NATIONAL DEPARTMENT OF HEALTH. National Malaria Control Program Strategic Plan

Transcription

1 NATIONAL DEPARTMENT OF HEALTH National Malaria Control Program Strategic Plan

2 TABLE OF CONTENTS

3 FORWARD

4 ACKNOWLEDGEMENTS

5 ABBREVIATIONS AND ACRONYMS

6 INTRODUCTION Malaria remains one of the largest burdens of disease in PNG. It affects men, women, pregnant women and children every day, causing lost days at work and school, premature deaths, and loss of economic productivity for the country. The programme to control malaria in PNG has been well documented and evaluated. This document represents the next 5 year strategic plan to address malaria, using evidence based policies and practice from PNG and internationally. Background In 1957 Papua New Guinea (PNG) joined the Global Malaria Eradication Programme (MEP). The major strategy at the time consisted of indoor residual spraying of houses throughout most parts of the country except for the highlands region where there was no malaria and mass drug administration (MDA) using Chloroquine. It was the single biggest vertical programme within the National Department of Health (NDOH) and was managed through four regional malaria control units. By the late 1970s it became clear that eradication would not be achieved. The Global MEP was abandoned, the national spraying programme wound down and MDA halted. Following a review of PNG s Malaria Programme in1975 spraying was limited to specific areas and responsibilities for implementing programme activities were integrated into the responsibilities of the provincial health services. Untreated bed nets were introduced for malaria control for the first time. In 1983 NDoH supported IRS stopped altogether. A malaria control policy with the goals to reduce morbidity and mortality was developed and approved. In this plan period, PNG led the world with the launch of the first trial of insecticide treated bed nets (ITN) for malaria control (1986). This trial demonstrated the effects of ITNs both on mosquito populations and on the prevalence and incidence of P. falciparum malaria in children. This success was scaled up in 1989 to a national ITN programme (incorporating a revolving fund). In most areas of the country ITNs now form the mainstay of malaria control, with 1.3 million ITNs distributed in the past 5 years through a combination of subsidized sales and community based mass distribution. In 1998 Rotary Against Malaria (RAM) was established in PNG and started importing bednets and insecticide and delivering them to provinces and districts at cost price. In addition to this prevention aspect of the programme the diagnosis and treatment of malaria has seen much advancement. In 1992 the collection of blood films was "rationalized" and their examination and associated quality assurance (QA) was halted (except for treatment failure and severe malaria, and for epidemiological purposes in selected indicator health facilities). Malaria case classification in the National Health Information System (HIS) was changed to distinguish between three categories: uncomplicated malaria, severe malaria, and treatment failure malaria. In 2000 the national treatment guidelines for malaria were changed from first line chloroquine (CQ) or amodiaquine (AQ) for small children to the combination of CQ and sulphadoxine pyrimethamine (SP). Artemether and SP combination therapy was adopted as the second line treatment and the use of quinine was shelved except for use during pregnancy.

7 The management and implementation of the malaria control programme has been affected by changes in government structures and levels of responsibility. In 1994 the "New Organic Law" extended the decentralization, resulting in the closure of regional DCOs. Malaria control (including the distribution of ITNs) became an entirely provincial function. At central level there was just one Specialist Medical Officer (SMO) responsible for overseeing the National Malaria Control Programme (NMCP). The 1997 Health Administration Act defined the roles and responsibilities of the different players. Recently the Provincial Health Authorities Act (2007) was passed with the aim of incorporating provincial health and hospital services under one management and directorship function, ensuring closer links between prevention, diagnosis treatment and care for all health activities including malaria. The roll out of these changes should be completed in every province by Planning for malaria control progressed with the approval and publication in 2001 of the National Health Plan (NHP) This plan explicitly set targets, objectives and strategies for malaria control in PNG, as well as identifying the roles and responsibilities of the various levels of government. During the same year the PNG Institute of Medical Research (PNG IMR) completed the mapping of malaria risk in the Highlands. This evidence based has helped target interventions more cost effectively. Development partners provided supported to the GoPNG reosurces to implement aspects of this programme. Based upon this plan, the National malaria Control programme was successful in winning a Global Fund for AIDS, Tuberculosis and Malaria (GFATM) Grant I worth US$20.1 million. This support commencing in 2004, provided the additional financial and human reosurces to scale up further the malaria control efforts and long lasting insecticide treated bednets (LLINs) were introduced for the first time (supported by GF). The National Department of Health is now responsible for setting policy standards and monitoring while the provinces and districts take on the role of implementing the national policies. As a result of the events that took place over the years, malaria control program has not received the prominence it rightfully deserves as a priority public health program. There had been no guidance provided to the provinces and districts to effectively implement the national policies for malaria control. This document aims to provide this guidance to implementing and funding agencies over the next 4 years. Development of the Strategic Plan It was recognised that the malaria control program needed more visibility and direction to effectively control the huge burden of malaria morbidity and mortality in PNG especially among the children less than 5 years of age, pregnant women, the non immune populations and the immune compromised persons. With the support of AusAID and WHO a review of the malaria control program was carried. The purpose of this review was to assess the performance and outcome of the National Malaria Control Programme (NMCP), to identify, investigate and describe current NMCP needs and provide recommendations for improvements. The timing of this review was scheduled to coincide with the start of the development of the GFATM Round 8 application so that recommendations could be incorporated into the application where appropriate.

