Roadmap to Achieve 2010,31st December RBM

Targets

September 2009 – December 2010

Country Summary

Intervention Units used Need to 2010

Already covered

Funded and expected to be distributed before end 2010

Gap

LLINs (Universal Access – avg 1 net for 2 pp)

Nets 7,367,600 2,343,100 (2008 -

2009)

3,657,000 1,367,500 gap for universal coverage of LLINs if all funds are received, otherwise minus R7, gap is 5,02,500;

ACTs Treatments 4,406,335 5,546,000 No gap,

To negotiate extra funds to procure RDTs

RDTs Number of tests

5,300,000 4,937,453 362,547

IPTp Women to be treated

3,708,979 2,000,000 1,708,979

IRS Financial / USD

10,850,000 10,022,000 828,000*

Population at risk (Projected): 12,900,000 (2009), 13,200,000 (2010), Ref: CSO Projection Reports, 2003

(*) PMI funding may be less as it includes other overheads and not the actual available hence IRS gap may have been under estimated

Country Summary

Intervention Units used Need to 2010 Already covered

Funded and expected to be distributed before end 2010

Gap

M&E Financial / USD

2,554,000

2,054,000 500,000

BCC/IEC Financial / USD 450,000 250,000 200,000

Human Resources (including Capacity Building)

Financial / USD ?? ?? ??

Other

LLIN resources available to achieve the 2010 targets

FUNDS AVAILABLE (In US $)

SOURCE COMMENT

1,383,8051,334,413

GFATM R4

Yr 4Yr 5

567, 446 LLINs procured and ready to be distributed to households (MOH) – R1 & R4 Y3

215,000 MOH negotiating Emergency procurement (UNICEF)208,000 for 2010 MOH procurement (UNICEF)

140,000 LLINs expected by October 2009 (CHAZ)

2,933,1315,120,0006,820,000

GFATM R7Yr 1Yr 2Yr 3

MOH R7 funds not yet disbursed – 2010 procurement454,815 LLINs - MOH800,000 LLINs - MOH1,000,000 LLINs – MOH

190,000 LLINs expected by October 2009 (CHAZ)Distribution costs are included

10,400,000

800,000

PMI

PMI

900,000 LLINs for the MIP 2010

These are funds for distribution costs for MIP to be given to implementation partner (SFH)

*No GFATM R7 disbursed and may not receive these funds

LLIN resources available to achieve the 2010 targets (2)

FUNDS AVAILABLE (US $)

SOURCE COMMENT

1,520,000 WORLD BANK

300,000 LLINs procured and delivered in country - Sep 2009Direct delivery to districts for mass distribution (door to door)

139,000 MACEPA 26,800 LLINs - expected by October, 2009 and immediate mass distribution (door to door)

1,516,750 RAPIDS 303,350 LLINs - procured (133,350 in the country and balance expected before end of 2009 (door to door campaign)

LLINs Ordering & Distribution to end of 2010Quantities GFATM (MOH and CHAZ) – 3,657,000 LLINs

World Bank - 300,000 LLINs

MACEPA - 26,800 LLINs

PMI - 900,000 LLINs

RAPIDS – 303,350 LLINs

Procurement dates GF procurements (UNICEF - Sept 2009; UNICEF/VPP? - Jan 2010)

Expected delivery 9 months from date tender is floated

September 2009, November 2009; The rest, June 2010, August 2010

Planned Campaign Date September to November 2009; July to October 2010

MIP (ANC) September 2009 to December 2010

BCC /IEC September 2009 to December 2010 – On going

Community radio stations, drama, Mobile Video units, National media, religious leaders announcements, door-to-door, training Malaria Focal Persons

Community mobilization September 2009 to December 2010,

Community malaria booster (COMBOR), Radio Listening Groups, Community health workers including use of CHW

Distribution Sept 2009 – Dec 2010

Nation wide priority given to non IRS areas and districts with high incidence rates

Distribution mechanisms Door-to-door mass campaigns, MIP routine distribution through ANC at health facilities

Monitoring and evaluation Sept 2009 – Dec 2010 – Routine Support Supervision, Routine HMIS data

October 2009 – Health facility survey

April-May 2010 – Malaria indicator survey

IRS resources available to achieve the 2010 targets

FUNDS AVAILABLE (US $)

SOURCE COMMENT

2,250,000 World Bank/Russian Trust Fund

US$ 1,000,000 for 2009 IRS actual implementation US$ 1,250,000 for 2010

120,000 GRZ US $ 100,000 for 2009US $ 20,000 for 2010

6,751,000 PMI US$ 501,000 for 2009US$ 6,250,000 for 2010

901,000 GFATM R4 400,000 for chemicals in 2009501,000 for cascade training in 2009GFR9 proposal submitted – IRS main intervention

