A Malaria Free Sri Lanka
Plan and implement a comprehensive programme to sustain intensive surveillance and outbreak preparedness, prevention and rapid response for malaria elimination in Sri Lanka and to prevent re-introduction of malaria to Sri Lanka
Objectives of the Anti Malaria Campaign
1. To sustain malaria free status by prevention of re-introduction of malaria to Sri Lanka.
2. To obtain WHO certification of malaria elimination in Sri Lanka by the end of 2016
3. To maintain zero mortality due to malaria in Sri Lanka
Strategies for malaria elimination in Sri Lanka
- Ensure 100% case detection and confirmation by microscopy or Rapid Diagnostic Tests (RDTs)
- Notification and investigation of all cases to ensure radical cure & prevention of secondary transmission.
- Strengthening malaria surveillance system
- Implement radical treatment policy for all P. vivax infections
- Continue ACT and gametocyte treatment policy for P. falciparum malaria.
- Implementing a quality control and quality assurance for diagnostic and treatment services including anti malarial drugs.
- Ensure total indoor residual spray coverage in and around each malaria case and implementing an integrated vector management strategy including the distribution of LLINs/ITNs where appropriate to control vector densities and eliminate disease transmission.
- Implementation of an outbreak preparedness and rapid response strategy for early containment of outbreaks
- Prevention of malaria in travelers overseas and prevention of re-introduction of malaria acquired in other countries
- Re-orienting public and private health sector staff towards the new goals of malaria elimination.
- Human resource development and capacity building in programme management, planning and implementation
- Operational research
Major activities to be implemented under the above strategies for malaria
elimination in Sri Lanka
Ensure 100% case detection and confirmation by microscopy or RDT, notification
and radical cure.
• Strengthening diagnostic facilities to achieve 100% case confirmation by microscopy and/or RDT and ensuring the availability of such facilities.
• Follow up of all malaria positive cases for four weeks to ensure complete clearance of parasitaemia
• Implement radical treatment policy for all P. vivax infections
• Continue ACT and gametocyte treatment policy for P. falciparum malaria
• The banning of artemisinin mono therapy through appropriate legislative measures
• Strengthening of active case surveillance.
• Conducting ACD in selected localities during transmission season
• Ensure availability of all anti malarial drugs including ACTs.
• Introduction of a DOTS strategy for treatment of all P. falciparum infections through hospitalization for a minimum of three days. Introduction of a suitable DOTS strategy for management of P. vivax infections.
• Quality control and quality assurance of diagnostic services and anti malarial drugs
• Monitoring anti malarial drug resistance
• Ensuring availability of preventive therapy for people at risk traveling to malarious areas both in and outside the country.
• Elimination of parasite reservoir through active detection and treatment of carriers
• Establishment and maintenance of a Malaria Elimination Database
• Introduction of PCR for screening of Blood Bank samples
• COMBI for improving effective diagnosis, treatment and chemoprophylaxis
• Introduction of blister packaging of anti malarial drugs and treatment cards
Strengthening the malaria surveillance system
• Strengthening & expanding APCD and selective ACD including MBS in transmission season
• Introduction of the internet based data management system and a website
• Enhance case investigation and follow up of malaria positives and clinical cases
• Screening, treatment and follow up of travelers and risk groups at ports of entry
• Enhance case notification in both public and private sectors
• Improve the epidemic forecasting capacity
• Enhance use of selective “indicator localities” for monitoring trends in vector dynamics
• Maintain a database on drug resistance to anti malarial drugs to guide national treatment policy
• Maintain a database on insecticide susceptibility status and insecticide usage for decision making
Implementation of an epidemic preparedness and rapid response strategy
• Introduction of real time monitoring of malaria cases through the strengthening of surveillance systems
• Establishment of a National Level and district level rapid response teams for rapid containment of outbreaks
• Ensure availability of buffer stocks of antimalarials including ACTs and insecticides for IRS
• Establishment and maintenance of a malaria elimination database
Ensure total indoor residual spray
coverage in and around each malaria case and implementing an integrated vector
management strategy including the distribution of LLINs/ITNs where appropriate to control vector densities and eliminate
• Total IRS coverage in around each malaria case and in foci. Application of IRS in at-risk situations/localities
• Expanding LLIN coverage and usage to protect risk populations
• Implementation of an IVM strategy where feasible
• COMBI for improving acceptance and usage of mosquito nets and other vector control interventions
• Selective application of eco-friendly larval control measures and chemical larvicides
• Promotion of other personal protection methods (such as safe housing)
• Monitoring the impact of vector control interventions through entomological surveillance
• Monitoring bio-efficacy of insecticides on malaria vectors and its operational impact
• Monitoring the persistence of insecticides on applied surfaces
• Ensure availability and quality assurances of entomological equipments & supplies, spray equipments including protective gear, insecticides, biocides, LLINs
• Quality control of entomological surveillance and vector control activities
• Use of GIS for monitoring vector densities and implementation of selective vector control
• Ensuring safe storage, transport and handling of insecticides
• Advocacy measures to minimize mosquito-genic potential and human-vector contact in developmental activities
• Appropriate vector control measures in ports of entry to the country
Re-orienting public and private health sector staff towards the new goals of
• Conducting awareness programmes for both public and private sector health staff on the new goals of malaria elimination
• Introduction of CME packages for health staff on radical treatment of malaria infections
• Introduction of in-service training for laboratory personnel engaged in malaria microscopy
Advocacy for political commitment, partnerships and enhancing community
• Establishment and sustaining high level National, Provincial and District working groups for malaria control with clear Plan of Action
• Establishment and strengthening of inter-sectoral partnerships including community based organizations
• Enhance use of target oriented advocacy instruments
• Increasing public awareness of malaria elimination intentions through “Malaria Day”
• Resource mobilization for the implementation of the programme
Human resource development and capacity building
• Ensuring adequate availability of essential cadres both at central level and in the regions
• Development and revision of duty lists for all cadres in keeping with re-orientation of programme objectives
• Provision of adequate job oriented training in keeping with the requirements of the programme, including basic and regular in-service training
• Providing identified cadres with needed foreign experience & training necessary to implement a successful programme
• Development of capacity of cadres to perform their scope of work through the provision of essential infrastructure facilities
• Seek necessary technical assistance
• Reorientation of programme structure, activities and staff according to the objectives and tasks
• Strengthening logistical management through procurements and improved management
• Identification of evolving research needs in consultation with the Technical Support Group (TSG).
• Utilization of locally and internationally available expertise to carry out operational research