Role of ROTARIANS AGAINST MALARIA (RAM) in Malaria Control in Papua New Guinea

Slide Note

ROTARIANS AGAINST MALARIA (RAM) plays a crucial role in malaria control in Papua New Guinea through various programs like net distribution, health facility supervision, and drug distribution. Funding from sources like the Global Fund, Against Malaria Foundation, and sustainable initiatives ensures the sustainability of these malaria control efforts. RAM's focus on LLIN distribution to households across different provinces and districts reflects their commitment to combating malaria effectively in PNG.

enrique Follow

Uploaded on Jul 19, 2024 | 0 Views

Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

E N D

Presentation Transcript

ROTARIANS AGAINST MALARIA PAPUA NEW GUINEA RAMs Role In Malaria Control In PNG RAM Meeting 12 September 2020 Tim Freeman

PNG MALARIA PROGRAMME RAM/NDOH PROGRAMME RAM/NDOH PROGRAMME Net Distribution Health Facility Supervision Visits Drug Distribution HMM (2020) Finance IMR and NDOH for research Chasing Malaria

PNG MALARIA PROGRAMME RAM PROGRAMME RAMs Funding Global Fund 77.6% of funding Nets over 1600 metres, drugs, HF supervision, IMR Against Malaria Foundation 19.3% of funding All nets under 1600 metres PNG Sustainable 2.4% of funding Western Province nets and drug distribution RAM (PNG and Australia) 0.6% of funding Chasing Malaria Exxon Mobil

PNG MALARIA PROGRAMME RAM PROGRAMME Funding Sources And Amounts Donor Global Fund AMF PNG Sustainable RAM Australia Exxon Mobil Total 2018 7,045,632 1,947,414 353,984 70,000 20,000 9,437,030 2019 9,013,004 2,078,858 395,954 70,000 2020 12,651,962 28,710,597 3,118,600 7,144,872 155,643 70,000 15,000 16,011,205 37,006,050 Total % 77.6 19.3 2.4 0.6 0.1 100.0 905,581 210,000 35,000 11,557,816 It is expected that RAM will expend all funds budgeted before the end of 2020

PNG - MALARIA PROGRAMME LLIN DISTRIBUTION RAM Distributes LLINs On A Three Year Basis To All Areas Of PNG Presently in Southern Highlands and Central Province and moving shortly to Gulf

PNG - MALARIA PROGRAMME LLIN DISTRIBUTION Distribution Of LLINs To Household Level Nets Delivered Period Dates Districts Provinces Phase One (2010-2011) Nov 09 - Oct 11 50 Districts 18 Provinces 1,890,448 Year 3 (2012) Year 4 (2013) Year 5 (2014) Year 5 (2014) No Cost Extension Year 6 (2015) Year 7 (2016) Year 8 (2017) Year 9 (2018) Year 10 (2019) Jan - Dec 2019 Nov 11 - Sep 12 Oct 12 - Sep 13 Oct 13 - Sep 14 27 Districts 28 Districts 23 Districts 10 Provinces 12 Provinces 11 Provinces 832,671 1,210,391 1,374,791 Okapa, Lufa, Madang, Angoram, Maprik, Yangoru Saussi, Wewak, Aitape Lumi, Nuku and Vanimo Green 29 Districts 27 Districts 36 Districts 27 Districts 26 Districts Pomio, Rabaul, Kokopo, Samurai Murua, Kiriwina Goodenough, Ess'ala, Alotau, Wabag Mul Bayer, Tambul Nebliyer, North Waghi, Anglimp South Waghi EHP, Madang, East Sepik and Sandaun Oct 14 - Dec 14 454,806 Jan - Dec 2015 Jan - Dec 2016 Jan - Dec 2017 Jan - Dec 2018 11 Provinces 13 Provinces 13 Provinces 11 Provinces 12 Provinces 932,822 805,597 1,543,947 1,211,922 1,266,525 East New Britain, Milne Bay, Enga Jan - Mar 2020 296,227 Enga, Western Highlands, Jiwaka Apr - Jun 2020 356,781 6,413,821 5,763,107 12,176,928 New Funding Model (2015-2018) Round Eight (2010 - 2014) Overall Total Phase One and Phase Two And NFM 103% of target achieved for 2019 and 97.2% for first six months of 2020

PNG - MALARIA PROGRAMME LLIN DISTRIBUTION Distribution Of LLINs To Vulnerable Groups Totals 261,658 542,169 460,007 134,716 66,298 4,052 3,100 208,166 Totals Phase One Phase Two Total NFM Total 2018 Total 2019 Jan-Mar 20 (Q9 GFNP) Apr-Jun 20 (Q10 GFNP) TOTAL GFNP Total Prog Percentage Perecentage GFNP Antenatal 208,602 444,603 440,021 134,274 65,468 4,052 3,100 206,894 1,300,120 88.3% Schools 43,242 83,229 17,466 Prisons 4,656 4,253 2,047 Others 5,158 10,084 473 302 200 0 140 630 0 0 0 0 0 0 0 630 140 502 144,567 9.8% 11,096 0.8% 16,217 1,472,000 1.1% 0.2 100.0% 100.0 99.4 0.3 0.1 No Targets For Antenatal Nets As No Nets Supplied By GF In 2018 and 2019

