1. Preparation of a plan
Najibullah Safi, MD, MSc. HPM

2. 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
3/11/2013 2

3. 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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4. 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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5. Situation analysis cont.
• The health care system
– Health care providers
• Government
• Households
• Private sector (for profit and non for profit)
• Traditional medicines
3/11/2013 5

6. 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
3/11/2013 6

7. 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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8. Situation analysis cont.
• Inter-sectoral links
– Environment
– Media and education
– Universities
– Research institutions
3/11/2013 8

9. Situation analysis cont.
• The malaria problem
– History of malaria problem
• Epidemiological picture
• Past epidemics
• Special risks that might reappear
• Changing trends
3/11/2013 9

10. 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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11. 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
3/11/2013 11

12. 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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13. 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
3/11/2013 13

14. National goals
• National economic and development goals
• National health goals
• Government health policies
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15. Objectives
• Existing national countrywide malaria control
objectives
• Proposed malaria control objectives by
stratum
• Relationship between existing and proposed
objectives
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16. Approaches
• Summary statement of approaches by stratum
and objectives
• List of activities to be implemented
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17. Research needs
• Information gaps
• Proposed applied research projects in the plan
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18. 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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19. 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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20. Organization and responsibilities
• Organization of systems and services
• Distribution of responsibilities at different
levels
• Coordination mechanism
• Community services
• Private sector
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21. 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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22. 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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23. 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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24. Costing and budgeting
• Salaries and allowances
• Expenses for organizational activities
• Supplies and equipment
• Training costs
• Miscellaneous expenses
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25. 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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26. Example of a plan
Afghanistan national malaria strategic
plan 2008 – 2013
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27. Introduction
• 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
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28. Stratification of malaria in Afghanistan
• 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
3/11/2013 28

29. 3/11/2013 29

30. Trend of Malaria 2002-2007
700000
626839
600000
585602
500000
433412
414407
400000
324650
300000
271763
200000
100000
0
2002 2003 2004 2005 2006 2007
Reported Malaria Cases
3/11/2013 30

31. Malaria Reported Cases, 2007
433412
450000
400000
347740
350000
300000
250000
200000
150000
79574
100000
50000
6098
0
Confirmed PV Cases Confirmed PF Cases Clinical Malaria Total Reported Cases
Malaria Cases
3/11/2013 31

32. Goal
To contribute to the improvement of the
health status in Afghanistan through
reduction of morbidity and mortality
associated with malaria
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33. Objectives
 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
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34. Strategies
 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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35. 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
3/11/2013 35

36. Prompt and reliable diagnosis and
effective treatment
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
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37. Prompt and reliable diagnosis and
effective treatment cont.
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
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38. Prompt and reliable diagnosis and
effective treatment cont.
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
3/11/2013 38

39. 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
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40. Application of effective
prevention measures
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
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41. Application of effective prevention
measures cont.
 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
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42. Detection and control of malaria
epidemics
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
3/11/2013 42

43. Detection and control of malaria
epidemics cont.
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
3/11/2013 43

44. Capacity building, institutional strengthening,
and integration
• 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
3/11/2013 44

45. Capacity building, institutional
strengthening, and integration cont.
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
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46. Malaria control and border areas
 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
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47. Operational research
 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
3/11/2013 47

48. 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
3/11/2013 48