Human Resource Requirements for Malaria Elimination Curso de

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

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 • Resistance Monitoring and • Entomological Surveillance IEC/BCC • Universal Access to High • Existing plans to strengthen • Quality Diagnosis and Treatment Near perfect surveillance (passive case detection) • Strong political support • Community Involvement and buy-in • the health system are executed (free malaria treatment for all) QA/QC, training, health worker incentives (? ), IEC/BCC • High level political involvement • IEC/BCC

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 o Interventions: IRS, testing and treating at periphery o Diagnostics as intervention o Logistics • Additional components: new interventions, operations research, cross-border and inter-regional program collaboration

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 o Community-based workers, community pharmacies • Learning agenda: refine and redefine tactics and technologies to adapt to work

Core Components of Malaria Elimination 17 February 2014 5

Malaria Elimination Key Competencies and Staffing 17 February 2014 6

Comprehensive Programming for Elimination

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: o Good/better vector control with ITNs and IRS o Better use of diagnosis (of both illness and asymptomatic infections) and treatment -- but in a proactive and preventive mode o Actionable information – ‘surveillance as an intervention’ o Transition to Rapid Diagnostic Testing

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!

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

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!