republic of the gambia · 2017-03-31 · national malaria strategic plan 2014-2020 a malaria free...

REPUBLIC OF THE GAMBIA

National Malaria Strategic Plan 2014-2020

A Malaria Free Gambia Page 1

REPUBLIC OF THE GAMBIA

MINISTRY OF HEALTH AND SOCIAL WELFARE

NATIONAL MALARIA STRATEGIC

PLAN 2014-2020



TABLE OF CONTENTS

Foreword ........................................................................................................................................... 4

Acknowledgements ........................................................................................................................... 5

List of Abbreviations and Acronyms ................................................................................................ 6

List of figures .................................................................................................................................... 9

List of tables .................................................................................................................................... 10

Executive summary ......................................................................................................................... 11

CHAPTER I: BACKGROUND ...................................................................................................... 12

1.1. Introduction .......................................................................................................................... 12

1.2. The Process of Developing the National Strategic Plan ....................................................... 12

CHAPTER II: COUNTRY PROFILE ............................................................................................ 14

2.1. Overview .............................................................................................................................. 14

2.2. Socio-Political system .......................................................................................................... 14

2.3. Demographic Characteristics ................................................................................................ 14

2.4. Ecosystem, environment and climate ................................................................................... 15

2.5. Socio-economic situation ..................................................................................................... 15

2.6. Health System Analysis ........................................................................................................ 16

CHAPTER III: MALARIA SITUATION ANALYSIS .................................................................. 22

3.1. Epidemiological profile ........................................................................................................ 22

3.2. Malaria Programme performance ......................................................................................... 26

3.3 Current situation of the malaria program. ............................................................................. 30

3.3.1 Policy context ..................................................................................................................... 30

3.3.1.1 Organisation ..................................................................................................................... 31

3.3.1.2 Guidance ...................................................................................................................... 32

3.3.1.3 Human Resources, training and capacity development .............................................. 32

3.3.1.4 Strategic and annual planning ..................................................................................... 32

CHAPTER IV: STRATEGIC PLAN FRAMEWORK ................................................................... 36

4.1. Vision .................................................................................................................................... 36

4.2. Mission ................................................................................................................................. 36

4.3 Guiding principles ................................................................................................................. 36

4.4. Strategic Directions and Policy Priorities ............................................................................. 36

4.5. Goal ...................................................................................................................................... 37



4.6. Objectives ............................................................................................................................. 38

CHAPTER V: INTERVENTIONS AND IMPLEMENTATION STRATEGIES.......................... 38

5.1 Multiple preventive interventions .......................................................................................... 38

5.2 Case management .................................................................................................................. 42

5.3 Integrated Support Systems ................................................................................................... 44

CHAPTER VI: MONITORING AND EVALUATION OF THE STRATEGIC PLAN ................ 50

6.1. Performance framework ....................................................................................................... 50

6.2. Tracking progress ................................................................................................................. 56

6.3. Measuring impact and outcome ............................................................................................ 56

CHAPTER VII: GOVERNANCE, PARTNERSHIP AND PROGRAMME MANAGEMENT ... 57

7.1. Governance and Program management ................................................................................ 57

National level .......................................................................................................................... 57

Regional Level ........................................................................................................................ 57

Health Facility Level ............................................................................................................... 57

Community Level .................................................................................................................... 58

7.2. Planning and implementation ............................................................................................... 58

7.3. Human Resource ................................................................................................................... 58

7.4. Malaria commodities Procurement and supply management system ................................... 59

7.5. Financial resource management ........................................................................................... 59

7.6. Partnership mechanism of coordination ............................................................................... 59

7.7. Risks and threats for the implementation of the strategic plan ............................................. 60

CHAPTER VIII: BUDGET AND FINANCIAL PLAN ................................................................ 61

8.1. Budget summary by Component .......................................................................................... 61

8.2. Budget summary by strategic Direction and Objectives ...................................................... 62

8.3. Budget summary by cost category ........................................................................................ 66

9.1. Budget gap analysis .............................................................................................................. 67

9.2. Donors mapping ................................................................................................................... 67



Foreword

In the Gambia, malaria remains to be one of the leading causes of morbidity and mortality among

children and pregnant women. Over the last decade, malaria control and prevention efforts have

been accelerated with increased availability of resources aimed at reducing the disease burden. As

part of efforts to improve program performance, the Ministry of Health and Social Welfare in

collaboration with Roll Back Malaria partners conducted a Malaria Program Review (MPR)

between 2011 and 2012. The results of the MPR highlighted strengths, weaknesses, opportunities

and threats as well as challenges to malaria prevention and control. Based on the recommendations

of the MPR the 2008-2015 malaria strategic plan was revised and updated. This new strategic plan

is aligned with Roll Back Malaria targets and National Blue prints. The vision of 2014 -2020 malaria

policy is “A Malaria-Free Gambia”. The current National Malaria Strategic Plan aims to achieve

pre elimination slide positivity rate of <5% by 2020 in The Gambia.

The new strategic plan places emphasis on universal coverage for key malaria interventions and

seeks to consolidate the gains already achieved. Thus, the strategic plan will provide basis for a

common ground for co-ordination, implementation and monitoring and evaluation of malaria

control activities for all partners.

Tremendous progress have been made in the control of malaria, however, the rate of change needs

to be accelerated to adequately respond to the needs of the population and this new strategic plan

will provide the framework for resource mobilization for malaria prevention and control activities

The revision of this strategic plan has been achieved through concerted efforts by all stakeholders

(Public and Private) in shared vision for a malaria-free Gambia and we look forward to the required

support in its implementation. I urge all partners to buy into this strategic plan to promote the

principle of “three ones” (one Coordination mechanism, one strategic plan and one monitoring

and evaluation plan).



Acknowledgements

The Ministry of Health and Social Welfare through The National Malaria Control Programme fully

acknowledge the commitment and active participation of all Roll Back Malaria Partners in the

review and updating of the strategic plan. Special thanks go to the Dr. Muhammad Kabir Cham, Dr.

Hatib Njie and Mr Momodou MK Cham for their technical oversight and immense contributions

during the review process.

I also wish to thank on behalf of the Ministry the WHO Country Office, the WHO Inter country

Support Team (IST), UNICEF, CRS and the Roll Back Malaria West Africa Regional Network for

providing technical support in the development of the strategic plan.

On behalf of the Minister of Health and Social Welfare and the people of The Gambia I wish to

express profound gratitude to The Global fund for providing the much needed financial resources

in malaria control and prevention in The Gambia.

