1. EXPANDED ACCESS TO DIAGNOSTIC TESTING NATIONWIDE OSLO, Malaria conference 12 – 13 April 2011 Dr P. M. Thior NMCP SENEGAL Ministère de la Santé et de la Prévention

2. PLAN 1.Introduction 2.Stratégie of implementation a) Pilot study b) Implementation mechanism c) Key interventions 3.Main results a)Cases b)Lessons learnt 4.Conclusion

3. INTRODUCTION Sénégal: malaria is endemic with saisonal upsurge Main targets: Population 11 000 000 habitants Population at risk for malaria 100% Children under five : 2 090 000 Pregnant women : 396 000

4. RECALL: Malaria situation in 2006 Source RBMME/PNLP/SN

5. Malaria situation just before introduction of RDT nationwide Proportional morbidity stationary: around 33% Despite: – Introduction LLIN – ACT – Community based intervention (BCC)

6. Implementation of R.A.M.P. strategy Implementation of R.A.M.P. strategy A strategy to reduce quickly mortality and morbidity (janvier 2006) – Scaling up of key interventions recommanded by WHO – Quality insurance of diagnosis and malaria treatment Introduction of RDT Microscopy strenghning Prompt and effective cases management using ACT – Data Quality insurance (RBMM&E, DQA, OSV)

7. PILOT STUDY in 10 heath centers 2006: feasabity study about RDT introduction in Senegal – By laboratory of parasitologie of UCAD (Gaye et al) Paracheck: HRP 2 Sensibility = 99.58% et Spécificity = 99.98% VPP = 99.93% et VPN = 99.88% Presomptif diagnosis: overestimation of malaria cases Feasability of RDT introduction in the health system Acceptability by the heathcare providers

8. IMPLEMENTATION MECANISM  Sharing et validating the key recommandation of this operational research  Elaboration  Training handbook  Algorithm (ordinogramme) +++  Developpement  Procurement mechanism  Management tools  Methodology of implementation: key interventions

9. KEYS INTERVENTIONS Training in cascade – Training of regional and district level management team – Training of health care providers at the district level procurement: – Initial Endowment of RDT kits – Three-party management PNA, NCMP and districts Communication: – increased awarness ofsensibilisation prestataires et populations Monitoring and evaluation – Regular data collecting about the use of RDT – Regular monitoring of morbidity data – Regular supervision of health care providers Quality insurance: – Quality control provid by l’UCAD (with find foundation)

10. SCALING UP OF RDT 2007: introduction RDT 2007: introduction RDT - Training health care providers: 2.607 agents trained -Implementation in 65 districts (centers and health postes ) 2008: 2008: -Introduction in hospitals, military garrison: training of 761 agents -Retraining of 2.187 agents

11. INTRODUCTION OF RDT AT THE COMMUNITY LEVEL

12. THE RDT IN HEATH HUTS 2009: 2009: introduction of RDT in health huts – Training of 3.716 CHW – Introduction of RDT in 94% of health huts (1611/1703)

13. RDT at home 2008-2009: 2008-2009: implementation of PECADOM (homebased case management) – ACT & RDT in villages of enclosed territory /far away – Training of 1.000 community health providers (DsDom)

14. RESULTS (end 2010) Total consultations (fever cases) TDR made Negatif RDT Positif RDT Invalid RDT Malaria cases treated & cured SIDE EFFECTS DEATHS 7.1986.7074.3772.300432.22623 0

15. REFERENCE TO THE UPPER LEVEL (HEALTH HUTS) Situation des Cas Référés Negative RDT Children undeer 2 months Pregnant women Severe malaria Total Refered cases TOTAL 3.54850 47 863.749

16. OPERATIONALS COSTS 3 main activities are concerned Training of health care providers – Average cost training of one healthcare provider : 41.000 FCFA / 62 euros (round 7 GFATM) Supervision – Average cost supervision of one healthcare provider : 27.645 FCFA / 42 euros Cost of the Pilot study: 21.374 euros

17. RESULTS OF IMPLEMENTATION OF RDTS IN SENEGAL

18. Evolution of malaria morbidy by month: comparison between 2006 & 2007 L’introduction des TDR dans notre système de santé a notablement amélioré le diagnostic et par voie de conséquence la qualité des données reportées.

20. RDT monthly achievement rate

23. Malaria and other deseases in Senegal from 2006 to 2009

25. Morbidity, Mortality and Hospital CFR SOURCE: RBM M&E / NMCP April 2010 RDTs ACTs LLINs IRS HBMM LLINs

26. Malaria Prévalence by région (MIS 2009) Tambacounda 23% Matam 4% Louga 1% Kolda 19% Kaolack 7% Saint-Louis 0% Fatick 8% Thiès 3% Ziguinchor 5% Diourbel 3% Dakar 1% Sénégal 5,6% Pourcentage d’enfants de 6-59 mois avec le paludisme

27. SCALING UP of RDT & EVOLUTION OF ACT CONSUMPTION & Plos medicine april 2011

28. CONCLUSION « The experience demonstrate that, when partners work together, and when strategies to fight against malaria (such as LLIN, ACTs, IRS, RDTs) are used in a compréhensive manner and scaled – up, an extrordinary success can be achieved » Professeur Awa-Marie Coll-Seck, Directeur Exécutif du Partenariat Faire Reculer le Paludisme, le 8 Février 2008