On January 2011, the National Malaria Control Programme (NMCP) submitted the Ministry of Health (MoH) and Government the draft of the National Strategy for Malaria Control and Elimination period 2011 - 2020 and vision to 2030. The Vietnamese full text of the draft has been published on the Government Web Portal (www.chinhphu.vn) to collect people's suggestions before being approved by the Prime Minister. We would like to publish the main contents and action plans of the Strategy, so that all readers interested in malaria control know and contribute ideas to this draft.
To actively control malaria in the moderate and highly endemic areas. To eliminate malaria in areas where the disease has been reduced to low level for many years. By 2020, malaria morbidity will be below 0.15/1,000 population and malaria mortality below 0.02/100,000 population; and malaria will be eliminated in at least 40 provinces, contributing to the health care of the population and to the cause of culture and economic development of the country.
1) To ensure that all people have better access to early diagnosis and prompt and effective treatment at the public and private health facilities.
2) To ensure the full coverage for people at risk of malaria by appropriate malaria control measures.
3) To enhance the use of malaria control services and increase the community mobilization and participation in malaria control through IEC (Information, Education and Communication) activities.
4) To improve the malaria epidemiological surveillance system and ensure sufficient capacity to malaria epidemic responses.
5) To eliminate malaria in the districts and provinces with low malaria endemicity.
1. Ensure that all people have better access to early diagnosis, prompt and effective treatment of malaria at the public and private health facilities.
- 90% of malaria clinical cases (suspected malaria) in the malaria endemic area to have blood slides taken for malaria examination by 2015 and 95% by 2020
- 95% of P.falciparum cases to receive treatment with highly effective antimalarial combination therapy by 2015 and 98% by 2020.
- 95% of malaria cases to receive accurate and proper treatment according to the treatment guideline issued the MoH by 2015 and 98% by 2020.
2. Ensure the full coverage of people at risk of malaria by appropriate malaria control measures.
- Households in the moderate and highly-endemic areas to get enough bed-nets for malaria control (averaged two people/double net) by 2015. - More than 90% of the existing bednets in the malaria endemic areas to be retreated by 2015 and 95% by 2020 (vs. 83.0% in 2010). - Above 90%of households in the insecticidal spraying designated areas to receive IRS (indoor residual spraying) by 2015 and 95% by 2020. - The number of highly-endemic malaria communes to reduce by 30% by 2015 and 60% by 2020 as compared with that in 2009 (325 communes). - The number of moderate and low malaria endemic communes to reduce by 30% and 60% by 2015 and 2020, respectively as compared with that in 2009 (734 moderate and 1,598 low malaria endemic communes). - By 2015, 85% of people at high risk of malaria (going to and staying overnight in the forest for cultivation) to apply malaria control measures (use of ITNs and other methods for personnal protection), and 95% by 2020.
- Households in the moderate and highly-endemic areas to get enough bed-nets for malaria control (averaged two people/double net) by 2015.
- More than 90% of the existing bednets in the malaria endemic areas to be retreated by 2015 and 95% by 2020 (vs. 83.0% in 2010).
- Above 90%of households in the insecticidal spraying designated areas to receive IRS (indoor residual spraying) by 2015 and 95% by 2020.
- The number of highly-endemic malaria communes to reduce by 30% by 2015 and 60% by 2020 as compared with that in 2009 (325 communes).
- The number of moderate and low malaria endemic communes to reduce by 30% and 60% by 2015 and 2020, respectively as compared with that in 2009 (734 moderate and 1,598 low malaria endemic communes).
- By 2015, 85% of people at high risk of malaria (going to and staying overnight in the forest for cultivation) to apply malaria control measures (use of ITNs and other methods for personnal protection), and 95% by 2020.
3. Enhance the use of malaria control services and mobilize the community participation in malaria control through IEC activities.
- More than 95% of population in the malaria endemic areas can recall at least 4 main messages of malaria control and malaria elimination by 2015 and 98% by 2020 (vs. 89.4% in 2009).
4. Improve the malaria epidemiological surveillance system and ensure sufficient capacity to malaria epidemic response.
- By 2015, more than 95% of villages (and hamlets) to have village health workers for malaria control (vs. 92% in 2009).
- Malaria outbreaks to be detected within 2 weeks of its onset and intervention measures to be carried out within 1 week after being informed/reported.
- No big malaria outbreaks to occur.
5. Eliminate malaria in the districts and provinces with low malaria endemicity.
- By 2015, there will be at least 16 provinces confirmed with malaria elimination, 24 provinces to reach the criteria of malaria elimination phase and 10 provinces reach the criteria of pre-elimination phase (Annex 10).
- By 2020, there will be at least 40 provinces confirmed with malaria elimination, 15 provinces to reach the criteria of malaria elimination and to implement the prevention of malaria re-establishment, and 8 remaining provinces will be at the malaria pre-elimination and elimination phases.
MALARIA EPIDEMIOLOGICAL STRATIFICATION FOR INTERVENTION IN CENTRAL VIETNAM
Solutions for Implementation
a) Strengthen the direction, coordination of the authorities at various levels in the implementation of malaria control and malaria elimination.
