UNDP RBA MDG-Based National Planning Workshop Malaria In Africa Awash Teklehaimanot Feb 27 March 3, 2006 Dares-Salaam, Tanzania

The Malaria Burden Malaria is a major global public health problem One fifth of the world’s population at risk Malaria on the resurgence: Spreading to previously controlled or malaria free areas Up to 500 million clinical cases and between2- 3 million deaths each year Over 90% of the deaths occur in Africa Significant disability from severe form of the disease

Mortality rate in Africa Death rates reduced in Asia but rising in Africa World Africa 3.0 Asia China Central & S.America 2.0 Annual Deaths from Malaria (millions) N.America & Europe 1.0 0.1 1900 1930 1950 1970 1990 2000 (R.Carter & Mendis 2000

Severe malaria

Malaria during pregnancy can lead to acute disease and Anaemia Women in endemic countries are four times more likely to suffer from malaria attacks when they are pregnant Malaria parasites can sequester in the placenta Anaemia & and placental malaria are associated with low birth weight, one of the primary causes of neo-natal mortality UNICEF/C-55-10/Watson

Malaria Control Strategy Early diagnosis and prompt treatment Prevention( ITNs, IRS, IPT) Early detection to prevent or contain epidemics Monitoring and evaluation Strengthening local capacities in basic and applied research

Community-based malaria control Provision of early diagnosis and treatment can reduce malaria mortality and should be the cornerstone of all national malaria control programs Community-based programs involving mothers, village health workers or drug vendors can reduce childhood mortality by up to 40% Decrease> 25% hospital admissions Increase by 30% on average the compliance to treatment Community-wide use of ITNs, reduces childhood mortality by up to 20%

Total Malaria Cases Treated As Out-Patients

Millennium Development Goal & Target for Malaria Have halted by 2015 and begun to reverse the incidence of malaria –Revised as follows: Reduce malaria morbidity & mortality by 75 % by 2015 from the 2005 baseline level. Consistent with the Goals and Targets that Focus on improving the health of pregnant women and young children.

Prospects for optimism Governments of endemic countries are seriously committed to malaria control as part of their poverty reduction strategies Growing interest from the international community to support the scaling-up of malaria interventions in the context of the overall MDG effort Funding from the Global Fund for malaria is steadily increasing

Scaling-up of National Malaria Control Programs in the Context of the Quick Impact Initiative by 2008 Quick Wins: Would provide a critical support for National Millennium Development Goals Strategies. Would Generate rapid momentum and early success stories that would broaden commitment to the Millennium Development Goals.

Targets for the Quick Impact Initiative One hundred percent of children under five years of age protected by long-lasting insecticide-treated nets; Eighty percent of people living at risk of malaria are protected by locally appropriate vector control interventions. Long-lasting Insecticidal Nets Indoor residual spraying Environmental management One Hundred percent of children under five years of age treated with effective anti-malarial drugs such as ACT, within one day of onset of illness.

Indicators Four indictors selected to measure progress towards the MDG /Malaria goal and targets. Malaria prevalence rate Malaria-related death rates in <5 & other population groups Proportion of children <5 and other population groups using effective preventive measures Proportion of children <5 and other population groups who receive appropriate clinical treatment for malaria.

Barriers to Scaling-up Implementation Lack of coordinated input to malaria control Inadequate financial recourses Inadequate national health systems for delivering essential anti-malaria commodities and effective interventions. Performance of Country Coordinating Mechanism (CCM) in moving national process forward

Human Resources constraints and red-tapes for timely procurement of anti-malaria drugs, nets and other essential commodities Lack of effective commodity management systems. Lack of detail operational plans for implementation at district and community level

Delays in assessment of effectiveness of control interventions and development of appropriate policies. Inadequate community – based services for prevention and treatment. Delays to complete administrative and financial processes required by funding Agents such as the GFATM In effective monitoring and evaluation systems

Malaria is also a great obstacle to social and economic development Peak malaria transmission coincides with planting & harvesting seasons; at a time when there is greatest need for agricultural work Subsistence farmers in Africa shoulder the heaviest burden of malaria as their productivity is severely affected A brief of illness that delays planting or harvesting produce catastrophic effects on farmers because of their fragile way of life Illness is also associated with loss of earnings and high treatment costs that must be purchased by the farmer out of his own meagre cash income.