta , RBM, May 2004
              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


WHO EMRO, Dr Hoda Atta , RBM, May 2004
             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 M&E

WHO EMRO, Dr Hoda Atta , RBM, May 2004
                Global Fund- malaria
  2nd round                Principal Recipient                Funds US $

                                                   1st year           Total

  Afghanistan              WHO Afghanistan        3.125.605            3.125.605
                                                                      (1.5 years)
  Pakistan                 National Programme     2.317.300            7.720.500
                                                                        (4 years)
  Somalia                  UNICEF Somalia         4.682.031           12.886.413
                                                                         3 years)
  Sudan                    UNDP??                 7.046.156           33.240.453
  (north)                                                               (5 years)
  Sudan                    UNDP ??                6.692.166           27.827.045
  (south)                                                               (5 years)

  Yemen                    MOH Yemen                830.667           11.878.206
                                                                        (5 years)
3rd round
Pakistan                   MOH                   1.548.636             2years
WHO EMRO, Dr Hoda Atta , RBM, May 2004
 Technical documents
 In process

 Guidelines for establishing a
 system for quality assurance of
 malaria laboratory diagnosis
 ( DRAFT AVAIABLE FORCOMMENTS)



 Protocol for monitoring insecticide
 resistance
WHO EMRO, Dr Hoda Atta , RBM, May 2004
                  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 )


WHO EMRO, Dr Hoda Atta , RBM, May 2004
               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
             M&E workshop including Malaria surveillance , Epidemic early
              detection
             GIS workshop in Arabic ( YEM, SYR, IRAQ, …others )




WHO EMRO, Dr Hoda Atta , RBM, May 2004
              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)
WHO EMRO, Dr Hoda Atta , RBM, May 2004
             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

WHO EMRO, Dr Hoda Atta , RBM, May 2004
     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
WHO EMRO, Dr Hoda Atta , RBM, May 2004
            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)

WHO EMRO, Dr Hoda Atta , RBM, May 2004
             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 )

WHO EMRO, Dr Hoda Atta , RBM, May 2004
   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



WHO EMRO, Dr Hoda Atta , RBM, May 2004
                            Sentinel sites for monitoring
                              drug efficacy in Yemen
  Bajil
ACPR: 58%
       Sa'dah




                                                                 h
                                                        t




                                                              hra
                                                     ou
                                  Al Jawf




                                                    m




                                                            Ma
                  Amran




                                                 dra
             Hajjah




                                                            Al
                                                Ha
                       da




                     Capital Ma'rib
                    day




                    Sana'a
                      Dhamar        Shabwah
                   u
               Al H




                           Al Bayda
                       Ibb                                           N
                        Al Dala
                  Ta'izz          Abyan
                          Lahj



       Al Odein                             W.Al Mesemeer
      ACPR: 61%                              ACPR: 43%,
                      400                    0            400 Kilometers
 WHO EMRO, Dr Hoda Atta , RBM, May 2004
        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%)
WHO EMRO, Dr Hoda Atta , RBM, May 2004
              Therapeutic efficacy of SP in Jamame,
              Jowhar, and Janale sites in SCZ of Somalia

   Responses to SP treatment             Study sites
                                         Jamame        Jowhar       Janale
                                         (n=48) (%)    (n=49) (%)   (n=51) (%)
   Early Treatment Failure (ETF)         8 (16.7%)     1 (2.0%)     3 (5.9%)

   Late Clinical Failure (LCF)           0 (0%)        1 (2.0%)     0 (0%)

   Late Parasitological Failure          8 (16.7%)     4 (8.2%)     1 (2%)
   (LPF)
   Adequate Clinical and                 18 (37.5%)    43 (87.8%)   47 (92%)
   Parasitological Response
   (ACPR)
   LCF/LPF                               5 (10.4%)     ------       -----

   Not Classifiable                      9 (18.7%)     ------       ------

WHO EMRO, Dr Hoda Atta , RBM, May 2004
                  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

WHO EMRO, Dr Hoda Atta , RBM, May 2004
              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
WHO EMRO, Dr Hoda Atta , RBM, May 2004
            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
WHO EMRO, Dr Hoda Atta , RBM, May 2004
      Epidemiological situation




