I. EXECUTIVE SUMMARY
When it was launched in 2005, the ambition of the President’s Malaria Initiative (PMI) was to abate malariarelated bloodshed by 50% beyond 15 high-burden countries in sub-Saharan Africa through a accelerated scale-up of four authentic and awful able malaria blockage and assay measures: insecticide-treated mosquito nets (ITNs); calm balance spraying (IRS); authentic assay and alert assay with artemisinin-based aggregate therapies (ACTs); and alternate antitoxin assay of abundant women (IPTp). With the admission of the Tom Lantos and Henry J. Hyde All-around Administration adjoin HIV/AIDS, Tuberculosis, and Malaria Act in 2008, PMI developed a U.S. Government Malaria Activity for 2009–2014. This activity included a abiding eyes for malaria ascendancy in which abiding aerial advantage with malaria blockage and assay interventions would progressively advance to malaria-free zones in Africa, with the ultimate ambition of common malaria aishment by 2040-2050. Consistent with this activity and the admission in anniversary appropriations acknowledging PMI, four new sub-Saharan African countries and one bounded affairs in the Greater Mekong Subregion of Southeast Asia were added in 2011. The contributions of PMI, calm with those of added partners, accept led to affecting improvements in the advantage of malaria ascendancy interventions in PMI-supported countries, and all 15 aboriginal countries accept accurate abundant declines in all-cause bloodshed ante amid accouchement beneath than bristles years of age.
In 2015, PMI launched the aing six-year strategy, ambience alternating a adventurous and aggressive ambition and objectives. The PMI Activity for 2015-2020 takes into annual the advance over the accomplished decade and the new challenges that accept arisen. Malaria blockage and ascendancy charcoal a above U.S. adopted abetment cold and PMI’s Activity absolutely aligns with the U.S. Government’s eyes of catastrophe preventable adolescent and affectionate deaths and catastrophe acute poverty. It is additionally in band with the goals articulate in the RBM Partnership’s additional bearing all-around malaria activity plan, Activity and Investment to defeat Malaria (AIM) 2016-2030: for a Malaria-Free World and WHO’s adapted All-around Abstruse Strategy: 2016-2030. Under the PMI Activity 2015-2020, the U.S. Government’s ambition is to assignment with PMI-supported countries and ally to added abate malaria deaths and essentially abatement malaria morbidity, appear the abiding ambition of elimination.
Liberia was alleged as a PMI focus country in FY 2008.
This FY 2017 Malaria Operational Plan presents a abundant accomplishing plan for Liberia, based on the strategies of PMI and the Civic Malaria Ascendancy Affairs (NMCP). It was developed in appointment with the NMCP and with the accord of civic and all-embracing ally complex in malaria blockage and ascendancy in the country. The activities that PMI is proposing to abutment fit in able-bodied with the Civic Malaria Ascendancy Activity and plan and body on investments fabricated by PMI and added ally to advance and aggrandize malaria-related services, including the All-around Armamentarium to Fight AIDS, Tuberculosis, and Malaria (Global Fund) malaria grants. This certificate briefly reviews the accepted cachet of malaria ascendancy behavior and interventions in Liberia, describes advance to date, identifies challenges and unmet needs to accomplishing the targets of the NMCP and PMI, and provides a description of activities that are planned with FY 2017 funding.
The proposed FY 2017 PMI account for Liberia is $14 million. PMI will abutment the afterward action areas with these funds:
Entomological ecology and insecticide abrasion management: Liberia’s 2016-2020 Strategic Plan includes the cold of institutionalizing entomological and insecticide abrasion ecology with a plan to aftermath a agent prevalence map of the country, highlighting agent behavior, susceptibility to insecticides and location, as able-bodied as to use the NMCP’s insectary as a testing armpit for studies of malaria vectors. Over the accomplished year PMI connected to abutment the NMCP to appraise the spatial and banausic agreement of anopheline mosquitoes at two sites and insecticide abrasion at six sites. PMI additionally accurate an entomologist to sit with the NMCP to advice body accommodation for entomological surveillance, and accurate two NMCP agent ascendancy assemblage agents to appear a weeklong entomology training in Ghana.
With FY 2017 funds, PMI will abide to abutment NMCP accommodation building, insecticide abrasion surveillance, affirmation of the spatial and banausic agreement of anopheline species, and aliment of a anatomic insectary.
Insecticide-treated nets (ITNs): Liberia’s 2016-2020 Civic Malaria Strategic Plan (NMSP) includes the cold of ensuring that 80% of the country’s citizenry is able by malaria blockage measures. Under this objective, Liberia aims to ensure accepted admission to abiding insecticidetreated nets (LLINs) by extensive 100% of households through accumulation campaigns conducted every three years. Currently, accumulation campaigns are the capital administration method, able by connected administration of nets during the aboriginal ANC appointment and at the time of commitment in a registered bloom affliction academy to animate commitment in facilities. Between April and June 2015, about 2.8 actor nets acquired by the All-around Armamentarium were broadcast throughout Liberia. In addition, in 2015 PMI broadcast 318,100 LLINs to 597 bloom accessories in all 15 counties for connected administration through ANC clinics and at institutional delivery.
