Somalia Road Map Plan to achieve 100% coverage of malaria control by Dec Sept. 2010

3 distinct areas: Somaliland, Puntland, Central/South Somalia Health indicators - UMR: 225 (per 1,000) - MMR: 1100 (per 100,000) - Malaria prevalence 1 – 10% Political / Social Population – approx 9.3 M. Insecurity Population displacement Few health worker Health system is fragmented & under financed General Context

Malaria Program Currently funded under the GF Rd 6 from Nov 2007 to Oct –Phase 1: Sept 2007 to Oct million –Phase 2: Nov 2009 to Oct million Implementation of activities guided by the National Malaria Strategy 2005 to 2010 Updated NMS / M&E Plan (2010 to 2015) revised, approved and endorsed by health authorities in the three zones. –Courtesy of the EARN/RBM support to finalize and endorse (March 31, 2010)

Situation Analysis Case Management –Introduction of ACT/RDT started in 2006, covering all Hospital & MCH –Guidelines in place BUT need revision –Just introduced ACT/RDT at the lower Health post levels (2009) –No funding Gap Malaria prevention –715,000 distributed: 50,000 procured and planned for distribution –76,480 received at Mombasa and earmarked for distribution in Lower Shabelle and Lower Juba/ Sept/Oct –So far coverage is estimated above 65% (except L.Sh)

Situation Analysis IEC –Implementation guided by Malaria communication strategy (2006/2010) –Malaria Communication strategy needs to be updated –Activities – Trained 30% of HWs on communication techniques: Community dialogue: Conducting malaria field days and annual World Malaria Day Malaria in pregnancy –Implemented only in the CSZ of Somalia –SP is procured by UNICEF: No funding gap –LLINs distributed as part of mass coverage (No ANC distribution)

Situation Analysis ctd Health system strengthening –60% of labs undergoing QC –30% of laboratory technicians trained –8 senior lab tech to be trained in lab QC Epidemic Preparedness and response –7% of health staff trained on epidemic preparedness & response –No clear EP&R strategy except Somaliland (mapping not done, estimate not done) – TA required HMIS –On-going under Rd 6: All districts covered in Somaliland & Puntland is on-going –Data has started flowing IDSR – Functioning by the end of 2010 Strengthening of Malaria Control Program –Established in all three zones. –NMCP Managers trained and supported

Road map Sept 2010 Evaluation - LLIN INTERVENTION: LLINS Activity implemented (Yes/No) Is the activity achievable by Dec 2010? (Yes/No) Can Univesal coveage be eached by Dec 2010? (Yes/No) Comments Situation analysis YESNO Analysis indicates LLINs need (1.1 million) Procurement YES NO Training YES Distribution YES Take over of warehouse and looting of LLINs by A.G.E

Road Map Sept 2010 Evaluation-ACT RDT Activities Procurement & logistics X Training XXXXXXXX Distribution XXXXXXXXXXXXXXXXX AMD policy (Revise Protocol) X

Road Map Sept 2010 Evaluation-ACT RDT INTERVENTION: Activity implémented (Yes/No) Is the activity achievable by Dec 2010? (Yes/No) Can Universal coverage be reached by Dec 2010? (Yes/No) Comments Procurement & Logistic YES NO ACT/RDT has been introduced up to MCH level: Lower level HP partially covered Training PartiallyYES Roll out to HPs level is on-going Distribution PartiallyYESNO Need to map out the HPs, affected by insecurity (take over of warehouse by A.G.E AMD policy (Revise Protocol) NoYES TA support needed from RBM partnership

Supervision & Capacity building 1 Activities % of labs undergoing QC xxxxxxxx MMRT 32/09&25/2010 x xxx QC for 2 senior Lab Tech xx*x* Mal case Mm (2)x MSc Ent 4/09&4/2010 xx * post pond-Jan11

Supervision & Capacity building Road Map Sept 2010 Supervision & Capacity building valuation- INTERVENTION Activity implemented (Yes/No) Is the activity achievable by Dec 2010? (Yes/No) Can Univesal coveage be eached by Dec 2010? (Yes/No) Comments 60% of labs undergoing QC Yes HF Not supported by GF need to be considered MMRT Yes Target has been reduced from 30 to 25 per yr & support is needed to keep the 80 target QC for 2 senior lab tech Yes Mal case Mm (2) Yes 8 MSc in Ent. (4/09&4/2010) Yes4/2009 2/2010 Yes Only 6 out of the 8 got the MSc (2/NW, 2/NE&2CSZ )

