MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
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elaborate entomological surveillance recommended in the<br />
surveillance section above will require the necessary human<br />
resource capacity for entomological surveillance (mainly assistants<br />
for field work) and for the management of the necessary<br />
entomologically evidence-based vector control activities.<br />
SURVEILLANCE AND RESPONSE UNIT<br />
Surveillance Unit<br />
The Surveillance Unit would be responsible for all activities<br />
needed to achieve high case detection rates. For passive case<br />
detection this implies that they would not only be responsible for<br />
the analysis of the data coming from the different health facilities<br />
but also for the training of staff and QA/QC of the different tests<br />
used in collaboration with the M&E and Operational Research<br />
Unit. The unit should also have a focal point for all active case<br />
detection activities if operational research suggests that active<br />
case detection of high risk groups or specific areas is required.<br />
The number of cases that need treatment will go down over time<br />
(to almost zero), but all fever cases will need to be tested to ensure<br />
that every case is identified to then avoid onward transmission.<br />
This will lead to an increased number of tests to be done, with<br />
few being positive and increased need for QA/QC of all tests used.<br />
The introduction of DNA PCR, as proposed in the HSS chapter,<br />
necessitates the hiring of competent laboratory staff at the central<br />
level. The constant need for fever testing, most probably in an<br />
environment where health workers might be less motivated as<br />
most tests will be negative, justifies the need to have training on<br />
malaria diagnosis on a regular basis. Training capacity should<br />
ideally be decentralized with training coordinators at the district<br />
level and a laboratory trainer of trainers for each island under the<br />
coordination of the ZMEP laboratory focal point. Ideally QA/<br />
QC (PCR Unit) capacity should be established on each island<br />
under the overall coordination of the laboratory coordinator of<br />
the ZMEP. This might not be possible from the start, as the<br />
program will need to build up the necessary expertise at the<br />
central level before establishing a PCR Unit on each island.<br />
Response Unit<br />
Once a case is detected, the foci will need to be investigated<br />
and treated in the shortest delay possible to avoid any onward<br />
transmission or, in the worst case, an epidemic in a population<br />
that over time will become non-immune. The response unit we<br />
propose should be lead by an epidemiologist and consist of two<br />
sub-units: A unit for rapid investigation/analysis and a rapid<br />
response unit. The coordinator of those units should be given full<br />
authority to start an investigation every time a case is detected<br />
and, based on the epidemiological assessment and analysis, start<br />
the appropriate and necessary malaria control interventions to<br />
clear the foci and avoid onward transmission. This obviously<br />
assumes that data on any detected case are transmitted<br />
immediately to the central unit. Where possible and appropriate<br />
(remote parts of Pemba, for example) capacity should be built<br />
at the district level to start the epidemiological investigation so<br />
that no time is lost. Both units would have to closely collaborate<br />
with the surveillance and vector control units respectively. For<br />
2 | Operational Feasibility<br />
example, the epidemiological investigation should include an<br />
entomological assessment, and the necessary staff should be<br />
drawn from the vector control unit to help do this.<br />
A separate active case detection unit only makes sense if the<br />
program decides to do pro-active case detection. In case the final<br />
recommendations, based on operational research recommended<br />
in this report, only suggest to do re-active case detection (case<br />
detection based on a passively detected index case) we suggest to<br />
collapse the active case detection and rapid response unit into one.<br />
M&E AND OPERATIONAL RESEARCH<br />
The M&E and Operational Research Unit will need the<br />
competency to manage complex databases and use complex<br />
geo-statistical software (see Surveillance and M&E sections in<br />
Chapter 3) and will need to hire and/or train additional staff for<br />
these tasks. We also recommend establishing a special reporting<br />
unit to respond to the often complicated financial and narrative<br />
reporting requirements of international donors.<br />
Operational research will be an important component of<br />
the elimination program and will most likely be done in<br />
collaboration with international partners/research institutes like<br />
ZAMRUKI and the CDC. Often these organizations employ<br />
their own staff, but close collaboration with the ZMEP and its<br />
different departments will nevertheless increase the program’s<br />
workload. We therefore suggest creating a position to coordinate<br />
all operation malaria-related research so that overlap is avoided<br />
and to ensure an efficient collaboration with the different<br />
departments within the program.<br />
COMMUNICATIONS DEPARTMENT<br />
We recommend that the ZMCP start a separate communication<br />
department. This department will play an essential role not only<br />
to achieve elimination but maybe even more to maintain it. It<br />
should be responsible for health education, both at the health<br />
facility and community level, and for mass communication<br />
campaigns explaining certain unpopular measures such as<br />
border screening, prophylaxis in migrant workers or a malaria<br />
elimination tax on tourists. While the latter can be easily<br />
coordinated from the central level, we propose to have at least one<br />
health education coordinator for each island. They should work<br />
in close collaboration with the districts and the communities<br />
and further decentralization in this unit is strongly encouraged.<br />
Initially the campaign should focus on achieving elimination<br />
through the testing of all fever cases and the continuous use of<br />
preventive measures while in the end stages the campaign will<br />
have to address the fact that for a disease that no longer affects<br />
the population, certain measures/health seeking behavior will<br />
still be required.<br />
We also believe it will be extremely important to have a public<br />
relations department responsible for all communications related<br />
to potential border screening, prophylaxis in at-risk groups and<br />
imposed malaria elimination taxes. The ZMEP should develop<br />
a communications strategy targeting the tourism industry at<br />
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