PNG - MALARIA PROGRAMME LLIN DISTRIBUTION

PNG - MALARIA PROGRAMME LLIN DISTRIBUTION

PNG - MALARIA PROGRAMME LLIN DISTRIBUTION CONSTRAINTS Tribal Fights Unable to do one complete district (Dei in Western Highlands) and several other areas. Had to evacuate a RAM team from one fly in area in Enga due to disputes between local health staff an communities. Aircraft compnies closed down as pilots have evacuated the country. Covid 19 has delayed operations in some places with flights not available when you need them and quarantine in Enga Province.

PNG - MALARIA PROGRAMME HEALTH CENTRE SUPERVISION RAM programme now employs eleven Regional Malaria Coordinators (RMCs) and seven Provincial Malaria Supervisors (PMS) RMCs visit all accessible health facilities (not Aid Posts) on a quarterly basis. At each health facility the RMCs carry out the following: Supply RDTs, ACTs and Antenatal LLINs to a predetermined level. Ensure that RDTs, ACTS are fully accounted for. Monitor testing and treatment of malaria and train where necessary. Ensure that all cases of malaria are recorded and data submitted to the NHIS on time.

PNG - MALARIA PROGRAMME HEALTH CENTRE ISSUES Reporting to the National Health Information System (NHIS) is very slow. Communication with remote health centres extremely difficult and supplying commodities to these locations problematic. However, an electronic National Health Information System (ENHIS) will be installed in all health centres in the coming year and hopefully this will allow health data to be available more quickly. RAM will work with ENHIS to ensure that it is used properly.

PNG - MALARIA PROGRAMME HEALTH CENTRE ISSUES Estimated that 40-50% cases of malaria are not recorded. This has made quantification of ACTs and RDTs very difficult. It is estimated that Negative cases are often not recorded. Clinically diagnosed malaria cases often not recorded. Treatment from AID posts not included in many cases but Aid Post Kit Drugs also not included in the above 2019 Total Treatments Distributed Cases Recorded % Recorded As Treated RDTs 2,632,586 1,212,337 46.05 ACTs 1,713,840 823,342 48.04

PNG - MALARIA PROGRAMME DRUG DISTRIBUTION Since January 2019, RMCs have visited all provinces at least four times. 14 out of 22 provinces already visited six times. RAM is working very closely with the National Department of Health Supply Division. RAM is filling in stock shortages of ACTs and RDTs throughout PNG and has distributed both RDTs and ACTs from Global Fund and from government of PNG in a combined distribution.

PNG - MALARIA PROGRAMME DRUG DISTRIBUTION

PNG - MALARIA PROGRAMME DRUG DISTRIBUTION 2019 Logistics Team and RMC distribute malaria commodities from both Global Fund and NDoH. Drugs procured through Global Fund. Distribution in coordination with RMCs and AMSs. In 2020 all RDTs and ACTs for PNG procured through Global Fund using Global Fund funds. AMS RDT 168,900 101,375 572,625 247,425 223,375 1,313,700 1,185,005 128,695 1,318,886 2,632,586 AL6 62,760 3,000 97,410 32,250 58,410 253,830 128,995 124,835 61,890 315,720 AL12 55,050 25,950 135,630 23,640 81,930 322,200 191,513 130,687 153,180 475,380 AL18 19,650 11,010 109,350 46,560 66,450 253,020 121,358 131,662 88,620 341,640 AL24 57,840 31,890 139,680 57,210 37,980 324,600 172,405 152,195 256,500 581,100 Total ACT 195,300 71,850 482,070 159,660 244,770 1,153,650 614,271 539,379 560,190 1,713,840 PQ Badili Hagen Lae Kokopo Wewak NDoH Total NDoH Distributed by RAM Distributed by NDoH RAM/GF/PNGSDP Grand Total % Of Drugs Distributed By RAM 4,089,700 1,774,000 4,574,200 1,184,000 2,294,700 13,916,600 639,100 14,555,700 - - 95.1 60.5 72.5 61.5 73.8 68.5 4.4

PNG - MALARIA PROGRAMME DRUG DISTRIBUTION

PNG - MALARIA PROGRAMME RESEARCH RAM is managing finances of IMR and NDoH in five studies being supported by the Global Fund. IMR Stratification of malaria in PNG in 2018. Insecticide Resistance in 2018 and 2020. Net quality Malaria Indicator Survey in 2019 2020. NDoH Therapeutic Efficacy Studies of ACTs

PNG - MALARIA LLIN PROGRAMME Net Quality Bednets supplied before 2013 not as good as those supplied 2012 activity. This is believed to have had massive impacts on malaria in PNG

