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Mkude.S (MD); NMCP/MoHSW
Malaria Elimination Concepts, Strategic direction (2008-
2010), Steps, Activities, Requirements
Feedback on New Global “Malaria elimination” Initiative to NMCP
12th November 2007
Morogoro
Mkude.S (MD); NMCP/MoHSW
Contents of Presentation
• Introduction• The concept: towards malaria elimination• Strategic direction (2008-2010)• Steps & activities (Global level)• “Resource moderators”• Requirements for initiation of the processSub regional responsibility Countries initiation processWHO country office responsibilities & support to
be given
Mkude.S (MD); NMCP/MoHSW
Introduction
Mkude.S (MD); NMCP/MoHSW
The Anatomy of Global Malaria initiative
WHO DG
WHO RBM
Partners
(Resource contributors)
WHO GMP
Technical Board
Regional WHO
WHO/AFRO
Country WHO Offices
HWG
(Resource Moderators)
HWG Nairobi Meeting 22nd-23rd October 2007
GMP Nairobi Meeting
24th- 26th October 2007
Nairobi 2 in 1 Meeting
Mkude.S (MD); NMCP/MoHSW
Introduction (1)• There is a Global movement which has created
new “Malaria Elimination” initiative• The initiative is going to be in full scale within 6
months • It advocate rapid scaling of intervention to achieve
RBM targets of universal coverage of 80% by 2010 (Intensive 36 months)
• What is immediately required by donors community is to know the individual country needs (Needs Assessment)
• Thereafter a business plan before February 2008• The country Needs Assessment (NA) & Business
Plan (BP) must be in line with (our) MMTSP
Mkude.S (MD); NMCP/MoHSW
Introduction 2
• The RBM Harmonization Working Group (HWG) will fill the gap of required resources
• WHO will be the focal partner at country level• There was a 2 in 1 meeting (WHO GMP & RBM
HWG) in Nairobi to initiate the process of country NA & BP
• The meeting was attended by NMCP’s PMs and their WHO Malaria NPO from selected 15 African
countries Representation from all WHO regional offices world wide WHO HQ RBM HWG members
Mkude.S (MD); NMCP/MoHSW
Introduction 3
• There was a request from participating countries for an official communication to Government Ministries of Health.
• In principal we are “nominated” but we have to fulfil the requirements:Initiate prescribed process in a tight
framework of timelinesCentre to all is the re-orientation of Country
Malaria STP
Mkude.S (MD); NMCP/MoHSW
The concept: towards malaria elimination
Mkude.S (MD); NMCP/MoHSW
The aims of the “new initiative” global fight against malaria
1. reduce the burden of malaria in endemic areas (rapid scaling up to 80% by 2010)
2. reduce the geographical extent of endemic areas (rapid scaling up to 80% by 2010)
3. Support elimination where feasible
Mkude.S (MD); NMCP/MoHSW
From malaria control to elimination
Mkude.S (MD); NMCP/MoHSW
II Attack 4 years
III Consolidation3 years
IV Maintenance
The Origin of the idea: Traditionally 4 phases in malaria eradication
WHO certification
annual reporting to WHO
3 years free of local transmission
I Preparatory 1 year
Intense malaria
end of population-based
interventions
information collected, plan developed, systems ready, trained staff and
resources in place
Mkude.S (MD); NMCP/MoHSW
Eligibility to “Malaria Elimination”
• Cut of point of slide positivity rate <5% in fever cases as a criterion for initiation of elimination process
• The minimum area is a district of about 100,000 population
Mkude.S (MD); NMCP/MoHSW
Mkude.S (MD); NMCP/MoHSW
Definitions
Malaria control: reducing disease burden to a level where it is no longer a public health problem
Malaria Elimination: interruption of local mosquito-borne malaria transmission in a defined geographical area. Means zero incidence of locally contracted cases , imported cases will continue to occur. Continued intervention measures are required
Eradication: permanent reduction to zero of the worldwide incidence of infection caused by a specific agent – i.e. Extermination of the infectious agent
Mkude.S (MD); NMCP/MoHSW
Malaria elimination: a WHO Field Manual
Target audience: endemic country governments, programme managers, staff from partner agencies
Purpose: provide the overall picture, point to more detailed information
Current format: 96 pages total
Mkude.S (MD); NMCP/MoHSW
GMP malaria elimination field manual
Clarity on malaria elimination concepts (for moderate-to-high transmission countries that consider moving towards elimination)
Clarity on WHO policies, procedures and reporting requirements (for countries that are near malaria elimination or have recently achieved it)
Mkude.S (MD); NMCP/MoHSW
Strategic direction (2008-2010)
Mkude.S (MD); NMCP/MoHSW
Strategic direction (2008-2010)
1. Develop scientific consensus on control strategy and business plan
2. Intensified implementation of national malaria programmes
3. Effective advocacy / resource mobilization
Mkude.S (MD); NMCP/MoHSW
Recommended (proven intervention) Malaria control package (1)
• Diagnosis-based treatmentDiagnostic useTreatment use
• Prevention (LLITN + IRS)Transmission control with ITNsTransmission control with IRS
• Monitoring and evaluation Performance monitoring and impact evaluation
• Insurance (protect effectiveness of current tools)• Operational research
Mkude.S (MD); NMCP/MoHSW
Malaria control package(2)
• "Documentable" effective case management systems
National – District – Health facility, Community, Private Sector
• Prevention LLITN for community prevention, 80% coverage of
total population at risk IRS for community prevention as a supplement to
LLITN, for epidemic preparedness, etc.
