Mitthi Office: Near Thar Coal Authority office Diplo road, Mithi Tharparkar. Ph: +92-333-2512637
The provision of services for malaria diagnosis and treatment has been integrated with the Primary health care (PHC) infrastructure of the districts since 1978, while the prevention and vector control component of the program remained vertical at provincial and district level. The huge network of PHC facilities in the country has improved the access of populations to the public sector health services in many parts of the country, but this objective remains to be achieved in bordering provinces and regions of the country where majority of highly malaria endemic districts are located. Weak health infrastructure, lack of trained human resource, weak disease surveillance system, problems in supply chain management of ant malarial drugs and lack of resources for the operations are the major health system constraints which hamper the implementation of current malaria control strategies in these regions. The situation is further compounded due to lack of proper community awareness program.
Lack of skilled staff to diagnose and treat malaria, lack of diagnostic equipment and supplies, regular stock outs of ant malarial drugs including ACTs and weak surveillance are the major obstacles in ensuring the access of population at risk to quality assured diagnosis and effective ant malarial treatment. Lack of resources for the procurement and distribution of LLINs and the application of other vector control measures is the major challenge to reduce the transmission potential of highly endemic regions and districts.
Malaria Control activities are on ground since the formulation of Health Services provision fundamentals outlined in Bohr’s commission in the Sub-continent; and in Pakistan these are functional since 1950s through succession of different approaches. The most ambitious program was the Malaria Education Campaign, spearheaded by USAID since 1961. Then the global approaches was changed due to health priorities and draw backs encountered with wide spread drug and insecticide resistance. Then as a strategy WHO initiated global malaria control program aiming to reducing the malaria burden to manageable levels. Pakistan program was also directed toward control approaches through the decentralization process and other funding difficulties during post this era did not allows successful transformation of the operations.
Malaria personnel cadres were amalgamated and Malaria Control program was made a Provincial transferred subject, leveling an apical set up at the Federal level, for the purpose of policy formulation and maintaining coordination. Further the implementation responsibilities were transferred to respective district government in line with the devolution plans. In 1977 Malaria control activities were integrated with the Communicable Disease Control Selection the Province Owing the two major failures in the endemic countries control programs, in 1998, Roll Back Malaria (RBM) initiative was coordinated and started by WHO, UNICEF, UNDP and the World Bank. Pakistan being the signatory to the effect, started RBM implementation in the phased manner by earmarking 273 million from PSDP allocations for 5 years since FY 2001-02, supplemented by the provincial PC-1 allocations while 658 million have been approved for the next 5 years 2007-2012 to support provincial programs.
Under 18th amendment in the constitution Federal Ministry of Health along with its attached departments including Directorate of malaria Control were devolved on 30th June 2011.Keeping in view the important role played by the Directorate of malaria Control, the honorable Prime Minister of Pakistan approved the revival of this Directorate with effect from 1st July 2011 and placed under the administrative control of Ministry of IPC with following functions and TORs:
Ø To act as Principal Recipient for all Global fund supported Health initiatives. Ø Preparation of proposals and liaising with international agencies for securing support of such partner agencies. Ø Providing technical and material resources to the provinces for successful implementation of disease control strategies and disease surveillance.
Pakistan has a population of 180 million inhabitants of which 177 million are at risk of malaria. With 3.5 million presumed and confirmed malaria cases annually.
Malaria in Pakistan is typically unstable and major transmission period is post monsoon i.e. from August to November. Major vector species are Anopheles culicifacies and A. stephensi, both still susceptible to the insecticides currently being used. The widely distributed causative organisms are Plasmodium falciparum and Plasmodium vivax. Vivax malaria still dominates the transmission though significant rise in the more lethal form falciparum is observed in Balochistan and Sindh. There is significant drug resistance (chloroquine and Fansidar resistance) prevalent throughout the country where the levels in the western border areas are very significant.The malariogenic potential of Pakistan has a negative impact on its socio-economic growth and productivity, as the main transmission season is spiraled with the harvesting and sowing of the main crops (wheat, rice, sugar cane). 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 Epidemiologically, Pakistan is classified as a moderate malaria endemic country with a National API averaging at 1.08 (MIS, 2015) 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. (Source: Malaria Information System)
The National strategy for Rolling Back Malaria (RBM) is based on the following key elements: Ω Early Diagnosis and prompt treatment at general health facilities and community based approaches towards home treatment. Ω Multiple prevention measures including promotion of insecticide treated bed nets & materials, targeted use of residual insecticide spraying, logical and environmental vector management approaches. Ω Intensive and comprehensive public education activities with appropriate IEC material to enhance pubic knowledge of malaria, treatments and prevention. Ω Improved detection and response to epidemics and malaria emergency situations. Ω Developing viable public and private partnerships in the country to combat malaria.
Goal By 2017, reduce the malaria burden by 60% in 09 high endemic District (Tharparkar, MirpurKhas, Khairpur, Tandoallayarr, Kmaber, Sukkur, Larkana, N-sheroForez and D.G Khan) of Sindh and Punjab -Pakistan
Objective 1. To ensure and sustain universal coverage of multiple prevention to population at risk in 02 target districts of (Tharparkar and Khairpur) by 2017. 2. 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. 3. 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. 4. To ensure availability of quality assured strategic information (epidemiological, entomological and operational) for informed decision making. 5. To enhance technical and managerial capacities of malaria control programs in planning, implementation, management and M&E.
Interventions for Malaria
The project is being implemented to Expanding support to Malaria Control Interventions in High Priority Districts of Pakistan. Pakistan Lions Youth Council is SR with Directorate of Malaria Control Ministry of National Health Services, Regulation & Coordination Government of Pakistan in 08 Districts of Sindh (Tharparkar, MirpurKhas , Tando Allayer and Khairpur, Sukkur, Larkana, NosharoFeroz and Kmaber Shadadkot ) and one district in Punjab (Dera Ghazi Khan), Pakistan Lions Youth Council implemented the project in the above mentioned districts with real spirits and on the basis of progress Pakistan Lions Youth Council has been awarded 05 new districts 04 in Sindh Province (Sukkur, NosharoFeroz, Larkana and Kmaber Shadadkot and one in Punjab (Dera Ghazi Khan)