WHO EMRO, Dr Hoda Atta , RBM, May 2004
                      Group 1 – Malaria eliminated
   Lebanon (1963)*
   Palestine (~1965)
   Jordan (1970)
   Qatar (~1970)
   Libya (1973)*
   Bahrain (1979)
   Tunisia (1979)    9 countries, 7% of the
   Kuwait                 population
   UAE
                                                   Im ported m alaria cas es


                    2000

                    1000

                           0
                                 Bahr        Jord    Kuw Leba Libya Pale Qata        Tuni   Unite

                     2003          87        163     229    62    16      1    138    30    1796
    WHO EMRO, Dr Hoda Atta , RBM, May 2004
             Imported cases in last 5 years
             in malaria free countries
  Countries                     1999           2000       2001      2002     2003
  Bahrain                        82             58         54       45        87
  Jordan                                 133     158      124       159      163
  Kuwait                                 349     249      233                229
  Lebanon                                49       44       40        59       62
  Libya                                  23      131        na      16         na
  Palestine                               2           3     2        1         1
  Qatar                                  243     140       114      138        na
  Tunisia                                32       47       30        na        na
  UAE                                    41       27       35        36      1796


WHO EMRO, Dr Hoda Atta , RBM, May 2004                UAE changed reporting in 2003
     Group 2 - Malaria under
     elimination

          Egypt
          Morocco
          Oman
          Syria   24% of the population

                              1000


                                500


                                     0
                                         Morocco   Egypt   Om an   Syria

               total                       71       10      740     24
               Autochthonous                4       0        6      2

WHO EMRO, Dr Hoda Atta , RBM, May 2004
                Cases in group 2 in last 5 years


Countries   Cases in 1999        Cases in 2000        Cases in 2001     Cases in 2002   Cases in 2003
        Total      Autochtho Total      Autochtho Total      Autochtho Total Autochtho total Autochtho
                      nous                 nous                 nous              nous            nous
Morocco     60         17        59          3        59          0     104        19   71          4
Egypt       61          0        17          0        11          0     10          0   na         na
Oman       901         30       694          6       635         2@     590 6@          740        6@
Syria       43          5        42          6        63         47     27         15   24          2

              @introduced cases
            all cases are confirmed
  WHO EMRO, Dr Hoda Atta , RBM, May 2004
              Group 3 – Low/Moderate
              endemicity
                                 Confirmed malaria cases only


                      Cases in 2001               Cases in 2002    Cases in 2003
                 Total              Autocht     Total    Autocht   total   Autocht
                                    honous               honous            honous
Saudi     3074                           1614   2612       1226    1724     700
Arabia
Iraq      1120                           most     952      most     316     most
Iran     19 274                          most    15558     9122    23562   16637
Pakistan 79 437                          most   101761     most      na      na
WHO EMRO, Dr Hoda Atta , RBM, May 2004
                                               Iran
     50,000

     40,000                       38,684
                                           32,951
     30,000
                                                    23,110
     20,000
                                                         13,419            16637
                                                                    9122
     10,000
                                                           12,294
                  0
                           1997 1998 1999 2000 2001 2002 2003

           Significant increase in malaria cases in 2003
           Cooperation with PAK, AFG is not functional
WHO EMRO, Dr Hoda Atta , RBM, May 2004
                                       Iraq

  16,000

  14,000            13,959

  12,000

  10,000                    9,684

    8,000

    6,000

    4,000                           4,134

    2,000                                     1,154
                                                             952
           0                                      1,120             316
                 1997   1998    1999     2000    2001     2002     2003




                     Coordination with the northern GOVs
                      Epidemic preparedness are priority
WHO EMRO, Dr Hoda Atta , RBM, May 2004
                                             Data from routine surveillance only ,
                                             Specific Surveys introduced in 2003
                                               Saudi Arabia
     35,000
                                             31,907
     30,000
     25,000
     20,000
                                    17,692
     15,000
     10,000                                           10,099
        5,000                                                  4,736
                   0                                              1,614        1226       700
                                1        1        1        2           2   2          2
                                9        9        9        0           0   0          0
                                9        9        9        0           0   0          0
                                7        8        9        0           1   2          3
WHO EMRO, Dr Hoda Atta , RBM, May 2004
                  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




                                           Fever            Ratio TSE:fever   SPR
                                          cases*    TSE**            cases    PCD
       Punjab                            1085455   360505             33%     3%

       Sindh                             1771579   311211             18%     4%

       Balochistan                        646931    99056             15%     10%

       NWFP                               639183   137404             21%     17%

       TOTAL***                          4505966   1E+06              24%     7%


WHO EMRO, Dr Hoda Atta , RBM, May 2004
                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

