Roadmap to Achieve 2010, 31 st December RBM Targets September 2009 – December 2010

Country Summary InterventionUnits usedNeed to 2010 Already covered Funded and expected to be distributed before end 2010 Gap LLINs (Universal Access – avg 1 net for 2 pp) Nets7,367,6002,343,100 ( ) 3,657,0001,367,500 gap for universal coverage of LLINs if all funds are received, otherwise minus R7, gap is 5,02,500; ACTsTreatments4,406,3355,546,000No gap, To negotiate extra funds to procure RDTs RDTsNumber of tests 5,300,0004,937,453362,547 IPTpWomen to be treated 3,708,9792,000,0001,708,979 IRSFinancial / USD 10,850,00010,022,000828,000* Population at risk (Projected): 12,900,000 (2009), 13,200,000 (2010), Ref: CSO Projection Reports, 2003 (*) PMI funding may be less as it includes other overheads and not the actual available hence IRS gap may have been under estimated

Country Summary InterventionUnits usedNeed to 2010Already covered Funded and expected to be distributed before end 2010 Gap M&E Financial / USD 2,554,000 2,054,000500,000 BCC/IEC Financial / USD 450, ,000200,000 Human Resources (including Capacity Building) Financial / USD ?? Other

LLIN resources available to achieve the 2010 targets FUNDS AVAILABLE (In US $) SOURCECOMMENT 1,383,805 1,334,413 GFATM R4 Yr 4 Yr 5 567, 446 LLINs procured and ready to be distributed to households (MOH) – R1 & R4 Y3 215,000 MOH negotiating Emergency procurement (UNICEF) 208,000 for 2010 MOH procurement (UNICEF) 140,000 LLINs expected by October 2009 (CHAZ) 2,933,131 5,120,000 6,820,000 GFATM R7 Yr 1 Yr 2 Yr 3 MOH R7 funds not yet disbursed – 2010 procurement 454,815 LLINs - MOH 800,000 LLINs - MOH 1,000,000 LLINs – MOH 190,000 LLINs expected by October 2009 (CHAZ) Distribution costs are included 10,400, ,000 PMI 900,000 LLINs for the MIP 2010 These are funds for distribution costs for MIP to be given to implementation partner (SFH) *No GFATM R7 disbursed and may not receive these funds

LLIN resources available to achieve the 2010 targets (2) FUNDS AVAILABLE (US $) SOURCECOMMENT 1,520,000WORLD BANK 300,000 LLINs procured and delivered in country - Sep 2009 Direct delivery to districts for mass distribution (door to door) 139,000MACEPA26,800 LLINs - expected by October, 2009 and immediate mass distribution (door to door) 1,516,750RAPIDS303,350 LLINs - procured (133,350 in the country and balance expected before end of 2009 (door to door campaign)

LLINs Ordering & Distribution to end of 2010 Quantities GFATM (MOH and CHAZ) – 3,657,000 LLINs World Bank - 300,000 LLINs MACEPA - 26,800 LLINs PMI - 900,000 LLINs RAPIDS – 303,350 LLINs Procurement dates GF procurements (UNICEF - Sept 2009; UNICEF/VPP? - Jan 2010) Expected delivery 9 months from date tender is floated September 2009, November 2009; The rest, June 2010, August 2010 Planned Campaign Date September to November 2009; July to October 2010 MIP (ANC) September 2009 to December 2010 BCC /IEC September 2009 to December 2010 – On going Community radio stations, drama, Mobile Video units, National media, religious leaders announcements, door-to-door, training Malaria Focal Persons Community mobilization September 2009 to December 2010, Community malaria booster (COMBOR), Radio Listening Groups, Community health workers including use of CHW Distribution Sept 2009 – Dec 2010 Nation wide priority given to non IRS areas and districts with high incidence rates Distribution mechanisms Door-to-door mass campaigns, MIP routine distribution through ANC at health facilities Monitoring and evaluation Sept 2009 – Dec 2010 – Routine Support Supervision, Routine HMIS data October 2009 – Health facility survey April-May 2010 – Malaria indicator survey

IRS resources available to achieve the 2010 targets FUNDS AVAILABLE (US $) SOURCECOMMENT 2,250,000World Bank/Russian Trust Fund US$ 1,000,000 for 2009 IRS actual implementation US$ 1,250,000 for ,000GRZUS $ 100,000 for 2009 US $ 20,000 for ,751,000PMIUS$ 501,000 for 2009 US$ 6,250,000 for ,000GFATM R4400,000 for chemicals in ,000 for cascade training in 2009 GFR9 proposal submitted – IRS main intervention

