Unit 10 PREPARING A PLAN FOR MALARIA ELIMINATION

Learning objectives ●By the end of this Unit, the Participant should be able to: ●Undertake situation analyses as basis for decision- making and planning in pre-elimination and elimination stages. ●Determine strategies, interventions, inputs, outcomes, M&E, timelines and human and financial resource needs in various type-situations ●The participant must prove his/her ability to develop a plan for a country or a part of it. ●And be able to defend the plan

What is planning ? ●analysing problems ●prediction of the effects of future activities on the present situation, ●making choices among alternatives, examining solutions, ●setting priorities, ●making decisions, ●developing strategies, ●setting objective and focus on its achievement. ●allocating resources

Malaria Problem or Statement ●History, changing trend, past epidemics ●Past, current control activities ●History of elimination attempts ●Current malaria epidemiology ●Stratification, risk mapping ●Inventory of foci and classification

Management of the Health data ●central data are necessary ● local intelligence  local data to assess the situation and take decisions at the peripheral level of the health system (e.g. in health centres, field mobile units, mobile clinics).  Be creative in the collection and use of data,  Use your good judgment, intuition, experience, understanding of the local conditions and needs.  good observers and know what they are looking for and how to evaluate the information

Malaria elimination - Feasibility analysis ● Conduct a feasibility analysis or feasibility analyses for several subregions ( Technical, Operational, Economic) ● Assess opportunities  Sub-regional initiatives  interrelationships with neighbouring countries  sub-national initiatives, e.g. economic development zones

The planning process logical framework ●ultimate goal. ●well-defined objectives ●Set activities with targets and fixed dates for their implementation ●Address questions  What is the situation now?  What is the desirable situation?  How will this situation be reached?  What interventions, why, where, when, who  How will success be identified?

Vulnerability and phasing ●Vulnerability is possibly the challenge that makes the greatest difference between elimination and control in the planning stage. ●Should one start with the worst or the easiest areas? ●Start at the fringes? ●Or concentrate on the hotspots?

Standards and targets ●Example of standard: ●A village has standard IRS coverage in a given calendar year, if >80% of the population of the village lives in houses, which were sprayed with insecticide [x] at minimal target dosage [y mg/m 2 ] before [date 1] and [date 2] in that calendar year. The achievement or not of the standard for each target village will be assessed by scrutiny of output reports from the IRS operations. ●Example of targets based on standard: ●By year [z] w % of target villages have standard IRS coverage; ●By year [z] w % of target population live in villages having standard IRS coverage. ●And in the elimination phase: By year [z] w % of active foci have standard IRS coverage in every village. w % of the population in active foci have standard IRS coverage.

Apply GPP (good planning practice) ●Define input, outputs, outcomes (targets), impact objectives ●SMART objectives and targets (specific, measurable achievable, realistic and timebound ●Define indicators ●When linking out puts to outcomes, and outcomes to objectives, make the assumptions clear ●Prioritize, coordinate, find opportunities, threats, risks (SWOT)

Elimination M&E framework ●Control programmes, surveillance focus on illness and mortality reduction. ●In elimination program surveillance methods focus also on detecting infections (with or without symptoms) and on transmission dynamics

National Development ●Malaria elimination is an integral part of any national development plan and national health plan ●Poverty reduction strategy ●Elimination benefits poor, marginalized groups, promoting equity (perhaps better than control!) ●Strengthening the malaria programme with a view to elimination will ensure increasing coverage with laboratories and treatment facilities, and strengthening surveillance, and will benefit programmes of other VBDs ●However, elimination is monomaniac/fanatic/obsessed or passionate. It has only one objective. The rest are, from the viewpoint of the elimination planner only collateral benefits. BUT maybe useful for advocacy

The core element of the template: Strategy (by stratum/Subregion) ●Strategy for each stratum can usually be conceptualized to include one or more of following elements: ●Burden reduction: In advanced control and pre- elimination phase ●Capacity development, systems strengthening: In pre- elimination phase ●The four specific elimination approaches (Learning Unit 3): In elimination phase ●Prevention of reintroduction activities and transfer of responsibilities to general health services: Later elimination phase.

●These strategies need to be described with the interventions selected and the expected levels of effective coverage to be attained when; and it needs to be explained how these interventions will allow the attainment of the benchmarks on the dates foreseen under Objectives. This should be supported by an analysis based on a feasibility study, with particular attention to the interaction between all malaria risk strata in the country and other countries as regards vulnerability. ● This will lead to the formulation of assumptions, which may be based on empirical evidence or on the modeling from Learning Unit 8. This is also the time to describe risks and threats to elimination or to the proposed timelines.

Learning Exercise ●writing a plan for malaria elimination. ●A proposed outline for such a plan is shown in Annex 23  Where possible, information should be provided in charts, tables, maps and graphs. These can be in the text or included in annexes.  one-page summary will be essential for the ministerial levels.  By putting most of the data and detailed information into annexes, the body of the plan can be kept to a minimum.  The text should be clear and concise, stating the effective period of the plan, (allowing at least one year for it to be approved) and the date the plan was formulated, the names and designation of the planning team members.

Mewlana Jalaluddin Balkhi Rumi, : Discourses of Rumi (44)).