Country report-Tanzania - Ross School of Business

Country report-Tanzania - Ross School of Business

Country report-Tanzania Presented to EARN Annual Malaria Conference Kigali, Rwanda 15th 19th November, 2004 NMCP Outline of Presentation Malaria problem Key achievements Challenges Opportunities Priority areas for 2004/05 Evaluation report Tanzania: Malaria Transmission Risk Mapping Malaria Risk in Africa Tarime Tarime Musoma Musoma

Bukoba Bukoba Karagwe Karagwe Muleba Muleba Ukerewe Ukerewe Bunda Bunda Serengeti Serengeti Sengerema Sengerema Magu Magu Ngara Ngara Mwanza Mwanza Ngorongoro Bariadi Ngorongoro Misungwi Misungwi Bariadi

Biharamulo Biharamulo Geita Geita Kwimba Kwimba Maswa Maswa Meatu Meatu Karatu Karatu Bukombe Bukombe Shinyanga Shinyanga Mbulu Mbulu Kahama Kahama Kibondo Kibondo Babati Babati Iramba

Iramba Nzega Nzega Igunga Kasulu Kasulu Igunga Hanang Hanang Tabora Tabora Urambo Urambo Singida Singida Kondoa Kondoa Monduli Monduli Hai Hai Rombo Rombo Arumeru

Arumeru Arusha Arusha Moshi Moshi Simanjiro Simanjiro Kiteto Kiteto Kilosa Kilosa Sumbawanga Sumbawanga Rufiji Rufiji Kilombero Kilombero Malaria Transmission Model

Climatic Suitability Mafia Mafia 0 < 0.10 0.10 - 0.25 0.25 - 0.50 0.50 - 0.75 0.75 - 0.90 > 0.90 Mbeya Mbeya Njombe Njombe Ulanga Ulanga Ileje Ileje Rungwe

Rungwe Liwale Liwale Kilwa Kilwa Lindi Lindi Ludewa Ludewa Makete Makete Kyela Kyela 200 Kisarawe Kisarawe Mkoani Mkoani Zanzibar

Zanzibar North North A A Zanzibar Zanzibar North North B B Zanzibar Zanzibar West West Zanzibar Zanzibar Central Central Zanzibar Zanzibar Municipal Municipal Kinondoni Kinondoni Zanzibar Zanzibar South South Ilala Ilala Temeke

Temeke Mkuranga Mkuranga Mufindi Mufindi Mbozi Mbozi 100 Kibaha Kibaha Iringa Iringa Mbarali Mbarali Kilometers Chakechake Chakechake

Bagamoyo Bagamoyo Mpwapwa Mpwapwa Chunya Chunya Wete Wete Tanga Tanga Handeni Handeni Pangani Pangani Dodoma Dodoma Manyoni

Manyoni Micheweni Micheweni Korogwe Korogwe Morogoro Morogoro 0 Muheza Muheza Kongwa Kongwa Sikonge Sikonge Nkansi Nkansi

Mwanga Mwanga Lushoto Lushoto Kigoma Kigoma Mpanda Mpanda Same Same Mbinga Mbinga Songea Songea Ruangwa Ruangwa

Nachingwea Nachingwea Mtwara Mtwara Tandahimba Tandahimba Tunduru Tunduru Masasi Masasi Newala Newala MOH NMCP TEHIP MARA Collaboration September, 2000 Population: 34.5 million; At risk Population close to 100% 16 million case Malaria problem Data collected by NMCP directly from the districts 110/114 districts for 2003 revealed:

proportion of malaria cases OPD 41% of all OPD cases 42% of all OPD <5 yrs cases 39 of all OPD >5 yrs cases Malaria problem All admissions 1,380,464 -690,690 = < 5 yrs -689,774 = > 5 yrs Proportion of malaria Deaths out of total Deaths - 34.4 deaths/total population -39.0 deaths/< 5yrs population - 30.1/>5yrs population ACHIEVEMENTS 2003/04 Malaria case management

Training of health personnel and tutors on management of malaria and supervisory skills Conducted follow-up after training to Prescribers in 38 districts Trained 550 MCH workers on the use of IPT and promotion of ITNs Revised, guideline on Focused Ante-Natal Care. It is in press Carried out monitoring for 1st and 2nd line drugs (SP and Amodiaquine) at 4 sites. Results show that there resistance to SP is reached the levels where the process of changing policy should start Applied for and received GFATM funding for ACTs Vector control Produced 1st draft guideline on Integrated Vector Control Contracted out to NIMR testing for vector pyrethroids resistance countrywide, results will be available in early 2005

Launch and rolling out of TNVS: Training of RCH staff and retailers, advocacy, distribution of voucher Increase of Ngao sales, in 2003 over 3 million kits Prevention and control of malaria epidemics Establishment of Early detection system Capacity building of CHMTs on the system for early detection and dissemination of the system Emergency stocks of anti-malarial drugs, insecticides and sprayers were procured and distributed to 10 epidemic prone districts Capacity building on data management Follow up of implementation of EDS IEC and Community Mobilization

