Informal Meeting for the Preparation of a Strategic Plan

DRAFT

MEETING REPORT

Informal Meeting for the Preparation of a Strategic Plan

for Capacity Development for Roll Back Malaria (RBM)

World Health Organization, Geneva, Switzerland

17-20 July 2000

MEETING REPORT

Informal Meeting for the Preparation of a Strategic Plan

for Capacity Development for Roll Back Malaria (RBM)

World Health Organization, Geneva, Switzerland

17-20 July 2000

Table of Contents

Page

1. Overview of the meeting 1

2. Rationale for development of a strategic plan 2

3. How the plan can be used 3

4. Definition of capacity development for RBM 3

5. Situation analysis 3

5.1. Provision of an enabling environment/

Human resources development 4

5.2. Strengthening managerial skills 5

5.3. Improving clinical and technical skills 5

5.4. Building on community capability 6

6. Draft framework for a strategic plan for capacity 6

development for RBM

7. Resource mobilization for the strategic plan 9

8. Plan for first-year activities 9

Annexes

1 List of participants

2. Meeting agenda

3. Preliminary situation analysis

4. Draft framework for strategic plan for capacity

development for RBM

MEETING REPORT

Informal Meeting for the Preparation of a Strategic Plan

for Capacity Development for Roll Back Malaria (RBM)

World Health Organization, Geneva, Switzerland

17-20 July 2000

1. Overview of the meeting

As a major step in developing a strategic plan for capacity development for RBM, a meeting of RBM partners with particular interest and expertise in capacity development was convened at WHO headquarters, Geneva from 17 to 20 July 2000 to draft the plan presented in this report. Participants are listed in Annex 1.

The meeting was opened by Dr Kamini Mendis, on behalf of the Acting Project Manager of the Roll Back Malaria (RBM) Initiative. (See meeting agenda in Annex 2.) Introductory comments were also made by Dr Elil Renganathan, Coordinator, Social Mobilization and Training, Department of Control, Prevention and Eradication, Communicable Diseases Control (CPE). The officers of the meeting were then elected. Dr Yeya Touré, from the University of Mali agreed to serve as chairperson of the meeting with Dr Ah Sian Tee from the State Health Department, Malaysia as his vice-chair. The rapporteurs were Dr Sylvia Meek from the Malaria Consortium, United Kingdom and Dr Erling Pedersen of the Danish Bilharziasis Laboratory (DBL), Denmark.

Dr Touré introduced Merri Weinger, CPE, who served as facilitator of the meeting. The first session was dedicated to presentation and discussion of a preliminary situation analysis on the status of capacity development for RBM that was drafted in preparation for the meeting. The situation analysis was based on a questionnaire sent to meeting participants and other partners, a review of relevant documents and interviews with RBM staff. The analysis will be further developed with inputs from a broader group of stakeholders during the process of consultation for development of the plan. The draft situation analysis is summarized in section 5 of this report and can be found in Annex 3.

A guided group process was then implemented to facilitate the development of a draft plan for capacity development for RBM. Participants worked collectively to define the overall mission and goals of the initiative. Small groups were then formed based on interest and experience to develop a draft capacity development proposal for each goal, including objectives, implementation strategy, activities, timeline and potential partners. Facilitation of the four small groups was provided by Dr Sylvia Meek and Sunil Mehra from the Malaria Consortium, Dr Yao Kassankogno, WHO-AFRO, and Dr Richard Allan and James Mullally from WHO headquarters. The draft plan is outlined below in section 6 and detailed in Annex 4. During the final session of the meeting, the group identified priority activities for the first year of the plan.

Further development of the plan will require inputs from regional and national levels to link strategies to locally identified needs and priorities. A process was identified at the meeting to move forward with preparation of the strategic plan. It was proposed that the preliminary framework developed at the meeting be circulated to the WHO Regional Offices, counterparts in governmental Ministries, partners active in capacity development at all levels, the RBM Secretariat and other interested parties. Based on inputs received, it is projected that the strategic plan would be consolidated and endorsed by the end of October, 2000. The revised document would then be widely distributed through RBM partners for adaptation and implementation. With the help of a network of partners in capacity development, the plan would be continually evaluated and updated as needed.

