1. Group C Country x District Y – village tract as last foci – Population - 150,000 in small poor villages – Topography – hilly – Dialect – Hospital and rural health center with 10 doctors, 15 nurses - 2 private practitioners in the capital

2. Alpha – focus village tract Population – 10,000 living in 25 scattered villages and hamlets 7 villages – with village volunteer trained on health education, first aid, referral and collaboration on EPI; not allowed to provide treatment 50 km distance of health center to the remotest hamlet

3. Governance at provincial level District Health director and supervisor reluctant to strengthen health services in alpha because it may be overwhelmed by patients from nearby villages on side of the border Interventions in the last 5 years LLINs supplied regularly ACD – month in some affected villages by Sanitary Inspectors from capital

4. Situation Cases decreased gradually Political problems hamper cross border collaboration Health- devolved – admin control is with local authority

5. How the NMCP manager to go about strengthening the health system in Alpha? -Should present situation and the evidence - Advocate for the proposed strategies to the district director

6. How to Strengthen Health System in Alpha? -recruit 18 new volunteer for all villages along the border who speak the dialect (to cover all 25 villages) -Train them to perform RDTs and treat patients, accordingly; for severe cases, refer patients to the health center; -Sanitary Inspectors to provide monthly supervision to the volunteers, especially to the volunteers along the borders