Indoor Residual Spraying 2010Total Households targeted 1,280,000 (structures) for 2009

1,800,000 (structures) for 2010

DDT required DDT 75% WP (40,000 sachets) for 2009 and DDT 75% WP (40,000 sachets) for 2010

Pyrethroids required K-othrine 25% WG and Lambdacyhalothrin 10% CS (735,200 sachets) for 2009 K-othrine 25% WG (700,000 sachets) for 2010Lambdacyhalothrin 10% CS (550,000 sachets) for 2010

Procurement schedules DDT and part of pyrethroids delivered in-countryExpected procurement of 350,000 sachets of pyrethroids at a cost of $ 1,500,000 in the fourth quarter (for 2009)2010 Procurements - chemicals, pumps and PPEs at a cost of $ 4,500,000; Tendering by first Quarter 2010 (Feb); No objection from donors by first quarter 2010 (March); Delivery/receipt of goods in country by Second Quarter (June) for 2010

Distribution First consignment of commodities delivered in August; Delivery of Insecticides in 4th quarter at $ 10,000 for 2009 and delivery of Equipment,

Insecticides and Personal Protective Equipment in 3rd quarter at $50,000 (in 2010)

Training Completion of Cascade training of 1,890 spray operators in September at a cost of $ 620,000 (2009)

2010 Training of Trainers (180 personnel) in July at a cost of $ 250,000

2010 Cascade training of 2,400 spray operators in August at a cost of $400,000

BCC/IEC Community mobilization Sep – Dec 2009

Provision of IEC/BCC all quarters at a cost of $ 250,000 in 2010

Indoor Residual Spraying to 2010

Spraying Implementing IRS in 36 districts in 4th quarter at

US$ 1,650,000 by 2009

Implementing IRS in 54 districts in 4th quarter

US$ 3,000,000 by 2010

Monitoring and evaluation (bioassays, insecticide resistance etc)

Conducting pre IRS entomological and Parasitological surveys in October at a cost of $50,000;

Supervision and Monitoring in 3rd and 4th quarters at $50,000 by 2009

Conducting pre and post IRS entomological & Parasitological to be done in all quarters at a cost of $250,000 by 2010 and

Supervision and Monitoring in third and fourth quarters at a cost of $50,000 in 2010 •Conduct insecticide susceptibility studies – Sep 2009, Aug 2010

Enumeration of households/structures in 18 districts

•To be done in all quarters at a cost of $300,000 in 2010

ACT resources available to achieve the 2010 targetsFUNDS

AVAILABLE (US $)SOURCE COMMENT

1,868,086

1,227,4461,265,5181,258,480

GFATM R1 Y3

GFATM R4 Y3GFATM R4 Y4GFATM R4 Y5

R1 balance from earlier ACT procurement (2,490,000 treatment courses)950,000 ACT treatment courses1,052,650 ACT treatment courses1,052,650 ACT treatment courses(total of 3,056,210 up to 2010 for R4)

4,406,335 treatment need (1,556,335 -2009 & 2,850,000 - 2010 ). To negotiate extra GF conversion to procure RDTsUNITAID supplies from 2011

164,400166,000

1,286,9161,430,537

690,0003,679,000

GFATM R4 Y3GFATM R4 Y5

GFATM R7Y1GFATM R7 Y2

World BankPMI

RDTs164,400 RDT kits166,000 RDT kits

1,286,916 RDT kits1,430,537 RDT kits(R7 not disbursed but due)690,000 RDT kits1,200,000 RDT kits (650,000 received; expecting 650,000) – Converted ACTs to procure RDTs

Case management (1)ACTs required

National Target : 100% public sector; Based on public sector consumption trends in past 6 months, plus 2008 HMIS data on malaria cases

1,556,335 ACTs treatment courses are required up to Dec 2009; 2,850,000 ACTs needed for 2010

No gap for ACTs in the public sector - May need to convert ACT funds

to RDTs procurement

Reprogrammed PMI ACTs to RDTs

RDTs required

3,737,853 RDTs available from Sep 2009 to December 2010 5,451,316 RDTs required from Sep 2009 to December 2010

1,713,463 RDT gap

Procurement schedules

GF procurements through UNICEF

All ACTs for 2009 expected in country by October 2009

1,3 million RDTs ordered; Expected delivery November, 2009;

4 million RDTs to be ordered in 2010.