Mkude.S (MD); NMCP/MoHSW
Strategic direction (2008-2010)
1. Develop scientific consensus on control strategy and business plan
2. Intensified implementation of national malaria programmes
3. Effective advocacy / resource mobilization
Mkude.S (MD); NMCP/MoHSW
2. Intensified implementation
• Effective treatment and prevention coverage increased to 80% in 54 countries
• Elimination / certification in 25 countries
• More gradual scale up in 28 countries
Mkude.S (MD); NMCP/MoHSW
Intensified implementation• 57 Programmes*: support led by WHO
– Endemic (10 in Africa; 22 in other regions)– elimination / certification: 25
• 22 Programmes* in Africa: support coordinated by RBM harmonization working group (which includes WHO)
• 28 Programmes*: scaling up gradually, supported by WHO & other interested partners
• Coordination with International Health Partnership on health systems strengthening (Burundi, Cambodia, Ethiopia, Kenya, Mozambique, Nepal, Zambia)
* Proposed
Mkude.S (MD); NMCP/MoHSW
Proposed countries
• Group A: Scaling up Malaria control to 80% (2008-2010)– Africa: Angola, Benin, Burundi, Burkina Faso, Cameroon, CAR, Chad,
Congo, DRC, Equatorial Guinea, Eritrea, Ethiopia, Ghana, Guinea, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Niger, Nigeria, Rwanda, Sao Tome & Principe Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Uganda, Zambia, Zimbabwe
– Latin America: Brazil, Colombia, Guatemala, Honduras, Nicaragua, Peru, Venezuela
– Asia & Middle East: Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Laos, Myanmar, Papua New Guinea, Philippines, Thailand, Solomon Islands, Vanuatu, Vietnam, Yemen
• Group B: Pre-elimination to elimination phase (2008-2010)– Algeria, Argentina, Azerbaijan, DPRK, El Salvador, Georgia, Iran, Iraq,
Krygsztan, Malaysia, Mexico, Paraguay, Tajikistan, Turkey, Turkmenistan, Russia, Sri Lanka, Saudi Arabia, Swaziland
• Group C: Certified Malaria Free (2008-2010)– Mauritius, Morocco, Oman, Armenia, Syria,
• Group D: Gradual scale-up in remaining 28 countries
Mkude.S (MD); NMCP/MoHSW
Strategic direction (2008-2010)
1. Develop scientific consensus on control strategy and business plan
2. Intensified implementation of national malaria programmes
3. Effective advocacy / resource mobilization
Mkude.S (MD); NMCP/MoHSW
3. Resource mobilization• Ensure investments and resource flows
– More resources and effective, innovative implementation of investments: GF
– More investments: PMI, WB, UNITAID, new bilaterals, new international NGOs
– Increasing National investments• Resources mobilization – USD 6 billion (2008 -2010)
– National programmes & commodities – 85 %– TA and Operational research – 15 %
• Advocacy– In-country efforts– Individual (Ray Chambers) and institutional (WHO, WB, PMI, UNICEF,
etc.) initiatives– UN Special envoy– Media campaigns (in-country and international)
Mkude.S (MD); NMCP/MoHSW
Phase 1(Strategic Direction): 6 months (Sep 07 – Feb 08)
• Development of the plan
• Consensus building
• Endorsement and launch of the plan
Mkude.S (MD); NMCP/MoHSW
Steps & Activities(Global level)
Mkude.S (MD); NMCP/MoHSW
Global Key activities in Phase 1(strategic direction-Plans on proven interventions):
6 months (Sep 07 – Feb 08)• Gates Malaria Forum- Seattle, 16-18 October
– Presentation of strategic direction by DG– Endorsement of strategy by key stakeholders (Tanzania attended
with 4 other African countries)• Operational plans
– Workshop to develop country plans - WHO supported national programmes, Nairobi, Kenya- October 22-26, 2007 (Tanzania attended)
– Workshop to develop country plans: (?? deadline for in country process end of January 2008) – facilitated by RBM harmonization working group
