Tanzania s Progress in Combating Malaria: Achievement and Challenges DR RENATA A MANDIKE DEPUTY PROGRAMME MANAGER NATIONAL MALARIA CONTROL PROGRAMME, MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN, TANZANIA MAINLAND Swiss TPH Winter Symposium 8 th -9 th December 2016, Basel Switzerland
Outline Background Malaria in Tanzania, c. 2000 Summary of resources and partnerships Strengthening and expanding intervention coverage over a decade Evolving strategies to distribute LLINs and increase use Improving malaria case management Impact of intensified coverage Looking ahead
Background: Malaria in Tanzania Among the top ten countries with high malaria burden in Africa Over 93% of the population at risk of malaria Available evidence suggest a transitioning epidemiology of malaria in Tanzania from very high to meso-endemic and low levels Malaria remains the leading cause of OPD, admissions and death High heterogeneity: aggregated parasite prevalence at district level ranging from 0%- 65% (SMPS 2015)
RBM Partnerships in Tanzania: from Inception to Present Inception in 1999 and implemented through thru Health sector reforms Increased political engagement in malaria control-abuja declaration, millennium development goals Increased partnership and investment in malaria control - GF, PMI, WB, UNICEF, SDC, DFID GF commenced in 2004 introduction of TNVS, later other interventions PMI support from 2006 covering all interventions Scaling up malaria control made possible
Key Interventions: 5
Milestones: Tanzania s Malaria Control Policy 2002-2007, 2008-2013 and 2015-2020 Social marketing of ITNs LSM targeted ITN Voucher Scheme for PW ITN Voucher scheme for infants IRS targeted IRS scale up LLIN catch-up campaign LLIN universal coverage campaign LSM scale up LLIN School net Replacement program Campaign LLIN RCH 2000 2002 04 06 2008 10 12 2014 16 18 2020 SP IPTp 1 st Medium-Term Strategic Plan, ACTs RDTs AMFm IPTp 3+ 2 nd Medium-Term Strategic Plan, Inj Artesunate Vaccine, MSAT, MDA 3 rd Medium-Term Strategic Plan, 2002-2007 2008-2013 2015-2020 Source: NMCP
Malaria Control Phases and Timeliness:
Malaria Control Funding in Tanzania: 2005 present Millions $250 $200 $150 $100 $50 $- 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 PMI GF GOT Others Source: Impact Evaluation Report (2011), Business Plan 2013 2017
INCREASING ACCESS AND USE OF LLINs: 2005 date Photo here
Population with Access To and Use of Insecticide Treated Nets (ITNS) 100 Percent population access to and use of LLINs 90 80 70 60 50 40 30 20 10 0 Percent of households with at least one ITN Persons with access to an ITN Population who slept under an ITN last night Population who slept under an ITN last night of those living in a household with at least one ITN 2004-05 DHS 2007-08 THMIS 2010 DHS 2011-12 THMIS 2015-16 TDHS_MIS Population with Access To and Use of Insecticide Treated Mosquito Nets (ITNS)
Population access to insecticide-treated net (ITN) by residence and wealth quintiles 70 60 50 40 30 20 10 0 Urban Rural Lowest Second Middle Fourth Highest Total Residence Wealth quintile 2008 2016 Source,: DHS, THMIS, MIS
Use of ITNs by Children under 5 and Pregnant Women; Use of SP Uptake in Pregnant Women %, use of ITNs by children and PW, and use of SP by PW 80 70 60 50 40 30 20 10 0 Children under 5 who slept under an insecticide-treated net (ITN) Pregnant women who slept under an ITN SP/Fansidar 2+ doses, at least one during ANC visit (IPTp) 2004-05 DHS 2007-08 THMIS 2010 DHS 2011-12 THMIS 2015-16 TDHS-MIS Population with Access To and Use of Insecticide Treated Mosquito Nets (ITNS)
INCREASING ACCESS AND USE OF RDTs and ACTs: 2005 Present Photo here
Children Under 5 with Fever who were Tested and Treated with ACTs % 90 80 70 60 50 40 30 20 10 0 Children under 5 with fever in the last two weeks Children with fever for whom advice or treatment was sought Children with fever who had blood taken from a finger or heel for testing Children with fever who took a combination with artemisinin Children with fever who took a combination with artemisinin the same day 2004-05 DHS 2007-08 THMIS 2010 DHS 2011-12THMIS 2015-16 TDHS-MIS Source,: DHS, THMIS, MIS
Malaria Diagnosis by Type: Jan 2013 Jun 2016 100% Sum of malaria clinical_opd public Sum of malaria mrdt +ve_opd public Sum of malaria bs +ve_opd public 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% January February March April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December January February March April May June 2013 2014 2015 2016
IMPACT OF ALL MALARIA CONTROL INTERVENTIONS: 2005 PRESENT
All-cause Child Mortality: 2000 2016 147 99 112 68 51 43 53 47 32 25 81 67 Infant Mortality Child Mortality U5 Mortality 2000 2005 2010 2016 Source,: DHS, THMIS, MIS
Changes in Endemicity Class as Reflected by Prevalence in Children Aged 2 10 Years In the last 10 years we have observed epochal changes from established high mesoendemicity to established the present low mesoendemicity/hypo-endemicity. In this context, malaria is now more unstable and highly sensitive to seasonal and annual climatic variations. Source,: NMCP Malaria prevalence and endemicity 100 90 80 70 60 50 40 30 20 10 0 2000 2004 2008 2012 2016
Parasite prevalence by setting and health quintiles, 2008 2016 25 20 15 10 5 0 Urban Rural Lowest Second Middle Fourth Highest Total Residence Wealth quintile 2008 2016 Source,: DHS, THMIS, MIS
Critical Factors Associated with Success in Tanzania Strong GoT commitment and leadership Stable and significant partner support Coordinated partnership with donors, implementing partners, research community Programme s willingness to try new and innovative interventions
Challenges Sustaining and expanding the gains to further reduce malaria burden; we don t have long term funding High diversity of malaria transmission, we need to plan effectively Data management capacity at NMCP is limited, limiting effective decision making using available data (National, school surveys and routine) Inadequate human resource and skills for effective delivery of health system including HMIS, Logistics, Quality of Care Insecticide resistance, limited and highly expensive choices for implementation of Insecticide resistance Mitigation Plan Limited involvement of other sectors that are linked to malaria transmission
Looking Ahead Maintain high LLIN coverage and use, using different delivery methods (Keep up strategies) Reliable supply of anti-malarials and diagnostics to avoid stock outs Strengthen malaria surveillance (disease, programmatic and transmission) Implement alternative vector control interventions to manage insecticide resistance and outdoor transmission (IRS and larviciding) Promote routine HF based data quality and use Better engagement of community in malaria control through effective behaviour change Mid review of the programme to plan strategically considering a stratified approach to maximize outcomes Resource mobilization: Government and Development Partners
Conclusions Significant progress has been achieved over the past decade, but this is fragile; long term investments are essential to maintain present gains As transmission is highly diverse and resources are limited, a stratified approach is essential to maximise outcomes and impact
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