Summary of potential priority actions for CMWG Case Management Working Group Meeting 8-9 July 2009

Introduction CMWG’s role is to coordinate partners for achieving access to treatment Meeting needs to review TORs to clarify role and avoid duplication RBM Board wants a strategy on resistance containment CMWG is asked to address how to strengthen implementation to increase access. Countries need more detailed operational plans. Activities to support RBM access targets days to do it…

Expected Outcomes Reviewed and revised TORs of CMWG Agreement on composition  Members  Co-chairs  Secretariat Agreement on modus operandi – eg creation of Task Forces (ongoing or time-limited) to achieve certain products List of priority actions to completed by:  November 2009  December 2010

Malaria Diagnosis Goal is to have all treatment based on parasitological diagnosis  Still much to do to achieve this goal  Approach should include complementary microscopy and RDT strategy  Approach needs to address context of changing transmission Areas for CMWG action:  Help to prioritise implementation approaches  Consider diagnosis of multiple diseases  Incentives for using diagnostics in private sector  Consideration of subsidised RDTs in AMFm – may be post- 2010?  Consider role of pharmaceutical companies in encouraging RDT use in private sector  Support more attention to user and patient perceptions

Malaria Diagnosis: areas for CMWG Action (2)  Tracking feasibility of community level RDT use  Include diagnosis as an epidemiological tool as well as a case management tool (fits best in this WG even if it goes beyond case management) this to include use of diagnostic data to track progress, discussions on Active Case Detection, infection versus case detection  Develop a framework for scaling up diagnosis  Outline a package of what is needed for good diagnosis to advise GFATM TRP what to look for (include training, supervision etc

Malaria treatment – policy and practice Use partners’ communication capacity to support use of WHO publications (Case Management Operational Manual and Treatment Guidelines  Provide feedback on the CMOM Support development of tools to measure quality of case management to show if there is progress Support system to track drug availability Outline a package to guide countries and TRPs on what is acceptable in GFATM proposals

Preventing and containing drug resistance Plan more broadly for policy intervention that can delay or contain resistance  Consider MDA, MSAT, deployment of new drugs.  Consider what to do when there is a choice of drugs – sequential, mosaic etc Gain consensus on strategy components Outline response scenarios for different regions Link actions such as banning monotherapy with operational context – ensuring reliable access to ACTs Advocate strongly for more efficacy monitoring  Make it a requirement in GFATM proposals, but also follow up in performance monitoring

Facility-based Case Management Encourage joint work with child health Identify cross-cutting operational issues between malaria and IMCI including resource mobilisation

Community-based case management Support more consideration of links between public health system and community systems Continue and communicate mapping of initiatives on community case management – include research and experiential evidence Review scaleability of primary health care approaches Advocate support for multiple models led by countries and assessed for effectiveness Highlight interim as well as final targets to assess progress

Conclusions – potential Task Forces Scaling up parasitological diagnosis Access, delivery systems, quality of services Quality and safety of drugs and diagnostics Strategic options for managing drug resistance