Overview of UNICEF s Malaria Activities:

Transcription

1 Overview of UNICEF s Malaria Activities: Global Efforts to support LLIN Scale Up & Strategies to sustain scale up Valentina Buj Health Section Programme Division UNICEF New York

2 Overview Malaria s Contribution to U5 Mortality UNICEF s activities Global Efforts on Scaling Up Challenges Future Directions

3 What are children under-5 dying of? Worldwide More than one third of child deaths are attributable to undernutrition Africa Source: Global causes of child deaths - CHERG 2010, WHO UNICEF estimates, as published in Black et al Global, regional, and national causes of child mortality in 2008: a systematic analysis. The Lancet, June 2010.

4 Children from poorer households, rural areas and mothers with less education are at higher risk of dying before age five Under-five mortality rate, by wealth quintile, mother s education, and residence, (deaths per 1,000 live births) by wealth quintile by mother's education by residence Poorest 20% Second 20% Middle 20% Fourth 20% Richest 20% No education Primary Secondary or higher Rural Urban Note: Calculation is based on 39 countries with most recent DHS surveys conducted after 2005 with further analyses by UNICEF for underfive mortality rates by wealth quintile, 40 countries for rates by mother s education and 45 countries for rates by residence. The average was calculated based on weighted under-five mortality rates. Number of births was used as the weight. The country specific estimates obtained from DHS refer to a ten year period prior to the survey. Because levels or trends may have changed since then, caution should be used in interpreting these results.

5 What is UNICEF: How do we work? Influence donors and countries to do the right thing (advocacy) Provide them with the how to to get it done (technical assistance) Help them the money they need to do it (leveraging) Assist them in getting the materiel and supplies they need to make it happen (procurement)

6 UNICEF s focus in health: scaling up proven interventions With its strong field presence, UNICEF s emphasis is scale-up: taking proven, effective interventions from pilots to sub-national or national level Our main question is not does an intervention work, but how can we help countries make it work in the complex environment of the real world in a sustainable way Which interventions are likely to have the greatest impact, especially for the poorest children? How can the individual interventions be packaged to ensure maximal use of scarce resources, and what are the best delivery strategies for these packages What human and financial resources can be leveraged? How do we resolve the bottlenecks that prevent scale-up?

7 What types of interventions do we scale up? Interventions with the greatest impact in children 1-59 months Exclusive breastfeeding Antimalarial treatment ORS/zinc for diarrhea HiB vaccine Insecticide treated bed nets Zinc prophylaxis Complementary feeding Water, sanitation, hygiene Pneumococcal vaccine Rotavirus vaccine Antibiotics for pneumonia (Measles vaccine) In low income countries, coverage for most of these interventions ranges from 0% to 40%

8 The Protect Prevent Treat approach Focused around three points of intervention: Protecting against exposure altogether and/or optimizing host defenses (e.g., breastfeeding, handwashing, bed nets) Preventing illness if exposure does occur (e.g., immunization) Treating (e.g., ORS/zinc, antibiotics, antimalarials) Interventions provided through three delivery channels Family and community Schedulable or outreach services Facility- or community-based care providers

9 Global Targets: RBM GMAP 2010 Targets 80% of people at risk from malaria are protected; 80% of malaria patients are diagnosed and treated within 24 hours of onset of symptoms; Reduce the malaria burden by 50% compared to 2000 baseline Targets Malaria morbidity and mortality are reduced by 75% in comparison to 2005 baseline; Malaria-related Millenium Development Goals are achieved.

10 Global Fund did commit to Building the Demand for a Scaled-up Malaria Response: GF/B17/DP18: The Board acknowledges and commends the call by the UN Secretary General and the Roll Back Malaria (RBM) Partnership to help countries achieve the G8, the World Health Assembly and RBM targets to achieve universal coverage of an essential malaria control intervention package by December 31, In particular, the Board recognizes the epidemiological rationale set forth by the WHO for a massive scale-up of effective preventive measures to reach these targets. As the largest external financier of malaria programs worldwide, the Board is committed to ensuring that the Global Fund is acting as a key partner, along with others, in this extraordinary public health effort to meet the demand from countries to scale-up their malaria programs. Given the urgency of the need to devote additional resources and to increase implementation capacities at country level to achieve universal coverage, the Board urges countries to submit ambitious Round 8, Round 9, and Rolling Continuation Channel proposals aimed at scaling up comprehensive malaria control programs (particularly the distribution of long-lasting insecticide treated nets (LLINs) and ACTs) and are linked to broader health systems strengthening.

11 The Global Fund s role as a Strategic Investor in Malaria, GF/B17/8 As the single largest external financier for malaria control, we have a role and responsibility in supporting countries in this scale up. We also need to encourage countries to scale up in a comprehensive approach that builds systems and capacity for the long-term. We urge the Global Fund Board and TRP to recognize the importance of carefully reviewing large Round 8 and 9 proposals that focus on large, up-front LLIN distribution, even if they are of a scale and scope far greater than in previous rounds. Countries are responding to a shift in RBM guidance to encourage much larger proposals given the need to finance a continent-wide net scale-up.

