Regional Malaria Action Plan 2016-2020

Towards Malaria FreeEastern Mediterranean Region

Dr Hoda Y. Atta WHO/EMRO

Pre RC meeting Kuwait, 5 October 2015

Malaria situation in EMRYear 2014

14 malaria free countries2 countries close to elimination

Year 200010 malaria free

countries

3

Malaria burden in EMR, 2014

Total reported cases 5.3 m total confirmed cases 1.5 m

others Afghanistan Djibouti Pakistan Somalia Sudan Yemen0

500000

1000000

1500000

2000000

2500000

3000000

3500000

4000000

total cases confirmed cases

4

Malaria MDG target achieved halt and begin to reverse the incidence and death rate

associated with malaria ( indicator 6.6)

2000 2014 % reduction

Total reported malaria cases 9.3 m 5.3 m 43%

Reported deaths due to malaria 2166 946 56%

Global ( 2000-2015)• Incidence declined by

estimated 37%• Death rate fell by 60%

Regional Data

Achievements, Challenges in EMR

Achievement of MDG related to malaria in EMR countries

Epidemic in Djibouti

2014 : Local cases in Iran 370 Local cases in KSA 51

Mortality in Sudan

MOR SYR IRQ IRA KSA AFG-100

-90-80-70-60-50-40-30-20-10

0

% reduction of reported confirmed malaria cases 2000-2014

0

500

1000

1500

2000

2500

3000

0

5

10

15

20

25

6

Coverage is increasing still far below the target

Country

% HH with at least one

ITN in targeted

areas

% Sleeping under ITN in targeted

areas*Source

Afg. 49.9 30.6 MIS 2011

Djibouti 18.0 13 MIS 2009

Pakistan 33.9 34.8 MIS 2013

Sudan 62.0 14.6 MIS 2012

Somalia 19.1 19.8 MIS 2014

Yemen 39.9 7.1 MIS 201320

0020

0120

0220

0320

0420

0520

0620

0720

0820

0920

1020

1120

1220

1320

14

0%

5%

10%

15%

20%

25%

30%

35%

29%

% of confirmed casesITN access and use

* Among those having the nets

Imported malaria in countries that achieved elimination ( 2004, 2014)

Bahrai

nEg

yptIra

qJord

an

Kuwait

Lebanon

Libya

Morocco

Occup. P

alest.

T.Oman

QatarSy

ria

Tunisia UAE

Total

1

10

100

1000

10000

100

291

2

102

268119

493986

643

21

98

4575

2004 2014

local cases 2014Egypt 22, Oman 15

From MDG to SDG looking forward

Obstacles, Challenges• Limited access diagnostic and treatment services• Low coverage of Vector control interventions • Weak malaria surveillance and information systems• Spread of resistance to drugs, insecticides • threat of malaria epidemics, increasing risk of

reintroduction to free countries• Weak border coordination • Humanitarian crisis, civil unrest• Limited and unsustainable resources

9

Guiding strategies for 2016-2030

WHO Global Technical Strategy (GTS) For Malaria, 2016-2030• Adopted by WHA, May 2015

Provides technical guidance to all countries and development partners for the next 15 years

Action and Investment to Defeat Malaria 2016 –2030 (AIM) For a Malaria Free World

• Developed by Roll back malaria partnership

• Builds the case of investment for mobilizing more resources

10

Regional malaria Action Plan (2016-2020) for EM

Vision All EMR countries are malaria free

Goals by 2030 1. Interrupt malaria transmission in areas where it is

feasible 2. Reduce the malaria burden of morbidity and

mortality by > 90% in areas where elimination is not immediately possible

( malaria will not be any more a public health problem or a barrier to social and economic development).

Regional action plan 2016-2020Objectives indicator1. Reduce malaria mortality rates compared

with 2015 >75%

2. Reduce malaria case incidence compared with 2015 >40%

3. Eliminate malaria from selected countries and districts in which malaria was transmitted in 2015

National : 2 countries: (KSA, IR Iran*)Subnational : 25% of endemic districts with low malaria transmission in the

high burden group of countries

4. Prevent re-establishment of malaria in all countries that are malaria-free

Re-establishment preventedin 14 countries that eliminated

malaria

*P falciparum

Strategic components

13

Pillar 1. Ensure universal access to malaria prevention

Key actions

1. Establish a functional vector control unit and integrated vector management strategy (IVM)

2. Scaling up coverage of population at risk by ITNs, IRS, or LSM to at least 80%

3. Ensure entomological surveillance and monitoring insecticide resistance

4. All countries should have harmonized their pesticide registration

14

Pillar 1. Ensure universal access to malaria diagnosis and treatment

Key actions• Increase converge of confirmation by microscopy or rapid

diagnostic test (RDTs) to at least 90% of cases in both public and private health facilities

• Ensure that at least 90% of cases receive effective treatment ( ACT for falciparum cases)

• Establish quality management system (QMS) for parasitological diagnosis, in coordination with national public health laboratory

• Monitoring antimalarial resistance in endemic countries with PF

15

Pillar 2. Accelerate efforts towards elimination and attainment of malaria-free status

 

Adopt district approach for malaria elimination, in high burden endemic countries

• Based on updated stratification of malaria by district level

• strategy for malaria elimination will developed

By 2020

1. 25% districts move from low to zero transmission

2. 50% of endemic districts (high-moderate transmission will shit to low transmission

Based on data of 2012 Will be updated

16

Pillar 3. Transform malaria surveillance into a core intervention

Key actions

• Implement epidemic preparedness and response plan (in all epidemic-prone countries, by 2017)

• Develop national malaria database of cases by foci ( in malaria elimination countries/district by 2017)

• Ensure reporting, analysis and feedback from at least 90% of health facilities ( in endemic countries by 2020)

• Malaria should be a compulsory notifiable disease in all countries of the Region ( 2020)

• Investment in national malaria surveillance by district (DHIS2).

17

Conclusions

• High level political commitment with financial allocation• Develop advocacy/investment strategy for resource mobilization

strategy • Ownership and investment in local capacity in priority districts• Promote integration with the health system, collaboration with other

programmes, community and CSOs• Establishing public-private partnership • Implement multi-sectoral approach (including agriculture, water,

energy, housing, educational , and community , etc…)• Strengthen border coordination, in-country cooperation• Identify and implement priority malaria research

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Thank you for endorsing the regional malaria action plan (2016-2020)

 

www.emro.who.int/malaria