Country report-Tanzania Presented to EARN Annual Malaria Conference Kigali, Rwanda 15th –19 th November, 2004 NMCP

Outline of Presentation Malaria problem Key achievements Challenges Opportunities Priority areas for 2004/05 Evaluation report

Population: 34.5 million; At risk Population close to 100% 16 million cases; 100,000 deaths, Economic loss: 3.4% of GDP ∽ 350 million US$

Malaria problem Data collected by NMCP directly from the districts 110/114 districts for 2003 revealed: proportion of malaria cases OPD 41% of all OPD cases 42% of all OPD <5 yrs cases 39 of all OPD >5 yrs cases

Malaria problem All admissions 1,380, ,690 = < 5 yrs -689,774 = > 5 yrs Proportion of malaria Deaths out of total Deaths deaths/total population deaths/< 5yrs population />5yrs population

ACHIEVEMENTS 2003/04

Malaria case management Training of health personnel and tutors on management of malaria and supervisory skills Conducted follow-up after training to Prescribers in 38 districts Trained 550 MCH workers on the use of IPT and promotion of ITNs Revised, guideline on Focused Ante-Natal Care. It is in press Carried out monitoring for 1 st and 2 nd line drugs (SP and Amodiaquine) at 4 sites. Results show that there resistance to SP is reached the levels where the process of changing policy should start Applied for and received GFATM funding for ACTs

Vector control Produced 1 st draft guideline on Integrated Vector Control Contracted out to NIMR testing for vector pyrethroids resistance countrywide, results will be available in early 2005 Launch and rolling out of TNVS: Training of RCH staff and retailers, advocacy, distribution of voucher Increase of Ngao sales, in 2003 over 3 million kits

Prevention and control of malaria epidemics Establishment of Early detection system Capacity building of CHMTs on the system for early detection and dissemination of the system Emergency stocks of anti-malarial drugs, insecticides and sprayers were procured and distributed to 10 epidemic prone districts Capacity building on data management Follow up of implementation of EDS

IEC and Community Mobilization Draft guideline on Malaria Communication Strategy was produced; Commemoration of Africa Malaria Day Malaria messages were aired in the media, all year round, thanks to efforts of our partner-PSI Advocacy to Members of Parliamentarians on Malaria controls

Programme Management WHO recruited a data Manager who was posted to work at NMCP Supervision of epidemic prone districts Collected malaria data for 2002/2003 from all districts Creating malaria data base at NMCP National Bureau of Statistics agreed to include some of the indicators on ITNs in the forthcoming Demographic and Health Survey

Programme management cont. National Malaria/IMCI Conference was held in Dodoma in April 2004, the theme was “ addressing malaria control challenges at district level” The meeting was attended by over 260 participants of which 121 were District Medical Officers Technical meeting met as scheduled. Appointed District Malaria and IMCI focal persons

Finance In 2003/2004 NMCP budgeted 1.8 million US$ from the MTEF (Mid Term Expenditure Framework. Over 90% of the budgeted funds were received

Challenges Lack of malaria communication strategy Parasite resistance Cost and availability of ACTs Operationalisation of ACTs: affordability Involvement of the private sector, compliance Poverty and accessibility to malaria interventions – what do we do with the most disadvantaged population Involvement of other key Ministries is not easy under current organizational set-up of NMCP Human resource constraints at all levels

Opportunities Government Commitment – Abuja declaration, MDG goals, malaria a priority health problem, HSR process and reinforcement of District Health Systems Partner commitment and involvement Increasing IMCI coverage Partner: Private sector involvement – the Cocacola initiative, TANAAM (NGOs), Management Science for Health, Research and Training Institutions etc GFATM

Priorities for 2004/05 Finalisation of Communication Strategy Continue the process towards drug policy change to ACT Explore the potential that Tanzania has in the agricultural production of Artemisia annua In collaboration with partners explore mechanism for funding for ACTs beyond GFATM

Priorities Capacity building and training of district Malaria/IMCI focal persons Anti-malarial drug quality Supervision, Monitoring and Evaluation Operational Research- Efficacy, vector resistance Implement the ITNs Voucher Scheme

Priorities for 04/05 Strengthen Surveillance systems for monitoring malaria epidemics Data base for malaria updated

EVALUATION OF Summary report based on 2001 and 2003 monitoring

Where are we? Access to Treatment Adequate Management of Severe Malaria ITNs use in children <5years ITNs use and pregnant women SP- IPT in pregnancy Capacity of early detect and respond to malaria epidemics Awareness and conformity by the population to malaria information

Towards Abuja targets (1) MMTSP targets by 2007 At least 80% of uncomplicated and severe malaria cases in children under five years of age, in health facilities at all levels of health care, will be appropriately treated (60% by 2005) Use of appropriate treatment for febrile episodes in children under five years of age, within 24 hours, will be raised from 19% to 60%

Malaria case management (Uncomplicated malaria)

Malaria case management (Severe malaria)

Malaria case management at home

Proportion of health facilities reporting no disruption of stocks of required anti-malarial drugs for more than seven days during the previous three months

Use of ITNs At least 60% of the children under 5 years of age and 60% of pregnant women will be sleeping under an insecticide treated mosquito net by 2007

Use of ITN in underfive Target 60%

Malaria in Pregnancy At least 60% of pregnant women will be effectively protected against malaria

Malaria in Pregnancy cont. ITN coverage

Malaria in Pregnancy IPT use

Prevention and control of Epidemics All epidemic prone districts will have increased their capacity to detect malaria epidemics early and contain them

Malaria Epidemics Prevention and Control cont.

THANK YOU AHSANTENI