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MALARIA SITUATION IN PAKISTAN PROGRAMME GOALS AND OBJECTIVES To reduce the burden of malaria by 50 percent by the year 2010 RBM Implementation all over the country by 2006 ELEMENTS OF NATIONAL RBM STRATEGY Early detection and prompt treatment of malaria cases

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MALARIA SITUATIONIN PAKISTAN


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PROGRAMME GOALS AND OBJECTIVES

  • To reduce the burden of malaria by 50 percent by the year 2010

  • RBM Implementation all over the country by 2006


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ELEMENTS OF NATIONAL RBM STRATEGY

  • Early detection and prompt treatment of malaria cases

  • Multiple prevention measures including ITNs and focal spraying with insecticides

  • Detection and control of malaria epidemics

  • Operational research

  • Viable partnerships with government, non-government and private sector partners


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Malaria Occurrence in Pakistan:Annual Parasite Incidence/1000 population



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2003 DATA - Malaria Control Programme Plasmodium Falciparum

Annual Parasite Incidence – API/1000 population

More than 3.5

1.6 – 3.5

0.5 – 1.5

Less than 0.5

No data available


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2003 Data - Malaria Control Programme Plasmodium Falciparum

Annual Falciparum Incidence – API/1000 population

More than 3.5

1.6 – 3.5

0.3 – 1.5

Less than 0.2

No Data available


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Districts with RBM in place Plasmodium Falciparum

PUNJAB: Muzzafargarh, D.G. Khan, Rajanpur, Bhawalnagar, Jhang, Kasoor, Sailkot, Khenewal, Rahimyar Khan, Liayah

SINDH: Hyderabad, Mirpurkhas, Badin, Jacobabad Thatta

NWFP:D.I. Khan, Sawabi, Laki Marwat, Kohat, Karak, Bunner, Bannu, Malakand

BALUCHISTAN:Pishin, Zhob, Kharan, Lasbella, Nasirabad



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ACTIVITIES Plasmodium Falciparum

  • DIPS IN 21 RBM DISTRICTS

  • CAPACITY BUILDING

  • CASE MANAGEMENT

  • TRAINING OF MEDICS/PARAMEDICS

  • TRAININGOF MICROSCOPISTS

  • PROVISION OF LOGISTICS

  • PROVISION OF ANTI MALARIAL DRUGS


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ACTIVITIES (contd) Plasmodium Falciparum

VECTOR CONTROL

IRSFOCAL SPRAY IN SELECTED AREAS

PROVISION OF SPRAY EQUIPMENTS

INSECTICIDES

LARVECIDES

ULV FOG GENERATORS (N.W.F.P)

ITNS


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Treatment & Diagnostic facilities Plasmodium Falciparum

  • The district and sub-district hospitals and rural health centers (and few selected basic health units) work as microscopy centers.

  • The primary health care facilities such as basic health units and dispensaries work as treatment centers.

  • The Tehsil and district headquarter hospitals also provide specialist care to complicated/severe malaria cases.


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EPIDEMIC CONTROL Plasmodium Falciparum

  • Epidemics in district, Okara, Mirpurkhas

  • Flood affected areas of Sindh and Balochistan

  • WHO support in investigation & response


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PROGRESS-1 Plasmodium Falciparum

  • National strategic plan developed.

  • Federal and Provincial PC-1s approved.

  • Case management guidelines and microscopy manual developed (local language).

  • 21 districts initiated RBM activities, as per DIPs.

  • Malaria early warning system (MEWS) drafted.

  • TV, radio and print materials developed.

  • GFATM support for programme strengthening


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Capacity Building/ Advocacy and Communication Plasmodium Falciparum

  • Revitalization of the former NIMRT

  • Training to various levels of malaria workers

  • National plan for advocacy & education in place

  • Advocacy and mass awareness activities started

    - TV: 500

    -Radio messages: 400

    - Newspaper: Advertised in leading News papers for



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Specialized Courses Conducted Plasmodium Falciparum



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PARTNERSHIPS Plasmodium Falciparum


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International & National partnerships-1 Plasmodium Falciparum

WHO

  • JPRM: US$ 72,000 (02 yrs.)

  • Tech Officer (RBM): 01

  • Further commitment for TA

    GFATM

  • Grant Round 2 : US$ 4.4 Million

    Strengthening microscopy in 23 districts

    Enhanced case management capacity in 23 districts

    Design and implement BCC strategy

    Promote the use of ITNs in 11 pilot districts through public-private partnership


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International & National partnerships-2 Plasmodium Falciparum

GFATM Round 3:

Proposal approved by Tech Rev Panel (TRP)

Total grant approved: US$ 1.5 million

DFID

  • DFID-NHF to provide TA and budget support to the MCP for strengthening RBM expansion.

    TA includes:

    • Human resource

    • Provincial level strategic planning and PC-1 revision.

    • Development of training materials and manuals


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International & National partnerships-3 Plasmodium Falciparum

The programme is piloting implementation of ITNs in 11 districts in partnership with following NGOs:

  • Health Net International Peshawar

  • National Rural Support Programme/ Association for Social Development

  • greenstar


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IMPLEMENTATION Plasmodium Falciparum

  • Drug resistance sentinel sites needs functional , trainings has been completed & implementation will start shortly.

  • Sentinel sites for recording and reporting of severe malaria morbidity & mortality identified

    workers are trained, tools for data collection provided & the sentinel sites will be functional in next quarter of this year.


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OPERATIONAL RESEARCH Plasmodium Falciparum

  • Drug resistance studies carried out in 12 districts.

  • Research study on care providers and community perspectives (contracted to IPH Lahore)

    - Assessment of public & private sector health care delivery capabilities and potential for malaria control

    - Assessment of community perceptions and practices regarding malaria and its control


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STRENGTHENING OF FEDRAL DIRCTORATE Plasmodium Falciparum

IN PROCESS

A. DFID

  • INTERNATIONAL ADVISOR 01

  • PROGRAMME OFFICERS 02

  • EPIDIMIOLOGIST 01

  • DEVELOPMENT OF GUIDELINES

    B. GFATM ROUND-II

  • PROJECT COORDINATOR (FIELD) 01

  • M/TECHNICIANS FOR NIMRT 02

  • M/REPAIR TECHNICIANS 05


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STRENGTHENING OF FEDRAL DIRECTORATE Plasmodium Falciparum

C.GOVERNMENT OF PAKISTAN

1.COMPUTOR PROGRAMMER 01

2.MEDICAL OFFICER 01

3.SCIENTIFIC OFFICER (NMIRT) 01

4.ADMIN OFFICER 01

AND SUPPORT STAFF.*

* Advertisement made


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ISSUES & CHALLANGES Plasmodium Falciparum


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ISSUES Plasmodium Falciparum

  • Need for provincial and district level strategic planning

  • Need for strengthening supervision and monitoring at provincial and district level

  • Sub-optimal use of malaria human & other resources

  • Inadequate field cost (TA/DA) for malaria staff

  • Involvement of private sector in malaria control


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ISSUES Plasmodium Falciparum

Drug resistance

  • RII level to chloroquine

  • Resistance is now on increase

    Insecticide resistance

  • Two primary malaria vectors are resistant to Organochlorines (DDT, BHC, Dieldrin) and Organophosphates (Malathion)


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ISSUES Plasmodium Falciparum

  • National Policy on the vector control (rational use of insecticide)

  • National Malaria Treatment Policy to be in line with WHO ACT

  • Integration of MCP activities with EPI and MCH

  • Uncontrolled private sector


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THANK YOU Plasmodium Falciparum


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