Draft guideline on Malaria Communication Strategy was produced; Commemoration of Africa Malaria Day Malaria messages were aired in the media, all year round, thanks to efforts of our partner-PSI Advocacy to Members of Parliamentarians on Malaria controls Programme Management WHO recruited a data Manager who was posted to work at NMCP Supervision of epidemic prone districts Collected malaria data for 2002/2003 from all districts

Creating malaria data base at NMCP National Bureau of Statistics agreed to include some of the indicators on ITNs in the forthcoming Demographic and Health Survey Programme management cont. National Malaria/IMCI Conference was held in Dodoma in April 2004, the theme was addressing malaria control challenges at district level The meeting was attended by over 260 participants of which 121 were District Medical Officers Technical meeting met as scheduled. Appointed District Malaria and IMCI focal persons Finance

In 2003/2004 NMCP budgeted 1.8 million US$ from the MTEF (Mid Term Expenditure Framework. Over 90% of the budgeted funds were received Challenges Lack of malaria communication strategy Parasite resistance Cost and availability of ACTs Operationalisation of ACTs: affordability Involvement of the private sector, compliance Poverty and accessibility to malaria interventions what do we do with the most disadvantaged population Involvement of other key Ministries is not easy under current organizational set-up of NMCP

Human resource constraints at all levels Opportunities Government Commitment Abuja declaration, MDG goals, malaria a priority health problem, HSR process and reinforcement of District Health Systems Partner commitment and involvement Increasing IMCI coverage Partner: Private sector involvement the Cocacola initiative, TANAAM (NGOs), Management Science for Health , Research and Training Institutions etc GFATM Priorities for 2004/05 Finalisation of Communication Strategy Continue the process towards drug policy change to ACT Explore the potential that Tanzania has in the agricultural production of Artemisia annua In collaboration with partners explore mechanism for funding for ACTs beyond GFATM

Priorities Capacity building and training of district Malaria/IMCI focal persons Anti-malarial drug quality Supervision, Monitoring and Evaluation Operational Research- Efficacy, vector resistance Implement the ITNs Voucher Scheme Priorities for 04/05 Strengthen Surveillance systems for monitoring malaria epidemics Data base for malaria updated EVALUATION OF 2001-2003 Summary report based on 2001 and 2003 monitoring Where are we?

Access to Treatment Adequate Management of Severe Malaria ITNs use in children <5years ITNs use and pregnant women SP- IPT in pregnancy Capacity of early detect and respond to malaria epidemics Awareness and conformity by the population to malaria information Towards Abuja targets (1) MMTSP targets by 2007 At least 80% of uncomplicated and severe malaria cases in children under five years of age, in health facilities at all levels of health care, will be appropriately treated (60% by 2005) Use of appropriate treatment for febrile episodes in children under five years of age, within 24 hours, will be raised from 19% to 60% Malaria case management

(Uncomplicated malaria) 100 OPD appropriate case management 80 60 target 07 64 51 target 05 40 20 2001 2003 2005 2007

Malaria case management (Severe malaria) 100 Inpatients appropriate manangement 80 60 54 58 2001 2003 target 07 target 05 40 20 2005

2007 Malaria case management at home % of under fives w ith m alaria attack/fever getting appropriate treatm ent w ithin 24 hours of onset 100% 80% 60% 40% 20% 0% 52 37 11 2001 correct action 35 38

27 2003 wrong action 2005 no action Proportion of health facilities reporting no disruption of stocks of required anti-malarial drugs for more than seven days during the previous three months 2003 Q tab 2001 Q inj 2nd line AM 1st line AM any antimalarials

20 40 60 80 100 Use of ITNs At least 60% of the children under 5 years of age and 60% of pregnant women will be sleeping under an insecticide treated mosquito net by 2007 Use of ITN in underfive 100% 80% underfive sleeping under a net

54 Target 60% 48 60% 40% 20% 0% no net 31 27 15 26 2001 2003

net ITN 2005 2007 Malaria in Pregnancy At least 60% of pregnant women will be effectively protected against malaria Malaria in Pregnancy cont. ITN coverage 80 Use of net in pregnancy target 07, 60 60 target 05, 50 40 20

0 Net ITN 21 28.1 7.6 2001 21 2003 2005 2007 Malaria in Pregnancy IPT use 100 IPT use in pregnancy

80 60 80 60 15.6 40 20 29.3 49.4 0 2001 IPT correct 2003 2005

2007 IPT not correct Prevention and control of Epidemics All epidemic prone districts will have increased their capacity to detect malaria epidemics early and contain them Malaria Epidemics Prevention and Control cont. 30 District with malaria epidemic early detection (ED) and response (res) system in place target 07 # o f d is trict s 25 20 target 05

ED 15 ED 10 Re s 5 0 2001 2002 2003 2004 2005 2006

2007 THANK YOU AHSANTENI

Recently Viewed Presentations