BCC/IEC Continuously Sept 2009 and 2010 December, by CHWs Sensitization and Mass media (TV/Community Radio) sensitizations on health seeking behaviours, early recognition of symptoms ; Orientation on Dispersible Coartem

Case management (2)

Distribution Mechanisms

Distribution through the Central Medical Stores to all public health facilities (HFs) through PULL system to district level and the district re-distributes to local facilities based on consumption data and district need. This includes community health worker supplies for Home management of malaria

Drug Efficacy Monitoring

Annually 2009 and 2010 – Six (6) sites for drug efficacy trials on

ACTs

Monitoring and Evaluation

2009 Health facility Survey (October 2009)

Private sector ACTs Studies (Sept-Dec 2009)

2010 Malaria Indicator Survey

Essential Drug pilot Evaluation (2009, 2010)

Data reviews

Performance assessment

Intermittent Preventive TherapyNumber of Pregnant women targeted

2009; 690,454 Pregnant women

2010; 710,447 pregnant women

SP doses required 2009: IPT3; 724,977 Sep – Dec 2009 (2,899,906 for 2009); 2010; IPT3; 2,984,003

Procurement schedules Procure by GRZ and PMI in Sep - Oct 2009

Delivery - GRZ Sep 2009; PMI Dec 2009

Distribution modalities Medical Store Ltd (MSL) will store and distribute monthly to various districts integrated with other essential drug supply

Implementation through ANC at health facilities through DOT (3 courses after first trimester, a month apart)

Training Training reproductive health unit of MOH supported by the malaria control programme

BCC / IEC 2009; Sept-Dec and continue 2010; Update advocacy plan & community mobilization, mass media

Monitoring and evaluation HF Survey Oct 2009; 2010 MIS in May-July

Performance review, HMIS data review

Other core interventions to be delivered by the end of 2010

Intervention DatesHome management of malaria (HMM) – training community health workers to strengthen skills in testing (confirm diagnosis) and treatment, health information

HMM- Sept-Oct;

Jul ,Nov 2010

IEC/ Advocacy - mobilize partnership, resources, increase advocacy to create/increase malaria awareness and utilization of malaria interventions.

Sept- Dec 2009 and Jan-Dec 2010

Quality control (QC), Quality assurance (QA) and reporting Sept2009-Dec 2010

Epidemic Preparedness and Response – Thresholds, capacity building, strengthen emergency drugs and commodity stocks, conduct assessments for preparedness, build capacities (training, community, mobilization).

Sept- Dec 2009

Jan-Feb 2010

May-Aug 2010

M&E, Operations research, surveillance - strengthen operations research and surveillance system

Sept-Dec 2009; Jan-Dec 2010

Other core interventions to be delivered by the end of 2010

Intervention Dates

Comprehensive Programme review, needs assessment and 2011-2015 Strategic plan

March – September 2010

Human Resources: Strengthen NMCP; Provincial focal persons and District focal persons

Oct 2009

Feb – March 2010

June to July 2010

Cross Border Initiatives – Support SARN and SADC in resource mobilization and implementation

Sept-Oct 2009;Jan-Apr 2010

Summary of rate-limiting factors ( Over the next 17 months)

Problems SolutionsFunding gap for commodities

- prompt diagnosis (RDTs),

- key interventions (LLINs and IRS) - - Support programmes (Operations Research, advocacy activities, M&E).

Resource mobilization and effective utilization of available resources

Low utilization of preventive interventions especially LLINs

Innovative messaging (IEC), mass media including Community radio stations, drama, Mobile Video units, National media, religious leaders involvement, household door-to-door activities and training Malaria Focal Persons, community empowerment to participate

Procurement bottleneck - Long processes coupled with delays in funds disbursement

Capacity building on PSM, holding of Technical meetings on commodity forecasting and quantification in the NMCP for malaria partners and financial management support

Human Resource; Staff shortage, high staff attrition at service delivery and retention of staff

Regular capacity building for staff on key interventions (case management, LLINs, IRS, M&E) and Programme management)

Integration of activities

Summary of technical assistance needs over the next 17 months

Needs & Dates PartnerProgramme Performance Review and Development of Malaria Control Strategic Plan; 2011-2015

WHO, MACEPA, UNICEF,

PMI, WB

Capacity building on PSMUSAID Deliver, WHO, PMI, GF

Revision of policy guidelines/documentsWHO, UNICEF, PMI, MACEPA

Management Systems - National Malaria Surveillance, Data base, drug efficacy trial

WHO, MACEPA, UNICEF, WB

PMI

Cross Border Initiatives to support SADC in resource mobilization

WHO/RBM/ MACEPA

Financial Management Support GF, PMI, WB, MACEPA

Partnership Coordination All Partners, RBM