- The Government provides guidance and considers malaria control and malaria elimination as one of the annual tasks of the socio-economic development; and gives direction to the Ministries and Government Agencies, People's Committees at various levels to actively carry out the malaria control and malaria elimination measures.
- The People's Committees at various levels regularly participate in the coordination and implementation of malaria control and elimination activities and consider them as one of the socio-economic development tasks of the locality. Integrating the malaria control and malaria elimination programme into the poverty and hunger elimination programme; prioritizing to the remote and disadvantaged areas.
- The Government and the People's Committees at various levels ensure adequate budgets, human resources and materials, and strengthen the organization aparatus for malaria control and malaria elimination.
- Strengthen the existing organization system from central to commune/village levels for malaria control and elimination, especially the commune and village health networks.To link the malaria control and elimination with the management and coordination functions of the authority at each level.
- Priority of budget and materials is given to the malaria high endemic areas as the southern and
- Training and re-training for health staff at different levels to upgrade their technical knowledge and skills on programme management, monitoring and evaluation on malaria control.
- Issue guidelines, regulations and training document on malaria elimination programme. To update and revise the guidelines for implementation of malaria control from central to commune levels.
- Apply the computerized malaria information system (MIS) for management, monitoring and evaluation of the programme.
Solutions for human resources
- Concentrate in developing, consolidating and sustaining the primary health care network, especially the commune and village levels in the remote and border areas by ensuring the quantity and qualified staff for malaria control and malaria management in the locality.
- Strengthen the training and re-training for malaria staff at all levels, especially for village, commune health workers and the newly replaced ones in order to ensure the quality and the effectiveness of malaria control and malaria elimination activities.
- More investments and human resources for malaria control and elimination, especially the specialized staff in charge of programme management and implementation, special attention is given to the commune and village health workers.
- Improve the working facilities with sufficient supplies and equipment of the Provincial Centres for Malaria Control, the Malaria Department of the Provincial Centres for Preventive Medicine and NIMPE/IMPEs.
Solutions for investment
a) The Government continues to provide budget for malaria control and elimination according to the decentralization of the State Budget Law, in accordance with the capacity and the social economic development conditions of the country in each period.
b) Mobilize the international supports for malaria control and elimination by developing proposals/applications, training and research projects with other countries and WHO. Effective use of the budget resources forright objectives.
c) Priority of budgets is given to malaria endemic areas such as the Central Highland, the South Eastern Vietnam, central and border provinces, the state economic development projects in the malaria endemic areas.
Solutions for IEC
- Promote IEC activities on malaria control and elimination by appropriate mass-media, especially the direct communication. Against the subjectivism and neglect of malaria control in thelow reduced malaria areas.
- Good cooperation with the related sectors and branches (Women andYouth Unions, Veteran, Farmer Red cross associations, village leaders...) in IEC activities for malaria control and elimination especially in the high and moderate malaria endemic areas.
- Mobilize the people to participate in the malaria control and elimination, to buy the bednets and to use the bednets at home and at the temporary huts in the forest for the protection of them selves and their family from malaria.
- Comprehensive behaviour change communication on malaria control and elimination for school children and pupils through cirricular and extracirricular training schedules.
- At the malaria elimination areas: IEC campaign is carried out for local authorities, health staff, school teachers and communitiesto improve their knowledge and behavior change on malaria elimination, on its different phases and measures for malaria elimination and prevention of malaria re-establishment.
a) Vector control measures for reducing malaria morbidity
- Carry out the malaria epidemiological stratification every 5 years in order to concentrate the resources for the high malaria endemic areas and to apply appropriate malaria control measures suitable with each region.
- Conduct vector surveillance on their density and distribution. Monitor the insecticide resistant vectors and the restore of vector density.
- Maintain the vector control measures by using high effect insecticides for residual spraying and bednet impregnation, and the LLINs. Apply special (combined) measures for mosquito control (twice a year) in the high malaria endemic areas where malaria morbidity is slowly reduced and unstable.
- Provide free of charge LLINs and LLINs with hammocks to the people living in the areas with artemisinin resistance, at high risk of artemisinin resistant transmission, high and moderate malaria endemicity; and poor people in the low malaria endemic areas. To mobilize the people to buy the bednets themselves and use the bednets regularly.
- Combined mosquito control measures are applied in the areas with artemisinin resistance and at high risk of artemisinin resistant malaria transmision: IRS once a year + ITNs twice a year (when LLINs are not yet available).
- Study on appropriate and high effective vector control measures, particularly for the high malaria endemic and slow reduced malaria areas, the artemisinin resistant and high risk of artemisinin resistant transmission areas.
- Integration of the vector control management (IVM).
- At the malaria elimination areas: main vector control measure is insecticide residual spraying at the foci to interrupt the malaria transmision locally (no local/indigenous malaria cases).
b) Case detection/diagnosis and treatment
- Early case detection, diagnosis, prompt and proper treatment in accordance with the national guidelines of the MOH.
- Application and update of the national guidelines on diagnosis and treatment of malaria every 2 years according to WHO guidelines or practical treatment of malaria in Vietnam.