Programe Manager

National Malaria Control Program



List of Abbreviations and Acronyms

AATG Action Aid The Gambia

ACT Artemisinin Combination Therapy

ADB African Development Bank

ADRs Adverse Drug Reactions

ADWAC Agency for the Development of Women and Children

AL Artemether-Lumefantrine

ANC Ante-Natal Care

AOHJ Association of Health Journalists

ASMBCC Advocacy, Social Mobilization and Behaviour Change Communication

CaDO Catholic Development Organisation

CBO Community Based Organisations

CCM Country Coordinating Mechanism/Community Case Management

CHN Community Health Nurse

CIAM Centre for Innovation Against Malaria-Public Health Research and

Development Centre

CRR Central River Region

CRS Catholic Relief Services

DDT Dichloro-Diphenyl Trichloro-ethane

DHIS District Health Information System

DHS Demographic and Health Survey

ECD Early Childhood Development

FGD Focused Group Discussion

GBoS Gambia Bureau of Statistics

GFATM The Global Fund to Fight AIDS, Tuberculosis and Malaria

GMAP Global Malaria Action Plan

GPPA Gambia Public Procurement Agency

GR Geographical Reconnaissance

HePDO Health Promotion and Development Organisation

HMIS Health Management Information System

IMNCI Integrated Management of Childhood and Neonatal Infections

IPTi Intermittent Preventive Treatment in Infant

IPTp Intermittent Preventive Treatment during Pregnancy

IRS Indoor Residual Insecticide Spraying

ITN Insecticide Treated Nets



IV Intravenous

IVM Integrated Vector Management

KABP Knowledge, Attitude, Behaviour and Practice

LFA Local Fund Agent

LLIN Long Lasting Insecticidal Treated Nets

LMIS Logistic Management Information System

LRR Lower River Region

M &E Monitoring and Evaluation

MCM Malaria Case Management

MDGs Millennium Development Goals

MESST Monitoring and Evaluation System Strengthening Tools

MICS Multiple Indicator Cluster Survey

MIS Malaria Indicator Survey

MoHSW Ministry of Health and Social Welfare

MOU Memorandum of Understanding

MPR Malaria Programme Review

MRC Medical Research Council

NAWFA National Women Finance Association

NAYAFS National Youth Association for Food Security

NBER North Bank East Region

NBWR North Bank West Region

NEA National Environment Agency

NGO Non-Governmental Organisation

NMCP National Malaria Control Programme

NMSP National Malaria Strategic Plan

NMSS National Malaria Surveillance Sites

NMTG National Malaria Treatment Guidelines

NPHL National Public Health Laboratories

NPS National Pharmaceutical Services

NSGA Nova-Scotia Gambia Association

NYAAMA

PR

Niamina Youth Association Against Malaria and AIDS

Principal Recipient

PAGE Programme for Accelerated Growth and Employment

PSM Procurement and Supply Management



QA Quality Assurance

QC Quality Control

RAC Regional Advisory Committee

RBM Roll Back Malaria

RCC Rolling Continuation Channel

RDT Rapid Diagnostic Test

RHT Regional Health Team

RMS Regional Medical Stores

RSQA Rapid Service Quality Assessment

SCC Social Change Communication

SM Social Mobilization

SMC Seasonal Malaria Chemoprevention

SOP Standard Operating Procedures

SP Sulphadoxine-Pyrimethamine

SPSS Statistical Package for the Social Sciences

SSF Single Stream Fund

SWOT Strengths, Weaknesses, Opportunities and Threats

TANGO The Association of Non-governmental Organisation

TCs Traditional Communicators

ToT Training of Trainers

TWG Technical Working Group

UNICEF United Nation Children’s Fund

URR Upper River Region

UTG University of The Gambia

VHW Village Health Worker

WARN West African Region Malaria Net Work

WCR West Coast Region

WHO World Health Organization

WHOPES World Health Organization Pesticide Evaluation Scheme

WR Western Region



List of figures

Figure 1: Map of the Gambia ......................................................................................................... 14

Figure 2: Map of the Gambia showing population by Health Region ............................................ 17

Figure 3: Malaria Control within the Organizational Structure of the Health Sector ..................... 21

Figure 4: Relative distribution of Malaria Vectors in the Gambia .................................................. 22

Figure 5: Malaria Case Incidence per 1000 population (2011-2013) ............................................. 24

Figure 6: Annual malaria case incidence per 1000 population (2011 and 2014) ............................ 25

Figure 7: Total Budget By year ....................................................................................................... 61

Figure 8: Budget by Strategic Direction ......................................................................................... 63

Figure 9: Budget by Objective ........................................................................................................ 64

Figure 10: Summary potential donors supporting the NMCP ......................................................... 67



List of tables

Table 1: Demographic Characteristics ........................................................................................... 15

Table 2: Malaria parasite prevalence by Health Region, MIS 2014 ............................................... 25

Table 3: Malaria stratification and recommended preventive interventions ................................... 25

Table 4: Staffing pattern and qualification of staff ......................................................................... 31

Table 5: Core Impact and Outcome indicators ................................................................................ 51

Table 6: Budget Summary by Component ...................................................................................... 61

Table 7: strategic Direction and Objectives .................................................................................... 62

Table 8: Budget by Objective .......................................................................................................... 64

Table 9: Budget summary by cost category .................................................................................... 66

Table 10: Summary financial gap analysis ..................................................................................... 67



Executive summary

The National Malaria Strategic Plan (NSP) builds on investments from the Government of The

Gambia, the Global Fund and other donors to lay the groundwork for the country to achieve malaria

pre elimination status by 2020. The overall NSP has two phases embedded within the overall plan:

1) Achieving control stage and consolidated control countrywide (2015-2017), 2) Achieve and

consolidate pre-elimination stage countrywide (2018-2020).

The NSP was informed by consultation with a diverse group of stakeholders, including government

officials, civil society representatives, international technical experts and local implementing

partners. Building upon both the challenges and successes of the past 13 years, the NSP lays the

framework for the Gambia to sustain investments to reduce malaria is no longer a public health

problem and transmission is down to pre elimination levels by 2020. This is consistent with the

Global Malaria Action Plan (GMAP), The Gambia National Health Strategy Plan (2014-2020) and

the National Malaria Policy. A robust M&E plan will inform and advance the strategy, allowing for

performance monitoring, mid-course corrections and the establishment of a robust surveillance

system in place to track the pace of the epidemic.

Previous plans developed in 2001 (beginning implementation in 2002) and subsequent revisions in

2008 have dovetailed with increased funding opportunities for malaria control leading to a

significant increase in coverage in all key interventions. These have translated to significant

improvements in key malaria indicators across the country. As the country transitions into the pre-

elimination stage, the necessity for consolidating program gains, sustaining and intensifying the

investments and interventions to ensure universal access and coverage becomes even more critical.

In order to tackle the multi-faceted nature of malaria transmission, the NSP continues investments

and improvements in 7 core strategic directions:

Management and Partnership Building

Malaria Case Management

Prevention and Control of Malaria in Pregnancy

Integrated Vector Management (IVM)

SMC

Advocacy, Social Mobilization and Communication

Surveillance, Monitoring and Evaluation & Operational Research.