8 The development of the strategic plan brought together a very wide range of stakeholders including the public and private sector. For the first time provinces and other stakeholders were able to participate and be owners of the national strategic plan. Over a period of 5 days, with the support of AusAID with a consultant and moderator, a program planning matrix (PPM) was constructed from which this plan is the end result. The program review provided very helpful insights into the needs of the program. This plan is intended to serve multipurpose in that it does not only sets the direction for implementation of government policy but also provides the direction and analyses the funding gaps. Goals of the Strategic Plan The goal of the National Malaria Control Program Strategic Plan is to reduce the malaria related morbidity and mortality in PNG. Service Delivery Areas (SDA) The plan addresses 6 key service delivery areas that will address the strengthening of the program to achieve better results. These key SDAs are; Leadership and Governance Leadership at the political level has been lacking for many years and this has seen lower priority placed on resourcing issues at all levels. This plan will take advocacy to all levels of government for awareness. The plan will advocate for recognition of the burden of malaria in the country so that adequate resources are allocated. System Strengthening and Capacity Development For the control program to be effective the plan will address the issue of capacity and to strengthen the administrative and technical aspects of the program. The review team also highlighted this in their report. There is a need to strengthen the human resources, the improvement of infrastructure and logistics at all levels of the program, strengthening of the financial management capacity, and establishment of partnerships with all stakeholders, strengthen the monitoring and evaluation capacities, anti malaria quality monitoring, research capacity and to develop evidence based policies. Accurate Diagnosis and Prompt, Effective Treatment for Malaria Ineffective treatment is recognized as a major problem and accurate diagnosis has contributed significantly to this. Good diagnosis has been lacking. This plan aims to improve confirmed diagnosis of malaria to be strengthened at all levels of the system. The plan also will look at improving diagnosis and treatment through other health programs such as the maternal and child health. Making available treatment and rapid tests at all levels of the health system will be improved. The outcome of this will be an improved system for reporting malaria cases. Vector Control As a core component of malaria control, the plan aims to revisit indoor residual spraying (IRS) in high epidemic risk areas. There is a need to build capacity in this area for effective intervention. With operational research other vector control methods will be investigated for operational feasibility.

9 Distribution of mosquito nets is still a major strategy but the delivery has to be improved including the utilization of the nets. Epidemic Preparedness and Response Epidemics are a common occurrence in the unstable transmission areas of the country and improving capacity to detect and control these outbreaks will save many lives and many more from suffering. The plan will look at improving detection and increased preparedness to control these epidemics. Behaviour Change Communication (community Outreach and Mass Media) Effective communication is essential for the awareness of the disease and participation by communities. The plan looks at building capacity to deliver the important messages and good coordination with other stake holders to get the message out. Communication, specifically designed for various needs of PNG populations, will be provided to all sectors of the population. Implementation of the Strategic Plan The Strategic Plan will be implemented over a period of 5 years from Each level of the health care system will have specific activities that will need to be implemented. The national, provincial and district activities have been specified. This plan will be implemented together with the national health plan but the strategic plan is more specific and will be used as a basis of developing the Annual Activity Plans (AAP).

10 THE STRATEGIC PLAN The National Malaria Control Program Strategic Plan goal is to reduce malaria morbidity and mortality in PNG. There are six key service delivery areas (SDA), and six objectives. Each SDA and objective has a set of strategic objectives and associated strategies that guide implementation. SDA 1: Leadership and Governance Advocacy Objective 1: To Strengthen Political Commitment for Malaria Control in Papua New Guinea 1.1 Intensify advocacy for malaria control in PNG Develop advocacy plans (Annual and 5 year) Strengthen key advocates for malaria control Adopt a sustained and proactive approach to increase awareness and advocacy at political and bureaucratic levels Strengthen relationships with Media council Provide regular briefings for provincial and local governments Provide regular briefings at Ministerial level Lobby the Central Agency Coordinating committee on the significance of NMCP Recruit and support celebrity ambassador for malaria control Participate actively in World Malaria Day and activities at all levels Identify funding sources and secure short, medium and long term financial support Participate actively in World Malaria day and related activities Annual review of expenditure framework for NMCP and identify resource gaps Identify funding sources Develop when required funding applications

11 SDA 2: Systems Strengthening and Capacity Development Objective 2: Strengthen technical and administrative management of the National Malaria Control Programme (NMCP) at all levels 2.1 Strengthen financial management at all levels Strengthen the financial systems and management of the health sector response to malaria To ensure appropriate financial reports are implemented each quarter Review financial management at all levels each quarter. 2.2 Strengthen human resources through recruitment and training Review and standardise overall programme structure and identify human resource requirements at all levels Recruit essential staff at all levels (paying due attention to gender issues) Identify pre and in service training needs Implement training programme Establish career development and retention scheme for health staff at all levels Ensure compliance with OHS requirements including HIV workplace policy for staff at all levels 2.3 Improve infrastructure and strengthen logistics for Malaria control programme at all levels Improve procurement practices to ensure quality of products procured Strengthening the supply management system for all health and related products Improve health staff housing Improve and expand office space for malaria control at central, regional and provincial levels Improve storage facilities for malaria related supplies at central and provincial levels Procure vehicles Procure office and communication equipment and supplies Improve asset management

