Project Background:

Pakistan has a population of approximately 185 million with 98% (182 million) of population at risk of developing Malaria. Global Fund (GF) support is the main driving force for changing malaria epidemiology in Pakistan since 2002. Epidemiologically, Pakistan is classified as a moderate malaria endemic country with a national API averaging at 1.69 (MIS, 2013) and wide diversity within and between the provinces and districts. Plasmodium Vivax and Plasmodium Falciparum are the only prevalent species of parasites detected so far, with P.Vivax being the major parasite species responsible for >80% reported confirmed cases in the country.

The key underlying risk factors for malaria endemicity and outbreaks in Pakistan include; unpredictable transmission patterns, low immune status of the population in lowest endemicity areas, poor socioeconomic conditions, mass population movements within the country and across international borders with Iran and Afghanistan, natural disasters including floods and heavy rain fall in a few areas, lack of access to quality assured care at the most peripheral health settings, low antenatal coverage and internally displaced population (IDPs) crisis in the agencies and districts along western border. About 700,000 people (National Disaster Management Authority) have recently been displaced from high endemic zone of North Waziristan to neighboring districts of KPK due to conflict situation.

The malaria indictor survey (MIS) was conducted in 2013 in 38 (GF R-10) highly endemic districts of the country showing highest prevalence rates in the region of Federally Administered Tribal Areas (FATA) (13.9%) followed by Balochistan (6.2%), and Khyber Pakhtunkhwa (KP) (3.8%).

The NFM grant envisages covering 43 districts of Pakistan with comprehensive Malaria Control Interventions identified in the Malaria National Strategic Plan 2015—2020. The proposed interventions are based on the national strategic framework 2015—2020 and comments of the Technical Review Panel (TRP) on the NFM concept note. The NFM grant is managed by two principal Recipients (PR) i.e Department of Malaria Control (DMC) and Indus Hospital. ACD is working with the DMC as Sub-recipient of the grant for Seven Agencies, Six FRs and Seven districts of KP.

Objectives of the Project:

  • To ensure and sustain universal coverage of multiple prevention to population at risk in 10 target Agencies-FATA (Bajaur, Khyber, Kurram, North-Waziristan, Mohmand, South-Waziristan, FR-Bannu/Lakki, FR-Peshawar/Kohat, Orakzai, FR-Tank/D-I-Khan) by 2017.
  • To ensure and sustain > 80% coverage for the provision of quality assured early diagnosis and prompt treatment services to population at risk in target districts by 2017.
  • To increase community awareness up to 80% on the benefits of early diagnosis, prompt treatment and Malaria preventive measures using health promotion, advocacy and BCC interventions by 2017.
  • To ensure availability of quality assured strategic information (epidemiological, entomological and operational) for informed decision making.
  • To enhance technical and managerial capacities of malaria control programs in planning, implementation, management and M&E.

Target Agencies & FRs:

Activities Description:
i. Strengthen Existing Diagnostic Services:
ACD supports the selected health facilities from existing public sector health facilities for diagnosis and treatment of Malaria. The support includes provision of microscopes, medicine, laboratory reagents, trainings and minor renovation of centers where needed. This support has enhanced the capacity for health centers for provision of Malaria Programme services to the target communities.
ii. Establishment of Rapid Diagnostic Test (RDT) Centers at First Level Care Facilities (FLCFs)
ACD supports the existing First Level Care Facilities (FLCFs) designated as Rapid Diagnostic Test (RDT) Centers for Malaria diagnosis and treatment. These centers were provided RDT kits and anti-Malaria medicine for early diagnosis and prompt treatment.
iii. Prompt and Effective Anti-Malaria Treatment
ACD provides support to 971 Malaria diagnosis and treatment centers in FATA and KP. Free of charge quality assured anti-malarial medicine are provided to patients needing Malaria treatment. The anti-malarial drugs include: tab. Chloroquine, tab. Primaquine, tab. Quinine, tab. ACT (Artesunate + SP), tab. Artemether + Lumafentrine. Provision of early diagnosis & prompt treatment with effective Anti- Malarial drug is the most efficient intervention in reducing parasite reservoir & overall morbidity & mortality.
iv. Enhancing the Capacity of Healthcare Providers in Proper Malaria Case Management Treatment
Malaria Case Management Treatment according to National Malaria guideline is essential for the provision of standardized and effective Anti- Malarial drugs & to avoid development of resistance. ACD has trained health care providers working in the public and private sector health facilities on the National guidelines and protocols for managing Malaria. These trainings are provided on Malaria Case management, rapid diagnostic test (RDT), Microscopy, Malaria information system (MIS).
v. Involvement of Private sector in Malaria diagnosis & treatment
Approximately 80% of patients in Pakistan are catered by private sector. However, 50% of Malaria patient in high endemic districts seek services of private sector (MIS 2013). Majority of Malaria cases in private sector are treated on clinical grounds without confirmatory tests. To involve private sector in malaria diagnosis and treatment ACD has established 255 RDT centers from the target of 255 private RDT centers in the target Agencies and FRs of FATA and Districts of KPK.
vi. Prevention through universal coverage of LLlNs in target Agencies/FRs
According to WHO Long Lasting Insecticidal Nets (LLlNs) is the most effective mean of vector control in highly endemic areas. LLlNs distribution outlets established in the agencies and FRS have been used for smooth and timely distribution of the LLlNs to the neediest populations. LLlNs have been distributed on mass scale to achieve universal coverage so that more than 80% of population in stratum IA agencies i.e. Kurram, Khyber, North Waziristan, FRS are covered.
vii. Behavior Change Communication
To enhance Malaria awareness, case detection and adherence to treatment, ACD implements the National Malaria Program Advocacy, Behavior change communication (BCC) strategy through a coordinated approach in the FATA region. The activities included community awareness sessions, health education & distribution of IEC materials. These activities have been carried out through LHWs, CBOs & ACD staff.
viii. Monitoring and Supervision
Regular Monitoring and Supervision of the field activities is carried out by the senior program management and monitoring team dedicated for the purpose. Monthly and quarterly review meetings at the national, provincial and district level are conducted for data validation and performance updates.