A SWOT (strengths, weaknesses, opportunities and threats) exercise was undertaken to determine

priority areas under each thematic area. Within each strategic direction, specific interventions and

activities have been considered to achieve the desired results.

While progress thus far has been substantial, much work remains to be done. The NSP provides a

multi-faceted, holistic response to malaria transmission that sets out a clear path, with specific

objectives, targets and goals to achieve the pre elimination goal by 2020.

This strategic plan would cost the Government of The Gambia a total sum of USD45, 139,804. It is

expected that the financial, technical and material support of partners and all stakeholders, that will

be mobilized using this document, would complement Government’s efforts in ensuring a successful

implementation of this plan.



CHAPTER I: BACKGROUND

1.1. Introduction

The second generation strategic plan for the National Malaria Control Programme was developed

for 2008–2015. The plan outlined key interventions and formed the basis of malaria control and

prevention services. Significant progress has been made in the implementation of the previous

strategic plan. Funding opportunities for malaria control has increased over the years leading to

increase in coverage for key interventions such as Insecticide Treated Nets (ITN) use by pregnant

women and children under 5, Intermittent Preventive Treatment for pregnant women (IPTp) and

access malaria treatment. Progress has shown that, The Gambia is working towards achieving pre-

elimination by 2020 The Strategic plan, 2015–2020 will build on the achievements of the previous

strategic plan. Recently, SMC has been introducing as a new intervention to complement existing

strategies. The focus of IRS has now changed from addressing the reduction of vector density to

managing insecticide resistance in targeted regions. Injectable Artesunate has been introduced to

improve the outcome of the treatment of severe malaria.

This strategic plan has been updated to reflect on the changing malaria trends in the country. It aims

to sustain and improve on the achievements gained in the last ten years and introduce new

interventions and strategies with support from all stakeholders including the global fund, health

partners, community members, research community, the academic sector and NGOs. It defines

strategies to be implemented to achieve the goal set for the Malaria Control Programme in The

Gambia.

There is therefore the need to mobilize additional resources to support the scaling up of

interventions, sustain control and build health systems capacity to provide directions to achieve the

goal (to control malaria so that it ceases to be a major public health problem in The Gambia).

1.2. The Process of Developing the National Strategic Plan

The Gambia conducted a Malaria Programme Review (MPR) in 2012-2013 which led to the revision

of the 2008-2013 National Malaria Strategic Plan. Recommendations from the MPR formed a

significant basis of the objectives and strategic directions of the NMSP. The new NSP runs from

2014-2020 and was developed in a consultative and participatory process involving all key

stakeholders and partners in line with the WHO recommendation for developing malaria strategic

plans. Technical support for the development of the Plan was provided by WHO, UNICEF and the

RBM West African Regional Network.

Malaria programme review (MPR) that informed the development of the new National Strategic

Plan (NSP) began in February 2012 and was concluded in February 2013. Steering committees and

technical working groups were formed based on individual expertise and technical competence of

partners. Facilitators and resource persons were also identified to guide the technical working groups

for better outcome. Following a full meeting of the technical working group where the draft NMSP

(2014-20) document was reviewed and finalized, the plan was shared with partners both within and

outside the country for review and comments that were used to further refine the strategic plan.

Finally, a wider stakeholder workshop was conducted to finalize the costing of the strategic plan

following which the NMSP 2014-20 was validated by partners and stakeholders, and approved by

the Ministry of Health and Social Welfare.



A further revision of the NMSP 2014-2020 was undertaken between June and July 2015 to align the

objectives and performance framework with key observations made on strategic actions and targets

in the course of the country dialogue organized to identify priority interventions for the Global Fund

New Funding Model malaria Concept Note. Also, the results of the 2014 Malaria indicator survey

showed significant decline in disease burden, thus necessitating revision of the performance

framework of the 2014-2020 strategic plan to readjust targets and timelines to conform to the rather

rapid progress in reduction of disease burden observed from the national survey. In keeping with

best practice, this revision has been perform with the full participation of stakeholders and partners

including civil society organizations. The revised NMSP 2014-20 was subsequently ratified by

partners in a meeting convened solely for this purpose and subsequently endorsed for use by the

authorities of The Gambia Ministry of Health and Social Welfare.



CHAPTER II: COUNTRY PROFILE

2.1. Overview

The Republic of The Gambia is located on the West Africa Coast between latitudes 13.0° North and

longitude 13.7° east and 16.0° west. The country stretches about 400 km from the coast inland with

its width varying between 25 to 60 Km occupying a total land area of 10,690 km sq. It is bordered

on the North, East and South by the Republic of Senegal and on the West by the Atlantic Ocean.

Figure 1: Map of the Gambia

2.2. Socio-Political system

The country is divided into seven administrative regions including two municipalities. The regions

are West Coast Region (WCR), Lower River Region (LRR), Central River Region (CRR), Upper

River Region (URR) and North Bank Region (NBR).

The municipalities are Banjul and Kanifing. The two municipalities have elected mayors whilst the

other regions have governors appointed by the President. The regions are further divided into

districts headed by chiefs.

The national development priorities as defined in the Programme for Accelerated Growth and

Employment (PAGE) include the following:

Accelerating and sustaining economic growth

Improving and modernizing infrastructure

Strengthening human capital stock to enhance employability

Improving governance and fighting corruption

Reinforcing social cohesion and cross cutting interventions

2.3. Demographic Characteristics

The Gambia has a projected population for 2013 of 1.8 million of which 50.7 per cent are female

and 49.3 per cent male. About 42 per cent of the population is below 15 years of age, 24 per cent

between 10 and 19 years old and 22 per cent are between 15 and 24. Only 3.4 percent of the

population is 65 and over. Life expectancy at birth is projected at 64 years for both sexes.

(Projections from 2003 Population and Housing Census). The literacy rate among young women 15

to 24 years is 63% whilst the national GDP per capita is about $543.00 (IMF Country Report

No.12/129, 2012). The under-five mortality rate has declined from 141/1000 in 2002 to 131/1000

in 2005/6 and by 2010 it dropped to 109/1000 (MICS 2010). According to the UNFPA State of the



World’s Population Report 2012, the projected maternal mortality rate in 2012 was 360/100,000

live births whilst the National Sentinel Surveillance (NSS) Report 2011 indicate a national HIV

prevalence rate of 1.7%. The Gambia is predominantly agricultural and the sector employs about

70% of the work force.

Table 1: Demographic Characteristics

2.4. Ecosystem, environment and climate

The Gambia has a Sahelian climate, characterized by a long dry season (November -May), and a

short wet season (June-October). Rainfall ranges from 850-1200 mm. Average temperatures range

from 18-30° Celsius during the dry season and 23-33° Celsius during the wet season. The relative

humidity is about 68% in coastal region and 41% inland during the dry season and generally about

77% throughout the country during the wet season. This climatic pattern only favours short period

of crop production (on average three months) which is the main source of employment and food

supply.