Supervision & Capacity building 2 Activities trained in malaria communication xxxx 326 health staff trained on EPR xxxxxxx INTERVENTION Activity implemented (Yes/No) Is the activity achievable by Dec 2010? (Yes/No) Can Univesal coveage be eached by Dec 2010? (Yes/No) Comments 167 HWs trained in malaria communication PartiallyYESYes Roll out is on- going 326 health staff trained on EPR Partially Yes 7% covered new SR (Mentors) on board to cascade trainings

Road map Sept 2010 Evaluation- Limiting Factors (Mitigation) Limiting factor: What are mitigation measures taken? Still a limiting factor Is the activity achievable by Dec 2010? (Yes/No) Can Universal coverage be archived by Dec 2010? (Yes/No) Comments Lack of strong central government Problem solving & Under standing Yes in NEZ& NWZ zones Yes in NEZ & NWZ Yes in ZonesSCZ in ? Poor capacity of SR Improve coordinatio SCZ Yes in NEZ&NWZ Strengthening Problem solving Weak HMIS/MIS Training data mangement Yes Improve & update data mangement system Trained staffs turn over. Improve staff motivation Sustainability of the ACT& RDTs supply for Somalia (After GF support?) Préparation of Future plan Support N0Yes Inadequate human capacity in malaria microscopy and Entomology & VC TrainingNoYes Lack of central reference laboratory for malaria QC Established NE&NW zone No for the North and Yes to CSZ Yes Established NE&NW zone

Technical Assistance needs over 3 months (Oct – Dec 2010) Updating communication strategy for malaria (Oct 2010) GF Rd 10 proposal (NSP and M&E costing on going) Development of Epidemic Preparedness & Response Strategy (Oct 2010) Establishment of 3 Ent Units (1/Zone - on going) – TA not needed Health Facility mapping (especially Health post) Participation request for support Nationals to attend the 29 th Dec meeting in Cairo on PRM AMD policy update/Work Shop – Oct/Nov 2010 SMS intruduction in Surveillance weekly data collection

TA needs Road Map Sept 2010 Evaluation- TA needs INTERVENTION Did you receive planned TA (Yes/No) If not, did you make a formal request either to WHO or to EARN (Yes/No) If yes, was TA on time? (Yes /No) If Yes,Level of satisfaction 1-Non Satisfied 2-Average 3-Very satisfied Comments National Malaria Strategy & M/E update ( ) DONEYES 3Costing of the NSP and M&E is going on Updating communication strategy for malaria NO Not done Develop Rd 10 proposal Yes 3Costing of the NSP and M&E is going on Develop EP&R strategy NoNot submitted

TA needs cont… Road Map Sept 2010 Evaluation- TA needs cont… INTERVENTION Did you receive planned TA (Yes/No) If not, did you make a formal request either to WHO or to EARN (Yes/No) If yes, was TA on time? (Yes /No) If Yes,Level of satisfaction 1-Non Satisfied 2-Average 3-Very satisfied Comments Operational research (insecticide resistance monitoring) Yes Somalia currently has 6 Ent. MSc with cabavle capacity of developing the Ent studies and insectories Establishment of 3 Ent Units no Costing of NSP and M&E noYes ongoing Update AMD Policy No

Latest activities Sept MMRT for 18 lab tech (8/NWZ, 10/NEZ) Ent Unit Equipments procured and will be distributed in Oct 2010 IRS campaigns implemented (in all zones) Successful and effective participation in 9 th inter-country meeting/ Marrakesh/Morocco Quarterly supervision of HF and distribution of lab supplies, ACTs and RDTs

Way forward – Oct – Dec 2010 PR/UNICEF: –1.2 Million LLINs planned for distribution under Rd 6 ending Nov 2012 –250,000 LLINs expected to arrive end of September : Gap of 1.2 million –Support NMCP offices (MW & NE only) WHO –Ent Units establishment – Oct 2010 – Procurements - done –MMRT – for CSZ 10 participants 16 th – 30 th Oct - DONE –Vector susceptibility tests – 10 th Oct - Done –Amend the MOU with PR/UNICEF for Yr 4 (Nov 2010 – Oct 11) Other SR: ?? (HAVOYOCO, CCM/Italy, MENTOR) CARITUS – IRS activities