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

0 100

Kilometers

200

MkoaniMkoaniMkoaniMkoaniMkoaniMkoaniMkoaniMkoaniMkoani

ChakechakeChakechakeChakechakeChakechakeChakechakeChakechakeChakechakeChakechakeChakechake

WeteWeteWeteWeteWeteWeteWeteWeteWete

Zanzibar North AZanzibar North AZanzibar North AZanzibar North AZanzibar North AZanzibar North AZanzibar North AZanzibar North AZanzibar North A

TangaTangaTangaTangaTangaTangaTangaTangaTanga

MicheweniMicheweniMicheweniMicheweniMicheweniMicheweniMicheweniMicheweniMicheweniMuhezaMuhezaMuhezaMuhezaMuhezaMuhezaMuhezaMuhezaMuheza

Zanzibar North BZanzibar North BZanzibar North BZanzibar North BZanzibar North BZanzibar North BZanzibar North BZanzibar North BZanzibar North B

IlalaIlalaIlalaIlalaIlalaIlalaIlalaIlalaIlalaZanzibar SouthZanzibar SouthZanzibar SouthZanzibar SouthZanzibar SouthZanzibar SouthZanzibar SouthZanzibar SouthZanzibar South

Zanzibar MunicipalZanzibar MunicipalZanzibar MunicipalZanzibar MunicipalZanzibar MunicipalZanzibar MunicipalZanzibar MunicipalZanzibar MunicipalZanzibar MunicipalZanzibar CentralZanzibar CentralZanzibar CentralZanzibar CentralZanzibar CentralZanzibar CentralZanzibar CentralZanzibar CentralZanzibar Central

KinondoniKinondoniKinondoniKinondoniKinondoniKinondoniKinondoniKinondoniKinondoni

TemekeTemekeTemekeTemekeTemekeTemekeTemekeTemekeTemekeKisaraweKisaraweKisaraweKisaraweKisaraweKisaraweKisaraweKisaraweKisaraweMkurangaMkurangaMkurangaMkurangaMkurangaMkurangaMkurangaMkurangaMkuranga

Zanzibar WestZanzibar WestZanzibar WestZanzibar WestZanzibar WestZanzibar WestZanzibar WestZanzibar WestZanzibar West

RungweRungweRungweRungweRungweRungweRungweRungweRungwe

IlejeIlejeIlejeIlejeIlejeIlejeIlejeIlejeIleje

MboziMboziMboziMboziMboziMboziMboziMboziMbozi

MaketeMaketeMaketeMaketeMaketeMaketeMaketeMaketeMakete

KyelaKyelaKyelaKyelaKyelaKyelaKyelaKyelaKyela

NgaraNgaraNgaraNgaraNgaraNgaraNgaraNgaraNgara

UlangaUlangaUlangaUlangaUlangaUlangaUlangaUlangaUlanga

KilomberoKilomberoKilomberoKilomberoKilomberoKilomberoKilomberoKilomberoKilombero

SongeaSongeaSongeaSongeaSongeaSongeaSongeaSongeaSongea

KigomaKigomaKigomaKigomaKigomaKigomaKigomaKigomaKigoma

MoshiMoshiMoshiMoshiMoshiMoshiMoshiMoshiMoshi

ArushaArushaArushaArushaArushaArushaArushaArushaArusha

ArumeruArumeruArumeruArumeruArumeruArumeruArumeruArumeruArumeru

MwangaMwangaMwangaMwangaMwangaMwangaMwangaMwangaMwanga

HaiHaiHaiHaiHaiHaiHaiHaiHaiRomboRomboRomboRomboRomboRomboRomboRomboRombo

MonduliMonduliMonduliMonduliMonduliMonduliMonduliMonduliMonduli

SimanjiroSimanjiroSimanjiroSimanjiroSimanjiroSimanjiroSimanjiroSimanjiroSimanjiro

KorogweKorogweKorogweKorogweKorogweKorogweKorogweKorogweKorogwe

BabatiBabatiBabatiBabatiBabatiBabatiBabatiBabatiBabati

KaratuKaratuKaratuKaratuKaratuKaratuKaratuKaratuKaratu

UkereweUkereweUkereweUkereweUkereweUkereweUkereweUkereweUkerewe

MisungwiMisungwiMisungwiMisungwiMisungwiMisungwiMisungwiMisungwiMisungwiGeitaGeitaGeitaGeitaGeitaGeitaGeitaGeitaGeita