Indoor Residual Spraying 2010 Total Households targeted 1,280,000 (structures) for ,800,000 (structures) for 2010 DDT required DDT 75% WP (40,000 sachets) for 2009 and DDT 75% WP (40,000 sachets) for 2010 Pyrethroids required K-othrine 25% WG and Lambdacyhalothrin 10% CS (735,200 sachets) for 2009 K-othrine 25% WG (700,000 sachets) for 2010 Lambdacyhalothrin 10% CS (550,000 sachets) for 2010 Procurement schedules DDT and part of pyrethroids delivered in-country Expected procurement of 350,000 sachets of pyrethroids at a cost of $ 1,500,000 in the fourth quarter (for 2009) 2010 Procurements - chemicals, pumps and PPEs at a cost of $ 4,500,000; Tendering by first Quarter 2010 (Feb); No objection from donors by first quarter 2010 (March); Delivery/receipt of goods in country by Second Quarter (June) for 2010 Distribution First consignment of commodities delivered in August; Delivery of Insecticides in 4 th quarter at $ 10,000 for 2009 and delivery of Equipment, Insecticides and Personal Protective Equipment in 3 rd quarter at $50,000 (in 2010) Training Completion of Cascade training of 1,890 spray operators in September at a cost of $ 620,000 (2009) 2010 Training of Trainers (180 personnel) in July at a cost of $ 250, Cascade training of 2,400 spray operators in August at a cost of $400,000 BCC/IEC Community mobilization Sep – Dec 2009 Provision of IEC/BCC all quarters at a cost of $ 250,000 in 2010

Indoor Residual Spraying to 2010 Spraying Implementing IRS in 36 districts in 4 th quarter at US$ 1,650,000 by 2009 Implementing IRS in 54 districts in 4 th quarter US$ 3,000,000 by 2010 Monitoring and evaluation (bioassays, insecticide resistance etc) Conducting pre IRS entomological and Parasitological surveys in October at a cost of $50,000; Supervision and Monitoring in 3 rd and 4 th quarters at $50,000 by 2009 Conducting pre and post IRS entomological & Parasitological to be done in all quarters at a cost of $250,000 by 2010 and Supervision and Monitoring in third and fourth quarters at a cost of $50,000 in 2010 Conduct insecticide susceptibility studies – Sep 2009, Aug 2010 Enumeration of households/structures in 18 districts To be done in all quarters at a cost of $300,000 in 2010

ACT resources available to achieve the 2010 targets FUNDS AVAILABLE (US $) SOURCECOMMENT 1,868,086 1,227,446 1,265,518 1,258,480 GFATM R1 Y3 GFATM R4 Y3 GFATM R4 Y4 GFATM R4 Y5 R1 balance from earlier ACT procurement (2,490,000 treatment courses) 950,000 ACT treatment courses 1,052,650 ACT treatment courses (total of 3,056,210 up to 2010 for R4) 4,406,335 treatment need (1,556, & 2,850, ). To negotiate extra GF conversion to procure RDTs UNITAID supplies from , ,000 1,286,916 1,430, ,000 3,679,000 GFATM R4 Y3 GFATM R4 Y5 GFATM R7Y1 GFATM R7 Y2 World Bank PMI RDTs 164,400 RDT kits 166,000 RDT kits 1,286,916 RDT kits 1,430,537 RDT kits (R7 not disbursed but due) 690,000 RDT kits 1,200,000 RDT kits (650,000 received; expecting 650,000) – Converted ACTs to procure RDTs

Case management (1) ACTs required National Target : 100% public sector; Based on public sector consumption trends in past 6 months, plus 2008 HMIS data on malaria cases 1,556,335 ACTs treatment courses are required up to Dec 2009; 2,850,000 ACTs needed for 2010 No gap for ACTs in the public sector - May need to convert ACT funds to RDTs procurement Reprogrammed PMI ACTs to RDTs RDTs required 3,737,853 RDTs available from Sep 2009 to December ,451,316 RDTs required from Sep 2009 to December ,713,463 RDT gap Procurement schedules GF procurements through UNICEF All ACTs for 2009 expected in country by October ,3 million RDTs ordered; Expected delivery November, 2009; 4 million RDTs to be ordered in BCC/IEC Continuously Sept 2009 and 2010 December, by CHWs Sensitization and Mass media (TV/Community Radio) sensitizations on health seeking behaviours, early recognition of symptoms ; Orientation on Dispersible Coartem

