National Malaria Control Programme
Three Year Annualised Plan
2010/11 - 2012/13
Ministry of Health
Plot 6 Lourdel Road, Wandegeya
P. O. Box 7272,
Kampala, Uganda
October 2011
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Government of Uganda, Ministry of Health: National Malaria Control Three year Annualised Plan for 2010/11 – 2012/13
Published by: Ministry of Health
PO Box 7272
Kampala, Uganda
Email:
Website: www.health.go.ug
Acronyms
ACT Artemisinin Combination Therapy
AMFm Affordable Medicines Facility Malaria
CDC Communicable Disease Control
CSO Civil Society Organisation
DMFP District Malaria Focal Person
HPAC Health Policy Advisory Committee
HW Health Worker
ICCM Integrated community Case Management
IMM Integrated Malaria Case Management
IPT Intermittent Presumptive Treatment
IRS Indoor residual Spraying
ITN Insecticide Treated Net
IVM Integrated Vector Management
LLIN Long Lasting Insecticide Treated Net
M&E Monitoring and Evaluation
MCH Maternal and Child Health
MoU Memorandum of Understanding
NMCP National malaria Control Program
NPO National Program Officer
PSM Procurement and Supply Management
QA Quality Assurance
RBM Roll Back Malaria
SBCC Social Behaviour Change Communication
TWG Technical Working Group
UMIS Uganda Malaria Indicator Survey
VHT Village Health Team
Table of Contents
1. Background 1
2. The Strategic Context 1
3. Detailed Strategic Workplan 3
1.1 Integrated Vector Management 3
1.2 Malaria Diagnosis and Case Management 6
1.3 Social Behaviour Change Communication 7
1.4 Monitoring, Evaluation, Research and Epidemic Preparedness 9
1.5 Program Coordination and Management 11
1. Background
This 3-year plan estimates the amount of work to be done for the first three year in order to meet the objectives for 5 years. The targets for the 3 years are the mid-term objectives of this strategic plan and are indicated in the annualised plan. This plan will also assist in development of the detailed annual implementation plans each year in accordance with the National Government Sector Planning Guidelines. The Plan is presented in business plan format for resource to enable partner’s mobilise resources and work towards the targets. This plan is part of and should be viewed together with the strategic plan.
2. The Strategic Context
The strategic direction in which this three year annualized plan operates is within the strategic plan whose framework is shown below:
Vision: / A Malaria free UgandaMission: / “To provide to all people in Uganda quality services for malaria prevention and treatment”
Goals: / 1. To reduce morbidity due to malaria by 75% of 2010 levels
2. To reduce mortality due to malaria by 80% of 2010 levels
Objective: / Key Intervention
Objective 1: To reduce malaria prevalence by 75% of 2010 levels by 2015 / Integrated management of malaria vectors in Uganda is an underdeveloped component of malaria control policy. Cooperation between the health and other sectors needs strengthening and funding in order to develop and effectively implement an appropriate IVM approach for the country. The whole country is viewed as highly endemic and interventions will be applied based on mapping planned in the first year
1.1. Reach universal coverage and utilization of Long-Lasting Insecticidal Nets (LLINs) so that each household owns at least one LLIN for every two persons
1.2. Scaling up of routine Indoor Residual Spraying to ensure that interior walls of targeted institutional and domestic structures in each district are routinely sprayed at appropriate intervals with an effective insecticide
Objective 2: To increase to 90% by 2015 the proportion of malaria cases parastologically confirmed and treated with effective antimalarials / There have significant policy changes to refine the diagnosis and treatment of fevers in Uganda. First, the direction is to ensure that all malaria cases are diagnosed before treatment with at all levels of care by the end of the three years. RDTs will be scaled up from community level in the context of ICCM and to health facilities without functional laboratory diagnosis capacity. Private sector RDTs will be piloted and expanded within the AMFm initiative. Secondly case management will focus on increasing use of ACTs for uncomplicated malaria both in the private and public facilities
2.1. Scale-up quality parasitological diagnosis with microscopy and RDTs
2.2. Appropriate treatment of malaria at public and private health facilities
2.3. Scale up home management of malaria (including referral) within ICCM strategy
2.4. Strengthen capacity for pre-referral treatment and management of severe malaria
Objective 3: To achieve by 2015, 80% of the population consistently using at least one malaria prevention method together with appropriate treatment seeking behaviours / The focus in the three years is on social, behaviour change communication and engagement of a wide range of actors to mobilise families and individuals. Within the three years, NMCP will work towards strengthening community system through advocacy to create enabling environments; mobilizing community networks; building linkages, broad partnerships and alliances with CSOs, traditional practitioners, Business community and private sector; and strengthening interventions towards concerted malaria control efforts at community and household level. IPT implementation has been integrated in MCH.
