Public Health Program-Disease Control and Public
Health System Development

	Introduction
	Strategy
	National & Regional Malaria Institutions
	WHO Inter Country & WHO Country & National Capacity
	National malaria task force, expert committees and subcommittees
	Malaria Annual Public Health Reports, Reviews-Monitoring and Evaluation
	Core Indicators for Malaria Control Programmes
	Malaria and Public Health Management Systems Chart

Introduction

The national malaria units and programs have to struggle to maintain a critical presence within changing and unstable health systems within the current health reform and sector wide process. The critical issues being how to create and maintain malaria as a priority health problem and ensure health policy support  and develop health systems and malaria control systems to rapidly scale up and effectively and equitably deliver access, coverage, quality and impact with the available malaria control tools (diagnostics, drugs, ITNs, House spraying) through a health delivery system  and to sustain continuing high levels of coverage.

	The Long Term Sustainable Malaria Systems To Deliver The Malaria Solutions
	Building Long Term Malaria Control Programmes & Systems With Annual And Sustained Universal Access And Coverage Of Malaria Control Services

Success has been achieved in Southern Africa in establishing malaria free areas and reducing the level of infection and reducing deaths from malaria in some countries. However, there is still a great challenge for national malaria control programs to widen their activities and coverage on an annual basis for the next 10-20 years to ensure that all people at risk of malaria have insecticide soaked bed nets or sprayed homes, and can reach and be diagnosed and treated quickly for malaria with drugs in the community, or at a health centre or hospital.

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Strategy

Malaria Control Planning & Management & Systems

	Malaria policy within national health policy
	National malaria task force, expert committees and   subcommittees
	National guidelines for malaria control
	Malaria strategic (five year) and annual work plans
	Standard operating procedures and checklist on supervision
	Annual malaria public health reports
	Indicators and mechanisms for monitoring and evaluation.
	Malaria programme reviews.
	Cost, financing and economics of malaria and its control.

Malaria Control as an Integral Part of  Public Health Systems

	Malaria control promoting equity in health
	Malaria control promoting communicable disease & vector tropical disease control and public health.
	Defining the function and roles of malaria control units
	Defining the function and roles of other key units,departments,projects and programmes in malaria control
	Defining the function and roles of malaria control units in other key departments, programmes and projects
	Defining the function and roles of other development – sectors and inter-sectoral approach to malaria control
	Defining the function and roles of  multilateral agencies in malaria control
	Defining the function and roles of  bilateral agencies in malaria control
	Defining the function and roles of  Non Governmental organization in malaria control
	Reorganising malaria control within health reform, decentralisation and health sector wide approaches

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Human Resources, National Capacity Building and Sustainability

	National malaria units/teams, provincial co-ordinaters and district focal point
	Job descriptions for malaria team members
	Adequate number and mix of malaria teams by level for field implementation and delivery
	Defining organisational structure and identity for malaria control within communicable disease control
	Malaria prevention and control within undergraduate and post graduate training
	Malaria apprenticeship training trough on the job work attachments

Drugs, Insecticides and ITMs Supply System

	Defining essential drugs, insecticides and ITMs by health sector level for malaria
	Methods for estimating national annual requirements
	Defining minimum stock by health sector level
	Methods for monitoring stock levels
	Establishing a buffer standby of emergency stocks
	Monitoring drug and insecticide efficacy and adverse effects of drugs
	Drugs and insecticide resistance monitoring

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Malaria A National Public Health Priority and Malaria Policy

	Increasing advocacy for malaria control
	Priority socially
	Priority economically
	Priority politically
	Priority professionally and technically
	Priority for allocation of resources
	Malaria will be recognised as a priority health problem both nationally and internationally.
	Malaria will be recognised as a priority health problem socially, politically, professionally and for the allocation of resources.
	Malaria control will be recognised as being everyone’s responsibility.