• Launch of the Business plan - High level forum, February 2008.– Endorsement of plan by Heads of State (US, UK, Canada, etc);
endemic countries; and H8 group (WHO, World Bank, UNICEF, Gates Foundation, GFATM, GAVI, UNITAID, and UNFPA)
– Launch of Intensified implementation towards a “malaria free world”
Mkude.S (MD); NMCP/MoHSW
Global Key activities in Phase 2: (strategic direction-Intensified implementation)
12 months (Mar 08 – Feb 09)• Intensified implementation
– Roll-out of WHO's new case management cum disease surveillance strategy
– Substantial strengthening of national malaria programme management (structure, logistics, etc)
– Roll-out of WHO new country monitoring and evaluation system– Roll-out of WHO new ITN and IRS strategy
• Establish commodity needs forecasting system (ACT & LLIN)– Negotiations with manufacturers– Establish ACT raw material buffer stock system– Expansion of LLIN production capacity
• Documentation and Report Card1. WHO Global Malaria Report (World Malaria Day in 2008)2. Monthly information system (tracking commodity & progress) 3. Biannual performance report on GMP website4. Analysis: impact, cost-effectiveness, success stories
Mkude.S (MD); NMCP/MoHSW
Global Key activities in Phase 2: (strategic direction-Advocacy)
12 months (Mar 08 – Feb 09)
• Media Awareness campaign with regular events • Clearer policy/position on other
interventions/tools (IPTp, IPTi, IVM, vaccine, etc)
• Global consensus on priority research agenda• Consensus-based new estimates of Global
Malaria Burden• Development of Plan Mar 2009 – Dec 2010• Development of Plan for a "Malaria Free World"
2010 - 2015
Mkude.S (MD); NMCP/MoHSW
“Resource Harmonization”
Mkude.S (MD); NMCP/MoHSW
RBM Harmonization Working Group (HWG)
• Major financial and implementation support partners
• Constituency Membership is decided by RBM Board
• Membership includes: WHO (AFRO and HQ), UNICEF, World Bank, Global Fund, MACEPA, Bill and Melinda Gates Foundation, Malaria No More, UN Foundation, Johns Hopkins VOICES Project, Millennium Project, UNF, PSI
• All RBM sub-regional networks and RBM Working Group Chairs
Mkude.S (MD); NMCP/MoHSW
Scaling-up for impact:
• The Board has endorsed a new rallying cry at the core of Roll Back Malaria:
• “Scale Up”– Existing full package of proven interventions
• Nation-wide to high coverage– Rapidly
• “For Impact” – Track action and document changes in coverage and
benefits in human and economic terms– Moving from high coverage towards elimination as
a public health problem and eventually eradication
Mkude.S (MD); NMCP/MoHSW
RBM Harmonization Working Group (HWG)
1. Coordinate a process to support the development of and adherence to the “3-ones” concept at country level
2. Assist countries to identify support needs for scaling-up through comprehensive gap analyses and needs assessment
3. Track and Facilitate resource flows from partners to countries
4. Harmonize partner efforts to fill country-identified gaps5. Facilitate the development of a “rapid-response”
mechanism to support countries to overcome implementation bottlenecks (reactively and proactively)
6. Secure additional resources from the Global Fund, PMI, World Bank and others in support of country scale-up
Mkude.S (MD); NMCP/MoHSW
But, 1st……Needs Assessments
• Support >30 national programs to develop malaria needs assessments and business plans over the next 4-6 months that will result in achievement of 2010 RBM Goals (>80% coverage)
• Plans will result in an improved understanding of country support needs (financial and technical/implementation support) and the resources and strategies required to fill them.