BukombeBukombeBukombeBukombeBukombeBukombeBukombeBukombeBukombe

KondoaKondoaKondoaKondoaKondoaKondoaKondoaKondoaKondoaKitetoKitetoKitetoKitetoKitetoKitetoKitetoKitetoKiteto

MbuluMbuluMbuluMbuluMbuluMbuluMbuluMbuluMbulu

IgungaIgungaIgungaIgungaIgungaIgungaIgungaIgungaIgunga

ChunyaChunyaChunyaChunyaChunyaChunyaChunyaChunyaChunya

MufindiMufindiMufindiMufindiMufindiMufindiMufindiMufindiMufindi

KilosaKilosaKilosaKilosaKilosaKilosaKilosaKilosaKilosaMorogoroMorogoroMorogoroMorogoroMorogoroMorogoroMorogoroMorogoroMorogoro

MafiaMafiaMafiaMafiaMafiaMafiaMafiaMafiaMafia

NewalaNewalaNewalaNewalaNewalaNewalaNewalaNewalaNewala

TandahimbaTandahimbaTandahimbaTandahimbaTandahimbaTandahimbaTandahimbaTandahimbaTandahimba

MtwaraMtwaraMtwaraMtwaraMtwaraMtwaraMtwaraMtwaraMtwara

LindiLindiLindiLindiLindiLindiLindiLindiLindi

MusomaMusomaMusomaMusomaMusomaMusomaMusomaMusomaMusoma

TarimeTarimeTarimeTarimeTarimeTarimeTarimeTarimeTarime

BagamoyoBagamoyoBagamoyoBagamoyoBagamoyoBagamoyoBagamoyoBagamoyoBagamoyo

BariadiBariadiBariadiBariadiBariadiBariadiBariadiBariadiBariadiBiharamuloBiharamuloBiharamuloBiharamuloBiharamuloBiharamuloBiharamuloBiharamuloBiharamulo

BukobaBukobaBukobaBukobaBukobaBukobaBukobaBukobaBukoba

BundaBundaBundaBundaBundaBundaBundaBundaBunda

DodomaDodomaDodomaDodomaDodomaDodomaDodomaDodomaDodoma

HanangHanangHanangHanangHanangHanangHanangHanangHanang

HandeniHandeniHandeniHandeniHandeniHandeniHandeniHandeniHandeni

IrambaIrambaIrambaIrambaIrambaIrambaIrambaIrambaIramba

IringaIringaIringaIringaIringaIringaIringaIringaIringa

KaragweKaragweKaragweKaragweKaragweKaragweKaragweKaragweKaragwe

KasuluKasuluKasuluKasuluKasuluKasuluKasuluKasuluKasulu

KibahaKibahaKibahaKibahaKibahaKibahaKibahaKibahaKibaha

KibondoKibondoKibondoKibondoKibondoKibondoKibondoKibondoKibondo

KilwaKilwaKilwaKilwaKilwaKilwaKilwaKilwaKilwa

KongwaKongwaKongwaKongwaKongwaKongwaKongwaKongwaKongwa

KwimbaKwimbaKwimbaKwimbaKwimbaKwimbaKwimbaKwimbaKwimba

LiwaleLiwaleLiwaleLiwaleLiwaleLiwaleLiwaleLiwaleLiwale

LudewaLudewaLudewaLudewaLudewaLudewaLudewaLudewaLudewa

LushotoLushotoLushotoLushotoLushotoLushotoLushotoLushotoLushoto

MaguMaguMaguMaguMaguMaguMaguMaguMagu

ManyoniManyoniManyoniManyoniManyoniManyoniManyoniManyoniManyoni

MasasiMasasiMasasiMasasiMasasiMasasiMasasiMasasiMasasi

MaswaMaswaMaswaMaswaMaswaMaswaMaswaMaswaMaswa

MbaraliMbaraliMbaraliMbaraliMbaraliMbaraliMbaraliMbaraliMbarali

MbeyaMbeyaMbeyaMbeyaMbeyaMbeyaMbeyaMbeyaMbeya

MbingaMbingaMbingaMbingaMbingaMbingaMbingaMbingaMbinga

MeatuMeatuMeatuMeatuMeatuMeatuMeatuMeatuMeatu

MpandaMpandaMpandaMpandaMpandaMpandaMpandaMpandaMpandaMpwapwaMpwapwaMpwapwaMpwapwaMpwapwaMpwapwaMpwapwaMpwapwaMpwapwa

MulebaMulebaMulebaMulebaMulebaMulebaMulebaMulebaMuleba

MwanzaMwanzaMwanzaMwanzaMwanzaMwanzaMwanzaMwanzaMwanza

NachingweaNachingweaNachingweaNachingweaNachingweaNachingweaNachingweaNachingweaNachingwea