Flood plains and fresh water swamps cover a large area of the country, particularly in the Central

River Region (CRR) and parts of the Lower River Region (LRR) and the North Bank Region (NBR).

The River Gambia is fringed by fresh water swamps in the eastern half of the country and salt water

in the western half that provide perfect breeding sites for the malaria vector.

Over 90% of clinical cases of malaria occur during and immediately after the rainy season, i.e.

between August and December.

2.5. Socio-economic situation

The Gambia is classified as a low income economy, with Gross National Income (GNI) per capita

of US$510 at 2012 (World Bank). Low income economies are countries with GNI US$ 1,025 or

less. The Gambia is among the poorest countries in the world. It ranked 168 out of 187 in the United

Nations Development Programme’s Human Development Report (HDR) for the year 2011.The

main drivers of economic growth for The Gambia remain the agriculture sector and tourism

industry. Real GDP growth declined from an average of 5.9 per cent between 2003 and 2006 to

about 4.7 per cent in 2007. In 2009 real GDP grew by 6.3 percent, led by strong growth in

Indicator Value Source Year

Total Population 1, 783, 424 GBoS, 2011 2013

Life expectancy at birth (both sexes) 64 years Census 2003

Literacy rate (women 15 –24 years) 63% Census 2003

HIV prevalence (HIV 1) 1.7% National Sentinel

Surveillance report

2011

HIV 2 0.07 National Sentinel

Surveillance report

2011

Dual (HIV1 &2) 0.02 National Sentinel

Surveillance report

2011

Under 5 mortality rate per 1000 live

births (both sexes)

109 MICS 2010

Maternal mortality ratio(per 100,000

live births)

360 UNFPA; State of the

world’s population

report

2012



agriculture, tourism, and the construction industry. These fluctuations are largely attributable to the

effect of climate conditions on agricultural output, but also due to variable growth in key sectors

such as tourism, industry, re-export trade activities, and construction in recent years (Programme

for Accelerated Growth and Development, PAGE, 2011).

The country does not have any significant mineral resources and the rainy season lasts for only four

months. The modern industrial sector in The Gambia is small and accounts for less than 8% of GDP.

The sector provides employment for less than 5% of the country’s labour force. Export of

groundnuts accounts for about 9% of total export earnings (NASS). Manufacturing activities in the

country include crushing of groundnuts, baking, brewing of alcoholic drinks, food processing and

production of plastic wares. In addition to the formal manufacturing sector, there exists a vibrant

small to medium scale enterprises in the country. Activities range from welding and fabrication to

furniture making, construction, batik and bee-keeping to pottery making. These activities are an

important source of income for families. Fishing is an important economic activity and source of

dietary improvement. It accounts for 2% (GBoS, 2013) of the economy whilst tourism and trade

account for 13.1% of GDP.

2.6. Health System Analysis

2.6.1. Governance, Health sector Commitment and Structures

The health sector is managed at two levels, the Central and Regional Levels. At the Central

Level, the Minister of Health & Social Welfare and the Permanent Secretary are the

Government’s appointees responsible for the whole health sector. In order to facilitate support,

the Central Level is organized into Directorates: Directorate of Health Services, Planning and

Information, Social Welfare, Health Promotion and Protection, National Public Health

Laboratory (NPHL); and Food Standards, Quality & Hygiene Enforcement. These Directorates

plan, direct and manage all health programmes, and decision-making is made at this level. The

Programme for Accelerated Growth and Employment (PAGE), successor to the Gambia’s

Poverty Reduction Strategy Paper II (PRSP II), is scheduled to be implemented during the

period 2012-2015. Vision 2020 lays emphasis on the control of endemic diseases in the country.

All of these instruments are linked to the Millennium Development Goals (MDGs), to which

the Government and its partners are highly committed. The development of the healthcare

infrastructure; human resources for health care; participation of the private sector, communities

and community groups and the socially disadvantaged groups, including women and people

with disability, are highlighted in the PAGE, Health Master Plan and other national and sector

policies.

The Ministry of Health and Social Welfare is responsible for the management of the health sector,

which includes: policy formulation and policy dialogue, resource mobilization, regulation, setting

standards, health service delivery, quality assurance, capacity development and technical support,

technical advice to other government line Ministries on matters of public health importance,

provision of nationally coordinated programmes such as epidemiology and disease control,

coordination of health research and monitoring and evaluation of the overall sector performance.

A National Health Sector Strategy Plan has been developed for the period 2010-2014 with the aim

to facilitate and guide the implementation of the national Health Policy. The Strategy Plan is geared



towards improving both access and quality of health care in the country with a view to reducing

morbidity and mortality rates.

The country is divided into seven health regions each with a regional health team (RHT) headed by

a Regional Health Director (RHD). The Regional Directors report to the Permanent Secretary

through the Director of Health Services.

The RHTs are responsible for the day-to-day administration, management and supervision of health

services including the primary and secondary health facilities in their respective regions. The RHTs

also provide significant administrative and technical support to 48 public health centres (6 major

and 42 minor facilities).

The frequent changes in top management positions at The Ministry of Health have been hampering

continuity, institutional memory and policy flow. The need to have a clear direction to improve

quality of health care and reduce the high morbidity and mortality rates requires a stable, supportive,

organizational and management framework with a strong flexible and knowledgeable leadership,

able and willing to take informed decision (National Health Policy 2012-2020)

Figure 2: Map of the Gambia showing population by Health Region

General health system challenges include the effects of high population growth rate; inadequate

financial and logistic support; weak health information system; uncoordinated donor support;

shortage of adequately and appropriately trained health staff; high attrition rate and lack of efficient

and effective referral system. In addition, poverty, low awareness of health issues and poor attitude

of service providers have led to inappropriate health care seeking behavior and contributed to ill

health. These factors have seriously constrained efforts to reduce morbidity and mortality rates as

desired and as a result health care delivery throughout the country has not lived up to expectation.

2.6.2. Health Care System Organization



Public sector

The Gambia’s healthcare delivery system is organized into a hierarchical three-tier system: Village

Health Services (VHS) providing primary care, Major and Minor Health centres providing

secondary health services, and Hospitals providing tertiary health services. The Regional Health

Teams have oversight for primary and secondary health care facilities within their respective

regions. The three levels of the Government health facilities provide subsidized services under the

national Basic Health Care Package (BHCP) scheme. The BHCP includes Reproductive and Child

Health; Control and management of communicable diseases; Control and management of non-

communicable diseases; Health Education and Promotion and Environmental Health and Safety.

There are 7 public hospitals at the tertiary level; 6 major health centres and 41 minor health centres

at the secondary level; 40 community clinics and 634 Primary Healthcare Villages.1 The public

sector is the principal source for seeking health care and/or treatment (85 percent), followed by the

private sector (17 percent). Other sources account only for 1 percent of the cases.

