World Health Organization 25 November 2017 WHO AFRO FRAMEWORK TO IMPLEMENT THE GLOBAL TECHNICAL STRATEGY FOR MALARIA 2016 – 2030 IN THE AFRICAN REGION Jackson SILLAH WHO/IAFRO Seasonal Malaria Chemoprevention Implementation Meeting Ouagadougou, Burkina Faso; 13 February 2017

Presentation Outline Background Scope of the framework Roles and Responsibilities Conclusion

Malaria mortality rates have decreased by 60% worldwide Since 2000, substantial progress achieved 2000 2015 Incidence rate The estimated number of cases per 1000 persons at risk of malaria showed a 37% reduction in case incidence globally ~14 600 per 100 000 persons at risk ~9 100 per 100 000 person at risk Mortality rate Malaria mortality rates have decreased by 60% worldwide ~47 for 100 000 person at risk ~19 for 100 000 person at risk Diagnostic coverage rate (WHO African Region) The % of patients with suspected malaria in WHO African Region who received a diagnostic test has increased by almost 60% <10% 65%

Background (1) The 2016 World Malaria report indicated that the estimated decrease in malaria case incidence and malaria mortality rate were 23% and 31% respectively during the period 2010 – 2015 in the African Region. It also indicates that the highest proportion of deaths was averted in the WHO African Region (94%). Of the estimated 6.8 million fewer malaria deaths between 2001 and 2015, about 6.6 million (97%) were for children aged under 5 years.

Background (2) The Global Technical Strategy (GTS) for malaria (2016-2030) adopted by the 68th WHA; GTS is founded on the vision of a world free of malaria; A Framework for implementing the Global Technical Strategy for Malaria (GTS 2016-2030) in Africa was adopted by Member States during the Regional Committee (RC 66) in August 2016; It describes priority interventions and actions for Member States and provides clear strategic approaches to accelerate progress toward malaria elimination in Africa.

Renewed Focus for a Malaria free World: Global Technical Strategy for Malaria (2016 – 2030)  AFRO Implementation Framework The GTS was endorsed by a Resolution of the World Health Assembly in May 2015 The Framework was endorsed in the 66th session of the Regional Committee for Africa in August 2016

Scope of the Framework Roles and Responsibility for Implementation

World Health Organization Framework for implementing the GTS for malaria (2016 – 2030) in the AFR 25 November, 2017 Goals Milestones Targets 2020 2025 2030 Reduce malaria mortality rates globally compared with 2015 >40% >75% >90% Reduce malaria case incidence globally compared with 2015 Eliminate malaria from countries in which malaria was transmitted in 2015 At least 8 countries At least 13 countries At least 20 countries Prevent re-establishment of malaria in all countries that are malaria-free Re-establishment prevented

Guiding Principles Country ownership and leadership in the context of a multi-sectoral approach; Equity in access to quality health services; Inclusive and coordinated partnership; Collaboration with regional economic communities;

Priority interventions Priority actions of the GTS are defined around 3 pillars and 2 supportive elements Pillar 1: ensure universal access to malaria prevention, diagnosis and treatment Pillar 2: Accelerate efforts towards elimination and attainment of malaria free status Pillar 3: Transform malaria surveillance into a core intervention in areas of high and low transmission and those targeted for elimination Supporting element 1: Harnessing innovation and expanding research Supporting element 2: Strengthening the enabling environment.

The strategic components are as follows : Ensure universal access to malaria prevention, diagnosis and treatment (Pillar 1) The strategic components are as follows : Quality-assured vector control Use of ITNs and IRS Maintaining adequate entomological surveillance Managing insecticide resistance and residual transmission. Chemoprevention Expand preventive treatment in the most vulnerable groups (IPT-p, IPT-i and SMC). Diagnostic testing and treatment Ensure universal testing of all suspected malaria cases Provide quality-assured treatment to all patients Scale up community-based diagnostic testing and treatment Monitor safety and efficacy of antimalarial medicines

Entails the following: Detection of every infection; Accelerate efforts towards elimination and attainment of malaria free status (Pillar 2) Entails the following: Detection of every infection; Implementation of targeted measures for attacking both parasites and vectors in order to interrupt local transmission; Elimination of all parasites from humans, and; Managing the risk of re-establishment through imported malaria; Setting up of a centralized reporting system for epidemiological surveillance of malaria. Prevention of re-establishment of local malaria transmission through: Targeted malaria vector control; Deployment of transmission blocking chemotherapy; Detection of all infections; Surveillance as an intervention.

Transform malaria surveillance into a core intervention in areas of high and low transmission and those targeted for elimination (Pillar 3) Investment in routine information systems to ensure collection of data necessary for understanding disease trends and overall programme performance; National plans to take into account the epidemiology and heterogeneity of malaria in a country.

Harnessing innovation and expanding research (Supportive element 1) New tools and approaches for vector control, New diagnostic testing tools for the detection of low-level parasitaemia; New treatment regimens; Malaria vaccines; and Surveillance approaches.

Strengthening the enabling environment (Supportive element 2) Increasing international and domestic financing, Ensuring a robust health sector response; Strengthening health workforce and malaria expert base; Ensure sustainability of malaria responses and improvement of government stewardship; Cross-border collaboration of malaria programmes and strengthening of multi-sectoral collaboration; Encourage private sector participation and engagement with non-governmental organizations.

Includes region-specific successive malaria programme phases Framework for implementing the GTS for malaria (2016 – 2030) in the AFR Includes region-specific successive malaria programme phases Phase 1, control programmes characterized by intensive malaria transmission,; Phase 2, pre-elimination programmes characterized by parasite prevalence of less than 5% in all ages, or Annual Parasite Index (API) of 2-4 with focalized and seasonal transmission patterns; Phase 3, elimination programmes characterized by few cases or API of 1 or less with highly focalized transmission; and Phase 4, programmes preventing re-establishment of local MAL transmission

Roles and Responsibilities of Stakeholders Countries Regional Economic Communities African Union Commission Academic and research Institutions Other stakeholders WHO Secretariat in the African Region

WHO AFRO Support Technical coordination and planning at the regional level Pooling evidence for setting agenda and guiding investments in malaria control/elimination in the region Implementation support to NMCPs including Development and/or adaptation of WHO guidelines tools Programme reviews and planning Capacity strengthening Secretariat : Africa Mal Task Force ; and Mal Elimination Committee Monitoring and reporting attainment of GTS milestones and targets

CONCLUSION

Conclusion (1) Achieving the 2030 malaria goals will make a substantial contribution to the attainment of Universal Health Coverage and SDG3 “Good Health and Well-being” Malaria interventions are highly cost-effective and demonstrate one of the highest returns on investment in public health. In countries where the disease is endemic, efforts to reduce and eliminate malaria are increasingly viewed as high-impact strategic investments that generate significant returns for public health, help to alleviate poverty, improve equity and contribute to overall development.

Conclusion (2) The world has reached a critical juncture in the fight against malaria. There is both an opportunity and an urgent need to accelerate progress by reducing morbidity and mortality in all countries, by increasing the number of malaria-free countries, territories and areas, and by identifying approaches that aim to reduce transmission. Progress can be hastened through a major expansion of existing interventions, by making the response to malaria a higher technical, financial and political priority, and by ensuring that the development and use of new tools and solutions are maximized. Great momentum to guide and support member states to deploy evidence-based targeting and scaling up of interventions for impact on malaria burden in the region.

Thank you for your attention World Health Organization 25 November, 2017 Thank you for your attention