Preparation of a plan

Preparation of a plan

Najibullah Safi, MD, MSc. HPM

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Learning objectives

• Describe the structure of a plan for malaria prevention, control and elimination

• Organize the available information into a realistic plan

• Write a preliminary plan for malaria prevention, control and elimination

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Proposed outline

• Introduction– Importance of malaria as public health problem– Importance of malaria as a socioeconomic problem– Place of malaria in the national health program– Brief description of malaria control program – Planning period

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Situation analysis

• Country profile– Demographic data – Geographical features (e.g. forest, desert, coastal

areas) – Metrological data (e.g. rainfall, rainy days,

temperature) – Economic development (e.g. GDP/GNP, agriculture)– Social and cultural aspects (e.g. education, housing,

sleeping habits)

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Situation analysis cont.

• The health care system – Health care providers • Government• Households • Private sector (for profit and non for profit) • Traditional medicines

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Situation analysis cont.

• Health services (public, private, community based)– Organization– Human resources– Facilities and their distribution– Supervisory system– Accessibility and coverage – Drug supplies and pharmacies– General supplies system – Training and educational infrastructure

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Situation analysis cont.

• Other health programs – Vector borne disease control – Programs targeting the sick child– Maternal health – Child health– Laboratory services– Tuberculosis– Health information system– Health education

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Situation analysis cont.

• Inter-sectoral links – Environment– Media and education– Universities– Research institutions

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Situation analysis cont.

• The malaria problem– History of malaria problem• Epidemiological picture• Past epidemics • Special risks that might reappear• Changing trends

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Situation analysis cont.

• Past and current malaria control activities– Policy and legislation – Status of the program and current control

activities– Human resources, organization chart– Building equipment and supplies – Budget – Major control activities in the past and the result – Research (past and current)

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Situation analysis cont.

• Current malaria problem– Spatial and temporal distribution of malaria – Drug resistance and efficacy – Vector (e.g. distribution, ecology, susceptibility) – Identification of major epidemiological types– Basic epidemiological data – Intensity and status of malaria– Estimation of burden of disease – Outstanding problems and major constraints – Priority groups

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Situation analysis cont.

• Conclusion– Priority (place of malaria among other problems)– Opportunities for malaria control• Political commitment • Inter-sectoral links • Technological development• Funding • Economical development projects• Opportunities for changes, especially in the context of PHC• Need for a new or revised plan of action

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Stratification

• Identification of major factors responsible for peculiarities of malaria problem

• Identification of additional data required to refine and update stratification for improved program implementation

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National goals

• National economic and development goals• National health goals• Government health policies

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Objectives

• Existing national countrywide malaria control objectives

• Proposed malaria control objectives by stratum

• Relationship between existing and proposed objectives

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Approaches

• Summary statement of approaches by stratum and objectives

• List of activities to be implemented

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Research needs

• Information gaps• Proposed applied research projects in the plan

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Operational targets

• Tabulation of the operational outputs for each approach

• Operational targets necessary to achieve each objective

• Time frame for achieving targets

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Operational milestones

• Plan for new services or expansion of existing services– Additional services (e.g. diagnostic, treatment)– Additional staffing– Additional facilities (e.g. lab, stores, office space) – Time frame for introduction and note for geographical

distribution • Training of staff– Basic training, refresher training, distance learning – Timetable of the course

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Organization and responsibilities

• Organization of systems and services • Distribution of responsibilities at different

levels• Coordination mechanism • Community services• Private sector

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Evaluation plan

• Short term– Epidemiological, operational and other indicators

• Long term – Health impact, socioeconomic and other

indicators • Information system– Health information system– Management information system

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Evaluation plan cont.

• Data and information to be reported• Levels of reporting• Frequency of reporting• Type of evaluation and level of responsibility• Analysis of information, level of responsibility and

degree of authority • Decision making mechanism • Supervision (for continuing education of the staff

at all levels)

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Resource requirements

• Must be quantifiable • Facilities (e.g. new clinics, insectarium) • Personnel • Fixed equipment• Supplies and consumables• Maintenance requirements• Training requirements

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Costing and budgeting

• Salaries and allowances• Expenses for organizational activities• Supplies and equipment• Training costs • Miscellaneous expenses

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Presentation of the plan

• Information should be provided in charts, tables, maps and graphs

• Summary for decision makers• Most information – annexes • Planning team • Appropriate format• Pages and figures should be clearly numbered

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Example of a plan

Afghanistan national malaria strategic plan 2008 – 2013

Introduction

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• One fifth of the world population is at the risk of malaria

• Global burden of 300-500 million cases and 1-2 million deaths per year

• Over 90% Sub-Sahara Africa• Most deaths; under five and pregnant women• Threat 40% of the world population in about

100 countries

Stratification of malaria in Afghanistan

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• Major determinant of malaria transmission in Afghanistan are:– Altitude (below 2000m above the sea level)– Agriculture (rice cultivation)

• Three strata– First stratum: medium to high transmission– Second stratum: low transmission– Third stratum: has less potential for malaria

transmission

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2002 2003 2004 2005 2006 20070