Private sector

The public health system is complemented by the private sector, NGO and Community Managed

Health Facilities. There are over 60 private service providers across the country, with the for-profit

facilities generally located in the urban areas2. In addition, there is a large number of Private-for-

profit Pharmacies, medicine outlets, and traditional healers that deliver other health services. It is

estimated that about 20% of malaria cases in the country are treated by the private sector (both

NGOs and for-profit). The NMCP trains private sector providers in malaria case management but

the MPR identified the need for better private sector engagement to ensure adherence to national

malaria policy and treatment guidelines as a priority. A strategy for more effective engagement of

the private sector in malaria control will be developed to address this.

2.6.3. Human Resource in the Health Sector

The Human Resources for Health (HRH) situation in the Ministry has been critical with key

challenges being high attrition rates, shortage of skilled health professionals (e.g. 0.1 doctors/1000

populations and 0.11 registered nurses/1000), and low morale among staff (GHSSP 2014-2020.

pg.78). The 2012 HMIS report reveal that there are significant regional variations in the distribution

and ratio of health workers in the country with implication for service delivery at all levels.

To address these challenges, Government has established the Directorate of Human Resources for

Health and implemented intervention measures including provision of such incentive packages as

in-service training, payment of special allowances for personnel serving in hard to reach areas,

special skills, risk allowance, teaching allowance, on-call allowances and responsibility allowance.

2.6.4. Procurement and Supplies Management

1 PHC Villages include all settlements of 400 or more people. Each has a trained VHW and TBA operating from Health

Posts within these villages. 2 HMIS Report, 2012



The procurement and supply unit of the Ministry is responsible for quantification, forecasting of

health products and equipment for quality health delivery in the country, whiles the GF procures

most of the health products and equipment for supported disease control programs. Procurement

and supply chain management in the health sector has been enhanced in recent times with the

upgrade Logistic Management Information System (LMIS) and with computerization of the

inventory control system at Central Medical Stores and increase in skilled human resource. LMIS

data is integrated into the HIMS. However, there are still challenges with stock-outs of some

medicines and supplies. There is need for continuous review and capacity development for key staff

the procurement and supply management divisions as well as LMIS unit of the Ministry of Health.

2.6.5. Health Management Information System

The Health Information System (HIS) in The Gambia comprises five main service areas namely

Health Management Information System (HMIS), Health research, Births and deaths registration,

Information and communication technology and Integrated Disease Surveillance and Response

(IDSR). The HMIS is the umbrella programme for collecting, analyzing, storing and disseminating

health data of the Ministry of Health. Thus all service data should be harmonized and integrated into

HMIS to facilitate easy flow and access to health information. From 2009, the HMIS has been

running on open source software called District Health Information System version 2 (DHIS2)

which has helped the process of integrating all service data into the HMIS.

The new initiative of the HMIS is the development and standardization of DHIS2 to replace the

existing Microsoft (MS) Excel form for data entry. This new initiative is expected to transfer data

electronically from selected health facilities and regions to the national level using the newly

proposed Virtual Private Network (VPN). For this purpose, the HMIS Unit, through a consultative

process with other health programmes has harmonized tools and a list of health indicators. A

functional District Health Information System (DHIS2) database which captures malaria and related

information is available. The database is institutionalized within the health service system where it

is up-dated quarterly by the information technology unit of the Directorate of Planning and

Information (DPI). A DHIS2 platform for the uploading of summary forms for data collection and

entry at the regional level has also been set up. This is expected to significantly improve the overall

reporting rates.

An Integrated Disease Surveillance Response (IDSR) system has been in existence in The Gambia

since 2003. More than thirty priority diseases, including malaria, are classified as reportable. These

diseases are reported to the WHO and other partners through the HMIS. The Epidemiology and

Disease Control (EDC) Unit coordinates the IDSR in the country. The Unit also oversees the

NMSSS under the M&E component of the NMCP in partnership with the NPHL, CIAM and the

MRC. The team (with members from the EDC, NMCP, NPHL and the MRC) conducts quarterly

monitoring visits, organizes and facilitates disease surveillance training activities, and coordinates

meetings of partners, among other functions.

A functional Logistics Management Information System (LMIS) has been developed and it forms

part of the HMIS. An effective LMIS is central to the procurement and management of drugs and

supplies. The key challenges of the HMIS are incompleteness and timeliness in data collection,

analysis and reporting.

The following describes the HMIS tools used for data collection as well as the data flow from the

facility, regional to the central level:



Out-Patient Department (OPD) Register: This is used to record all disease conditions for children

under-five years of age and adults. The OPD collects data on the following variables: diagnosis,

treatment, age and sex etc. The service provider records all OPD data.

Ante-natal Register: This captures data on pregnancy related services at service delivering points.

Ante-natal Cards (ANC) and Infant Welfare Cards (IWC): Children and pregnant women are

issued with IWC/ANC during registration. These cards are kept by clients and all services delivered

are recorded on these cards. The cards also served as a means of monitoring the services provided.

The MoHSW operates a website, which includes information on all the technical units in the

Ministry. However, the website is not updated on a regular basis.

The key challenges faced by the HMIS include, inadequate number and skilled personnel with

capacity to manage data at all levels, parallel systems of data collection, weak reporting from some

hospitals and private sector, inadequate functional ICT equipment of HMIS nodes in the regions,

poor power supply and poor internet connectivity.

2.6.6. Health Sector Financial Management

In The Gambia, the main sources of financing health care are through the government, donors, NGO,

and private out-of-pocket expenditures. Public sector financing of health has grown over the years.

The first National Health Account Survey conducted in 2007 showed that the contribution of the

Government to the health sector grew from 18% in 2002 to 24% of the total health expenditure in

2004. The households, through direct out-of-pocket payments for health care contributed 12% in

2002, 11% in 2003 and 9% in 2004 to the total health expenditure.

The health budget is disproportionately distributed favouring the tertiary level and urban over rural

areas with hospitals currently accounting for nearly half of the total government expenditures in

public health care.

The health sector has increasingly become dependent on donor funds from WHO, UNICEF, UNFPA

and particularly the Global Fund for AIDS, TB and Malaria (GFATM).

During the three year period, 2002-2004, over 66% of the total health funding came from donors

including international health development partners. Strategies to equalize this imbalance include

on-going advocacy to mobilize resources for health financing from traditional and non-traditional

partners/donors and the strengthening of cost sharing mechanisms for all levels of health care

delivery.