12 2.4 Develop and strengthen partnerships for malaria control and improve coordination of activities Integrate malaria control activities with other public health programmes through joint planning and implementation Increase effective coordination of BCC with partners Strengthen contract management of outsourcing of activities through Private Public Partnership initiatives Strengthen regulation of insecticide use in private sector in association with Department of Environment (liaise with regional network) 2.5 Strengthen and support monitoring and evaluation of National Malaria Control Programme Support the strengthening of the reporting system and upgrade to include from aid posts and private sector facilities (NHIS) Improve and implement M&E system including supervision Provide regular programme progress reports (success and obstacles) to decision makers Conduct malariological surveys, household surveys for coverage and usage of LLINs, health seeking behaviours, mass blood surveys and efficacy trials on 1 st and 2 nd line antimalarial drugs Conduct annual surveys in two health centres and four aid posts in 20 provinces annuallyundertaking facility survey, participant observations and key informant interviews to measure proportion of adequate antimalarial availability / proportion Conduct modelling and analysis of NHIS data, to detect time trends, biases for all indicators Conduct regular surveys to measure the coverage of key indicators in the M&E plan Develop annual activity plan (AAP) for Malaria control at all levels Review progress and revise national malaria control strategic plan (mid term review) in light of operational research results and M&E findings Develop National Strategic Plan for Malaria Control in Establish antimalarial drug efficacy, quality and resistance monitoring and adverse drug reaction reporting system Regularly monitor efficacy of 1 st and 2 nd line antimalarial drugs (including molecular analysis and resistance) Establish a drug QA system and regularly monitor antimalarial drug quality

13 2.7 Conduct needs based operational research Establish adverse drug reaction reporting system Conduct operational research on malaria in pregnancy including IPTp Conduct operational research on HIV and Malaria Conduct operational research on causes of non malarial fevers Conduct study on longevity of LLIN in PNG Conduct study of IRS vs. LLIN vs. both Other research relevant to NMCP strategies as identified through programme progress reviews 2.8 Continue to develop evidence based policies, strategies and guidelines for malaria control Disseminate research findings Ratify new malaria treatment guidelines Review policy for malaria in pregnancy Develop policy on HIV and malaria Develop strategy for vivax malaria relapse treatment Develop strategy to ban the use of Artemisisin monotherapy Develop IRS guidelines according to the identified alternative to DDT Develop IRS SOPs Develop SOPs for epidemic response Develop a strategy for provision of ACT through the private sector (Public, private mix) trade stores (over the counter)

14 SDA 3: Accurate Diagnosis and Prompt, Effective Treatment for Malaria Objective 3: Maximise access to prompt quality malaria diagnosis (including differential diagnosis for dengue, typhoid and lymphatic Filariasis) and appropriate treatment for malaria 3.1 Strengthen malaria parasite based diagnosis at all levels Expand malaria microscopy to health centre level Roll out RDT based diagnosis from facility to community level Improve and expand laboratory quality assurance 3.2 Improve treatment of malaria Implement the new national malaria treatment guidelines Procure and distribute antimalarials for public and private sectors Train all health staff on new treatment regime Improve the packaging of antimalarial drugs for better compliance Provide weighing scales with colour codes (matching the colour of the colour of the Coartem TM blisters) to improve treatment Provide support for referral of sever malaria patients (free treatment) Develop testing capacity for G6PD diagnosis at the hospital level and implement primaquine treatment of vivax malaria 3.3 Improve access to quality malaria diagnosis and appropriate treatment Collaborate with private sector to ensure provision of quality malaria diagnosis and treatment (including through social marketing) Introduce home based diagnosis and treatment services Undertake review of existing models of community based diagnosis and treatment for malaria, ARIs and diarrhea to Mekong and other regions

15 3.4 Implement malaria diagnosis and treatment through other health programmes Maternal and Child Health Integrate malaria diagnosis and treatment into all maternal and child health programmes Update algorithm to treat non malaria fevers for children <5 years Update malaria component in all maternal and child health programmes into all curricula material and tools Ensure availability of RDTs and ACTs in maternal and child health programmes Support distribution of LLIN through maternal and child health programs HIV Integrate malaria diagnosis and treatment into all ART centres Update algorithm to screen and treat malaria in people living with HIV Ensure availability of RDTs and ACTs in ACT centres Support distribution of LLIN through ART centres 3.5 Improve anti malarial drug and RDT supply management systems Improve supply management system (from port to Aid post) Improve RDT and antimalarial drug quantification and forecasting system Explore and provide appropriate cooling devices for the transport and storage of RDTs and ACTs SDA 4: VECTOR CONTROL Objective 4: Improve vector control measures Maximise coverage of long lasting insecticide treated bednets (LLINs) with special provision for vulnerable groups Plan annual bed net program Procure nets Distribute free LLINs nationwide To provide LLIN to vulnerable groups (see 3.4) Develop and implement social marketing of LLINs Monitor and evaluate LLIN coverage