WHO EMRO, Dr Hoda Atta , RBM, May 2004
              Group 4 – With intense malaria
              transmission (chronic, complex
              emergencies)

              16% of population
             95% of the cases
   Afghanistan
   Djibouti
   Yemen
              Countries                  Year   Total Cases    Cases       Cases
   Sudan
   Somalia                                      reported     confirmed   estimated
                  Afghanistan            2003     511,654      348,158    2 500 000
                  Djibouti               2001      4,312        4,312      80 000
                  Somalia                2002     15,772        1,851     2 000 000
                  Sudan                  2002    3,587,132    1,434,853   7 500 000
                  Yemen                  2002     172,482      68,122     3 000 000
WHO EMRO, Dr Hoda Atta , RBM, May 2004
      Summary of the regional plan
      for 2004-5




WHO EMRO, Dr Hoda Atta , RBM, May 2004
  Summary Of RBM Regional Extra-Budgetary Plan of Action 2004-5
                                             ACTIVITY                                              FUNDS


          Staff                                                                                 $1,576,000


           ER1 Product 1         Ensure sufficient human and institutional capacity at EMRO            726,000
                                 and

           ER1 Product 2         Sufficient human capacity in priority countries: Sudan,               850,000
                                 Somalia, Yemen, Djibouti, Afghanistan, Pakistan


          Country support                                                                       $ 2, 590, 000

           ER1 Product 3         Support countries to scale up actions to roll back malaria         2, 550, 000
                                 including selected interventions, policy development,
                                 management and delivery systems, capacity strengthening

           ER2 Product 1         Support ccommunity based management of malaria in                      40, 000
                                 endemic and introduce COMBI planning methodology


          Advocacy, partnership, resource                                                       $ 100,000

          mobilization
           ER4 Product 1         RBM partnership at regional level is maintained, advocacy is          100,000
                                 fostered and resources mobilized

WHO EMRO, Dr Hoda Atta , RBM, May 2004
  Summary Of RBM Regional Extra-Budgetary Plan of Action 2004-5

       Technical standard, technical support and                                     $340,000
       establishing monitoring systems
       ER3 Product 1         The National capacity to detect, monitor and respond         70,000
                             to anti-infective drug resistance is strengthened

       ER3 Product 2         The epidemiological situation and the Global and             70,000
                             Regional indicators are monitored

       ER3 Product 3         Insecticide resistance monitoring and management             20,000
                             strengthened and Pesticide management practices
                             strengthened
     ER 5 Product 1         Regional strategies and policies are updated and               20,000
                            formulation of MTAG
     ER5 Product 2          Increase technical capacity for epidemic preparedness          30,000
                            and response
     ER5 Product 3          WHO policies on certification of interruption of              50,000
                            malaria transmission are agreed upon and guidelines
                            developed
       ER5                   National IVM strategic plans – including ITNs                80,000
       Product 4             developed


     Research                                                                        $ 50,000
       ER6 Product 1         Operational research for evidence based decisions and        50,000
                             programme effectiveness are supported
WHO EMRO, Dr Hoda Atta , RBM, May 2004
  Summary Of RBM Regional Extra-Budgetary Plan of Action 2004-5
     Meeting and Regional workshops                                               $ 400,000

     ER7               Support Regional courses and IC workshops to strengthen               200,000
     Product 1         human capacities for planning and implementing RBM
                       programs
     ER7               Inter-country Programme mangers meetings, Inter-regional              200,000
     Product 2         consultations, Cross border meetings

     Support collaborating centers                                                $ 90,000

     ER7               Strengthening the collaborating centers and the                        90,000
     Product 3         institutional capacity for proper implementation of RBM
                       programs
     Duty travel                                                                  $70,000

     Total                                                                        5, 216,000


    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
WHO EMRO, Dr Hoda Atta , RBM, May 2004
               Challenges
   Weak           M&E
   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
   Nationalcapacity for planning and evaluation in
   endemic countries is still weak


WHO EMRO, Dr Hoda Atta , RBM, May 2004
         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


WHO EMRO, Dr Hoda Atta , RBM, May 2004
               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 challenges—Sudan
       started
      Cooperation with other programmes EPI, STB, HIV



WHO EMRO, Dr Hoda Atta , RBM, May 2004

				
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