2.6.7 Malaria control within the health sector

The NMCP is well-represented in the Ministry’s policy and decision-making processes. Given the

high political commitment to malaria prevention and control, the President of the Republic of The

Gambia declared operation ‘’Eradicate Malaria’’ in February 2008. This move led to the

institutionalization of Operation Clean the Nation, introduction of Indoor Residual Spraying (IRS),

and Social Mobilization campaigns for malaria prevention and control. Consequently, the National

Malaria Policy and Strategy Plan were reviewed and included the malaria pre-elimination agenda

by 2015. Another development that reflects the Government’s recognition that health is a



developmental issue is the declaration that all public sector Reproductive and Child Health (RCH)

services including malaria are free of charge to the consumer.

Malaria control interventions are supported by the Directorate of Health Services and other support

services within the MoHSW, notably the NPS, NPHL, Division of Public Health, Directorate of

Planning, Directorate of Health Promotion and the RCH programme. The Transport Management

Agency (Riders for Health) plays a crucial supportive role in the programme. The Regional Health

Teams provide significant administrative and technical support to 48 public health centres (6 major

and 42 minor facilities). At the community level, there are over 600 village health workers who

provide malaria control services with the support of Community Health Nurses (CHNs).

The NMCP is a key specialized unit within the national health services and operates under the aegis

of the Directorate of Health Services in the MoHSW. The prevailing inadequacy in the health system

affect significantly the malaria programme implementation with challenges related specifically to

malaria capacity diagnosis, number and quality of trained human resources currently, supply chain

and health information system.

The development of a National Malaria Policy and Strategy Plan is an important milestone in the

national response to the disease and its social and economic impact. The Malaria Policy and Strategy

Plan in combination with the Health Master Plan and National Health Policy, serve as important

resources for guiding and streamlining the malaria intervention strategies.

Figure 3: Malaria Control within the Organizational Structure of the Health Sector



CHAPTER III: MALARIA SITUATION ANALYSIS

Malaria remains a disease of public health importance in the country. The endemic nature of the

disease is influenced by ecological factors that favour breeding of the vectors.

3.1. Epidemiological profile

Malaria affects the entire population of The Gambia as it is meso-endemic in the country. The

disease has a marked seasonal variation, with about 90% of cases occurring in the rainy season. It

is a leading cause of morbidity and mortality, especially among children under 5 years. Since 2004,

there has been a continuous decline in the incidence of malaria in The Gambia, as reported in studies

conducted by the MoHSW and Medical Research Council in 2008 and 2010. There are indications

of an age-group (5 -14 yrs) shift with regards to the burden of malaria.

3.1.1. Malaria parasites

The dominant malaria parasite in the country is Plasmodium falciparum which accounts for more

than 95% of all reported malaria cases. Plasmodium malariae and ovale account for the remainder.

3.1.2. Malaria vectors

Members of Anopheles gambiae species complex are the main vectors of malaria in The Gambia.

These include Anopheles gambiae s.s., Anopheles arabiensis and Anopheles melas. The first 2 are

fresh water breeders and are the main malaria vectors. They are distributed throughout the country.

Anopheles melas on the other hand is a salt water breeder, often found in lagoons and edge of flood

plains in western parts of the Gambia. The main malaria vectors are indoor biting and indoor resting

species. The annual entomological inoculation rate ranges from 1 – 80 infective bites per person per

year.

The distribution of malaria vectors is well defined. A species determination by PCR in a study

jointly conducted by MRC and NMCP in 2010/11 in Central River Region (CRR) revealed that 57%

(312/549) of captured Anopheles mosquitoes were Anopheles gambiae s.s., while 42% (n=232)

were Anopheles arabiensis.

Anopheles melas was not detected indicating its preference for high salinity regions. Furthermore,

312 Anopheles gambiae s.s. were further tested for “M” (Mopti) and “S” (Savannah) molecular

forms. Of these, 116 were “M” molecular form, 45 “S” and 1 hybrid of M/S. This confirms the

concentration of Anopheles gambiae s.s. and Anopheles arabiensis in middle reaches of The

Gambia.

Anopheles gambiae s.s. and An. arabiensis were found in all six regions. Anopheles melas was

recorded only in Brikama where it constituted about 50% of the mosquitoes collected. The relative

proportions of An. gambiae s.s. and An. arabiensis varied between the different study sites.

Mosquitoes assembled from Farafenni and Basse study sites were primarily An. arabiensis

(Farafenni: 91.1%; Basse: 97.1%). In Kuntaur area in contrast, most (88.3%) anophelines were An.

gambiae s.s. Figure 2 shows the vector distribution across the country.

Figure 4: Relative distribution of Malaria Vectors in the Gambia



3.1.3. Population at risk and vulnerable Groups

Malaria is meso-endemic and affects the whole population. Historical data indicate that the disease

was a major cause of morbidity and mortality among children under-five years of age. However,

data from the National Malaria Sentinel Surveillance Report (2011) indicate a shift in the pattern of

the disease burden from children under 5 to older children.

3.1.4. Dynamics of malaria transmission and level of endemicity

Malaria is still endemic in the country. Data from MIS 2010 indicate that the malaria distribution

pattern is not uniform across the country, confirming the findings of earlier studies by the MRC and

MRC/NMCP. Central River has the highest prevalence of malaria (9.9%) among children less than

five years, followed by Upper River Region (4.4%). The lowest malaria prevalence is recorded in

North Bank East Region, with 0.5%. Therefore, The Gambia can be stratified into 2 strata, a

relatively high malaria transmission in the eastern part of the country and a much lower transmission

in the western part. Such stratification is similar to what is observed in Senegal where the highest

transmission is observed in the south-eastern part of the country. There have been a number of

factors in the last decade that may have contributed to the changing malaria epidemiology in The

Gambia. These include increasing coverage of malaria interventions, increased access to education,

improvements in communication amongst others

There has been further decline in overall malaria burden with a prevalence of 0.2% (MIS2014). This

indicates that the country may in the early pre-elimination stage. However with the fluctuating case

incidence rate in the Regions it would be more appropriate to classify the Gambia malaria situation

to be in the control consolidation phase with potential to achieve pre-elimination in the later part of

the plan period.

.

3.1.5. Morbidity and mortality

In 2003, clinically suspected malaria cases accounted for 78% of all out-patients attendance and

58% of all in-patient admissions (HMIS Service data Report, 2004). About 40% of total outpatient

consultations in public sector health facilities in 2006 were due to uncomplicated malaria whilst



diarrhoeal diseases and acute respiratory infections together constituted about 25%. Since the

scaling up of key interventions from 2004, there has been a continuous decline in the incidence of

malaria in The Gambia. This was reported in studies conducted by the Ministry of Health and

Medical Research Council (Ceesay et.al, 2008, 2010). In 2008, a total of 258,165 episodes of clinical

malaria were reported including 5,183 among pregnant women and 120,524 among children <5

years of age (HMIS 2008). A study conducted over the period 2003-2007 at four sites in the country

with complete slide examination records showed that the proportion of malaria-positive slides

decreased by 82% at site 1, 85% at site 2, 73% at site 3 and 50% at site 4 (Ceesay et al 2008). The

proportion of malaria admissions at three sites with complete admission records dropped by 74%,

69% and 27% respectively. The under 5 mortality rate, has been declining over the period from

141/1,000 (MICS 2000) to 131/1000 in 2005. The 2010 MICS has shown a further decline to

109/1000. Such decline is confirmed by data from the Health and Demographic Surveillance system

in Farafenni covering a population of about 50,000 individuals. Under 5 mortality decreased from

159/1000 live births in 1990 to 45/1000 live births in 2008, with the major drops in infants >1 month

of age and children 1-4 years old. (Jasseh et al, 2011)i. Therefore, The Gambia attained the MDG4

seven years in advance of the target year of 2015.

