MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies

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54 PROGRAM MANAGEMENT: FROM ZMCP TO ZMEP “He should have the quality of LEADERSHIP, because during a number of years he will be the chief of an army that must win a difficult war. He needs COURAGE, because he must dare to recognize the faults of his organization, to correct his mistakes, to dismiss the wrong men, to face unpopularity and to fight continuously against the lukewarm, if not definitely cold, attitude of a number of officials whose routine administrative habits are disrupted by his request for punctuality, and who sometimes happen to be superior in rank, and/or may have a say as regards to his future position when eradication is complete. He must have FAITH, because a number of influential people in his country think they know better and will look at the program as at an unrealistic, extravagant and costly enterprise; and because if he has not faith in the success he will not be able to inspire his staff, to stimulate them to sustain those efforts and hardships that are their lot. He must show PERSISTENCE, because it is only too likely that during all the 8 or more years of the malaria eradication program, new problems will arise, trained men will leave, the cooperation of the population will deteriorate, the enthusiasm of his own staff will gradually disappear; while that degree of the perfect of the work, necessary for success, must always be maintained during all those long years. To those four virtues must be added the ABILITY TO ESTABLISH GOOD RELATIONSHIPS with the critics and dissenters.” –Emilio Pampana, 1969, on the qualities of a Director of a National Eradication Program. INTRODUCTION FIGURE 24: ZMCP ORGANIZATIONAL CHART When moving towards elimination, the ZMCP will be faced with different requirements related to the administration of the national program. Today, the ZMCP has sufficient capacity to implement the control interventions specified in their national strategy. However, the shift in focus from the classical control measures, such as the distribution of impregnated mosquito nets and ACTs, to more intensive surveillance will require a shift in competencies and capacity within the program. An important difference from control as illustrated by Emilio Pampana’s quote lies in the program leadership required. In addition, the program will need to be provided with the necessary tools and competencies to implement a far more complicated M&E system. This chapter compares the current capacity of the ZMCP with the requirements for an elimination program and identifies gaps in terms of human resources, equipment and infrastructure that will need to be addressed before embarking on elimination. STRUCTURE AND RESPONSIBILITIES OF THE ZMCP The ZMCP is responsible for the coordination of all malaria activities on Zanzibar. It is a sub-Unit of the Directorate of Preventive Services and Health Education of the Ministry of Health and Social Welfare. The latter are the principle recipient of the Global Fund grants but the day-to-day management of the grants has been delegated to the ZMCP. The set-up of the ZMCP can be seen in the organizational chart below (Figure 24).
The ZMCP is relatively well staffed with departments responsible for the coordination–and sometimes implementation–of different activities related to the objectives of the strategic plan. The program is financially supported by the MOHSW and through funding from different grants that provide not only financial support but also technical assistance. Under the Global Fund Round 8 grant, the ZMCP has asked for technical assistance to strengthen its capacity in a number of areas, including quality control of laboratory services. �� QA/QC of laboratory services to ensure that the recent physical upgrade of the central referral laboratory is complemented by technical capacity upgrading for QA/QC in order strengthen the system and expand coverage to all private and public laboratories. �� Pharmaco-vigilance to allow the MOHSW to collect information on drug adverse events for not only antimalarial sbut also other products and provide the ZMCP and other relevant health sector programs with information for evidence-based decision making. �� Strengthening the HMIS at central and district level over a two year period. �� Community systems strengthening to develop a community-based BCC communications tool kit and train community and health facility resource persons in order 2 | Operational Feasibility to ensure consistent activities (in terms of quality and effectiveness) at the community level and enhance linkages with the peripheral facilities. Although not elimination specific, all of the above will further enhance the ZMCP when moving towards elimination. More specific requirements for the ZMCP and the necessary strengthening related to these requirements are discussed below. REQUIREMENTS FOR AN ELIMINATION PROGRAM Historically, the GMEP was mainly focused on IRS, and the programmatic requirements for the elimination program were strongly related to the management of the spray teams at all levels by what was called the “Division of Operations”. Pampana (1969) further proposed a Division of Epidemiology (or Evaluation) and a Division of Administration composed of an entomological, parasitological, epidemiological, statistical and administrative, health education, and public relation section, respectively. He also stressed the importance of strong leadership and the need of independence of the NMEP, with preferably a direct management link between the director of the eradication program and senior management in the MOH. FIGURE 25: ORGANIZATIONAL CHART PROPOSED BY EMILIO PAMPANA IN “A TEXTBOOK OF MALARIA ERADICATION”, OXFORD UNIVERSITY PRESS, 1969 55
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PHOTO: © SASJA VAN VECHGEL MALARIA
Page 5: ACKNOWLEDGEMENTS The feasibility as
Page 9 and 10: EXECUTIVE SUMMARY Over the past sev
Page 11 and 12: Financial Feasibility The optimal m
Page 13 and 14: INTRODUCTION BACKGROUND In October
Page 15 and 16: FIGURE 2.1: AVERAGE MONTHLY RAINFAL
Page 17 and 18: CHAPTER 1: TECHNICAL FEASIBILITY IN
Page 19 and 20: to below 1% with IRS (Bhattarai et
Page 21 and 22: DEFINING IMPORTATION RISK As illust
Page 23 and 24: those regions from where the greate
Page 25 and 26: PROBABILITY OF ACQUIRING INFECTION
Page 27 and 28: NUMBER OF INFECTED INDIVIDUALS achi
Page 29 and 30: PERCENTAGE OF INDIVIDUALS INFECTED
Page 31 and 32: the same time, it is expected that
Page 33 and 34: test, about 80% of infections could
Page 35 and 36: CHAPTER 2: OPERATIONAL FEASIBILITY
Page 37 and 38: DATA COLLECTION METHODS A robust su
Page 39 and 40: most secondary cases but would occa
Page 41 and 42: TABLE 5: RAPID RESPONSE ACTION FOR
Page 43 and 44: up. It will also allow for the iden
Page 45 and 46: TABLE 7: PRE-ELIMINATION AND ELIMIN
Page 47 and 48: essential components of an eliminat
Page 49 and 50: THE ZANZIBAR HEALTH CARE SYSTEM THE
Page 51 and 52: community needs to be aware that fe
Page 53 and 54: conditions. Health worker motivatio
Page 55: A key challenge will be that as an
Page 59 and 60: elaborate entomological surveillanc
Page 61 and 62: COMMUNITY INVOLVEMENT ON ZANZIBAR Z
Page 63 and 64: �� Communities should, as far a
Page 65 and 66: preventive measures, mainly related
Page 67: CONCLUSIONS This chapter considers
Page 70 and 71: elimination will raise two major fi
Page 72 and 73: INDOOR RESIDUAL SPRAYING As noted a
Page 74 and 75: analysis be conducted. Moreover, gi
Page 76 and 77: FIGURE 30: AVERAGE COST PER YEAR FO
Page 78 and 79: which are being explored by the glo
Page 80 and 81: portion of those costs). Before thi
Page 83 and 84: REFERENCES Afridi MK (2009). Use of
Page 85 and 86: Jacobs, Lesley A (9/2007). Rights a
Page 87 and 88: Sandberg, Ingstad K, Bjune G (2007)
Page 89: World Health Organization, Global M
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