ROLL BACK MALARIA

INITIATIVE
PAKISTAN

- Epidemiological Profile
- Specific Interventions/

Malaria cases/1000
population, 2001

NWFP

API/1000
POPULATION
Red
8-27
Yellow 1-8
Green 0-1

FATA
PUNJAB
BALOCHISTAN
N

SINDH

E
S

Falciparum as % of
all malaria cases, 2001

NWFP

Falciparum %
Orange 40-85 %
Pink 8-40 %
Green 1-8 %

FATA
PUNJAB
BALOCHISTAN
N

SINDH

E
S

Annual Parasite Incidence (API/1000)

from 1997 - 2001
6
5

1997

1998

1999

2000

2001

4
3
2
1
0
1997
1998
1999
2000
2001

Punjab

Sindh

0.33
0.21
0.17
0.18
0.17

0.54
0.54
0.69
0.71
0.64

NWFP & FATA Baluchistan

1.11
1.21
1.37
1.55
1.5

2.24
2.53
4
5.74
4.99

PAKISTAN
0.6
0.56
0.56
0.81
0.72

Percentage of Plasmodium Falciparum

from 1997 - 2001
70

1997

60

1998

1999

2000

2001

50
40
30
20
10
0
1997
1998
1999
2000
2001

Punjab

Sindh

28.8
25.1
24.2
21.9
26.2

63.7
63.8
62.1
57.3
49.9

NWFP & FATA Baluchistan

17.1
22.9
24.2
23.4
21.9

29.6
29.2
24.8
32
37.4

PAKISTAN
32.6
33.9
33.1
33.2
33.8

Annual Parasite Incidence (API) in 2001

6

API /1000

5
4
3
2
1
0
API /1000

Punjab
0.17

Sindh
0.64

NWFP & FATA

1.5

Baluchistan
4.99

PAKISTAN
0.72

Percentage of Plasmodium Falciparum &

Plasmodium Vivax in 2001
100

% Falciparum

% Vivax

80
60
40
20
0
% Falciparum
% Vivax

Punjab
26.2
73.8

Sindh
49.9
50.1

NWFP & FATA

21.9
78.1

Baluchistan
37.4
62.6

PAKISTAN
33.8
66.2

RBM INTERVENTIONS

Diagnosis
Treatment

and prompt access to treatment

Guidelines updated

Situation

analysis of district level facilities for

diagnosis and treatment of malaria

PHC

system being strengthened for malaria care

Passive

case detection (PCD) with limited ACD

INTEGRATED VECTOR CONTROL

APPROACH

Focal residual spray with insecticides

ITN promotion through public-private partnership

20,000 ITNs (WHO), 10,000 (GoP) for

implementation

Larval control through larviciding and source

reduction

Monitoring of vector resistance to insecticides

OPERATIONAL RESEARCH
Research institutions (PMRC, NIH, IPH, HSA, HNI
etc.) are being involved in programme research
Completed:
Drug resistance studies in 12 districts
Impact of ITNs on malaria transmission (ITN impact
significant of P. falciparum)
In-Process:
Studies on community perceptions and private
sector potential for malaria control
Role of A. stephensi in malaria transmission

PARNERSHIP DEVELOPMENT
Enhanced coordination with health programs
including TB, AIDS, LHW
Coordination initiated with agriculture, irrigation etc.

Non-government partners involved in program

activities
Partnership with international and bilateral agencies
including WHO, WB, DFID, overseas institutions.

RESOURCE MOBILIZATION
Government:
Rs: 235 million (3.9 m $) allocated
Rs: 106 million (1.8 m $) additional allocation for
current year

Others:
US$ 88,000 through WHO, JPRM
US$ 2.6 million requested from GFATM

Capacity Building/ Advocacy and

Communication
Revitalization of the former NIMRT
Establishment of federal reference laboratory
Strengthening of quality control network in
provinces
Establishment of Information Resource Center
250 Microscopists and 25 District level
Entomologist trained
National plan for advocacy and education
developed
Advocacy and mass awareness activities started

PROGRESS

National strategic plan drafted

Provincial PC-1s developed, in process of

approval.

Technical assistance priorities

identified/documented

National Scientific Committee & Technical

Workgroup in place

TV spots, video material, and radio

messages & press material for mass
awareness developed

CHALLENGES

Devolution and district capacity for malaria

control

Operational guidelines

Training materials for care providers and

managers

Strengthening of surveillance system

Public-private partnership

Private Sector Involvement in

Struggle against Malaria in Pakistan

Private sector comprises NGOs & private practitioners

Only about 20% patients visit public sector facility

National Health Policy emphasizes the partnership with

private sector in health care delivery and development.

Non-government sector has complementary strengths:

Research and development
Community mobilization

Expertise in specialized field such as anthropology

health economics, training material development etc.

Private Sector Involvement

Initiatives

NGOs involved in programme development, care delivery & implementation of

preventive measures:

Strategic and programme planning (HNI - ASD)

Development of technical & operat. guidelines (ASD)

Development of training materials (HNI - ASD)

Delivery of malaria care in emergency situation (HNI)

Improved case management through capacity building (HNI GoP)

Improved surveillance and record maintenance systems ( HNI HMIS GoP)

Private Sector Involvement

Initiatives

Promotion of ITNs through Rural Support Network:

A nationwide chain of rural support programs (RSP)

non-government organizations working through CBOs

CBOs are trained to plan, run and manage micro-credit

and other development work on self-help basis

RSPs can support CBOs to promote ITN use in villages

Private Sector Involvement

Initiatives

Small scale research on ITN promotion done (HNI ASD)

A project concept has been agreed

Detailed mechanisms are being developed

Implementation of agreed mechanisms would start in May

2002.

Scaling up of ITNs, in light of early implementation

experience of HNI in the region