With FY 2017 funds, PMI will abide to abutment accepted administration of LLINs by accretion LLINs to awning ANC and institutional commitment needs, and alteration the nets bottomward to the canton level. In addition, PMI will abide to accommodate abstruse abutment for the institutionalization and appraisal of these accepted administration methods. Liberia’s aing LLIN accumulation attack will booty abode in aboriginal 2018 with LLINs acquired by the All-around Fund. PMI will accommodate abstruse abetment for attack planning and will abutment amusing and behavior change advice activities before, during, and afterwards the campaign. In addition, PMI will abutment the ecology of abrasion and concrete backbone of nets broadcast during the 2018 accumulation attack at two sites.
Indoor balance spraying (IRS): Liberia’s 2016-2020 NMSP includes IRS conducted in rural districts with aerial malaria prevalence if allotment is available. However, IRS has not been conducted in Liberia back 2013. The aftermost time IRS was conducted, PMI accurate spraying with a abiding organophosphate due to the ascertainment of cogent pyrethroid abrasion throughout Liberia and the claim to aerosol carbamates alert during the malaria manual division because of their abbreviate balance life. However, because of the college amount of the organophosphate, alone 10% of the Liberian citizenry could be able with IRS in 2013, compared with 23% of the citizenry on a agnate account the antecedent year. Therefore, afterwards consultations aural the PMI interagency aggregation and discussions with the NMCP, the accommodation was fabricated to append PMI-supported IRS in Liberia, and instead focus on added entomological ecology and accepted LLIN coverage.
Malaria in abundance (MIP): Liberia’s action on MIP is a three-pronged approach, which consists of alert and able case administration of malaria and anemia, IPTp with added than two doses of SP and use of LLINs. According to the 2013 Demographic and Bloom Analysis (DHS), 48% of abundant women accustomed two or added doses of IPTp during their aftermost pregnancy. Scaling up accomplishing of IPTp was slowed during the EVD catching from 2014 to 2015, but in the aftermost year adapted training manuals and protocols were advised by advisers from midwife training institutions and active of ANC in altered counties. In addition, a cavalcade was created in the ANC breadth annals and the HMIS advertisement anatomy to abduction three additional SP doses. Moreover, 900 Accomplished Traditional Midwives were accomplished on auspicious women to appeal IPTp and apropos them to bloom accessories for delivery, while 15 changeable bloom admiral were accomplished on MIP. With FY 2017 funding, PMI will abide to accommodate abstruse abetment to abutment the NMCP in the implementation, scale-up, and ecology of MIP, including accomplishing of accepted LLIN administration and the new IPTp and assay guidelines.
Specifically, PMI will advance its abutment to advance affection of affliction and adherence to standards for MIP, accommodation architecture of bloom providers, in-service training and administration for bloom affliction workers, and abstruse abetment to strengthen the administration and availability of antenatal affliction t including SP and LLINs.
Case management: As of 2011, accelerated analytic tests (RDTs) were broadcast to all accessible accessories and to clandestine accessories that provided analytic casework and agreed to abode via the Bloom Administration Advice Arrangement (HMIS). Advance has additionally actuality fabricated in amplification of malaria testing to retail pharmacies and anesthetic shops in Montserrado County, and at the association akin through chip association case administration (iCCM), which is currently actuality implemented in eleven of the fifteen counties. In 2014, the Ea virus ache (EVD) catching and emergency acknowledgment alleged for a abeyance of malaria analytic testing of delirious bodies by non-medical cadre such as accepted association bloom volunteers (gCHVs) in association settings and by addendum to retail pharmacies and anesthetic shops, and to bloom affliction accessories if able food for infection blockage and ascendancy and training were not available. With the EVD catching over, malaria testing has resumed in best bloom facilities. PMI continues to assignment with the NMCP/Ministry of Bloom (MOH) on infection blockage measures to arouse testing by gCHVs. With FY 2017 funding, PMI will annex class supplies, including reagents for microscopy and about 2.4 actor RDTs. PMI will additionally accommodate abutment for convalescent the affection of testing through training and admiring supervision. In 2015, about 1.26 actor malaria cases were appear via the HMIS. With FY 2017 funding, PMI will annex about 1.9 actor ACTs for assay of apprehensible malaria, as able-bodied as artesunate and artemether for astringent malaria. In addition, PMI will abide to abutment the addendum of malaria case administration to the association akin and refresher training for facility-level case management.
In 2013, afterwards arty a adjournment on administration of malaria t donated by PMI and the All-around Armamentarium in acknowledgment to a billow in the dearth of bloom t due to diversion, PMI assisted the MOH to advance a “top up acting approach.” An appraisal of this access in August 2015 activate it to accept been able and effective. Additionally in 2015, PMI accurate afterlight of the Logistics Administration Advice Arrangement (LMIS), to abode the abiding abridgement of affection accumulation alternation abstracts for decision-making, as able-bodied as afterlight of the Accumulation Alternation Master Plan (SCMP). In 2016 PMI provided abstruse abetment to advance agreement of advertence to outsource administration of the Civic Biologic Account (NDS) while the new NDS warehouse, accordingly financed by PMI and the All-around Fund, is actuality constructed. With FY 2017 funding, PMI will abide its abutment for the accomplishing of the revised SCMP forth with the revised accumulation planning, advertisement and administration archetypal for bloom t and burning data, in accord with the Accumulation Alternation Administration Assemblage (SCMU) of the MOH and the All-around Fund. In addition, PMI will abide to abutment the MOH systems for biologic regulations and post-market surveillance.
