THE PAN AMERICAN HEALTH ORGANIZATION’S 2006–2010 REGIONAL STRATEGIC PLAN FOR MALARIA IN THE AMERICAS: Overview of the Proposal Dr. Rainier P. Escalada Meeting of National Directors of Epidemiology and Malaria Programs (San José, Costa Rica, )7-10 November 2005

Costa Rica 2005 Pan American Health Organization 2 Objectives Clarifies PAHO’s mandate, role and commitment in combating malaria in the Americas; Provides a comprehensive analysis of the malaria situation in the region in the light of recent global efforts and objectives of direct relevance to malaria Identifies and prioritizes areas of technical cooperation and sets objectives / parameters by which the Malaria Program will be evaluated; Probes on the institutional implications of the identified plan components and priorities; and Presents a general framework on the implementation, monitoring, and evaluation of the plan

Costa Rica 2005 Pan American Health Organization 3 Outline / Overview of the Document 1.Introduction 2.PAHO’s Mandate and Regional Commitment 3.The Malaria Challenge in the Region: The Context and Environment for the Development and Execution of the Malaria Plan 4.The Malaria Plan: Components and Priorities 5.Institutional Implications on PAHO’s Malaria Program 6.Implementation, Monitoring, and Evaluation: PAHO’s Logical Framework for Fulfilling Its Global, Regional, and National Commitments on Malaria 7.Annexes

Costa Rica 2005 Pan American Health Organization 4 Introduction Highlights the historical role of PAHO in the Global and Regional battle against malaria Directly states the five specific objectives of the strategic plan “It supplements and complements PAHO’s Strategic Plan and defines the focus of the Malaria Program in the region and guides the programming of technical cooperation at the country level for the period ” Optimizes allocation and use of PAHO’s resources for malaria Useful for PAHO, member states and partner institutions

Costa Rica 2005 Pan American Health Organization 5 PAHO’s Mandate and Regional Commitment  The United Nations Millennium Development Goals (September 2000) o “Halt and begin to reverse the incidence of malaria (and other major diseases) by 2015”  The Roll Back Malaria (RBM) Initiative (October 1998) o “Halve the malaria burden in participating countries through interventions that are adapted to local needs and reinforcement of the health sector by 2010”

Costa Rica 2005 Pan American Health Organization 6 PAHO’s Mandate and Regional Commitment  The Global Malaria Control Strategy (GMCS) (October 1992) –Provide early diagnosis and prompt treatment; –Plan and implement selective and sustainable preventive measures, including vector control; –Detect early, contain or prevent epidemics; –Strengthen local capacities in basic and applied research to permit and promote the regular assessment of a country’s malaria situation, in particular the ecological, social, and economic determinants of the disease.

Costa Rica 2005 Pan American Health Organization 7 PAHO’s Mandate and Regional Commitment  Resolutions made in the recent World Health Assemblies and various meetings and conferences of WHO and PAHO o 46th PAHO Directing Council Resolution: Malaria and the Internationally Agreed-Upon Development Goals, Including Those Contained in the Millennium Declaration (CD46.PR.6; September 30, 2005) o 58th World Health Assembly: Malaria Control (WHA58.2; May 23, 2005) / 115th Session of the Executive Board: Malaria (EB115.R14; January 24, 2005) o 26th Pan American Sanitary Conference: AIDS in the Americas (CSP26.R12; September , 2002) o 42nd PAHO Directing Council Resolutions: Roll Back Malaria in the Region of the Americas (CD42.R15; September 25-29, 2000) o 52nd World Health Assembly: Roll Back Malaria(WHA52.11; May 24, 1999 )

Costa Rica 2005 Pan American Health Organization 8 The Malaria Challenge in the Region Epidemiological Patterns Socio-Political and Economic Dimensions Behavioral and Environmental Dimensions Educational Dimension Administrative and Policy Dimension The format for the analysis was patterned after the PRECEDE-PROCEED Model of Health Program Planning and Evaluation (Green and Kreuter, 2005) Source of Data: Annual Reports and Country Questionnaires provided by Member States to PAHO from 2000 to 2004

Costa Rica 2005 Pan American Health Organization 9 The Malaria Plan Developed based on: “…the realities of the malaria challenge in the region and PAHO’s commitment to global efforts and of the nations of the Americas…” PAHO’s Malaria Program will focus on: –Intensifying efforts on malaria prevention / early detection and containment of epidemics –Improving the system of malaria diagnosis and treatment in the region –Fostering an environment that promotes and is supportive of efforts against the malaria disease –Maximizing efforts to strengthen the health systems and build the capacities of the nations to relevantly and adequately address their respective malaria challenge