Malaria is accepted as national and regional public health priority in Southern Africa . However the priority tends to be higher in countries such as Botswana , Namibia, Zimbabwe, South Africa and Swaziland where unstable malaria with annual and cyclical epidemics causes alarm and crises. Unfortunately  malaria as a  priority appears low in stable endemic countries (Zambia, Malawi, Tanzania) where chronic malaria with a higher but less dramatic burden continues to be accepted as a problem to live and die with. Angola remains a challenge with the conflicting priorities for basic survival within a 35 years of chronic conflict situation.

Efforts have been made to advocate through use of estimates of 2000-3000 deaths per year in Southern Africa. National economics estimates of burden of malaria in dollars has also initiated toe create a priority for economic investments.

There still needs to be  a sustained advocacy within the RBM movement for national, regional mobilization of individuals, communities, professionals, politicians, policy makers, governments, private sectors, service clubs, non- governmental organizations, consumers associations bilateral and multilateral organizations to commit them selves into a long terms, 25-50 years efforts to control malaria.

National Malaria policy continues to be developed and articulated intermittently within malaria programs through malaria manuals, guidelines, strategic plans and annual conferences. Malaria policy when developed tend not to be re-visited regularly to take in context changing policy makers and political and social environments. However more specific broad based, sustained articulation is required within malaria control programs and broader context of national health policy and national development polices. A regional SADC Malaria policy and strategy has been developed.

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National and Regional Malaria Institutions

Building national leadership and institutions within the public health system

1. National Malaria Control Managers, Committees and Programmes will co-ordinate, and provide the leadership for, Roll Back Malaria. 
   (Roll Back Malaria Charts)
2. National Malaria Control Units and National Malaria Programmes will have sufficient human and financial  resources.

3. A national network of malaria consultants and institutions will provide ad hoc technical support to National Malaria Control Programmes.

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Commitment To Work Together Under One National Leadership - Building National Institutions and Partnerships

	Joint situation analysis and needs assessment in malaria
	Joint strategic and annul plans development
	Joint monitoring and evaluation and reporting on progress in implementation

Building National Malaria Leadership and Responsibility

National leadership and coordination of all malaria control activities are being achieved through the development of national malaria control units and programs in the Ministries of Health at national, provincial and districts levels.

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WHO Inter-Country and WHO-Country and National Capacity

The SAMC team is building a core basic WHO inter-country capacity to provide support to WHO country offices and national malaria control programs. The core multi-disciplinary team consists of Epidemiologist- Program Manager, Medical Entomologist, Epidemic-Emergency Officer, Information Officer and Research and Monitoring-Evaluation Officer. The team is to be consolidated through continued support by a clinician to ensure the special focus on diagnosis, case management, drug policy and malaria in pregnancy. An Information and education officer to support the key areas of advocacy, community information and mobilization. A health economist to assess the financing of malaria control program and support the area of malaria control and poverty alleviation

WHO country office capacity in malaria continues to be developed with WHO National Officers on malaria and WHO international malaria officers.

Efforts have continued to increase the capacity within NMCPs by negotiations with national Ministries of Health to re-assign or recruit new staff. National capacity still continues to be bellow critical mass level, Increasing focus is being given to evaluating and supporting provincial and district malaria capacity development.

The increasing twin demands due to development of the RBM malaria movement and improving the quality, couverge of  technical interventions of malaria control is creating an urgent demand to build and retain country national leadership and capacity and WHO country and inter-country international coordination and technical capacity.

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National Malaria Task Force, Expert Committees and Sub-Committees

A malaria task-force or technical committee are to be established and functional in Botswana and South Africa. The facilitators groups developed to support  RBM inception need to be integrated with or strengthen the existing malaria task forces or committees. The RBM stakeholders meetings are being developed to continue to develop the inter-sectoral and inter-agency support for malaria control. A loose network of malaria experts and institutions and those with an interest in malaria exist in all countries but are not systematically tapped to provide and integrated support for malaria control. Through the national malaria unit and annual malaria conference there needs to be efforts to bring together the national interest and expertise in malaria control.