Case management (2) Distribution Mechanisms Distribution through the Central Medical Stores to all public health facilities (HFs) through PULL system to district level and the district re-distributes to local facilities based on consumption data and district need. This includes community health worker supplies for Home management of malaria Drug Efficacy Monitoring Annually 2009 and 2010 – Six (6) sites for drug efficacy trials on ACTs Monitoring and Evaluation 2009 Health facility Survey (October 2009) Private sector ACTs Studies (Sept-Dec 2009) 2010 Malaria Indicator Survey Essential Drug pilot Evaluation (2009, 2010) Data reviews Performance assessment

Intermittent Preventive Therapy Number of Pregnant women targeted 2009; 690,454 Pregnant women 2010; 710,447 pregnant women SP doses required 2009: IPT3; 724,977 Sep – Dec 2009 (2,899,906 for 2009); 2010; IPT3; 2,984,003 Procurement schedules Procure by GRZ and PMI in Sep - Oct 2009 Delivery - GRZ Sep 2009; PMI Dec 2009 Distribution modalities Medical Store Ltd (MSL) will store and distribute monthly to various districts integrated with other essential drug supply Implementation through ANC at health facilities through DOT (3 courses after first trimester, a month apart) Training Training reproductive health unit of MOH supported by the malaria control programme BCC / IEC 2009; Sept-Dec and continue 2010; Update advocacy plan & community mobilization, mass media Monitoring and evaluation HF Survey Oct 2009; 2010 MIS in May-July Performance review, HMIS data review

Other core interventions to be delivered by the end of 2010 InterventionDates Home management of malaria (HMM) – training community health workers to strengthen skills in testing (confirm diagnosis) and treatment, health information HMM- Sept-Oct; Jul,Nov 2010 IEC/ Advocacy - mobilize partnership, resources, increase advocacy to create/increase malaria awareness and utilization of malaria interventions. Sept- Dec 2009 and Jan- Dec 2010 Quality control (QC), Quality assurance (QA) and reporting Sept2009-Dec 2010 Epidemic Preparedness and Response – Thresholds, capacity building, s trengthen emergency drugs and commodity stocks, conduct assessments for preparedness, build capacities (training, community, mobilization). Sept- Dec 2009 Jan-Feb 2010 May-Aug 2010 M&E, Operations research, surveillance - strengthen operations research and surveillance system Sept-Dec 2009; Jan-Dec 2010

Other core interventions to be delivered by the end of 2010 InterventionDates Comprehensive Programme review, needs assessment and Strategic plan March – September 2010 Human Resources: Strengthen NMCP; Provincial focal persons and District focal persons Oct 2009 Feb – March 2010 June to July 2010 Cross Border Initiatives – Support SARN and SADC in resource mobilization and implementation Sept-Oct 2009;Jan-Apr 2010

Summary of rate-limiting factors ( Over the next 17 months) ProblemsSolutions Funding gap for commodities - prompt diagnosis (RDTs), - key interventions (LLINs and IRS) - - Support programmes ( Operations Research, advocacy activities, M&E). Resource mobilization and effective utilization of available resources Low utilization of preventive interventions especially LLINs Innovative messaging (IEC), mass media including Community radio stations, drama, Mobile Video units, National media, religious leaders involvement, household door-to-door activities and training Malaria Focal Persons, community empowerment to participate Procurement bottleneck - Long processes coupled with delays in funds disbursement Capacity building on PSM, holding of Technical meetings on commodity forecasting and quantification in the NMCP for malaria partners and financial management support Human Resource; Staff shortage, high staff attrition at service delivery and retention of staff Regular capacity building for staff on key interventions (case management, LLINs, IRS, M&E) and Programme management) Integration of activities

Summary of technical assistance needs over the next 17 months Needs & Dates Partner Programme Performance Review and Development of Malaria Control Strategic Plan; WHO, MACEPA, UNICEF, PMI, WB Capacity building on PSM USAID Deliver, WHO, PMI, GF Revision of policy guidelines/documents WHO, UNICEF, PMI, MACEPA Management Systems - National Malaria Surveillance, Data base, drug efficacy trial WHO, MACEPA, UNICEF, WB PMI Cross Border Initiatives to support SADC in resource mobilization WHO/RBM/ MACEPA Financial Management Support GF, PMI, WB, MACEPA Partnership Coordination All Partners, RBM