3.1. Advocacy in all political, economic and social spheres;
3.2. Empowerment of women in malaria control activities;
3.3. Community mobilization to change beliefs, attitudes and practices towards malaria treatment and prevention;
3.4. Strengthen alliances with CSO and private sector for SBCC strategic planning;
3.5. Research on behavioural obstacles to poor uptake of interventions;
3.6. Expand effective engagement with business coalitions in malaria Control.
Objective 4: To strengthen M&E systems to assess progress towards set targets, and informing refinement and decision making during implementation; / Relevant information for monitoring and evaluating progress in national malaria control comes from many sources and stakeholders encompassing governmental, non-governmental, private, and international agencies. Collecting, analysing, interpreting, and reporting quality information from various sources will be crucial part of national M&E activities. The effort in M&E is expounded in the M&E strategic plan.
4.1. Strengthen the functionality of the national RBM M&E working group
4.2. Strengthen the NMCP M&E Unit, NMCP and partner reporting system to monitor the strategic plan
4.3. Strengthen District M&E capacity and functionality encompassing logistics/inventory monitoring, private sector, community VHT reporting
4.4. Health facility based sentinel malaria surveillance including in-patient reporting
4.5. Strengthen linkage between research and other sectors with NMCP
4.6. Monitoring human resource capacity for malaria control
4.7. Quality Assurance through monitoring of quality of service delivery, client satisfaction and tracking of training information systems
4.8. Strengthen monitoring and evaluation of community BCC activities and IVM
4.9. Conduct operational research to inform implementation, especially in the following areas:
i) Mass Screening and Treatment (MST);
ii) Application of chemical and biological larvicides;
iii) Application of live-bait technology.
Objective 5: To strengthen NMCP for effective malaria control policy development, planning, management, partnership coordination and timely implementation of planned interventions in order to achieve all country objectives and targets set for 2015. / The NMCP will focus on achieving coordinated nationwide coverage of prevention, case management and supportive interventions during the first three years of the strategic plan. The Program will work towards filling in intervention gaps and maintaining the coverage, strengthening planning, training and M&E to ensure sustenance of high coverage. The key structures in the organisation of the strategy implementation involve strengthening national, regional, district and community levels
5.1. Advocacy and resource mobilization
5.2. Ensure well-coordinated efforts to scale up
5.3. Elevate NMCP to the level of a Department in the MoH
5.4. Strengthening competencies within malaria control related sectors
5.5. Strengthening PSM systems for malaria commodities
5.6. Strengthening Human Resource capacities for malaria control
5.7. Establishing performance improvement at district level.
7
3. Detailed Strategic Work Plan
1.1 Integrated Vector Management
Objective / Target / Intervention / Activities / Period / 3 year target/Indicator / Responsible / Cost (‘000) / Source of Funding /Year 1
2011/12 / Year 2
2012/13 / Year 3
2013/14 /
Objective 1:
To reduce malaria prevalence by at least 75% of 2010 levels by 2015 / Malaria prevalence reduced to 10% of the baseline value / Intervention 1.1:
Reach universal coverage and utilization of Long-Lasting Insecticidal Nets (LLINs) so that each household owns at least one LLIN for every two persons through:
i. Provision of free LLINs to households by mass campaign distribution at intervals of three years
ii. Maintaining high coverage of LLINs through ANC and EPI outlets / 1.1.1. Planning the implementation and coordination of the campaigns / x / x / 80% of households with at least one LLIN per two person / NMCP/Partners / 2,231,000 / GOU, GF
1.1.2. Testing of imported LLINs for quality control and quality assurance / x / x / x / NDA and UNBS / 66,000 / GF
1.1.3. Train for Mass and Routine ANC distribution of LLINs at all levels / x / x / x / NMCP/Partners / 4,212,000 / GF, PMI
1.1.4. Distribution of LLINs to beneficiaries, supervision and monitoring / x / x / x / NMCP/Partners / 16,324,000 / GOU, GF, PMI
Intervention 1.2:
Scaling up of routine Indoor Residual Spraying to ensure that interior walls of targeted institutional and domestic structures in each district are routinely sprayed at appropriate intervals with an effective insecticide / 1.2.1. Needs Assessment / x / x / x / 85% of targeted houses sprayed at least twice with a residual insecticide in the last 12 months