100000

200000

300000

400000

500000

600000

700000

626839

585602

271763

324650

414407433412

Trend of Malaria 2002-2007

Reported Malaria Cases

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Confirmed PV Cases Confirmed PF Cases Clinical Malaria Total Reported Cases0

50000

100000

150000

200000

250000

300000

350000

400000

450000

79574

6098

347740

433412

Malaria Reported Cases, 2007

Malaria Cases

Goal

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To contribute to the improvement of the health status in Afghanistan through reduction of morbidity and mortality associated with malaria

Objectives

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To reduce malaria morbidity by 60% by the year 2013

To reduce malaria mortality by 90% by the year 2013

To reduce the incidence of Falciparum malaria to sporadic cases by the end of 2013 with a vision to interrupt transmission of PF

Strategies

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Prompt and reliable diagnosis and effective treatment

Application of effective preventive measures in the framework of IVM such as ITNs

Detection and control of malaria epidemics

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Strategies cont.

Strengthening of the health system and malaria control program Institutional development Improving surveillance system Human resource development M&E Private sector involvement Operational research and partnership building

Prompt and reliable diagnosis and effective treatment

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Targets: By the end of 2013, 90% of uncomplicated

malaria cases will be managed according to national diagnosis and treatment guidelines

By the end of 2013, 95% of severe and complicated malaria cases will be managed according to national diagnosis and treatment guidelines

By the end of 2013, 60% of targeted Health Posts will be able to diagnose malaria by RDTs

Prompt and reliable diagnosis and effective treatment cont.

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Targets: By the end of 2013, all CHCs and 90% of

targeted BHCs in priority areas (stratum 1) will provide quality microscopy diagnosis for malaria, TB and leishmaniasis

By the end of 2013, all Public health facilities will provide appropriate and effective malaria treatment according to National Treatment Guideline

Prompt and reliable diagnosis and effective treatment cont.

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Targets: By the end of 2013, all Public health facilities

offering laboratory diagnosis will be regularly monitored for quality assurance

By the end of 2010, 90% of private sector in malaria prone areas involved in malaria diagnosis and treatment will be informed about national diagnosis and treatment guidelines

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Prompt and reliable diagnosis and effective treatment cont.

Targets: By the end of 2013, 50% of private sector

clinics and doctors will be certified to a standard set by MoPH and technical partners

By the end of 2010, a functioning referral system for management of severe malaria cases will be in place in 90% of health facilities in target areas

Application of effective prevention measures

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Targets: By the end of 2010, 85% of households in

targeted population will have at least one ITNs By the end of 2013, 85% of target population

will be protected by ITNs through scaling up of effective implementation strategies

By the end of 2008, an IVM strategic plan based on a comprehensive vector control needs assessment will be developed

Application of effective prevention measures cont.

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By the end of 2009, three entomological sentinel sites- including monitoring of insecticide resistance in Kabul, Jalalabad and Kunduz will be fully functional

By the end of 2013, 12 million people living in the targeted provinces will be stimulated through COMBI strategy to acquire and regularly use LLINs throughout the transmission season

By the end of 2013, 6 million LLINs will be distributed in targeted provinces

Detection and control of malaria epidemics

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Targets: By the end of 2013, 90% of malaria epidemics

will be detected and controlled within 2 weeks

By the end of 2008, 90% of health facilities (CHCs and BHCs) in strata 1 will be strengthened to detect malaria epidemics within one week of the beginning of epidemics by utilizing weekly watch charts

Detection and control of malaria epidemics cont.

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Targets: By the end of 2008, all provincial

Epidemiology, Early Warning, Epidemic preparedness & Surveillance teams will be able to investigate any epidemic notification and respond within one week

By the end of 2013, all epidemic prone provinces have an early warning and detection system for malaria epidemics

Capacity building, institutional strengthening, and integration

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• At the beginning of 2009, an assessment for institutional development of NMLCP will be conducted leading to the development of a framework and action plan for institutional development

• By the end of 2009 all malaria control programme staff will be trained in their respective disciplines

• By the end of 2009 NMLCP and all PMLCPs will be upgraded (buildings, equipment, vehicles) and made fully functional

Capacity building, institutional strengthening, and integration cont.

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Targets: By the end of 2009 in order to strengthen the

malaria control at the community level, NMLCP and all PMLCPs will have a Community Based Initiative (CBI) component

From 2008 every two years a thorough evaluation will be undertaken by Malaria Task Force to assess the performance of all national and provincial malaria control staff

By the end of 2008 a COMBI plan of action for promotion of effective prevention and treatment of malaria will be designed and implemented in all targeted provinces

Malaria control and border areas

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By the end of 2010 a Border Coordination Committee will be established and fully functional to coordinate malaria control activities in bordering areas with neighbouring countries

Operational research

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To develop evidence based strategies it is essential to conduct operation research as needed by the program focusing on Health system research Prevention Treatment

Target By the end of 2008 malaria taskforce will develop

a well define mechanism for setting research priorities and dissemination of research results

By the end of 2010, national institute for malaria and leishmaniasis will be fully functional, equipped and adequately staff

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Learning objectives

• Describe the structure of a plan for malaria prevention, control and elimination

• Organize the available information into a realistic plan

• Write a preliminary plan for malaria prevention, control and elimination