16 4.2.1 Reintroduce preventative indoor residual spraying (IRS) for malaria control Improve capacity of MSCU to coordinate IRS Training in insecticide management Conduct regular supportive supervision Establish and maintain insecticide database Routine preventative IRS in epidemic prone/vulnerable areas Update mapping of malaria risk in highlands for targeted preventative spraying Identify suitable alternatives to DDT Quantification of needs for insecticides and spraying equipment Improve spraying capacities Procure insecticides Procure spraying equipment and personal protection equipment Maintain spraying equipment Recruit and train spray men Implement IRS Monitor IRS field activities Evaluate quality and coverage of IRS operations Explore and support the use of other vector control, personal protection and prevention measures, as appropriate Support targeted operational research with scaling up of activities and where there are successful treatment activities Implementation of social marketing activities to support scaling up and other vector control measures Implement awareness activities at all levels

17 SDA 5: Epidemic Preparedness and Response Objective 5: Improve epidemic preparedness, detection and response 5.1 Strengthen epidemic surveillance and response capacity of the malaria surveillance and control unit Recruit and train MSCU staff Refurbish and maintain infrastructure at MSCU Install health network radio at MSCU Develop sentinel sites and maintain data collection Carry out active case detection Undertake regular analysis and review of surveillance data 5.2 Improve outbreak detection in the Highlands at Provincial and District Level Undertake regular analysis and review of surveillance data including from sentinel sites Train provincial and district health staff on epidemic detection and response 5.3 Increase preparedness for epidemics Establish and maintain epidemic emergency fund at all levels Work with national and provincial authorities to develop local epidemic response plan Establish storage facilities for emergency supplies Procure insecticide, spray pumps, equipment, LLINs, RDTs and medicines for emergency Practice stock rotation of emergency supplies with supplies for routine supplies Carry out regular communication checks 5.4 Implement and monitor epidemic response Confirm epidemic Develop response plan Mobilise resources

18 5.4.4 Implement response plan Monitor response plan Undertake post epidemic response evaluation SDA 6: Behaviour Change Communication (Community Outreach and Mass Media) Objective 6: Improve knowledge, behaviour and participation of communities and individuals including health staff in the national malaria control effort Strengthen management and coordination of health promotion at all levels and cooperation with other sectors and partners Establish and support ongoing development of a national network for malaria health promotions Finalise a Performance Management Framework for all stakeholders in PNG involved in malaria health promotion Strengthen capacity to develop and implement an effective malaria health promotion (including BCC) programme Conduct research on messages, audiences and modes of communication related to various aspects of malaria treatment Implement partnerships with BCC specialist Develop target population specific communication strategies 6.3 Support expansion of malaria control activities within healthy villages and other community participation activities Strengthen implementation of BCC Implement innovative BCC campaigns in association with partners Develop and implement a plan to improve treatment seeking behaviour and treatment compliance with health providers, established village health volunteer networks and other partners engaged with communities and risk groups Target health care providers through specific BCC activities Develop and disseminate BCC for providers

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20 National OBJECTIVE 1: TO STRENGTHEN POLITICAL COMMITMENT FOR MALARIA CONTROL IN PNG Develop advocacy plans (Annual & 5 year) Strengthen key advocates for malaria control SDA 1: Leadership and Governance Advocacy 1.1 Intensify advocacy for Malaria control in PNG 1.2 Identify funding sources and secure short, medium and long term financial support Adopt a sustained and proactive approach to increase awareness and advocacy at political and bureaucratic levels Strengthen relationships with Media Council Provide regular briefings at Ministerial level Lobby the Central Agency Coordinating Committee on the significance of the NMCP Recruit and support celebrity ambassador for malaria control Participate actively in World Malaria Day and related activities Annual review of expenditure framework for NMCP and identify resource gaps Identify funding sources Develop when required funding applications OBJECTIVE 2: STRENGTHEN TECHNICAL AND ADMINISTRATIVE MANAGEMENT OF THE NMCP AT ALL LEVELS 2.1 Strengthen the financial systems and management of the health sector response to malaria SDA 2: Systems Strengthening and capacity development 2.1 Strengthen financial management at all levels 2.2 Strengthen human resources through recruitment and training 2.3 Improve infrastructure and strengthen logistics for Malaria control programme at all levels 2.4 Develop and strengthen partnerships for Malaria control and improve coordination of activities 2.2 To ensure appropriate financial reports are implemented each quarter 2.3 Review financial management at all levels each quarter Review and standardize overall programme structure and identify human resource requirements at all levels Recruit essential staff at all levels (paying due attention to gender issues) Identify pre and in service training needs Implement training programme Establish career development and retention scheme for health staff at all levels Ensure compliance with OHS requirements including HIV workplace policy for staff at all levels Improve procurement practices to ensure quality of products procured Strengthening of the supply management system for all health and related products Improve health staff housing Improve and expand office space for malaria control at central, regional and provincial levels Improve storage facilities for malaria related supplies at central and provincial levels Procure vehicles Procure office equipment, communication equipment and supplies Improve asset management Integrate malaria control activities with other public health programmes through joint planning and implementation Increase effective coordination of BCC with partners Strengthen contract management of outsourcing of activities through private public partnerships Strengthen regulation of insecticide use in private sector in association with Dept of Environment (liaise with regional network)