Proportion of persons protected after IRS spraying / NMCP/Partners / 122,000 / GOU, PMI
1.2.2. Planning / x / x / x / NMCP/Partners / 854,000 / GOU, PMI
1.2.3. Capacity building for IRS at all levels / x / x / x / NMCP/Partners / 477,220 / GOU, PMI
1.2.4. Environmental compliance activities / x / x / x / NMCP/Partners / 750,000 / GOU, PMI
1.2.5. IEC/BCC activities / x / x / x / NMCP/Partners / 492,000 / GOU, PMI
1.2.6. Baseline and post-IRS entomological and epidemiological studies / x / x / x / NMCP/Partners / 2, 551,371 / GOU, PMI
1.2.7. IRS implementation, supervision and monitoring / x / x / x / NMCP/Partners / 135,036,309 / GOU, PMI
1.2.8. Conduct bio-assay studies to monitor quality of IRS / x / x / x / 3 studies conducted (1 per year) / NMCP/Partners / 612,000 / GOU, PMI
1.2.9. Feedback activities and re-planning / x / x / x / At least 12 review and planning meetings held by the IVM coordination committee / NMCP/Partners / 954,000 / GOU, PMI
Intervention 1.3:
Application of chemical and biological larvicides through:
· Integrating larviciding with control of other vector-borne diseases
· Working closely with environmental health division to expand coverage, as appropriate / 1.3.1. Capacity Building for larval control / x / x / x / Number of staff trained in 25 municipal local authorities / NMCP/Districts/Partners / 123,000 / GOU
1.3.2. Mapping of mosquito breeding habitats / x / x / x / Number of defined breeding sites / NMCP/Districts/Partners / 345,567 / GOU
1.3.3. Larval mosquito control implementation, supervision and monitoring / x / x / x / Number of routinely treated larval sites / NMCP/Districts/Partners / 7,542,003 / GOU
1.3.4. Live-bait technology mosquito control implementation, supervision and monitoring / x / x / x / 50% reduction in mosquito density / ICC Secretariat/ NMCP / 187,000 / GOU
1.5.1. Mapping of districts/sub-counties for application of live-bait technology / x / x / x / Number of district/sub-county sites identified / NMCP/MAAIF / 323,000 / GOU
1.2 Malaria Diagnosis and Case Management
Objective / Target / Intervention / Activities / Period / 3 year target/Indicator / Responsible / Cost / Source of Funding /Year 1
2011/12 / Year 2
2012/13 / Year 3
2013/14 /
Objective 2
To increase to 90% by 2015 the proportion of malaria cases parasitologically confirmed and treated with effective antimalarials / 60 % of clinical malaria cases that are confirmed by microscopy/RDT at health facility level
60% of children under five years old with fever in the last two weeks who received treatment with ACTs according to national policy within 24 hours of onset of fever / Intervention 2.1:
Scale-up quality parasitological diagnostics with microscopy and RDTs so as to increase the proportion of malaria cases tested by definitive parasitological diagnosis from 24% (2008/9) to 90% by 2015 / 2.1.1. Training health workers at all levels, including the private sector, on use of RDTs, and on microscopic diagnosis / x / x / 80% of suspected malaria cases tested using microscopy and RDT / NMCP / 3,012,070 / GOU, and partners
2.1.2. Roll out a quality assurance system for parasitological testing (EQA) / x / x / x / NMCP / 5,566,848 / GOU,GF,PMI
Intervention 2.2:
Appropriate treatment of malaria at public and private health facilities by ensuring 100% access to and utilisation of artemisnin-based combination therapy (ACT) by all people including those accessing treatment through the private sector by 2015 / 2.2.1. Train health workers at all levels including the private sector in integrated management of malaria (IMM) / x / x / 85% of outpatient malaria cases that received an appropriate antimalarial treatment according to national policy / NMCP / 7,126,738 / GOU, GF, PMI
2.2.2. Develop, update, print and disseminate guidelines and job aides on malaria treatment / x / x / x / NMCP / 215,000 / GOU, partners
2.2.3. Conduct technical support supervision / x / x / x / NMCP / 988,235 / GOU, GF, PMI
Intervention 2.3:
Contribute to the scale-up of the ICCM strategy (including referral) so as to increase the proportion of children under 5 receiving prompt treatment within 24 hours at all health care levels, including the community level using ACTs to reach 85% by 2015 / 2.3.1. Train VHTs on IMM through ICCM / x / x / 60% of children under five years old with fever in the last two weeks who received treatment with ACTs according to national policy within 24 hours of onset of fever / NMCP / 1,860,684 / GOU, GF
2.3.2. Conduct support supervision of VHTs / x / x / x / NMCP / 1,200,000 / GOU, GF