Costa Rica 2005 Pan American Health Organization 10 The Malaria Plan “Each major focus of action constitutes a component of the plan under which issues and challenges are identified; objectives are clarified; institutional resources are analyzed; strategies are designed and implemented; and evaluation parameters are developed and used.” Components of the Plan A.Malaria Prevention / Early Detection and Containment of Epidemics B.Malaria Diagnosis and Treatment C.Malaria Prevention and Control Supportive Environment D.Health Systems Strengthening / Country-Level Capacity-Building

Costa Rica 2005 Pan American Health Organization 11 The Malaria Plan A.Malaria Prevention / Early Detection and Containment of Epidemics 1.Issues and Challenges 2.Component Objectives 3.Institutional Strengths and Experiences / Scaling-up Opportunities 4.Strategies C. Malaria Prevention and Control Supportive Environment 1.Issues and Challenges 2.Component Objectives 3.Institutional Strengths and Experiences / Scaling-up Opportunities 4.Strategies B. Malaria Diagnosis and Treatment 1.Issues and Challenges 2.Component Objectives 3.Institutional Strengths and Experiences / Scaling-up Opportunities 4.Strategies D. Health Systems Strengthening / Country-Level Capacity-Building 1.Issues and Challenges 2.Component Objectives 3.Institutional Strengths and Experiences / Scaling-up Opportunities 4.Strategies

Costa Rica 2005 Pan American Health Organization 12 The Malaria Plan 1. Issues and Challenges –Annual Reports and Country Questionnaires provided by Member States to PAHO from 2000 to 2004 –Consultations with malaria professionals in the different levels of work 2. Component Objectives –Designed to respond to the issues and challenges identified –Specific Measurable Achievable Realistic Time-bound 3. Institutional Strengths and Experiences / Scaling-up Opportunities –Strengths Weaknesses Opportunities Threats 4. Strategies –Balanced degree of broadness and specificity –To be used as guide in making programmatic decisions and prioritization.

Costa Rica 2005 Pan American Health Organization 13 Institutional Implications of PAHO’s Malaria Program Importance of putting into practice and optimally using the lessons learned from previous experiences Alignment of the revised program strategies with the challenges identified in the proposed WHO’s General Program of Work for 2006 to 2015 (Table 3 on the document) Malaria Plan as response to the challenge of bridging gaps between policy and actual program implementation the Malaria Plan enables the Regional Malaria Program to concur with PAHO’s over-all goal of being a high- performance organization

Costa Rica 2005 Pan American Health Organization 14 Institutional Implications of PAHO’s Malaria Program Malaria Plan increases effectiveness and efficiency of the regional program by: –focusing on strengthening the existing regional strategies on prevention, control, diagnosis and treatment; –integrating provisions for specific population groups (pregnant women, children, persons living with HIV/AIDS, travelers, miners, loggers, banana and sugarcane plantation workers, indigenous groups, and populations in areas of armed conflict); –integrating plans for specific situations (epidemics, complex emergencies, urban malaria, malaria in remote and border areas, low-incidence and other areas of possible malaria elimination); –performance of effective and efficient regional and sub-regional monitoring and evaluation; –capacity-building among member states; –social mobilization, communication, and advocacy; –research and development; and –optimizing opportunities and mechanisms for knowledge-sharing

Costa Rica 2005 Pan American Health Organization 15 Implementation, Monitoring, and Evaluation PAHO’s Logical Framework for Fulfilling Its Global, Regional, and National Commitments on Malaria Annual evaluations in concurrence with the institutionalized monitoring mechanisms within WHO, RBM, and PAHO (Mid-term Reviews and Biennial Evaluations) Consolidation of a comprehensive report towards the end of 2010 Format of the logical framework is based from the Roll Back Malaria Strategic Plan and clarifies the indicators to be used in evaluating the progress of the Malaria Plan

Costa Rica 2005 Pan American Health Organization 16 Annex B: The Regional Malaria Program Organigram PAHO ASSISTANT DIRECTOR Disease Prevention and Control (DPC) Area Manager Communicable Disease Unit Chief Regional Malaria Advisor PWR’s RBM Sub-Regional Advisor for Mesoamerica RBM Sub-Regional Advisor for the Amazon RAVREDA Project Coordinator Technical and Administrative Assistants CD Focal Point(s) In the Respective Countries Directors of National Malaria Programs Principal Recipient GFATM Country Coordinating Mechanisms GFATM (Global Fund to fight AIDS, TB, and Malaria) RAVREDA ( Amazon Network for the Surveillance of Antimalarial Drug Resistance) RBM (Roll Back Malaria) clarify responsibilities of individuals / offices in the different levels of work, and likewise establish a stronger mechanism for accountability on specific activities

Costa Rica 2005 Pan American Health Organization 17 “By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the most bitter. “ Confucius

Costa Rica 2005 Pan American Health Organization 18 Thank You!!!