The ability to bring together, experts and institutions to provide advice and guidance to national malaria control programs requires a well established national malaria unit and team which has the time and resources and is confident to request and maximize support.

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National Malaria Control Standards and Guidelines

All countries have a basic national guidelines on chemo-therapy and chemo-prophylaxis of malaria with Malawi, Zambia, Zimbabwe, Tanzania and Botswana undergoing their second revisions. In Swaziland, Angola, South Africa, Namibia and Mozambique are in the process of moving towards a second revision. Mozambique has a vector control guidelines which is due for a second revision. Botswana has developed its first version of vector control guidelines. Zimbabwe and Namibia have draft vector control guidelines awaiting completion. Draft epidemic control guidelines have been developed in Namibia, Tanzania, Botswana and South Africa. There is need for gradual development a comprehensive national malaria control manual as the example of Botswana. Supervision check list have been developed for various areas mainly case management and vector control within national malaria programs, but the efforts have varied from country to country.

Inter-country framework guidelines have been developed on planning, surveillance, surveys, malaria and population, malaria and school health, vector control. Guidelines in early draft form are community malaria control, and inter-sectoral approach to malaria control, malaria epidemics and malaria emergency.

The development of national and inter-country guidelines or standards is a gradual process, which requires the effective functioning of national malaria committees and sub-committees supported by a network of experts and institutions.

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Malaria Annual Public Health Reports, Reviews-Monitoring and Evaluation

Framework for annul reports have been developed to support national and inter-country programs. Annual reports are complied regularly by programs in Swaziland, Botswana, Zimbabwe, Zambia and South Africa specifically for malaria control or within departments of endemic disease control in Ministries of Health. The documentation and accounting of work within national malaria control programs still requires further support and has to be developed within a framework of monthly and six-monthly reports to support the monitoring of annual plan implementation and financial accounting.  Annual reviews were successfully carried out in 1997 and 1998, but has now been suspended as the process of Roll Back Malaria development and  inception process had been initiated. There has been attempts to continue the review process and integrate it as part of the rapid assessments, desk reviews and situation analysis of Roll Back Malaria development.

Format for country profiles and core monitoring and evaluation indicators have been developed, but efforts have to be made to ensure that supportive baseline surveys have been conducted and surveillance, information and operation research systems are being adjusted to collect the relevant indicators. The malaria country profile formats have to be supported by further data base development which is being systematically updated and the information is being used to re-direct malaria program activities.

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Malaria Policy Document:

Clear and precise consensus statement of national political and technical policy commitment recognizing malaria as national health priority problem and statement of malaria control as priority and the major strategies and interventions proposed to control malaria

Malaria Manual-Guidelines:

Expert technical standards and norms developed by consultation and clearly defined as a guidance for all health professionals

National Malaria Unit:

A unit established to ensure the management of malaria control activities within the health system through effective problem definitions, planning , organizing, .coordinating, monitoring and evaluation.

National Malaria Control Officer:

Technical and managerial leadership with the time available to assume individual responsibility for national malaria control activities

Malaria Task-Force Technical Committee:

Technical, management advise, consensus and collective and shared responsibility for national malaria control.

Five Year Strategic Plan:

Strategic long-term priorities liked with health development plan and national development plan

Annual Malaria Plan:

Annual priorities regards implementation of the strategic five year plan

Anual Malaria Report:

Audit, accountability and transparency regards, progress, constraints and priorities based on the overall strategic five year plan on an annual basis

Annual Malaria Consultation and Planning Conference:

National consultation process with the decentralized provinces and districts to share achievements, success, and introduce new approaches, widen the information, communication and consultation process. 

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 Core Indicators for Malaria Control Programmes

IDS: Integrated Disease Surveillance

Declarations | WHO-SAMC Organisational Structure

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