12 Thirty-five countries are responsible for 98% of the total malaria deaths worldwide To achieve the 2010 and 2015 targets, achieving malaria control goals in the following countries is essential: 30 countries in Africa: Nigeria, Democratic Republic of Congo, Uganda, Ethiopia, Tanzania, Sudan, Niger, Kenya, Burkina Faso, Ghana, Mali, Cameroon, Angola, Cote d Ivoire, Mozambique, Chad, Guinea, Zambia, Malawi, Benin, Senegal, Sierra Leone, Burundi, Togo, Liberia, Rwanda, Congo (Brazzaville), Central African Republic, Somalia, and Guinea Bissau 5 countries in Asia-Pacific: India, Myanmar, Bangladesh, Indonesia and Papua New Guinea

13 The GOAL (ITNs) Provide mosquito nets to everyone who needs them in Sub Saharan Africa ( universal access) This would result in: 6 lives per year saved per 1,000 children using ITN Child deaths reduced by 20% Eliminating malaria as a major public health threat

14 Number of LLINS (millions) Mosquito Net Production and Procurement Number of Insecticide-treated nets procured by UNICEF, By 2009, UNICEF ITN procurement is 20 times greater today than it was in GLOBAL PRODUCTION 145 million LLINs were delivered in An estimated 50% of households in SSA now have at least one bed net, and 96% of persons with access to a net use it UNICEF PROCUREMENT Historically, UNICEF nets are mostly distributed through ROUTINE systems ANC, EPI

15 Prevention Rapid progress in scaling up ITN use in sub-saharan Africa Proportion of children under five years of age sleeping under an insecticide-treated mosquito net (ITN), all African countries with two or more comparable points

16 An estimated 125,000 malaria deaths were averted in 10 African countries by scaling up ITNs, most since 2006 Access to health care & disease surveillance systems is still poor. Impact of scale-up of all interventions won t be known unless further investments are made into health information systems particularly in African countries. Source: Global Fund Five-Year Evaluation: Study Area 3 (Health Impact). May Geneva: Global Fund to Fight AIDS, Tuberculosis and Malaria

17 Why UNICEF? World s biggest distributor of nets In country presence allows delivery of nets integrated in maternal and child health services Expertise in behaviour change communication so nets are correctly used Expertise in monitoring and evaluation, supply and logistics, technical assistance. All parts of UNICEF are closely linked from fundraising, to supply division, programme division and country offices. UNICEF s distributions are closely linked from local capacity building through to delivery and monitoring and evaluation.

18 Sustaining Gains: What is working UNICEF has strong policy influence at all levels, particularly at country level Technical support UNICEF s ability to deliver malaria commodities, especially to the most vulnerable, is globally recognized Global Fund accelerated implementation Leveraging resources for commodities and increasing access Strong coordination is required at all levels of procurement and supply especially for LLINs Timing is key Delivery to hard to reach areas builds confidence in the supply system

19 Challenges Global Fund VPP orders are often ad-hoc Only PRs are involved in development of PSM plans during grant signature CCMs are not looking at overall country programmes to sequence deliveries and harmonize incoming commodities Programming Campaign mentality dominates, not focusing on routine deliveries Quantifications (census, populations quantifications) Leakage in the system Financing Ensuring timely, sustainable, predictable financing Supply chain Reaching the most vulnerable in an equitable manner

20 Opportunities for Integrated Support Child Health Days Integrated Mass Campaigns Measles & Polio Vaccination campaigns, Vit A, Deworming and Malaria Bednet distribution House to house census and delivery EPI & ANC Opportunities for routine bednet distribution at first vaccination and during ante-natal visits Outreach: Community Health Workers Bednet distribution as well as hangup campaigns, Harmonized Funding: National Strategy Applications, IHP+ Introduction of a coordinated system for donor funding for malaria control Leveraging existing and new funding in a coordinated fashion Private Sector Subsidized delivery

21 Challenges

22 Challenge: LLIN Delivery In addition to the base cost of an LLIN, it is estimated that an additional US$2.50 is required to support distribution of nets including: Behaviour change communication Training In-country distribution costs Monitoring and evaluation

23 Challenge: LLIN Use Why people don t want to use nets: Perceived heat and airlessness Don t have anywhere to hang the nets Don t know how to hang the nets Challenges Getting people to use them each and every night Repair and maintenance Ensuring that the most vulnerable are those who sleep under the net.

24 Next Steps Increasing net use BCC/PSM LLIN delivery through routine systems (quantifications and financing) Replacement nets: it is estimated that 100 M nets per year needed in replacement Keeping up coverage Scaling up monitoring and evaluation LLIN durability studies

25 Progress According to the World malaria report 2011, malaria mortality rates have fallen by more than 25% globally since 2000, and by 33% in the WHO African Region. However, this still means that there were an estimated 216 million cases of malaria in 106 endemic countries and territories in the world in 2010 Projected shortfalls in funding threaten the fragile gains. Drug and insecticide resistance are emerging and need to be proactively addressed.

26 Thank You Merci Obrigado Melesi Asante Sana Twasanta Mani Matondo Wasakidjila wa bunyi