Strengthening SME system for national programmes from transmission reduction to elimination phase China Dr Li Xiao Hong National Program officer WHO, China

purposes Rome was not built in a day China’s current malaria elimination strategy Address other questions in the exercise

Background , China Malaria Elimination Action Plan ( ), launched by 13 ministers/sectors – Malaria Elimination Technical Strategy (2011) – Malaria Surveillance Strategy (2011) – Malaria surveillance Strategy (draft, )

Surveillance PCD (Nation wide) Case reporting system by IT (1) Case detection: microscopy, RDT (2) Annual blood examination rate: 1/1000 (Note: Number of patients receiving a parasitological test /whole population) (3) 80% must be conducted during transmission seasons Case investigation 49 surveillance sites (county): (1) Enhanced PCD: Annual blood examination rate:2% (2) IFA (to estimate malaria endemic level) Two townships were selected, 300 people/townchip (3) Vector survey (4)Vector insecticide resistance survey PCD Nation wide Case reporting system by IT (1) Case detection: microscopy, RDT (make it clear) (2) Cancelled Sentinel hospital in each county: parasitological tests/ patients with fevers : 10-20% (3) Cancelled Case investigation Foci investigation: (1)RACD (2) Vector survey Foci intervention (1)TMDA (2)TIRS (3)Targeted health education and promotion Surveillance sites: (1)Insecticide resistance survey (four different vectors, one for each) (2)plasmodium drug resistance(Jiangsu province: imported cases, Yunnan province: local cases)

M&E (1) Case detection county CDC: reconfirm all positive cases + 10% negative cases, Provincial CDC : all positive, 5% negative) (2) survey on missing report Hospitals: check clinic record data, whether suspicious cases received a blood exmaination or not; treatment reports Door to door survey 2 administrative villages selected from two townships/county 200 persons/ad village (1) Case detection county CDC: Provincial CDC : Reference laboratory in provincial CDC: microscopy+ PCR (2) strategy implementation Timing Quality

Case Detection & Notification ① Case Investigation & Classification ③ Foci Investigation & response ⑦ Hospital County CDC Diagnosis Treatment Reporting Diagnosis Treatment Reporting Lab Confirmed Case Classification Lab Confirmed Case Classification Focus investigation RADC Entomological Focus investigation RADC Entomological Focus Response Vector Control Target MDA Health education Focus Response Vector Control Target MDA Health education The new “1,3,7” strategy 1 Day (24 hrs) 3 Days 7 Days

Reporting system 1 Case reporting system based in IT Reporting system 2 Reporting system for malaria management Based in CDC. “1,3,7” strategy---two reporting systems

Reporting system 1 1case reporting system based on IT Elimination phase

Microscopist in diagnosis laboratory Clinical cases Confirmed cases Public health worker data recording data transmission Reporting system case reporting system based on IT data reporting

Reporting system 2 2Reporting system for malaria management Based in CDC. Four functions of this system: a.Reconfirm all reported cases, by PCR or microscopy b.For confirmed cases, perform case investigation, case classification c.For those classified as local cases, to conduct foci investigation a.Foci intervention (vector control, target MDA, health education) Elimination phase

High transmission risk area (e.g. Yunnan province)(natural village) Low transmission risk area ACD foci investigation RACD New confirmed case will add in the case based reporting system !!! data recording, reporting and transmission all done by CDC staff

Administrative village township County province Village doctor Hospital (laboratory microscopist, clinic doctor, public health worker) CDC (surveillance officer, epidemiologist) CDC (surveillance officer, epidemiologist, entomologists, parasitologist) Human Resource 1. daily check case reporting system, 2. withdraw the case information and forward it to the team leader, to initiate case investigation and foci investigation

5&8 indicators No. of cases – Report cases – With detailed information – Confirmed cases(local or imported) No. of foci (classifications) Annual blood examination rate(only apply to Yunnan and Motuo) strategy implementation (timing, quality) QA for blood examination (100% positive, 10% negative Note: indicators in black, evaluation of SME system performance

9 Data analysis, reporting, feedback Nation level Weekly data analysis and report (1)1-3-7 timing performance for each province (2) Case unclassified, un-confirmed Province level Also weekly report (1)(2)+(3)1-2-3 quality

10. National independent malaria elimination committee Administrative officers from health system CDC Professors from universities Researchers/professors from institutes Not functioning! Malaria elimination evaluation in each level in different provinces, members in evaluation panel are basically administrative officers from health system Take home message!

Facilitator? Participant? Willing heart Determined mind Persistence Work out your own solution to eliminate malaria in your country

Contact information Dr Li Xiao Hong Surname: Li Name: Xiao Hong (Hong, for short) WHO, China CO