• Present plans to a series of high-level donor meetings, as well as to individual partners, for immediate support
Mkude.S (MD); NMCP/MoHSW
Process for Needs Assessments
• Develop common template for needs assessment and plan
• Countries lead needs assessment and business plan development
• Each country will be paired with one lead partner and additional supporting partners
• Each country will be offered consultant support to assist in writing/documentation of assessment and plan
• RBM will aggregate assessments and plans, and assist in the development of regional/cross-border investments/actions
Mkude.S (MD); NMCP/MoHSW
SudanSudan
MaliMali
ChadChad
NigerNiger
Congo, DRCCongo, DRC
AngolaAngola
EthiopiaEthiopiaNigeriaNigeria
NamibiaNamibia
TanzaniaTanzania
MauritaniaMauritania
ZambiaZambia
KenyaKenya
BotswanaBotswana
GuineaGuinea
MozambiqueMozambique
MadagascarMadagascar
CongoCongo
ZimbabweZimbabwe
Ghana
UgandaUganda
Cote d'Ivoire
SenegalSenegal
Burkina Faso
Benin
Eritrea
MalawiMalawi
LiberiaLiberia
TogoSierra LeoneSierra Leone
BurundiBurundi
RwandaRwanda
DjiboutiDjibouti
SwazilandSwaziland
The GambiaThe Gambia
Cameroun
Eq Guinea
Gabon
Central African Rep
South AfricaLesotho
Somolia
Comprehensive Needs Assessments
August-December
Not targeted
October-February
January - March
Timeframe
Mkude.S (MD); NMCP/MoHSW
Process for Needs Assessments & Business plan
Needs Assessments:• Workshop (Nairobi), October 22nd -23rd , 2007 with initial 15
countries to be hosted by WHO • Template to be developed by MACEPA and revised by wider
partnership• Consultants will be contracted to carry out the data collection
and actual writing/filling-in of the template to ensure consistency
Business Plans:• Template to be developed by MACEPA • Process for country level development to be managed by RBM
HWG Task Force members with in-country presence, namely WHO, UNICEF, MACEPA, US PMI, and the World Bank, under the auspices of the RBM sub-regional networks.
Mkude.S (MD); NMCP/MoHSW
Requirements(Sub regional & Countries)
Mkude.S (MD); NMCP/MoHSW
Requirement (1):
Sub regional
Mkude.S (MD); NMCP/MoHSW
1st Nairobi workshop, October 22, 2007 with initial 15 countries
• Adaptation of proposed initiation process to individual countries – Identification of key milestones in country – (Selection and) timing of consultants– Discussion on mechanism of in-country
initiation of the processes (Need Assessment) (workshops/retreats)
– Financial requirements
Mkude.S (MD); NMCP/MoHSW
Sub region requirements
• HWG develop a template for business plan by end November
• 2nd workshop for countries on business plan template (early February 2008?).
• translation of needs assessment to business plan through in-country planning
• Finalization (March)
Mkude.S (MD); NMCP/MoHSW
Sub region to facilitate
• Global level synthesis (March)
• High level donor/partner consultation (march) to mobilize necessary resources to meet identified needs:– financial– technical– implementation support
Mkude.S (MD); NMCP/MoHSW
INITIATION FOR RAPID SCALING OF MALARIA
INTERVENTIONS IN TANZANIAStepping in “Malaria Elimination”
Initiative
Mkude.S (MD); NMCP/MoHSW
Contents
• Where are we in line with what is required?
• Key milestones (events) in the initiation process
• Resources to support Focal Partner (WHO Country Office)
• Some future implementation issues to be considered
Mkude.S (MD); NMCP/MoHSW
Where are we in line with what is required?
Requirement 1: In each individual country Malaria Medium Term Strategic Plan (MMTSP) will be the reference document to the “Malaria
Elimination” initiative• The current 2002-2007 Malaria MTSP is in its last
days. • In the development process of the new MMTSP
(2008-12) we are aware that: The context of malaria prevention and control has changed and a much more aggressive approach is needed
Mkude.S (MD); NMCP/MoHSW
Where are we in line with what is required?