Figure 5: Malaria Case Incidence per 1000 population (2011-2013)

3.1.6. Malaria stratification and mapping

Malaria is an important public health problem in The Gambia. It is meso-endemic, with the whole

population at risk of infection. Transmission is perennial transmission but with marked seasonal

variation and most cases (about 90%) occurring in the later stages of the rainy season from

September to December. The 2010 Malaria Indicator Survey (MIS) conducted in the peak malaria

season showed that malaria prevalence by microscopy among children less than five years was 4%

across the country. However prevalence varies widely across regions of the country, with the Central

River Region having the highest rates (about 10%), moderate prevalence rates of 4% occur in the

Upper River Region, and the North Bank East Region having the lowest prevalence rates of only

0.5%3. A nationwide community cross-sectional survey conducted during the peak malaria season

3 The Gambia Malaria Indicator Survey, 2010/11. Ministry of Health and Social Welfare Banjul, The Gambia



in 2012 and using molecular methods found overall prevalence of P. falciparum infection was 16.0%

with marked heterogeneity between regions (4.3 to 36.8%) and also between villages (1.6% to

49.1%). However a more recent MIS, 2014 shows an overall malaria parasite prevalence rate of

0.1% among under-five year children across the country during the peak malaria season compared

to 4% in 2010. (MIS 2014 Preliminary Report). Please refer to the table below for details of the

results of the 2014 MIS by health region.

Table 2: Malaria parasite prevalence by Health Region, MIS 2014

Heath Region MIS 2010/11 Prevalence

(%)

MIS 2014 Prevalence

(%)

Western Region 1* 2.5 0.1

Western Region 2* 2.5 0.3

North Bank West Region

3.1 0.2

North Bank East Region

0.5

0.0

Lower River Region 0.8 0.1

Central River Region 9.9 0.1

Upper River Region 4.4 0.1

Overall /National 4.0 0.1

* Western region was split into two regions in 2013.

Figure 6: Annual malaria case incidence per 1000 population (2011 and 2014)

Table 3: Malaria stratification and recommended preventive interventions Malaria case incidence

per 1000 population

Universal

LLIN access

Targeted

IRS*

Targeted

larviciding*

IPTp in

Pregnancy

SMC 3-59 months children

Surveillance

/case detection



0.0 – 49.0 Yes No Yes Yes Yes Active

50.0 – 74.0 Yes No Yes Yes Yes Passive

75.0 – 99.0 Yes No No Yes Yes Passive

100.0 – 124.0 Yes Yes No Yes Yes Passive

125.0 – 177.0 Yes Yes No Yes Yes Passive

*Targeted as insecticide resistance management strategy; **Larviciding in fixed, few, findable site

3.2. Malaria Programme performance

3.2.1. Historical milestones in malaria control

The Malaria Control Unit was created by the Ministry of Health and Social Welfare in 1990 in

recognition of the importance of malaria as a major public health problem in The Gambia. In 1993,

the Unit was placed under the Directorate of Disease Control to give it the attention it deserved. In

1997/ 98, as part of a health system reform process, the program was restructured and strengthened

through the provision of additional staff. Since then, the program has evolved into a national

program for malaria control.

The first five-year malaria control strategic plan for the period 2002 to 2007 was developed in 2001.

The plan outlined key interventions and formed the basis of malaria control and prevention services.

This was revised in 2008, covering a seven-year, from 2008 – 2015. Significant progress has been

made in the implementation of the plan. Funding opportunities for malaria control increased over

the years leading to a significant increase in coverage in all key interventions.

The implementation of comprehensive malaria control strategies started in Western Health Region

in 2004 with the commencement of support from the Global Fund. After successful implementation

of malaria control activities in Western Health Region, activities were scaled up to the remaining

health regions of the country in 2007 with the acquisition of additional Global Fund Grants.

Following an increase in the size of the Global Fund grants for malaria, a Single Stream Funding

(SSF) mechanism was developed by the Fund with all the malaria control program grants

consolidated into a single stream.

3.2.2. Current situation of the malaria program

3.2.2.1. Institutional organization and programming framework

The NMCP is one of the specialized programme within the MoHSW. A clearly defined structure

for management and co-ordination of the Program exists covering malaria case management;

malaria in pregnancy; vector control; surveillance, monitoring, evaluation, and operational research;

and support services, such as procurement and finance. The Program Manager reports to the

Director of Health Services at the MoHSW. At the regional level, malaria control and prevention

activities are managed and coordinated by regional teams.

There is a National Steering Committee that provides support to the NMCP in carrying out its

activities. Chaired by the Director of Health Services, the Committee comprises representatives

from the MoHSW, various ministries and other stakeholders including the Office of The President,

Agriculture, Finance and Economic Affairs, Basic and Secondary Education, Regional

Administration and Lands, Youth and Sports, Transport, Works and Infrastructure, Water

Resources, Fisheries and Environment, The National Environment Agency (NEA), University of



The Gambia, Medical Research Council The Gambia, and The Association of NGOs in The

Gambia (TANGO). The NMCP serves as secretary to the body.

3.2.2.2. Policy and guidance

The National Malaria Policy 2004-2020, revised in 2013, highlight specific malaria control

strategies and interventions accordingly to the last recommendation of WHO. These key strategies

are related to Management and Partnership Building; Malaria Case Management; Malaria in

Pregnancy; Seasonal Malaria Chemoprevention; Integrated Vector Management (IVM), Advocacy,

Social mobilization and Communication; Surveillance, Monitoring and Evaluation and Operational

Research.

The goal of the Gambia National Malaria Policy and Strategic Plan is malaria pre-elimination by

2020. The program main direction is to increase and sustain coverage through the use of effective

and evidence based interventions to achieve high impact. An integrated approach to malaria

prevention and case management interventions is being used focusing mainly on universal access

to LLINs, prompt and effective case management, IRS, IPTp, SMC and BCC.

3.2.2.3. Key Program achievements

The results presented here come mainly from the MICS 2010, MIS 2010, HMIS reports (from 2008

to 2013), The Gambia Malaria Programme Performance Review, 2013, and The Gambia DHS 2013.

