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Analytical summary - Malaria

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The arid regions of Erongo, Hardap, Khomas and Karas are considered free of malaria transmission and almost risk-free. Some risk exists in the southern regions, but it is uncertain whether the cases reported in these areas are imported or locally acquired. The areas of high transmission and population density are located along the northern border of the country. (MoHSS, December 2010)

In 2008 there were 128,531 (62/1,000) reported outpatient malaria cases and 5,233 (0.9/1,000) inpatient cases. A total of 199 deaths were reported in the same year. (HMIS data of August 2010) Transmission risk is currently estimated between 15% in low risk areas and 55% in high risk areas. (MoHSS, December 2010)

The National Vector-borne Diseases Control Programme (NVDCP) was introduced in 1991 and supported by the National Policy and Strategy for Malaria Control in 1995 (MoHSS, 1995). In 2006 a policy of parasitological diagnosis using Rapid Diagnosis tests (RDTs) was introduced.

The National Vector-borne Diseases Control Programme (NVDCP) has successfully introduced and rapidly scaled up all malaria control interventions, prioritizing high risk districts and achieving overall MDG targets of halving morbidity and mortality. Trends in outpatient cases, inpatient cases, and deaths exhibit a decline of 78 percent, 87 percent, and 88 percent respectively between 2001 and 2008.

Following the success of malaria control over the last ten years, and remarkable declines in local transmission of the disease, Namibia has also been recognized as one of four countries in southern Africa that is well positioned to reorient the malaria program from a malaria control program to an elimination program. The current Malaria Strategic Plan 2010-2016 is2016 is a pre-elimination plan which aims to make a major impact on transmission and reducing incidence to less than 1 case per 1,000 in each district by 2016; this will position Namibia to follow through with the complete interruption of indigenous transmission by 2020. (MoHSS, November 2010)

The five strategic interventions set out in the plan are: The five strategic interventions set out in the plan are: programme and operations management; diagnosis and case management; surveillance, epidemic preparedness and response; integrated vector control; behaviour change communication and community mobilisation. (MoHSS, November 2010)

A National Malaria Elimination Task Force will be formed to oversee implementation with support from technical working groups. The NVDCP, an independent programme within the directorate Special Programs (DSP) in Windhoek and Oshakati, will coordinate day-to-day activities and inputs from partners.

The programme will be rolled out using a decentralised approach including capacity building at district and community level. A new staff establishment for the NVDCP is proposed to address critical shortfalls in programme management and technical capacity. The team is currently funded jointly by the MoHSS and donors, but the goal is to eventually shift all posts so that they can be fully sustained by the MoHSS. At the regional level Regional Malaria Elimination Coordinators and Regional Clinic Mentors are proposed and District Malaria Elimination Officers are needed to support EHOs who currently conduct malaria activities under PHC.

The implementation of the elimination effort requires unprecedented support from all stakeholders and partners, including implementing partners that have capacity in laboratory systems, quality assurance systems, research, procurement and supply management, and behaviour change communication. (MoHSS, November 2010)

In March of 2009, Namibia hosted the Inaugural meeting of the Elimination 8, a mechanism for eight Southern Africa Development Community (SADC) countries which have similarly committed to forging a sub-regional alliance to launch a united intensive offensive against malaria. Namibia will work with its neighbouring countries and development partners to contribute to the malaria elimination goals of the eight individual countries, and the sub-region as a whole. In particular, it will work closely with its neighbours to put in place programs that increase access to malaria interventions in the border districts (MoHSS, November 2010).

The total budget for the 2010-2016 strategic plan is US$93,052,380, to be met by the Namibian Government, together with development partners and other local and international stakeholders. (MoHSS, November 2010)

Systems that are currently used for malaria data collection are the Health ManagaementManagement Information System (HMIS), Integrated Disease Surveillance and Response (IDSR) system, and the weekly routine malaria surveillance system. Surveillance of malaria has previously been passive and focussed on data collection for monitoring and evaluation.

With the new push towards elimination, surveillance will become a key intervention in the identification/diagnosis of cases and infections to map malaria foci for effective targeting of interventions and interruption of onwards transmission. The objective is therefore to strengthen the passive system and then create an active system. Regional Surveillance Officers are required in order to achieve this. (MoHSS, November 2010)

Bibliography MoHSS. (November 2010). Malaria Strategic Plan (2010-2016) . Windhoek: Republic of Namibia. MoHSS. (December 2010). National Malaria Monitoring and Evaluation Plan (2010-2016). Windhoek: Republic of Namibia. MoHSS. (1995). National Policy and Strategy for Malaria Control. Windhoek: Republic of Namibia.

DSP Directorate Special Programs EHO Environmental Health Officer HMIS Health Management Information System IDSR Integrated Disease Surveillance and Response MoHSS Ministry of Health and Social Services NVDCP National Vector-borne Diseases Control Programme PHC Primary Health Care