• At present the consensus on the framework of our new MMTSP (2008-2012) has been much influenced by GFR7 application, it is a right direction: Concept partNeeds assessment/Gap analysisOperational plan/Business plan (1 year roll out
plan? Fixed .e.g. 3 yrs plan? .e.t.c.)
Mkude.S (MD); NMCP/MoHSW
Where are we in line with what is required?
• In the meantime available needs assessment/Gap Analysis (NA/GA) have been calculated through different recent requested proposal (GF R7, IRS Master Plan, ITN “Sacchs”) based on the new strategies identified in the draft of 2008-12 MMTSP
• Through different above proposals we have in place the patchy frame works for MMTSP Needs Assessment/Gap Analysis which will contribute to our MTSP Operational/business plan
• The MMTSP (2008-2012) draft still needs developed/adoptation NA/GA from different recent proposal to contribute to operational/business plan (a resource moderation component of MMTSP)
Mkude.S (MD); NMCP/MoHSW
Where are we in line with what is required?• Mid of November 2008 there is an already planned
NMCP workshop to finalize the draft of the MMTSP/dissemination
• In principle, we have to review our Goals, Objectives & Targets in the concept part in the new MMTSP to address the high universal coverage (80% or above) concept to every intervention (SUFI).
• The timing for the country initiation process of new “Malaria Elimination” with regard to MMTSP is perfect
• Finalization of our MMTSP in November 2008 is now a must! It will in time(!) merge issues from the new Malaria Elimination initiative required to be reflected in MMTSP
Mkude.S (MD); NMCP/MoHSW
Where are we in line with what is required?
Requirement 2: In each individual country WHO country office is
proposed to be focal partner among country partners
• In Tanzania is a known fact among Development Partners Group in SWAP: WHO is the lead partners for health
Mkude.S (MD); NMCP/MoHSW
Requirement 3: Initiation & process for Needs Assessment
– Identification of preparatory ground key milestones (Events) for Needs Assessment
– Selection/confirmation of local/ international consultant
– Implementation framework for Needs Assessment
– Financial requirements
Mkude.S (MD); NMCP/MoHSW
Identification of preparatory ground key
milestones (Events) for Needs Assessment Activity Timelines Budget
Review and finalization Mid Term Strategic Plan 2008-2012
2nd week of November 2007
Funds available
Dissemination of MTSP to stakeholders/partners/Regional & Districts representative
3rd-4th week of November 2007
$ 50,000
Orientation of MTSP with submitted GMP/HWG business plan frame work to 21 RHMTs and 130 CHMTs
May 2008 $ 200,000
Mkude.S (MD); NMCP/MoHSW
Implementation Framework for Needs Assessments
(Selection of consultants for Needs Assessment)
Activity Timelines Budget
International consultant
1st week of December 2007
WHO/RBM
Local consultant
1st week of December 2007
NMCP/MoH
Mkude.S (MD); NMCP/MoHSW
Activity Timelines Budget Timing of consultants•International consultant
2nd- 4th week January 2008
(WHO/RBM to cost for international consultant)
Local consultant 2nd- 4th week
January 2008
$ 9,000
Arrival of international consultant
6th Jan 2008
Consultants meet with NMCP/Desk Review/Field visit
7th-13th January 2008
Field visit of task force
and consultants 8th – 13th January 2008
$25,000
Implementation Framework for Needs Assessments
Mkude.S (MD); NMCP/MoHSW
Implementation framework for Needs Assessments Activity Timelines Budget
Summarizing field and desk review
13th – 14th January 2008
Retreat 14-19th week January 2008
$ 10,000
Prepare final draft NA 20th-21st January 2008
Feedback of the 1st draft to NMCP and incorporation of comments
22nd-23rd January 2008 $ 3,000
Partners dissemination and incorporation of any comments etc
24th January 2008 $ 20,000
Consultants leave 26th January 2008
Mkude.S (MD); NMCP/MoHSW
Resources to support WHO country office
1) to support country initiation process, needs assessment & Business plan
2) To support scaling up of interventions
Mkude.S (MD); NMCP/MoHSW
RESOURCES FOR NEEDS ASSESMENT FOR WHO - estimates
Milestone1: • Consensus building and briefing on rapid scaling-up at country level
(Government and partners) and support available from HWG• Mobilise partners to contribute to process at country level (HWG to
