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MPR Pakistan

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MPR Pakistan PAKISTAN MALARIA PROGRAMME REVIEW (MPR) 1 Contents Executive summary ......................................................................................................................... 4 1. Introduction ............................................................................................................................... 17 1.1 Background ...................................................................................................................... 17 1.2 Objectives of the MPR ........................................................................................................ 17 1.3 Methodology of the MPR ................................................................................................... 18 1.4 Outline of the document...................................................... Error! Bookmark not defined. 2. Context of malaria control ........................................................................................................ 20 2.1 Historical milestones in malaria control .............................. Error! Bookmark not defined. 2.2 Malaria control within the national development agenda .... Error! Bookmark not defined. 2.3 National health policy .......................................................... Error! Bookmark not defined. 2.4 National health sector strategic plan .................................... Error! Bookmark not defined. 2.5National development plan ................................................... Error! Bookmark not defined. 2.6 Organizational structure for malaria control ....................................................................... 25 2.7 Key strategies for malaria control ....................................................................................... 26 2.8 Key players in malaria control ............................................................................................ 27 2.9 Linkages and coordination .................................................................................................. 28 2.10 Conclusions and Recommendations ................................................................................. 28 3. Epidemiology of malaria ........................................................................................................... 28 3.1 Geographical distribution of malaria ................................... Error! Bookmark not defined. 3.2 Population at risk ................................................................. Error! Bookmark not defined. 3.3 Stratification and risk map ................................................... Error! Bookmark not defined. 3.4 Malaria parasites .................................................................. Error! Bookmark not defined. 3.5 Malaria vectors..................................................................... Error! Bookmark not defined. 3.6 Disease trends ...................................................................... Error! Bookmark not defined. 3.7 Conclusions and recommendations . .................................... Error! Bookmark not defined. 4. Programme performance by thematic areas ............................... Error! Bookmark not defined. 4.1 Programme management ..................................................... Error! Bookmark not defined. 4.2 Procurement and supply chain management ....................................................................... 91 4.3 Malaria vector control .......................................................... Error! Bookmark not defined. 4.4 Malaria diagnosis and case management .......................................................................... 213 2 4. 5 Advocacy, BCC, IEC and social mobilization.................... Error! Bookmark not defined. Error! Bookmark not defined. 4.7 Surveillance, Monitoring and Evaluation ......................................................................... 168 Conclusions .................................................................................... Error! Bookmark not defined. Key recommendations ................................................................... Error! Bookmark not defined. Annexes.......................................................................................... Error! Bookmark not defined. Annex 1: Agenda for all the phases of the MPR ....................... Error! Bookmark not defined. Annex 2: People involved in MPR ............................................ Error! Bookmark not defined. References ...................................................................................... Error! Bookmark not defined. 3 Executive summary The specific objectives of the MPR were: • To review the epidemiological outlook of malaria disease in each province of Pakistan with particular reference to disease trends, Slide positivity rate, Species wise distribution, Blood exam rate BER, Severe Malaria and Outcome of the managed cases at health facility with particular reference on disease specific mortality. • To review the Malaria program structure, capacity and management in each province and at national level (DOMC), in view of its new roles after devolution and identify issues and challenges arising post devolution. • To assess the current programme performance by intervention thematic areas and review progress, challenges and towards achievement of targets in each province and progress towards achieving national and regional goals. • To identify way forward, priority needs and gaps for improving programme performance and coordination at provincial and federal level. • To define steps to improve programme performance and redefine the strategic direction and focus, including revision of policies and strategic plans at provincial levels which can help tapping the available funds from various sources including the public sector and donors e.g. Global Fund from R10 malaria grant phase II and from the new funding model. • To assess the effectiveness of Global Fund grants supported projects in highly endemic regions of the country and to suggest ways and means for quality assured interventions following the principals of transparency, accountability and value for money. • To develop the post MDG strategic plan at provincial and national level for Pakistan for 2015-2020, based on the results of PRM, which will help mobilize resources based on new funding model. Key Findings Pakistan was one of the high endemic countries who launched Malaria eradication program in the 1960’s, with the support of WHO, UNICEF and USAID. As a result of this campaign there was marked reduction in malaria cases from a reported 7 million cases in 1961 to 9,500 cases in 1967 with associated slide positivity rate reduction from 15% to less than 0.01%. However there was a major resurgence and epidemics in early 1970s even in urban areas such as Karachi with reported malaria cases rising to 10 million in 1974. Some of the reasons for the resurgence were the onset of vector resistance to Organochlorines (DDT & Dieldrin/BHC), under estimation of A. stephensi in maintenance of urban malaria, inadequate planning for malaria control within irrigation and water development projects together with financial and administrative constraints, inadequate administration of programs, inadequate research, training, and supplies of chemicals and drugs, inadequate health services infrastructure with premature withdrawal of donor support. The Malaria Program switched from Eradication to Control Program during 1975-1985 and implementation handed over to provincial government and district health offices and malaria control program was integrated with general health services in 1985. In 2003 as part of the global Roll Back Malaria Movement, Pakistan launched its Roll Back Malaria program with support of government planning commission Roll Back Malaria plan 2008/2009-2012/2013 with support of GF Round 7 and Round 10 malaria grant. This started accelerated malaria control activities in 38 priority high malaria transmission districts out of the 136 districts in the country. 4 Today Pakistan has an estimated population of 173.5 million people, out of which, according to the 2012 national malaria disease surveillance annual report, 9% are living in high transmission districts (34) with an annual parasitic index (API) ranging from 5 to 28, 20% are living in moderately endemic districts (41 districts) with API ranging from 1 to 5, and 71% living in low endemic districts with an API below 1/1000 population. The national API for the entire country is averaging 1.69, which classifies Pakistan as a moderate malaria endemic country. Malaria mappings show clearly that the highly endemic districts are located mainly in the provinces of Baluchistan, FATA, Sindh, and KPK. The lowest malaria incidence was reported in two provinces – Punjab and AJK with combined population of more than 56% of total population of the country. The primary malaria vectors are A.culicifacies and A.stephensi. A number of secondary vectors have been reported and their contribution to malaria transmission is being investigated. The last nationwide vector surveillance was in 2009 and a new one has been completed in 2013 and data is being analysed and report under preparation The primary malaria parasite is P. Vivax with P. falciparum being the secondary parasite. In 2012, Annual Blood Examination Rate (ABER) varied between 1.78% in Punjab to 7.09% in Baluchistan. Out of the 289,759 malaria cases confirmed positive in 2012, 249,504 were identified by microscopy (86.1 %), while 40,255(13.89%) by rapid diagnostic
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