Human Resource Requirements for Malaria Elimination Curso de actualización: "Eliminación de la Malaria en Mesoamérica y la Española“ CC Campbell 19 February 2014

The Success of an Elimination Program Depends on Key Components… The Success of an Elimination Program Depends on Key Components….and Commitment and Financing TOOLS HEALTH SYSTEM ENVIRONMENT Drugs and Insecticides remain effective LLINs are used by > 80% even in the absence of malaria in the community Universal Access to High Quality Diagnosis and Treatment Near perfect surveillance (passive case detection) Strong political support Community Involvement and buy-in Resistance Monitoring and Entomological Surveillance IEC/BCC Existing plans to strengthen the health system are executed (free malaria treatment for all) QA/QC, training, health worker incentives (?), IEC/BCC High level political involvement

Malaria Elimination Vertical or Integrated Program? Elimination will be a major commitment for governments and civil society Transition in the Americas building on SNEMs, to incorporate additional capacities, competencies and staffing dedicated to malaria Retention and strengthening key components of historical malaria programs Interventions: IRS, testing and treating at periphery Diagnostics as intervention Logistics Additional components: new interventions, operations research, cross-border and inter-regional program collaboration

Staffing Priorities Just expanding SNEMs will not be adequate Build capacity to support staff in remote and challenged areas Data for decision-making and planning, in real time Engage nontraditional partners Community-based workers, community pharmacies Learning agenda: refine and redefine tactics and technologies to adapt to work

Core Components of Malaria Elimination 17 February 2014

Malaria Elimination Key Competencies and Staffing 17 February 2014

Comprehensive Programming for Elimination

Eliminating Transmission (1) Sustain existing gains and ending malaria deaths and markedly decreasing illness will require further major steps in reducing transmission Some will suggest that ‘better case management’ will be required to do this; it will actually rely on ‘stepping up prevention’ – including: Good/better vector control with ITNs and IRS Better use of diagnosis (of both illness and asymptomatic infections) and treatment -- but in a proactive and preventive mode Actionable information – ‘surveillance as an intervention’ Transition to Rapid Diagnostic Testing

Prevention of Reintroduction is the Challenge The Zanzibar Experience Surveys on the ferry boats and at “informal” landing sites: Where are people coming from and where are they going? How long are they staying for? What is the Infection Prevalence in travelers? Border Screening? Prophylaxis in travelers/migrant workers? Screening of high risk groups? Before any prevention measures can be scaled back, surveillance must be (near) perfect!

Eliminating Transmission (2) Operations and intervention science partners In-country or international academic partners Long term capacity to proactively monitor intervention efficacy and effectiveness Program advocacy and sustaining financing Established program for capturing story of elimination: success stories in particular to create and build support Invest in sub-regional program advocacy stories and how they contribute to eliminating sustainably

Lessons to be Learned…..are we Listening? Elimination and eradication are serious long-term commitments Time is of the essence….resistance and waning commitment will eventually undo the effort A continuing portfolio of impressive successes is essential Financing will never be enough and will be required for longer that we can ever anticipate Technical contingencies and innovations must continue to evolve Start where you will end up!