Prior to closure of the meeting, both Dr Awash Teklehaimanot, Acting Project Manager, Roll Back Malaria and Dr Maria Neira, Director of CPE addressed the group.

The following sections of the report summarize the products of the meeting: consensus on the rationale for development of a strategic plan, how it will be used, definition of capacity development for RBM and summary of the situation analysis, as well as an overview of the draft framework of a strategic plan, strategies for resource mobilization and a draft action plan for the first year of implementation.

2. Rationale for development of a strategic plan

In response to the enormous and unacceptable burden of malaria, the Roll Back Malaria (RBM) Initiative was launched in 1998 by WHO, the World Bank, UNICEF and UNDP. Roll Back Malaria aims to halve deaths due to malaria by 2010. A key barrier to reducing the avoidable burden of malaria is the lack of capacity at all levels to control it effectively. Investments in capacity development have been inadequate and fragmented. The new approaches within the strategy of Roll Back Malaria, the changing organisation of health systems in many countries and recent developments in tools and technology to tackle malaria all require new skills at different levels. The increasing recognition of the importance of the private sector and the community in malaria control demands rethinking of where capacity development is needed. The limitations of earlier training methodologies, the lack of support following training and the lack of an enabling environment to apply new skills have all limited the impact of investments in capacity development.

The very significant increase in effort and resources brought by RBM provides a unique opportunity to address capacity development strategically and with a long-term perspective. At the African Summit on RBM held in Abuja in April 2000, Heads of State and other delegates ratified an action-oriented declaration with human resources development as a cornerstone. In response to the Abuja declaration, the strategic plan for capacity development will aim to:

· Target resources toward established short, medium and long-term priorities and avoid duplication of services;

· Help improve and expand capacity development efforts for RBM;

· Strengthen coordination and collaboration among interested partners;

· Assist in ongoing resource mobilization; and

· Act as an advocacy tool for sustained political commitment.

3. How the plan can be used

The plan is designed for use by governments, agencies, organizations and individuals who promote, implement and fund capacity development efforts for RBM at the global, regional and local levels. The plan will set forth priorities and an action plan, which if widely adapted and implemented, can make a major impact on strengthening the RBM initiative.

The plan should not be seen as prescriptive, but rather as a catalyst and guide for planning, conducting and evaluating capacity development for RBM. Different objectives can be adapted and selectively implemented based on local conditions and needs. Interested partners can also use and add to on the plan’s inventory of resources on capacity development. To be successful, the plan will need the ideas and commitment of many people who are concerned with all aspects of malaria prevention and control. Partners will be invited to participate actively in the strategic planning process through the RBM web site and in direct contact with the RBM Secretariat.

4. Definition of capacity development for RBM

Capacity development for RBM, within the context of the meeting, was defined as building on current capability at all levels to prevent and control malaria through:

· Provision of an enabling environment (e.g., enhanced national commitment; development and implementation of appropriate recruitment and career policies; provision of facilities and resources; strengthened training institutions);

· Intensification of training and retraining of personnel;

· Technical support mechanisms (e.g., information, communication and supply systems to support trained personnel, supervision, monitoring and evaluation).

5. Situation analysis

The major needs for and barriers to capacity development are summarised below for each of the core areas defined in the situation analysis and further elaborated by participants at the meeting: provision of an enabling environment, including an infrastructure for human resources development; strengthening managerial skills; improving clinical and technical skills; and building on community capability. Topics that need to be targeted within the context of capacity building initiatives are the six elements of the Roll Back Malaria strategy: (1) early detection of malaria outbreaks; (2) rapid diagnosis and treatment; (3) multiple prevention; (4) focused research; (5) well coordinated action; and (6) a dynamic global movement.

5.1. Provision of an enabling environment including systems for human resources development

The enabling environment comprises the regulatory, supervisory and institutional supports necessary to allow trained personnel to be productive. The outstanding needs for ensuring an enabling environment include the following elements:

· Strengthened health systems;

· Sustained political commitment based on perceived importance of capacity development at all levels;

· Regulatory structure (e.g. for curriculum review, career policies, recruitment, training standards);

· Infrastructure for human resources development;

· Material resources (e.g. equipment, drugs, bednets, computers, transport, internet access); and

· Coordination (communication, harmonisation, intra-sectoral collaboration).