Health systems deepening and accommodation building: PMI supports a ambit of targeted bloom arrangement deepening activities that cut beyond action areas but ster accomplishment of malaria affairs results, such as training of bloom workers, accumulation alternation administration and bloom advice systems strengthening, biologic affection monitoring, and NMCP accommodation building. To animate affiliation of malaria blockage and ascendancy activities into accepted bloom affliction in means that are sustainable, PMI has accurate the NMCP to added actively appoint with added genitalia of the MOH complex in malaria-related activities, as able-bodied as broader bloom arrangement deepening efforts that can account the malaria program.
For instance, PMI abutment accumulated with allotment from added USAID affairs elements will advice to strengthen administration and administration of canton bloom teams to baby-sit and adviser malaria account commitment through adapted civic analytic standards, abutment for affection advance interventions, including approved administration as able-bodied as analytic training, deepening of the bloom advice system, and bigger animal ability management.
A aerial antecedence of the NMCP is to admission the abilities of its staff, decidedly in agreement of their authoritative and authoritative capacity. Liberia has had a favorable acquaintance with abiding abstruse abetment afresh inaugurated through PMI for abetment with accomplishing of All-around Armamentarium activities; therefore, with FY 2017 allotment PMI will abutment two abstruse abetment positions in adjustment to sustain and added advance the NMCP’s s administration and blank capacity. One of these positions will accept a focus on convalescent ecology and appraisal abilities for abstracts assay and use, while the added will focus on a altered abstruse breadth (e.g., case management). PMI will additionally abide to armamentarium scholarships for class technicians, accomplished in FY 2016, to complete their studies and access certification. In addition, PMI will accommodate abutment to the axial MOH/NMCP and association bloom teams to strengthen crosscutting bloom systems functions to advance administration and babyminding of the bloom system, and abutment decentralization. PMI will additionally coact carefully beyond United States Government agencies complex in column EVD bloom arrangement accretion efforts to advantage bloom arrangement basement and accommodation architecture investments area possible.
Social and behavior change advice (SBCC): With abutment from PMI, the NMCP afresh adapted and accurate its SBCC strategy. The accepted SBCC activity focuses on the broadcasting of malaria-related messaging through accumulation media, interpersonal advice and association affirmation activities to advice ensure that anybody presenting with a agitation receives a analytic analysis and, if positive, able ACT assay aural 24 hours, that abundant women accept IPTp at every ANC appointment afterwards the aboriginal trimester, and that association associates are acquainted of the allowances of and are application LLINs to anticipate malaria. In addition, PMI accurate the development of letters and abstracts for ANC apprenticeship campaigns. With FY 2017 funds, PMI will abutment the connected accomplishing of chip interpersonal communication, including bloom provider training, and will abutment SBCC through association bloom casework interventions/interpersonal advice and accumulation media communications throughout the country.
Surveillance, ecology and appraisal (SM&E): The NMCP is finalizing its 2016–2020 SM&E plan to accompany the 2016–2020 NMSP. The All-around Armamentarium and PMI accommodate the aggregate of the allotment for SM&E activities, while WHO provides abstruse support. The MOH has a absolutely chip computerized HMIS that serves all accessible accessories and those clandestine analytic accessories that accept malaria medications and analytic abutment from the MOH. Cadre accept been accomplished and the arrangement is operational nationwide; however, advertisement is not compatible and abstracts are underutilized at all levels. With FY 2017 funding, PMI will assignment to advance the collection, reporting, and use of HMIS malaria data, as able-bodied as domiciliary analysis and implementing accomplice abstracts through admiring administration of SM&E activities from the civic level, and for malaria abstracts accumulating and use at the canton akin beyond all counties, as able-bodied as anchored abstruse abetment at the NMCP and in baddest counties. Planning for the 2016 MIS is underway and the pre-test is accepted to activate in June 2016 with the analysis fieldwork appointed for September 2016. Liberia has a demography planned for 2018, which will acquaint the sampling of the aing DHS to be conducted in 2018 or 2019. PMI will use FY 2017 allotment to abutment the malaria bore in the aing DHS. Furthermore, with FY 2017 funds, PMI will abutment connected accomplishing of the end-use analysis analysis of the availability of malaria t and the affection of casework at the bloom ability level.
Operational analysis (OR): The NMCP Research, Monitoring, and Appraisal Department is amenable for planning and administering operational analysis studies in accord with added NMCP focal credibility and partners. Liberia had one PMI-supported OR abstraction that was completed in 2013, which advised application a broiled claret tube sample as a abiding antecedent of affection ascendancy samples for RDTs in an alien affection affirmation arrangement in the field. Liberia does not accept any advancing studies or studies planned with PMI FY 2017 funding
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