debrief partner HQ)Resource requirements $ 5 000 Nov (WHO costs) for 8 countries
(Approximate :: $625 available for Tanzania in November)
Milestone 2:Secretariat /Task Force for coordination until Business Plan completed
(country specific depending on country co-ordination mechanism) 6 months
Task force to –pre-review tool
Resource requirement: $5 000 (WHO costs) for 8 countries(Approximate :: $625 available for Tanzania for 6 months)
Mkude.S (MD); NMCP/MoHSW
RESOURCES FOR NEEDS ASSESMENT FOR WHO - estimates
Milestone 3: Comprehensive needs assessment Methodology – desk review + data collection & analysis / 4 * stakeholder meetings (includes districts / regional / provincial meetings) / field visits / Interviews / retreat Logistics - $30 000 – $50 000 TA costs - $20 000 (exclusive of 25,000 allocated for NMCP Field visit of task force and consultants)
Milestone 4: Dissemination meetingTA costs - $10 000(exclusive of 25,000 allocated for NMCP Partners dissemination and incorporation of any comments etc)
)
Mkude.S (MD); NMCP/MoHSW
RESOURCES FOR SUPPORT TO SCALE-UP FOR WHO - estimates
2008 2009 2010
HR (for 8 ESMC)
See detail next slide
$760 000 – $7,990,000
$760 000 – $7,990,000
$760 000 – $7,990,000
Office Operating costs (includes
training and travel, transport, stationery etc)
$ 300 000 $200 000 $200 000
TA $200 000 $200 000 $200 000
M&E $500 000 $400 000 $500 000
Advocacy $100 000 $100 000 $100 000
Mkude.S (MD); NMCP/MoHSW
WHO country office /NMCP strengthening issues(thru WHO funding channel)
• Technical assistance Human Resource: i. Mainland: M&E, logistician, Program
assistant, IPO (partnership), NPO (existing), 8 zonal officers, 1 NPO (lab).
ii. Zanzibar: - IPO+ NPO, 2 Program assistantNeeded approx $1 300 000 annually
Communication (fast internet services) Short course training on Program
management (managerial skills) to Program officers;
Mkude.S (MD); NMCP/MoHSW
Some future implementation issues to be considered
(Raised by NMCP Program Manager during feed back)
Mkude.S (MD); NMCP/MoHSW
Some implementation considerations (1)
• Service areas on Technical Strategies no big deal• Diagnosis-based treatment
Diagnostic useTreatment use
• Prevention (LLITN + IRS)Transmission control with ITNsTransmission control with IRS
• Monitoring and evaluation Performance monitoring and impact evaluation
• Insurance (protect effectiveness of current tools)Efficacy testing
• Operational research
Mkude.S (MD); NMCP/MoHSW
Some implementation considerations (1)
But probably revisit our capacities on:• Program management (Organization,
administration, financial management & reporting)
• District (Region?) & community involvement (review service delivery arrangement at district level towards the community ie Community Malaria intervention package)
• Partnership engagement (including summarization of various partner contribution, both financial &human resources as well as reporting needs
Mkude.S (MD); NMCP/MoHSW
Some implementation considerations (1)
• Given the expected very rapid scale up of activities, resource available & recommended Malaria control package .
i. Coordination (inside NMCP)?a. Critical analysis of strength & weaknesses of NMCP for
the expected activities ii. Revisit Home Malaria Management (HMM) approach?a. Prepare community ant malaria based package(RDTs,
peripheral rectal artesunate, paracetamol, case reporting data)
b. Should we explore further the issue of (C/VHW) with other programs (Structural/functions/coverage) and have at least 2 C/V-HWs per village as 1° implementers of HMM (Approx 20,000 C/V-HWs country wide)
Mkude.S (MD); NMCP/MoHSW
Some implementation considerations (2)
iii. Coordination (outside NMCP)?
a. Should we explore further the potential roles of “Regional Malaria Focal Person” (RMIFP)? Train them with CMIFP like package?
b. Should we find the way to facilitate the RMIFP to easily access the districts? (4-wheel car?, fuel?)
c. NGOs network to facilitate CHMTs (CMIFP) coordination of C/V-HWs ? Through peripheral HFs? etc etc
Mkude.S (MD); NMCP/MoHSW
Rapid scaling up to 80%! 2008-10! Within 36 months!What are the implications?
I hope we are clear on the burden of activities!
Thank you for listening