Malaria in Pakistan

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Malaria in Pakistan
API/1000 Red 8-27 Yellow 1-8 Green 0-1
China
Afghan Refugees(gt3 million)
Kashmir
Afghanistan
Earth Quake (gt3 million)
India
Iran
Coastal Areas
M. Naeem Durrani, Technical Advisor HealthNet
International
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Malaria Control In Pakistan

• During the past two decades, the programme has
  received very little attention and is considered
  as a dying cadre at district and provincial level
  in the Country.
• Very Limited microscopy and treatment at District
  level for the countrys 90 population at Risk.
  (150 million)
• Estimated 80 population seeks diagnosis and
  treatment at under resourced and under skilled
  Quasi private sector.
• Focal IRS through countrys own limited resources
• Surveillance that need development
• Gaps Identified in 2003 for GF Round 2, project.
• Prioritized areas with high case load and prone
  to epidemics
• Strengthen and expand Microscopy.
• Build Capacities of Malaria related health
  Personnel
• Need for very heavy BCC component to bring
  positive change in target populations behaviour
  for timely utilization of malaria control
  services.
• Implementation of ITNs in 11 pilot districts/
  tribal agencies.

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Round 2 Project Objectives

• To ensure sustained functioning of 92 peripheral
  microscopy centers 23 district, five provincial
  and national malaria-training centre to improve
  early diagnosis and prompt treatment at health
  facility level including improving monitoring of
  quality assurance standards at district level and
  above.
• To strengthen case management capacity of the
  care providers and Monitoring Evaluation of the
  project activities
• To implement / continue a behavior change
  communication (BCC) strategy to improve the
  knowledge and decision making of general
  population for access to diagnostic and or
  treatment services within first 24 hours of onset
  of fever and avail the benefits of simple and
  safe preventive measures.
• To introduce and promote the use of Long Lasting
  Insecticide Treated Nets in selected districts
  through public private partnership.

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Implementing Partners

• Objective 1 Strengthening and Expansion of
  Microscopy
• DOMC
• Objective 2 Up gradation of technical and
  management capacities of Malaria related health
  personnel in 23 districts,
  DOMC
• Objective 3 BCC implementation, DOMC
• Objective 4 Implementation of ITNs in 11 pilot
  districts
• HealthNet, Green Star (PSI), NRSP
• DOMC SETS OVER AMBITIOUS TARGETS FOR ITSELF

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Problems Encountered in Phase 1

• LFA did not assess the capacities of individual
  SRs.
• Lack of Clarity over GF system, policies and
  procedures at all level (CCM,PR,SRs) A learning
  phase for all
• No continuity in Programme management, sharp
  staff turn over of managers and technical staff
• Serious delays in Procurements for both health
  and non health items, ITNs were provided to SRs
  in quarter 7 (18 months delay)
• Serious delay in project staff recruitment at
  DOMC.
• Lack of Communication and Coordination between PR
  and DoMC.
• Public sector dominant CCM and its sub committees
  failed to identify problems during course of
  implementation, they learned about slow progress
  when it was too late for remedial action.
• Conflict of interests at various level in the
  programme

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Progress assessed by GF to decide on phase 2
Continuation
GF- HQ Decision after assessment based on
progress till Q-8 NO PHASE 2 EXTENSION
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Way Forward.

• Consortium based Programs need to be reviewed
  independently for each sub recipient every 2nd
  quarter.
• Greater role for INGOs/ bilateral Agencies to
  develop public and private for profit sector to
  deliver quality services.
• Political commitment to ensure management
  continuity through institutional reforms
• Need for up-gradation of management Capacities at
  program level.
• Reform at CCM and its charter of mandate. Third
  party PR, to avoid conflict of interest
• An independent ME Committee with its own small
  budget to assess progress regularly and keep CCM
  informed on progress, problems and challenges.
• Go for round 6 and subsequent rounds after the
  IRM recommendations are available to add
  credibility to the country proposal, Tasks should
  be divided among SRs inline with their
  capacities.

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• THANK YOU