21 National (Cont) OBJECTIVE 2: STRENGTHEN TECHNICAL AND ADMINISTRATIVE MANAGEMENT OF THE NMCP AT ALL LEVELS 2.5 Strengthen and support monitoring and evaluation of National Malaria control programme Support the strengthening of the reporting system and upgrade to include data from aid posts and private sector facilities (HIS) Improve and implement M&E system incl. supervision Conduct annual surveys in 2 health centres and 4 aid posts in 20 provinces annually undertaking facility survey, participant observation and key informant interviews to measure proportion of adequate antimalarial availability, proportion Conduct modeling and analysis of NHIS data. To detect time trends, biases for all indicators Develop annual activity plan (AAP) for malaria control at all levels Review progress and revise National Malaria Control Strategic Plan (mid term review) in light of operational research results and M&E findings Develop National Strategic Plan for Malaria Control in SDA 2: Systems Strengthening and capacity development 2.6 Establish antimalarial drug efficacy, quality and resistance monitoring and adverse drug reaction reporting system 2.7 Conduct needs based operational research 2.8 Continue to develop evidence based policies strategies and guidelines for Malaria control Regularly monitor efficacy of 1st and 2nd line antimalarial drugs (including molecular analysis and resistance) Establish a drug QA system and regularly monitor antimalarial drug quality Establish adverse drug reaction reporting system Conduct operational research on malaria in pregnancy including IPTp Conduct operational research on HIV and malaria Conduct operational research on causes of non malarial fevers Conduct study on longevity of LLIN in PNG Conduct study of IRS vs. LLIN vs both Other research relevant to NMCP strategies as identified through programme progress review Disseminate research findings Ratify new malaria treatment guidelines Review policy for malaria in pregnancy Develop policy on HIV and malaria Develop strategy for vivax malaria relapse treatment Develop strategy to ban the use of artemisinin monotherapy Develop IRS guidelines according to the identified alternatives to DDT Develop IRS SOPs Develop SOPs for epidemic response Develop a strategy for provision of ACT through the private sector (Public Private Mix), trade stores (over the counter)

22 National (Cont) OBJECTIVE 3: MAXIMISE ACCESS TO PROMPT QUALITY MALARIA DIAGNOSIS (INCLUDING DIFFERENTIAL DIAGNOSIS FOR DENGUE, TYPHOID AND LYMPHATIC FILARIASIS) AND APPROPRIATE TREATMENT FOR MALARIA 3.1 Strengthen Malaria parasite based diagnosis at all Improve and expand laboratory quality assurance levels Implement the new national malaria treatment guidelines Procure and distribute antimalarials for public and private sectors Train all health staff on new treatment guidelines 3.2 Improve treatment of Malaria Improve packaging of antimalarial drugs for better compliance Provide weighing scales with color codes (matching the color of the CoartemTM blisters) to improve SDA 3: Accurate diagnosis and prompt, effective treatment for Malaria treatment Develop testing capacity for G6PD diagnosis at the hospital level and implement primaquine treatment of vivax malaria Collaborate with private sector to ensure provision of quality malaria diagnosis and treatment 3.3 Improve access to quality malaria diagnosis and (including through social marketing) appropriate treatment Undertake review of existing models of community based diagnosis and treatment for malaria, ARIs and diarrhea to Mekong and other regions 3.4 Implement malaria diagnosis and treatment through other health programmes 3.5 Improve anti malaria drug and RDT supply management systems Maternal and Child health Update algorithm to treat non malarials fevers for children < 5 years Update malaria component in all maternal and child health programmes into all curricula material and tools HIV Update algorithm to screen and treat malaria in people living with HIV Improve supply management system (from port to aid posts) Improve RDT and antimalarial drug quantification and forecasting system Explore and provide appropriate cooling devices for the transport and storage of RDTs and ACTs OBJECTIVE 4: IMPROVE VECTOR CONTROL MEASURES 4.1 Maximise coverage of long lasting insecticide treated Monitor and evaluate LLIN coverage bednets (LLINs) with special provision for vulnerable groups Develop sentinel sites for LLIN monitoring and evaluation SDA 4: VECTOR CONTROL 4.2 Reintroduce preventative indoor residual spraying (IRS for Malaria control 4.3 Routine preventative IRS in epidemic prone/vulnerable areas Training in insecticide management Procure insecticides Procure spraying equipment and personal protection equipment Evaluate quality and coverage of IRS operations

