Malaria Control Program in Nepal

Malaria Control Program in Nepal

1. MALARIA
CONTROL
PROGRAM
Presented by:
Mohammad Aslam Shaiekh
Master of Public Health (MPH)
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2. Background
■Nepal’s malaria control programme began in 1954, mainly in
the Tarai belt of central Nepal with support from the United
States.
■In 1958, national malaria eradication program was launched
with the objective of eradicating malaria from the country.
■The eradication concept reverted to control program in 1978.

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3. Cont ….
■Following the call of WHO to revamp the malaria control
programs in 1998, Roll Back Malaria (RBM) initiative was
launched to control malaria transmission in hard‐core forests,
foot‐hills, inner‐Terai and hill river valleys, which accounted
for more than 70 % of the total malaria cases in the country.

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4. Cont…
■Based on recommendations from the internal and external
evaluation of Nepal’s malaria control programme in 2010, the
country has been preparing for a pre-elimination phase since
2011.
■The trends of the malaria epidemiological situation between
2071/72 and 2073/74 show a slightly increasing trend of
confirmed cases and 3 deaths
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5. Cont…
■Nepal has recently adopted a long-term malaria elimination
strategy with the ambitious vision of a malaria-free Nepal by
the year 2026 (National Malaria Strategic Plan 2014-2025).
■The strategic plan was divided into two phases: achieve
Malaria Pre - Elimination by 2018 and attain Malaria
Elimination by 2026.
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7. Trend of malaria cases
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8. National Malaria Strategic Plan 2014-2025

■Vision
Malaria‐free Nepal in 2025
■Mission
To empower the health staff and the communities at risk of
malaria to contribute towards the vision of malaria‐free Nepal
in 2025.

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9. ■Goals
–To sustain zero death due to malaria from 2012 onwards;
–To reduce the incidence of indigenous malaria cases by 90% by
2018 (relative to 2012);
–To reduce no. of VDCs having indigenous malaria cases by
70% by 2018 (relative to 2012);
–To receive WHO certification of malaria free status by 2025.

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10. Major activities in 2073/74
■413403 LLIN was distributed as mass distribution and 55919 LLIN was
distributed to pregnant women at their first ANC visits.
■Conducted the ward-level micro-stratification of malaria cases in 44
districts.
■Introduced case-based surveillance system, including web-based
recording and reporting system for districts.
■Conducted a national malaria vector survey.
■Orientated district and peripheral level health workers on case based
surveillance and response.
.
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11. Cont…
■Carried out detailed foci investigation at more than four sites.
■Conducted G6PD deficiency prevalence study across 30 wards in 54 high
risk VDCs
■Orientated district health workers and FCHVs on the government’s
malaria elimination initiative and their role in detecting cases and
facilitating early treatment.
■Orientated mother groups and school children on malaria prevention and
the need for early diagnosis and prompt treatment.
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12. Cont…
■Conducted regular vector control (indoor residual spraying) biannually
across high and moderate risk districts.
■Conducted detailed case based investigation and fever surveys around
positive index cases.
■ Conducted integrated entomological surveillance around twelve different
site of thought-out the country.
■Celebrated World Malaria Day on 25 April.
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13. Current Achievement
■By 2016, National Malaria Program had achieved 54% reduction in
indigenous malaria cases compared to 2012, death was recorded in
an imported case of malaria.
■Nepal achieved MDG 6 ahead of time by reducing malaria
morbidity and mortality rates by more than 50 percent in 2010.
Despite political instability, Nepal’s malaria program has
successfully implemented planned interventions to eliminate the
remaining active malaria foci (VDCs).
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14. Management of Malaria Control
Program
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15. Planning
■Epidemiology and disease control division (EDCD) is prime
responsible for planning and implementation, M&E, prevention and
control activities.
■The malaria strategic plan has five major strategic objectives:
i) to strengthen strategic information for decision making towards
malaria elimination
ii) to further reduce malaria transmission and eliminate the foci
wherever feasible
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16. Cont…
iii) to improve quality of and access to early diagnosis and
effective treatment of malaria
iv) to develop and sustain support through advocacy and
communication, from the political leadership and the communities
towards malaria elimination and
v) To strengthen programmatic technical and managerial capacities
towards malaria elimination.

