MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
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CONCLUSIONS<br />
This chapter considers the legal principles that would apply to<br />
the recommended malaria elimination decisions and analyzes<br />
several of the restrictive interventions that the country may wish<br />
to employ in an elimination program. It provides an overview of<br />
the relevant issues, principles, and considerations to provide a<br />
foundation for more detailed analysis later as relevant.<br />
The overall approach recommended by this group, which is also<br />
required under international law as described above, is for the<br />
government to first try the least restrictive measures that<br />
might achieve the objectives of a malaria elimination program<br />
before employing other options in order of increasing<br />
restrictiveness.<br />
Legislation enforcing the acceptance of IRS will most probably<br />
not be required in the short-term. But in the end stages of<br />
elimination and during the maintenance period, the risk of<br />
resurgence and its consequences in the absence of other control<br />
measures might justify legally enforced acceptance or fines in case<br />
of refusal.<br />
People should be encouraged to seek care when they have a fever<br />
through IEC/BCC campaigns, and it is not desirable to use law<br />
enforcement to ensure people to go for testing. Once at the health<br />
facility, people should provide oral informed consent before<br />
being tested and the results should obviously remain confidential.<br />
Enforcing treatment or penalizing its refusal is both necessary (to<br />
avoid secondary cases and even deaths) and proportional. We<br />
recommend that legislative options for enforcing treatment or<br />
penalizing its refusal are explored. We do not recommend any<br />
form of isolation, admission or quarantine as this is against the<br />
principles laid out in the IHR and technically not justifiable.<br />
However, infected people should be encouraged to use an LL<strong>IN</strong><br />
not only to protect themselves, but also to protect their family<br />
and community.<br />
In terms of screening for active case detection, the program<br />
should consider methods that would be more easily accepted<br />
and that would have a similar impact if only a portion of the<br />
individuals are screened such as people with fever or a recent<br />
history of fever in stead of the general population. If a border<br />
screening approach is deemed technically necessary to prevent<br />
resurgence in the future, it is recommended that, as with other<br />
interventions, travelers initially be offered a clear explanation<br />
and provide informed consent to participate. Only if this clearly<br />
undermines the effectiveness of the intervention should the<br />
testing be made compulsory.<br />
It will always be better to secure the voluntary compliance or<br />
“buy-in” of the population (e.g., through a widespread education<br />
campaign) than to force behavior change and compliance<br />
through restrictive measures.<br />
2 | Operational Feasibility<br />
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