NgorongoroNgorongoroNgorongoroNgorongoroNgorongoroNgorongoroNgorongoroNgorongoroNgorongoro

NjombeNjombeNjombeNjombeNjombeNjombeNjombeNjombeNjombe

NkansiNkansiNkansiNkansiNkansiNkansiNkansiNkansiNkansi

NzegaNzegaNzegaNzegaNzegaNzegaNzegaNzegaNzega

PanganiPanganiPanganiPanganiPanganiPanganiPanganiPanganiPangani

RuangwaRuangwaRuangwaRuangwaRuangwaRuangwaRuangwaRuangwaRuangwa

RufijiRufijiRufijiRufijiRufijiRufijiRufijiRufijiRufiji

SameSameSameSameSameSameSameSameSame

SengeremaSengeremaSengeremaSengeremaSengeremaSengeremaSengeremaSengeremaSengeremaSerengetiSerengetiSerengetiSerengetiSerengetiSerengetiSerengetiSerengetiSerengeti

ShinyangaShinyangaShinyangaShinyangaShinyangaShinyangaShinyangaShinyangaShinyanga

SikongeSikongeSikongeSikongeSikongeSikongeSikongeSikongeSikonge

SingidaSingidaSingidaSingidaSingidaSingidaSingidaSingidaSingida

SumbawangaSumbawangaSumbawangaSumbawangaSumbawangaSumbawangaSumbawangaSumbawangaSumbawanga

TaboraTaboraTaboraTaboraTaboraTaboraTaboraTaboraTabora

TunduruTunduruTunduruTunduruTunduruTunduruTunduruTunduruTunduru

UramboUramboUramboUramboUramboUramboUramboUramboUrambo

KahamaKahamaKahamaKahamaKahamaKahamaKahamaKahamaKahama

Malaria Transmission Model Climatic Suitability

0< 0.100.10 - 0.250.25 - 0.500.50 - 0.750.75 - 0.90> 0.90

MOH NMCP TEHIP MARA CollaborationSeptember, 2000

Mapping Malaria Risk in Africa Tanzania: Malaria Transmission RiskTanzania: Malaria Transmission RiskTanzania: Malaria Transmission RiskTanzania: Malaria Transmission RiskTanzania: Malaria Transmission RiskTanzania: Malaria Transmission RiskTanzania: Malaria Transmission RiskTanzania: Malaria Transmission RiskTanzania: Malaria Transmission Risk 

Population: 34.5 million; At risk Population close to 100% 16 million cases; 100,000 deaths, Economic loss: 3.4% of GDP 350 million US$∽

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%

OPD appropriate case management

5164

target 05

target 07

-

20

40

60

80

100

2001 2003 2005 2007

Malaria case management (Uncomplicated malaria)

Inpatients appropriate manangement

54 58target 05

target 07

-

20

40

60

80

100

2001 2003 2005 2007

Malaria case management (Severe malaria)

% of under fives w ith malaria attack/fever getting appropriate treatment w ithin 24 hours of onset

3738

52 35

11 270%

20%40%60%80%

100%

2001 2003 2005

correct action wrong action no action

Malaria case management at home

20 40 60 80 100

any antimalarials

1st line AM

2nd line AM

Q inj

Q tab2003

2001

Proportion of health facilities reporting no disruption of stocks of required anti-malarial drugs for more than seven days during the previous three months

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 ITNin underfive

underfive sleeping under a net

15 26

3127

54 48

0%

20%

40%

60%

80%

100%

2001 2003 2005 2007

no net

net

ITN

Target 60%

Malaria in Pregnancy

At least 60% of pregnant women will be effectively protected against malaria

Use of net in pregnancy

217.6

28.121

target 05, 50

target 07, 60

0

20

40

60

80

2001 2003 2005 2007NetITN

Malaria in Pregnancy cont. ITN coverage

IPT use in pregnancy

29.349.4

15.660

80

0

20

40

60

80

100

2001 2003 2005 2007

IPT correct IPT not correct

Malaria in Pregnancy IPT use

Prevention and control of Epidemics

All epidemic prone districts will have increased their capacity to detect malaria epidemics early and contain them

District with malaria epidemic early detection (ED) and response (res) system in place

ED

ED

Res

target 05

target 07

0

5

10

15

20

25

30

2001 2002 2003 2004 2005 2006 2007

# o

f d

istr

icts

Malaria Epidemics Prevention and Control cont.

THANK YOU

AHSANTENI