23 National (Cont) OBJECTIVE 5: IMPROVE EPIDEMIC PREPAREDNESS, DETECTION AND RESPONSE Recruit and train MSCU staff SDA 5: Epidemic preparedness and response 5.1 Strengthen epidemic surveillance and response capacity of the Malaria surveillance and control unit Refurbish & maintain infrastructure at MSCU Install health network radio at MSCU Develop sentinel sites and maintain data collection Undertake regular analysis and review of surveillance data 5.2 Improve outbreak detection in the highlands at provincial and district level Train provincial and district health staff on epidemic detection and response Establish and maintain epidemic emergency fund at all levels Establish storage facilities for emergency supplies 5.3 Increase preparedness for epidemics 5.4 Implement and monitor epidemic response Procure insecticide, spray pumps, equipment, LLINs, RDTs and medicines for emergency use (integrated with routine procurement) Practice stock rotation of emergency supplies with supplies for routine use Carry out regular communication checks Monitor response plan Undertake post epidemic response evaluation OBJECTIVE 6: IMPROVE KNOWLEDGE, BEHAVIOUR AND PARTICIPATION OF COMMUNITIES SDA 6: Behaviour Change Communication (Community outreach and Mass media) 6.1 Strengthen management and coordination of health promotion at all levels and cooperation 6.2 Strengthen capacity to develop and implement an effective malaria health promotion (including BCC) programme Establish and support ongoing development of a national network for malaria health promotion Finalize a Performance Management Framework for all stakeholders in PNG involved in malaria health promotion Conduct research on messages, audiences and modes of communication related to various aspects of malaria treatment Implement partnerships with BCC specialist Develop target population specific communication strategies Strengthen implementation of BCC Develop BCC annual plan at all levels

24 Provincial OBJECTIVE 1: TO STRENGTHEN POLITICAL COMMITMENT FOR MALARIA CONTROL IN PNG SDA 1: Leadership and Governance Advocacy 1.1 Intensify advocacy for Malaria control in PNG Develop advocacy plans (annual and 5 year) Provide regular briefings for provincial and local governments Participate actively in World Malaria day and related activities OBJECTIVE 2: STRENGTHEN TECHNICAL AND ADMINISTRATIVE MANAGEMENT OF THE NMCP AT ALL LEVELS 2.1 Strengthen financial management at all levels To ensure appropriate financial reports are implemented each quarter Review and standardise overall programme structure and identify human resource requirement at all levels SDA 2: Systems Strengthening and capacity development 2.2 Strengthen human resources through recruitment and training 2.3 Improve infrastructure and strengthen logistics for Malaria control programme at all levels 2.4 Develop and strengthen partnerships for Malaria control and improve coordination of activities 2.5 Strengthen and support monitoring and evaluation of National Malaria control programme Recruit essential staff at all levels (paying due attention to gender issues) Identify pre and in service training needs Implement training programme Establish career development and retention scheme for health staff at all levels Develop advocacy plans (annual and 5 year) Improve and expand office space for malaria control at central, regional and provincial levels Improve storage facilities for malaria related supplies at central and provincial levels Improve asset management Integrate malaria control activities with other public health programmes through joint planning and implementation Increase effective coordination of BCC with partners Strengthen contract management of outsourcing activities Support the strengthening of the reporting system and upgrade to include from aid posts and private sector facilities (NHIS) Improve and implement M&E system including supervision Provide regular programme progress reports (success and obstacles) to decision makers Conduct malariological survyes, household surveys for coverage and usage of LLINs, health seeking behaviours, mass blood surveys and efficacy trails on 1st and 2nd line antimalarial drugs Conduct annual surveys, in two health centres and four aid posts in 20 provinces annuallyundertaking facility survey, participant observations and key informant interviews to measure proportion of adequate antimalarial availability/proportion Conduct regular surveys to measure the coverage of key indicators in the M&E plan Develop annual activity plan (AAP) for malaria control at all levels Develop national strategic plan for malaria control in Conduct study on longevity of LLIN in PNG 2.7 Conduct needs based operational research Conduct study of IRS vs. LLIN vs. both Other research relevant to NMCP strategies as identified through programme progress reviews 2.8 Continue to develop eveidence based policies, strategies Develop IRS guidelines according to the identified alternative to DDT and guidelines for malaria control Develop IRS SOPs, including for epidemic response

