Cold Chain Management during MR Vaccination. Campaign 2014

Transcription

1 Cold Chain Management during MR Vaccination Indicators in the context of Campaign 2014 Prevention of Re-introduction Risintha Premaratne MBBS, MPH (Bio-security), MSc, MD (Community Medicine) Director, Anti Malaria Campaign, Ministry of Health, Sri Lanka APMEN SWRG Meeting - Phuket, Thailand - May 2015

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9 Disease burden due to malaria, (to date) Year Indigenous cases Imported cases Deaths , , , , , , , (to date) - 9 -

10 Malaria elimination continuum

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13 Risk of Malaria Resurgence High Receptivity: Suitable temperature and humidity Breeding places: paddy cultivation, irrigation wells, quarry pits, streams, river beds, sand pools and ecological changes. An. culicifacies species E an efficient, endophilic, endophagus, anthropophagic and intensely domestic species. High Vulnerability: Migration, development projects with no malaria impact assessment. Delay in detection and treatment of cases Unstable, seasonal, focal, low transmission rural plain ecotype malaria, prone to explosive epidemic.

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16 Challenges in determining indicators for PoR context

17 Challenges in determining indicators for PoR context Indicators on cases may no longer be sensitive enough to assess the performance & progress Mapping interventions for prevention / control of imported malaria: a daunting task Reporting based on commonly used indicators may lead to misinterpretation Rare disease events leading to malaria becoming a forgotten disease: Keeping attention & interest of health staff towards elimination Sustaining spending for malaria elimination in the face of a low disease burden:? indicators related to specifics of domestic funding

18 (Commonly used; proposed by GF for NFM) Impact indicators No. of indigenous malaria cases (confirmed) Disaggregated by sex, age, geographical area, time, species, others No. of imported malaria cases (confirmed) Disaggregated by sex, age, geographical area, time, species, others Confirmed (indigenous) malaria cases (microscopy or RDT) per 1000 persons/year Inpatient malaria deaths per 1000 persons per year Malaria test positivity rate All-cause under-5 mortality rate per 1000 live births

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21 Clusters of imported malaria in Negombo & Kochchikade areas

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23 Challenges in determining indicators for PoR context Indicators on cases may no longer be sensitive enough to assess the performance & progress Mapping interventions for prevention / control of imported malaria: a daunting task Reporting based on commonly used indicators may lead to misinterpretation Rare disease events leading to malaria becoming a forgotten disease: Keeping attention & interest of health staff towards elimination Sustaining spending for malaria elimination in the face of a low disease burden:? indicators related to specifics of domestic funding

24 (Commonly used; proposed by GF for NFM) Outcome indicators Proportion of population that slept under an ITN the previous night Proportion of children under five years old who slept under an ITN the previous night Proportion of pregnant women who slept under an ITN the previous night Proportion of population with access to an ITN within their household Proportion of population using an ITN among the population with access to an ITN Proportion of households with at least one ITN for every two people and/or sprayed by IRS within the last 12 months Proportion of households with at least one ITN Proportion of households with at least one ITN for every two people

25 (Commonly used; proposed by GF for NFM) Output indicators: Vector control Number of LLIN distributed to- at-risk populations through mass campaigns Proportion of population at risk potentially covered by LLIN distributed No. of LLIN distributed to- targeted risk groups through continuous distribution Proportion of targeted risk groups receiving LLIN Proportion of households in targeted areas that received IRS during the reporting period Proportion of population protected by IRS within the last 12 months

26 Challenges in determining indicators for PoR context Indicators on cases are no longer sensitive enough to assess the performance & progress Reporting based on commonly used indicators may lead to misinterpretation Mapping interventions for prevention / control of imported malaria: a daunting task Rare disease events leading to malaria becoming a forgotten disease: Keeping attention & interest of health staff towards elimination Sustaining spending for malaria elimination in the face of a low disease burden:? indicators related to specifics of domestic funding

27 Time to diagnosis in imported malaria patients Days from onset of illness to blood test Cases (in ascending order of time to diagnosis) % of patients having 5 days or less 37% % of patients having 6-10 days 33% % of patients having more than 10 days 31%

28 Challenges in determining indicators for PoR context Indicators on cases are no longer sensitive enough to assess the performance & progress Reporting based on commonly used indicators may lead to misinterpretation Mapping interventions for prevention / control of imported malaria: a daunting task Rare disease events leading to malaria becoming a forgotten disease: Keeping attention & interest of health staff towards elimination Sustaining spending for malaria elimination in the face of a low disease burden:? indicators related to specifics of domestic funding

29 An example: funding landscape for National Malaria Programme Sri Lanka NFM funding divide: 60% domestic, ~40% GFATM (proposed) Funding for malaria in Sri Lanka: a low priority Domestic funding progressively decreasing in the backdrop of competing interests Minimal capital expenditure Budget for insecticides: 350M in 2008, 10M in 2015 Sri Lanka is in GF NFM Band 4 (higher income/lower burden) Need for earmarked minimum funding for malaria (as in vaccine budget for EIP)

30 High level strategies National Budget Influencing Partnership Building Provincial Budget Influencing Evidence gathering Short-term outcomes Malaria budget aligned with current elimination and POR activities. Malaria Technical Support Group and TSG Chair mobilized to support re-allocation process (2015) and national budget justification (2017). GFATM activities categorized into relevant national budget allocation categories. Historical allocation ( ) and expenditure data on national budget analyzed. Director of Planning (MoH) and DGHS; and Secretary Health commits to malaria elimination and POR reallocation. RDHS are committed to malaria elimination allocations & expenditures. Requested domestic allocation for malaria elimination and POR is justified with evidence. Channel established for provincial allocations for malaria elimination and POR activities (e.g. WB or Treasury earmark) Medium-term outcomes Malaria budget justification submitted to MOH for 2017 budget (Feb-March 2016) DDG (Planning), DGHS, Addl. Sec. Health [PHS], & Secretary Health (MoH) commit to malaria 2017 budget. Ministry of Finance, Dept of Treasury committed to budget request and re-allocation for malaria elimination and POR. Tools developed to track subnational expenditures for malaria. Long-term outcomes Parliamentary Special Committee on Health defends malaria elimination budget allocations, justification and investment case. Parliamentarians at Standing Committee level support reallocation of funds for malaria during appropriations process. Malaria expenditures by provinces are tracked & analyzed to ensure expenditures match re-alignment of malaria elimination allocations in national budget. SMART Objective Proportion of Gov. of Sri Lanka contribution to National Malaria Strategic Plan ( ) is increased from 60% to 90% by 2017.

31 Thank you