1. 1 IASC Weekly meeting Geneva, 14 September 2005 Malaria control in emergency settings Charles Delacollette WHO/Roll Back Malaria Department

2. 2 Definition of fragile states Governments cannot or will not deliver core functions to the majority of its people, including the poor, lack of territorial control, lack of safety and security, lack of capacity to manage public resources, lack of delivery of basic services, limited ability to protect and support the ways in which the poorest people sustain themselves. From World Bank country policy and institutional assessment – GDP per capita income is less than USD 1 per day.

3. 3 Out of 46 "Fragile States" and countries of humanitarian concern, malaria is endemic in 43 In Africa: Population in countries of humanitarian concern is estimated at around 2/3 of total population at risk.

4. 4 At least 30% of the malaria burden is in countries of humanitarian concern

5. 5 Best practices in emergency situations

6. 6 Major steps (acute phase) Quick situation analysis Malaria diagnosis available (microscopy or Rapid Diagnostic Tests) – Artemisinin Combination Therapy (ACT) free of charge to the users Include malaria in EWARN (surveillance)

7. 7 Major steps (acute phase) Continued Active malaria detection (priority ONE: Pregnant Women, Children under 2, HIV+, highly malnourished) Impregnated Treated Nets (if available) for the above at risk

8. 8 Major steps (chronic phase) In addition to previous health items, consider increasing ITNs coverage and / or use of Indoor Residual Spraying to impact on transmission Consolidation of Surveillance and Monitoring & Evaluation (addressing lack of documentation on impact)

9. 9 GTATM in emergency settings 37 (out of 43) have GFATM grant Poor performance in 13 (35%) versus 12 (21%) out of 55 non fragile countries Principal Recipients: UNDP in 9, UNICEF in 1, Int'l NGOs in 3 and Ministry of Health in the remaining

10. 10 GTATM in emergency settings Bottlenecks: capacity, logistics (procurement), low disbursement, M&E Response: International Programme Officers, increasing the capacity of nationals (MOH strategic leadership), focused assistance in procurement, implementation / disbursement plan, M&E, surveillance…