- Improve the capacity for health staff at the health facilities on diagnosis and treatment of malaria: Training and re-training for health staff at all levels, adequate supplies and equipment for diagnosis and treatment such as microscope, RDTs and national treatment guideline booklets…
- Prevent severe and complicated malaria by early diagnosis and promtp treatment of severe malaria to reduce malaria deaths.
- Develop and sustain the communal microscopic points for early diagnosis and treatment of malaria. Use rapid diagnostic test (RDTs) for case detection in the high malaria endemic and remote communes, the mountainous villages far from the commune health centers (CHCs) and where microscopy is not yet available.
- Ensure sufficient provision of high effectice antimalarial drugs, artemisinin combined therapy and other antimalarial drugsfor all levels, particularly the commune and village levels.
- For the areas with artemisinin resistance and at high risk of artemisinin resistant transmission:
· Develop and maintain the sentinel sites for monitoring of drug resistance. Adequate provision of anti-resistant drugs and RDTs for VHWs, CHWs, the district and provincial hospitals.
· Ensure parasite clearance and radical treatments for malaria patients with anti-resistant drugs by application of direct observation treatment method (DOT). Treatment follow-up is taken by blood slide/RDT examinations.
- Carry out researches on new antimalarial drugs and high effective treatment schedules. Monitor regularly drug resistant parasites at the sentinel sites and in the laboratory.
- For the malaria elimination areas: management of population movement (people coming back from malaria endemic areas), close management and follow-up of malaria cases; active case detection is carried out when there is an imported malaria case.Strengthen case management in the hospitals as well as in the community including radical treatment to prevent the local re-establishment of malaria.
c) Programme monitoring and evaluation.
- Build up and strengthen the M&E system from central to grass-root levels strong enough to meet the needs of the NMCP, regional and international requirements.
- Develop the procedures and guidelines on M&E for different levels and improve the capacity for M&E staff at all levels.
- Carry out programme evaluation and malaria epidemiological stratification every 5 year implementation of the programe workplan.
- Organize review meeting every year and every 5 years to evaluate the effectiveness of the programme, to withdraw experiences and lessons learned and to set realistic targets and detailed workplan for the next year to ensure the progress of the approved plan.
- At the malaria elimination areas: Carry out training and supervisions on the implementation of the malaria elimination measures from central to commune and village levels. Ensure good supervision, correct statistic and reporting of each case.
d) Scientific researches
- Identify research priorities towards the development of basic, operational and evaluation researches for the malaria control and elimination programme.
- Priority is given to the research on drug resistant mechanism, artemisinin resistant containment and insecticide resistance, study on appropriate malaria control measures for migrant people, seasonal workers and people involved in swidden field for agriculture, border malaria and malaria elimination.
- Research on new high effective antimalarial drugs. Strengthen the supervision and management of the drug quality, particularly at private sector to ensure the Vietnam standard quality of the drugs used.
- Enhance the technical transfer and exchange of experieces and expert training with the cooperative institutions.
- Organize periodically scientific meetings to share experiences and to public the results of researches and to apply them in the malaria control.
Socialization of malaria control/elimination
The People's Committees at various levels provide directions and promote the inter-sector cooperation and community at the locality to participate actively in the malaria control and elimination activities:
- High socialization of malaria control and elimination, mobilization of all sectors, organizations, communities, private health practitioners and individuals to involve in the malaria control and elimination.
- Encourage the social-political organizations, community groups to take part in IEC activities for malaria control and elimination.
- Raise the sence of initiative of the community to participate actively in the malaria control and elimination activities: sleep in the bednets regularly, come to the health centre when getting fever, enviromental sanitation...
- Mobilize the private health practitioners involving in IEC activities and in malaria diagnosis and treatmentat the community by providing them with RDTs and antimalarial drugs (under control) and requesting them to send report monthly to the health sector.
- The specialized agency in the province informs the bussiness enterprises and factories, construction sites, state farms and plantations in the locality to actively carry out the malaria control measures for protection of their workers.
Health staff educating local people on how to prevent malaria.
Health staff educating local people on how to prevent malaria.
The action plans of the National Strategy for Malaria Control and Elimination will be implemeted simultaneously and integrated with each other in each stage of the five-year plan:
1. Plan of health communication and education on malaria prevention and elimination, to help all authorities, organizations and communities understand the strategy of malaria elimination better, direct and implement measures of containing and eliminating malaria.
2. Plan of malaria epidemiological stratification for intervention and effectiveness evaluation of malaria control and elimination programme, will be implemented nationwide for assessing the quality and effectiveness of the National Strategy of Malaria Prevention and Elimination, periodically determining the risk of malaria in each stage, thereby applying appropriate and highly-effective measures in carrying outthe strategic objectives.
3. Plan of prevention and stop of the transmission of malaria parasites resistant to artemisinin and its derivatives, will be implemented in areas with the existence of drug-resistant malaria parasites to minimize the development and rate of drug resistance as well as spread of malaria parasites to other areas nationwide; a technical difficulty can have a great influence on the effectiveness of the strategy.