25 Provincial (cont) OBJECTIVE 3: MAXIMISE ACCESS TO PROMPT QUALITY MALARIA DIAGNOSIS (INCLUDING DIFFERENTIAL DIAGNOSIS FOR DENGUE, TYPHOID AND LYMPHATIC FILARIASIS) AND APPROPRIATE TREATMENT FOR MALARIA Expand malaria microscopy to health centre level 3.1 Strengthen malaria parasite based diagnosis at all levels Roll out RDT based diagnosis from facility to community level Improve and expand laboratory quality assurance Implement the new national malaria treatment guidelines Train all health staff on new treatment regime 3.2 Improve treatment of malaria Provide support for referral of sever malaria patients (free treatment) Develop testing capacity for G6PD diagnosis at the hospital level and implement promaquine treatment of vivax malaria SDA 3: Accurate diagnosis Collaborate with private sector to ensure provision of quality malaria diagnosis and treatment 3.3 Improve access to quality malaria diagnosis and and prompt, effective (including through social marketing) appropriate treatment treatment for Malaria Introduce home based diagnosis and treatment services 3.4 Implement malaria diagnosis and treatment into other health programmes Integrate malaria diagnosis and treatment into all maternal and child health programmes Ensure availability of RDTs and ACTs in maternal and child health programmes Support the distribution of LLIN through maternal and child health programmes Integrate malaria diagnosis and treatment into all ART centres Ensure availability of RDTs and ACTs in ART centres Support the distribution of LLIN through ART centres 3.5 Improve anti malarial drug and RDT supply management systems Improve supply management system (from port to aid post) OBJECTIVE 4: IMPROVE VECTOR CONTROL MEASURES Plan annual bed net program SDA 4: VECTOR CONTROL 4.1 Maximise coverage of long lasting insecticide treated bednets (LLINs) with special provision for vulnerable groups Procure nets and distribute free LLINs nationwide Provide LLIN to vulnerable groups Develop and implement social marketing of LLINs Monitor and evaluate LLIN coverage 4.2 Reintroduce preventative indoor residual spraying (IRS) Training in insecticide management for Malaria control Conduct regular supportive supervision Update mapping of malaria risk in highlands for targeted preventative spraying 4.3 Routine preventative IRS in epidemic prone/vulnerable areas Quantification of needs for insecticides and spraying equipment Improve spraying capacities Procure and maintain insecticides, spraying equipment and personal protection equipment Recruit spray men Implement, monitor and evaluate IRS field operations

26 Provincial (cont) OBJECTIVE 5: IMPROVE EPIDEMIC PREPAREDNESS, DETECTION AND RESPONSE 5.1 Strengthen epidemic surveillance and response capacity Carry out active case detection of the malaria surveillance and control unit 5.2 Improve outbreak detection in the highlands at provincial Undertake regular analysis and review of surveillance data including from sentinel sites and district level Train provincial and district health staff on epidemic detection and response Establish and maintain epidemic emergency fund at all levels Establish storage facilities for emergency supplies SDA 5: Epidemic preparedness and response 5.3 Increase preparedness for epidemics 5.4 Implement and monitor epidemic response Procure insecticide, spray pumps, equipment, LLINs, RDTs and medicines for emergency use (integrated with routine procurement) Practice stock rotation of emergency supplies with supplies for routine use Carry out regular communication checks Confirm epidemic Develop response plan and mobilise resources Implement and monitor response Undertake post epidemic response evaluation. OBJECTIVE 6: IMPROVE KNOWLEDGE, BEHAVIOUR AND PARTICIPATION OF COMMUNITIES SDA 6: Behaviour Change Communication (Community outreach and Mass media) 6.1 Strengthen management and coordination of health promotion at all levels and cooperation with other sectors and partners 6.2. Strengthen capacity to develop and implement an effective malaria health promotion (including BCC) programme 6.3 Supportive expansion of malaria control activities within healthy villages and other community participation activities Conduct research on messages, audience and modes of communication related to various aspects of malaria treatment Implement partnerships with BCC specialist Implement innovative BCC campaigns in association with partners Develop and implement a plan to improve treatment seeking behaviour and treatment compliance with health providers, established village health volunteer networks and other partners engaged with communities and risk groups

27 District OBJECTIVE 1: TO STRENGTHEN POLITICAL COMMITMENT FOR MALARIA CONTROL IN PNG SDA 1: Leadership and Participate actively in World Malaria Day and related activities 1.1 Intensify advocacy for Malaria control in PNG Governance Advocacy SDA 2: Systems Strengthening and capacity development OBJECTIVE 2: STRENGTHEN TECHNICAL AND ADMINISTRATIVE MANAGEMENT OF THE NMCP AT ALL LEVELS Review and standardise overall programme structure and identify human resource requirements at 2.2 Strengthen human resources through recruitment and all levels training Recruit essential staff at all levels (pay due attention to gender issues) 2.4 Develop and strengthen partnerships for Malaria control activities and improve coordination of activities 2.5 Strengthen and support monitoring and evaluation of National Malaria control programme Implement training programme Integrate malaria control activities with other public health programmes through joint planning and implementation Increase effective coordination of BCC with partners Support the strengthening of the reporting system and upgrade to include from aid posts and private sector facilities (NHIS) Provide regular programme progress reports (success and obstacles) to decision makers Conduct malariological surveys, household surveys for coverage and usage of LLINs, health seeking behaviours, mass blood surveys and efficacy trials on 1st and 2nd line antimalarial drugs Develop annual activity plan (AAP) for malaria control at all levels OBJECTIVE 3: MAXIMISE ACCESS TO PROMPT QUALITY MALARIA DIAGNOSIS (INCLUDING DIFFERENTIAL DIAGNOSIS FOR DENGUE, TYPHOID AND LYMPHATIC FILARIASIS) AND APPROPRIATE TREATMENT FOR MALARIA 3.1 Strengthen malaria parasite based diagnosis at all levels Expand malaria microscopy to health centre level Roll out RDT based diagnosis from facility to community level SDA 3: Accurate diagnosis and prompt, effective treatment for Malaria 3.2 Improve treatment of Malaria Implement the new national malaria treatment guidelines 3.3 Improve access to quality malaria diagnosis and appropriate treatment 3.4 Implement malaria diagnosis and treatment through other health programmes Collaborate with private sector to ensure provision of quality malaria diagnosis and treatment (including social marketing) Integrate malaria treatment, diagnosis and control activities into all ART centres Integrate malaria treatment, diagnosis and control activities into all maternal and child health programmes

