1. Human Resource Requirements for Malaria Elimination
Curso de actualización: "Eliminación de la Malaria en Mesoamérica y la Española“
CC Campbell
19 February 2014

2. The Success of an Elimination Program Depends on Key Components…
The Success of an Elimination Program Depends on Key Components….and Commitment and Financing
TOOLS
HEALTH SYSTEM
ENVIRONMENT
Drugs and Insecticides
remain effective
LLINs are used by > 80%
even in the absence of
malaria in the community
Universal Access to High Quality Diagnosis and Treatment
Near perfect surveillance (passive case detection)
Strong political support
Community Involvement
and buy-in
Resistance Monitoring and Entomological Surveillance
IEC/BCC
Existing plans to strengthen the health system are executed (free malaria treatment for all)
QA/QC, training, health worker incentives (?), IEC/BCC
High level political involvement

3. Malaria Elimination Vertical or Integrated Program?
Elimination will be a major commitment for governments and civil society
Transition in the Americas building on SNEMs, to incorporate additional capacities, competencies and staffing dedicated to malaria
Retention and strengthening key components of historical malaria programs
Interventions: IRS, testing and treating at periphery
Diagnostics as intervention
Logistics
Additional components: new interventions, operations research, cross-border and inter-regional program collaboration

4. Staffing Priorities Just expanding SNEMs will not be adequate
Build capacity to support staff in remote and challenged areas
Data for decision-making and planning, in real time
Engage nontraditional partners
Community-based workers, community pharmacies
Learning agenda: refine and redefine tactics and technologies to adapt to work

5. Core Components of Malaria Elimination
17 February 2014

6. Malaria Elimination Key Competencies and Staffing
17 February 2014

7. Comprehensive Programming for Elimination

8. Eliminating Transmission (1)
Sustain existing gains and ending malaria deaths and markedly decreasing illness will require further major steps in reducing transmission
Some will suggest that ‘better case management’ will be required to do this; it will actually rely on ‘stepping up prevention’ – including:
Good/better vector control with ITNs and IRS
Better use of diagnosis (of both illness and asymptomatic infections) and treatment -- but in a proactive and preventive mode
Actionable information – ‘surveillance as an intervention’
Transition to Rapid Diagnostic Testing

9. Prevention of Reintroduction is the Challenge The Zanzibar Experience
Surveys on the ferry boats and at “informal” landing sites:
Where are people coming from and where are they going?
How long are they staying for?
What is the Infection Prevalence in travelers?
Border Screening?
Prophylaxis in travelers/migrant workers?
Screening of high risk groups?
Before any prevention measures can be scaled back, surveillance must be (near) perfect!

10. Eliminating Transmission (2)
Operations and intervention science partners
In-country or international academic partners
Long term capacity to proactively monitor intervention efficacy and effectiveness
Program advocacy and sustaining financing
Established program for capturing story of elimination: success stories in particular to create and build support
Invest in sub-regional program advocacy stories and how they contribute to eliminating sustainably

11. Lessons to be Learned…..are we Listening?
Elimination and eradication are serious long-term commitments
Time is of the essence….resistance and waning commitment will eventually undo the effort
A continuing portfolio of impressive successes is essential
Financing will never be enough and will be required for longer that we can ever anticipate
Technical contingencies and innovations must continue to evolve
Start where you will end up!