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17. Organizing
■EDCD deals with all matters of disease surveillance, outbreak
responses and mobilization of RRT. Also responsible for
provision of expert support to carry out activities on VBDs.

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18. Organogram of Epidemiology and
Disease Control Division
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19. Staffing pattern
At Central Level
In addition to the Director of EDCD, Disease Control Unit of the EDCD has
six sanctioned posts:
–Malariologist(Sr. Health Administrator) -1,
–Public Health Officer -1,
–Vector Control Inspectors-2,
–Medical officer -1
–Health assistant-1

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20. At Regional/Provincial Level
■There is a disease control sub-section under the public health section of
Regional Health Directorate.
■Based in each of the five regions, the sub-section is staffed with:
–Vector Inspector-1,
–Entomologist-1,
–Asst. Entomologist -1,
–Vector Control Inspectors/Malaria Inspectors/Entomological
technicians -4,
–Lab.boy-1,
–Laboratory technician-1,
–Laboratory assistants-2 and
–Maintenance technicians-2

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21. At District/Local Level

■Malaria and Vector Borne Disease unit is staffed with:
−a Vector control inspector or malaria inspector or both
−a laboratory technician/Laboratory Assistant.

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22. Directing

■Directing and controlling mechanism is conducted in top down
approach.

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23. Coordination

■General Management: correspondence with MoHP, Partners,
Provincial Health Directorate and DHO/DPHO
■Review meetings at provincial and district level; quarterly
district review meetings and an annual national review
meeting.
■Cross border coordination for the control of malaria with high
level meetings.
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24. ■Interventions delivery with close coordination with PSI Nepal,
NGO’s, CBO’s, WHO, Save the Children, Global Fund and
involvement of media houses, public and private academic
institutions, private medical college & hospitals, professionals
associations, councils, as suitable and available.

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25. Reporting

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26. EWARS (Early Warning and Response
System)

■EWARS was established to complement HMIS in its function of
surveillance for disease outbreaks.
■EWARS prepares weekly reports of number of cases and deaths
(including ‘Zero’ reports) from 39 sentinel hospitals.
■EWARS is the only comprehensive source of hospital admitted
cases of severe malaria and their treatment outcome.

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27. Cont…
■Equally focuses on immediate reporting (to be reported as soon
as possible within 24 hours of diagnosis) of One confirmed
case of severe and complicated Malaria
■The data collection, recording and reporting is done at the
sentinel hospital and is reported weekly and immediately
(within 24 hours) to EDCD by fax.

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28. Cont…
■EDCD consolidates the weekly report and prepares a weekly
EWARS Bulletin for dissemination to stakeholders including
the sentinel hospitals.
■EDCD has recently developed a web-based malaria case
recording and reporting system (Malaria Disease Information
System-MDIS) with a provision of SMS recording and
reporting and rolled out for web based reporting, which is
expected to be fully utilized in coming years.

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29. Budgeting
■Budget demand is bottom up approach i.e. from local to central
level.
■Budget flow is top down approach i.e. from central to local
level.
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30. Problems/Constraints
■Confirmation of suspected and probable malaria cases.
■Low blood slide examination rates for malaria elimination
program.
■Insufficient orientation on malaria programme to health
workers.
■Insufficient variables in HMIS tool (for e.g. slide and RDT
classification).
■Malaria cases increasing in nonendemic district.

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31. Recommendations
■Malaria microscopy trainings of all untrained lab personnel.
■Availability of RDT at non microscopic sites.
■Orientation of service providers, clinicians, health workers and
private practitioners.
■Train health workers on RDT and microscopy in malaria
reported districts.



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32. ■Run training programs.
■Orient district and peripheral staff on case investigation and
reporting.
■EDCD to address the insufficient variables during HMIS tools
revision.
■Program should address non-endemic districts.

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33. References
■Government of Nepal. Annual Report. Department of Health
Services 2073/74 (2016/2017).
■Nepal Malaria Strategic Plan, 2014-2025


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