PNG - MALARIA PROGRAMME HOME MANAGEMENT OF MALARIA Program involved training Community Volunteers in remote areas in the testing and treatment of malaria. Home Management of Malaria (HMM) previously carried out in Sandaun (PSI), East Sepik (Save the Children) and East New Britain (Burnet Institute) from 2015 to 2017. Program abandoned in 2017 due to high cost. However continued in Sandaun by PHA which RAM supports. PHA HMM program like the one in Sandaun now being rolled out in 2020 Morobe, Madang, East Sepik, New Ireland, Central, Gulf and Milne Bay. Training already carried out in East Sepik (6), Madang (3), NIP (4), Morobe (6) and Central (5), Gulf (1), Milne Bay (4). To date 531 volunteers around the country trained

PNG - MALARIA PROGRAMME CHASING MALARIA PROGRAM Working closely alongside the NCD, Gulf and Central PHAs. Activities include: 1) Giving out nets to all malaria positive patients. 2) Map all positive cases. 3) Work with schools and communities for malaria education and create school clubs to destroy mosquito breeding sites. 4) Training school teachers in test and treating malaria and keeping them supplied with drugs 5) Support World Malaria Day 6) School malaria prevalence surveys

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA MAPPING IN NCD This map shows malaria cases in children in NCD. This suggests that malaria is still being transmitted in Kaugere.

PNG - MALARIA LLIN PROGRAMME SCHOOL PROGRAM RAM PNG started the first Community Program in 2012. Has worked in several areas but now works mainly in a high malaria area known as Kuriva. The objective of the programs is to involve communities and school children in malaria control activities. At this moment, the program concentrates on eleven schools, six of which are in Kuriva. Involves training teachers and school children in malaria and it control. School Malaria Clubs are created and children in the clubs are expected to go our once a week and look for mosquito breeding sites. Once the mosquito breeding sites are identified, mosquito breeding sites should be destroyed or controlled.

PNG - MALARIA LLIN PROGRAMME SCHOOL PROGRAM Problems include Schools tend to relax when RAM team is not there Snakes so buying gum boots Major problem is that community and school response are very good when RAM teams were around but tended to drop off when RAM staff were not there. Despite this, generally malaria in this area has reduced in the last two years. Chasing Malaria is also Supporting Home Management Of Malaria HMM to train community members and teachers in other parts of the province.

PNG - MALARIA LLIN PROGRAMME SCHOOL PROGRAM To strengthen the school program we are not jointly working with a NGO called the Skillz program which comes under the YWCA and works in schools. Skills has a good but limited school malaria program and we are jointly creating a new curriculum for Skills to carry out the same type of work which Chasing Malaria has developed. We are hoping this approach will give more sustainability into the school program so that it will continue in schools whether RAM of Skillz program is there/

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA School And Community Involvement

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA Community Involvement

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA School Program TRAINING PRIMARYSCHOOL TEACHERS IN KURIVA CENTRAL PROVINCE IN APRIL 2019 April 2019 - 13 teachers trained in testing and treating malaria.

PNG - MALARIA LLIN PROGRAMME WORLD MALARIA DAY PREVALENCE SURVEYS School Prevalence Surveys Initiated On World Malaria Day in Kuriva in 2018 Central Province showed very high prevalence rates Row Labels Berere Brown River Doromoku Kerea Vanapa Grand Total Neg 14 77 33 83 74 281 Pf 9 17 4 20 16 66 Non Pf Mixed Tested Positivity 39 144 46 123 132 484 8 8 64.1 46.5 28.3 32.5 43.9 41.9 26 6 10 20 70 24 3 10 22 67

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA Private Sector Sale Of Nets RAM had engaged a salesman in 2014 and 2015 to sell nets around Port Moresby. Revenue from his sales supported his salary. Salesman left and as nets in supply chain were few this project was abandoned. It is hoped that this will now be resurrected. We would like to have a target of LLINs being sold in every district capital in PNG so that people can replace their nets when they wear out early. New nets just arriving shortly in PNG

PNG - MALARIA PROGRAMME The Malaria Challenge Annual Malaria Incidence Of Suspected Malaria Cases Clinical Diagnosed And Those Tested

PNG - MALARIA PROGRAMME MALARIA INCIDENCE Malaria increasing in some parts of PNG but not in all areas

PNG - MALARIA PROGRAMME FUTURE CHALLENGES OUR MAJOR CHALLENGE IS TO REVERSE THE PRESENT MALARIA TREND Need to find a good LLIN. It seems that the quality is very variable despite they all being categorized as equal. Other challenge is to improve all aspects of malaria program. It is hoped that we can at least eliminate malaria from one part of PNG such as Bougainville

PNG - MALARIA LLIN PROGRAMME Next Steps (3) Initial Data From Chasing Malaria Project Showing Malaria Cases Recorded In NCD and Hiri and Kairuku District Of Central Province The Realities Of Distributing Nets In PMG