Although a cadre of malaria control managers and senior officials has been developed over the years in many countries, more attention should be directed toward an overall approach to human resources development (HRD) within national health systems. Currently, there is no organized strategy to plan for and manage capacity development for RBM in malaria control programmes. Among the needs for a sustainable HRD system are the following:

Planning for HRD

· Capacity-building needs assessment in countries;

· Short, medium, long-term HRD programme for RBM in the context of national health training plans;

· Evaluation indicators for capacity development;

Producing the necessary personnel

· Adequate numbers of trained personnel at all levels;

· Core competencies for RBM topics; clear job descriptions;

· Quality and consistency of training;

· A trained cadre of trainers;

· Use of appropriate and innovative training methods and technologies;

· Available training resources and materials (standardized and diversified according to needs);

· Follow-up and supervision of trainees;

· Creation and maintenance of a training database;

· Training of new personnel;

· Monitoring and evaluation of trainees including feedback;

Managing and sustaining the trained workforce

· Deployment of personnel to areas of greatest need;

· Ensuring equipment and resources for the job;

· Provision of refresher training and continuous updating as needed;

· Career path, adequate salary structure, and incentives for both recruitment and management of staff performance; and

· Post-training networking among trainees.

5.2. Strengthening managerial skills

The targets for managerial skill-building in countries are the RBM programme managers at national and district levels, other relevant health sector managers (e.g. Integrated Management of Childhood Illness, Communicable Diseases), medical officers in hospitals and health centers and technicians who may coordinate anti-malaria programmes at the district level. Of significance for building managerial capacity is the need to balance the development of both managerial and technical skills at all levels. Additional outstanding needs include the following:

· Re-evaluation of job description/expectations of managers at national and district levels. In the context of health service reform, competencies in malaria control should be defined for all members of the local health service team;

· Specific skill-building at national and district levels, e.g. in partnership building (with the private sector, NGOs and others), fund-raising and financial resource management, tools for effective advocacy with policy makers;

· Monitoring of management skills after training;

· Skill-building strategies other than standard in-service training;

· Expanded access to the Internet.

5.3. Improving clinical and technical skills

Partners in this category in the public sector include health care providers at district or local level, lab technicians or managers, GIS/ health information systems staff, vector control specialists, sanitary and civil engineers, community health workers and volunteers. Training and information sharing methodologies for these cadres should be carefully selected and monitored.

A consolidated approach for reaching private sector partners is needed in most regions. The primary target audience will be private practitioners who treat a substantial portion of malaria cases, however other potential partners may be private industry which provides malaria-related services through employee health programmes, the commercial sector (e.g. drug companies, pesticide manufacturers) and pharmacists.

Some of the needs identified for this group include the following:

Ø In-service training

· Strengthen capacity of practitioners at provincial and district levels;

· Strengthen national training institutes;

· Address specific training needs, such as:

- training for vector control technicians in the field (e.g. on resistance monitoring)

- training for programme managers on vector control

- training on implementation, monitoring and evaluation of Insecticide Treated Materials (ITM) programmes

- malaria microscopy/diagnostics for laboratory technicians

- treatment of uncomplicated and severe malaria for health care providers

- operational research training.

Ø Pre-service training

· Develop focused strategy to include malaria in curriculum for pre-service training of doctors, nurses and other allied health workers, including teacher training.

5.4. Building on community capability

Since the home is “the first hospital” in the majority of malaria cases, the objectives of capacity development at the community level are to improve family and community practices such as early detection and rapid treatment of severe malaria and the use of personal and community prevention strategies (e.g. bednets). Implementing partners include caregivers, community leaders, drug vendors, non-governmental organizations (NGOs), religious groups, traditional healers, school teachers and women’s groups, among others.

Areas of need include the following:

· Varying levels of information and skills; the need for consistent messages from NGOs, community agencies, community health workers and volunteers;

· Need for community education on recognition of malaria, early treatment and multiple prevention;