28 District (cont) OBJECTIVE 4: IMPROVE VECTOR CONTROL MEASURES Plan for annual bed net program including district level quantification and household surveys SDA 4: VECTOR CONTROL 4.1 Maximise coverage of long lasting insecticide treated bednets (LLINs) with special provision for vulnerable groups 4.3 Reintroduce preventative indoor residual spraying (IRS) for Malaria control Procure nets Distribute free LLINs nationwide Provide LLINs to vulnerable groups Develop and implement social marketing of LLINs Monitor and evaluate LLIN coverage Quantification of needs for insecticides and spraying equipment Improve spraying capacities Implement, monitor and evaluate IRS OBJECTIVE 5: IMPROVE EPIDEMIC PREPAREDNESS, DETECTION AND RESPONSE 5.1 Strengthen epidemic surveillance and response capacity of the Malaria surveillance and control unit Carry out active case detection SDA 5: Epidemic preparedness and response Establish and maintain epidemic emergency fund at all levels Work with national and provincial authorities to develop local epidemic response plan 5.3 Increase preparedness for epidemics Establish storage facilities for emergency supplies 5.4 Implement and monitor epidemic Develop and implement response plans OBJECTIVE 6: IMPROVE KNOWLEDGE, BEHAVIOUR AND PARTICIPATION OF COMMUNITIES SDA 6: Behaviour Change Communication (Community outreach and Mass media) 6.1 Strengthen management and coordination of health promotion at all levels and cooperation with other health sectors and partners 6.2 Strengthen capacity to develop and implement an effective malaria health promotion (including BCC) programme 6.3 Support expansion of malaria control activities within Healthy villages and other community participation activities Implement partnership with BCC specialist Strengthen implementation of BCC Implement innovative BCC campaigns in association with partners Develop and implement a plan to improve treatment seeking behaviour and treatment compliance with health providers, established village health volunteer networks and other partners engaged with communities and risk groups

29 ANNEX 2: OBJECTIVE AND STRATEGY INDICATORS FOR THE NATIONAL MALARIA CONTROL PROGRAMME SDA Objective Indicator Strategies Indicators SDA 1: Leadership and Governance Advocacy SDA 2: Systems strengthening and capacity development Objective 1: Strengthen political commitment for Malaria control in PNG Objective 2: Strengthen technical and administrative management of the National Malaria control program at all levels a) Increase in proportion of budget allocation by the National Government to NMCP a) At least 75% of planned activities implemented 1.1 Intensify advocacy for malaria control in PNG 1.2 Identify funding sources and secure short, medium and long term financial support 2.1 Strengthen financial management at all levels 2.2 Strengthen human resources through recruitment and training 2.3 Improve infrastructure and strengthen logistics for malaria control programme at all levels 2.4 Develop and strengthen partnerships for malaria control and improve coordination of activities 2.5 Strengthen and support monitoring and evaluation of National Malaria Control Programme 2.6 Establish antimalarial drug efficacy, quality and resistance monitoring and adverse drug reaction reporting system 2.7 Conduct needsbased operational research 2.8 Continue to develop evidencebased policies, strategies and guidelines for malaria control Total number of people reached with advocacy related activities Number of positive and accurate media articles appearing in the PNG and international press on an annual basis Number of government of PNG officials reached with internal advocacy materials aimed at increasing central budget allocation to the NMCP and HPB Number of sources identified and percentage of budget allocation secured Percentage allocation to NMCP from Government and other donor sources At least 80% of allocated financial resources are disbursed and expended accountably according to plan and financial guidelines All required human resources are in place by the end of the Strategic plan Percentage of vacant positions within the NMCP and related departments filled All infrastructure is provided All health products provided in timely and correct quantity Malaria control activities included in annual activity plans of relevant NDoH branches and provincial plans Number of malaria control activities that are undertaken by other public health programmes and external partners Percentage of partners carrying out malaria control activities NMCP meets at least 80% of its reporting requirements according to National M&E plan Number of M&E activities completed NSP for completed Monitoring of the efficacy of the national 1st line antimalarial drug regimen carried out at least every 2 years in sentinel sites A drug QA system is operational by end 2010 All planned operational research completed and disseminated The new malaria treatment guidelines are officially endorsed not later than 2009 IRS guidelines are developed by June2009 SOP for epidemic response is developed by the end of 2009