FIFTH INTERCOUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS

1
INTEGRATED DELIVERY OF INTERVENTIONS - ITNs

• Abraham Mnzava
• Scientist, Vector Control
• RBM/EMRO

2
VBDs still a major public health problem in EMR
3
Available Tools

• Indoor residual house spraying
• Effective against indoor-biting/resting vectors
• Insecticide treated bednets including LLINs
• Physical barrier/kill/irritation/repellancy
• Larval control where appropriate
• Larviciding (chemicals, biologicals)
• Environmental management (source reduction, good
  farming practices intermittent irrigation)

4
Implementation of ITNs in EMR

• Historically untreated nets used
• Recognizing the potential of ITNs for VBDs
  prevention
• 8 countries drafted strategic plans
• Finalized in 5 (SUD, YEM, DJI, SAA, AFG)
• Countries identified implementation strategies
• Vehicle for resource mobilization

5
Vehicle for Resource Mobilization - GFATM
6
Hurdles to attaining high coverage

• Current funding levels still low
• Problems of identifying targeting methods
• Geographical access as a result of weak
  infrastructures
• In some cases unavailability of Nets
• Moving to LLINs
• Problems of advocacy and community awareness

7
THERE IS A GAP
8
Highlights ..

• Syria
• Estimated 100 000 new cases of ACL per year
• 7 persons per family
• 3 000 chronic cases every year
• Sudan
• 1.2 m nets per year for 5 years 6.0 m
• 300 000 from GFATM 2005
• 400 000 by private sector
• 600 000 from UNICEF

9
Even if nets were available .

• Getting them where they are needed and in time
  is the issue
• Could Integration of delivery of interventions be
  part of the solution??

10
Experiences of integrated delivery of
interventions

• Early planning with all stakeholders
• Ensure availability of required logistics and
  supplies in time
• Effective coordination at all levels
• Community acceptance of integrated package of
  services
• Operational challenges
• delivery of interventions with different target
  age groups

11
WHAT IS NEEDED

• Striving to ensure equity in the delivery of
  interventions
• Enhancing resource mobilization because of the
  gaps
• Optimizing existing health systems
• Strengthening of coordination at all levels
• Strengthening capacity building and ME

12
The African Experience Togo, Ghana and Zambia

• Linking distribution of ITNs and vaccinations
• Increased access to ITNs exceeding Abuja
  targets in the targeted areas
• Created huge demands for ITNs overall
• Promoted the use of ITNs
• Improved vaccination coverage

13
Linking ITNs distribution with vaccinations in
the EMR

• Attempts to scale up integrated delivery in three
  countries (YEM, SUD and SOM)
• Two of these countries are under emergency
  operations mainly by NGOs
• Iraq distribution by public sector were easy
  to mobilize unlike SOM and AFG
• Expansion to other countries need closer
  coordination with EPI

14
Conclusions

• Huge gaps of ITNs needed exist
• Even where they are available getting them in
  time where they are needed is a problem
• Potential to link distribution with other
  interventions especially child saving is
  crucial
• In a region where 4 out of the 8 earmarked
  countries are in emergency is a challenge
• Recommend a regional meeting with key partners
  (donors, EPI, RBM etc) to develop a regional
  framework