The synergistic effects of the deployment of these strategies have impacted positively on key malaria

indicators. Prevalence of malaria parasite infection among children aged 6-59 months mentioned in

section 1.1a above, declined by 80% from 4% in 20104 to 0.8% in 20135. In 2008, a total of 508,846

episodes of clinical malaria were reported across the country compared to 273,507 in 2013

representing a 38% reduction of malaria cases within a five year period (HMIS 2008 -2013)6.

The 2010 MIS report revealed that treatment with anti-malarial medicines is high (about 70%).

Results of the 2013 DHS point to a wide coverage of the IPTp use among pregnant women with

92% of mothers reported to have received an IPT during their last pregnancy at an ANC visit. The

survey also revealed that about 62% of women received two doses of IPT, at least one of which was

during an ANC visit7, indicating that substantial efforts must be put into achieving the target of 85%

by 2015 in the NMSP

3.2.2.3.1 Programme Management

Effective malaria control and prevention in The Gambia is important to achieve pre-elimination

targets by 2020. The MoHSW and its partners have developed a strategic framework consistent with

the Malaria Policy Vision “Gambia, where malaria ceases to be a major public health problem”. The

National Malaria Control Policy clearly outlines strategies and service delivery areas.

The mission of the NMCP is to support, coordinate and manage the national malaria control

programme. This mission is carried out through various arrangements and with the active support

of the MoHSW. The provision of high quality, timely information for effective planning,

4 The Gambia Malaria Indicator Survey, 2010. Ministry of Health and Social Welfare Banjul, The Gambia 5 The Gambia Demographic and Health Survey, 2013. Gambia Bureau of Statistics, Banjul, The Gambia 6 HMIS Service Data Report, Several years. Ministry of Health and Social Welfare Banjul, The Gambia 7The Gambia Demographic and Health Survey, 2013. Gambia Bureau of Statistics, Banjul, The Gambia



implementation, monitoring and evaluation of malaria control activities is a major component of

programme activities.

3.2.2.3.2 Case management

Malaria treatment policy was changed in 2008 from Chloroquine to ACTs while confirmatory

diagnosis with either Microscopy or RDTs was adopted in 2010 and currently more than 80 % of

suspected cases get tested and the malaria parasite prevalence rate in under-five children was 4.0%

in 2010 (MIS 2010) and 2.3% in 2013 (DHS 2013). For reasons of comparability, the DHS+ results

should be treated with caution as the study was conducted during the low malaria season. In 2013,

proportion of children under five years with fever in the last 2 weeks that received an antimalarial

was 64.6% (DHS 2013). There has been policy shift for treatment for severe malaria from Quinine

to artesunate injection. The malaria case management guideline will be updated to include artesunate

injectable for treatment and management of sever malaria.

Community Case Management of malaria has been integrated in the health care system as an

approach to improve prompt access to malaria diagnoses and treatment in hard-to-reach areas.

Community based services including community case management of malaria are implemented

through the Village Health Services of the national Primary Health Care structure.

Therapeutics Efficacy Surveillance - Biannual monitoring of anti-malaria efficacy was conducted at

malaria sentinel surveillance sites using WHO protocols. This is important to ensure quality

antimalarial medicines are provided for the populace, and to monitor the level of parasite resistance

to the first line medicines in the treatment of uncomplicated malaria. Therapeutic efficacy studies

on ACTs have been conducted in 2010, 2012 and 2014. Results of all these studies show drug

efficacy rate of over 95%.

Ensuring Drug Quality -In order to ensure drug quality, national Quality Assurance (QA) and

Quality Control (QC) Systems have been established. Quality Assurance and control systems have

also been established for slide microscopy and RDTs. This is done by NMCP in collaboration with

National Public Health Laboratory (NPHL) and Medical Research Council. However, for quality

control of antimalarial medicines, samples are collected and sent to reference labs where tests are

done to confirm the potency of the antimalarial medicines. Quality control of microscopy and RDT

slides is undertaken in all 6 malaria sentinel sites every quarter.

3.2.2.3.3 Integrated vector control

IRS: Under the Government limited funding, Indoor Residual Spaying as an intervention begun in

2008 as a pilot which covered only the Island district of Janjanbureh. It was scaled up in 2009 to

cover Upper River Region, Central River Region, Lower River Region, North Bank Region East

and North Bank Region West. In 2010 due to inadequate funding IRS was only conducted in four

districts of Western Health region.

Funding from GF for IRS implementation was acquired in 2011 but covered only three regions;

Central River Region, North Bank Regions, Lower River Region and one district in Western health

region which was Foni Jarrol District, while in 2012 IRS covered CRR, NBR and LRR. Since the

introduction of IRS, the choice of insecticide has been DDT, non-pyrethroids as a way of insecticide

management.

In 2013, the entire country excluding urban areas was sprayed. However, in 2014, due to inadequate

quantities of insecticide, IRS was conducted in Upper River Region and Central River Region. The



total number of rooms targeted was 185,879. Of this 185,951, 72 extra rooms were sprayed

representing 100% coverage. For the planned periods 2016 and 2017, Bendiocarb, a carbonate, will

be used to curb DDT-Pyrethroid resistant mosquitoes on rotational basis. Since LLINs are also

being distributed countrywide, IRS will target only two regions as an insecticide resistance

management strategy.

Entomological Monitoring - For effective insecticide resistance management, monitoring of vector

resistance status to insecticide was carried out in 2010, 2011, and 2013. In 2010/11, Medical

Research Council and NMCP conducted a study in Upper River Region under the project; Spraying

and Nets Towards Eliminating Malaria (SANTE) and pockets of malaria vector resistance to DDT

was spotted. Furthermore, NMCP carried out vector resistance monitoring in 2013 and the results

were that vector susceptibility DDT after 24 h exposure was 95%, Permethrin was 98% and

Bendiocarb was 95%.This monitoring will continue not only in IRS selected regions, but in all eight

entomological surveillance sites nationwide.

LLIN: In 2011, the MoH&SW with the support of partners conducted a mass LLIN distribution

campaign with 558,000 nets across the country with the aim of achieving universal coverage of one

LLIN per two persons. In addition, a total of 230, 000 LLINs were distributed through routine RCH

service delivery points. More recently, a total of 971,665 LLINs were distributed in another mass

campaign in 2013, achieving 96% of the universal coverage target.

The results of the MIS 2010 indicate that overall, 81% of the households have at least one ever-

treated net. In general, net ownership is higher in the rural settings compared to the urban. The 2013

DHS showed household ownership of at least one ITN to be 69%, with an average of 2 ITNs per

households.

3.2.2.3.4 Malaria in pregnancy

Control of malaria in pregnancy (MIP) consists of 3 core interventions namely case management,

IPTp (at least 3 doses of IPT with SP) and use of LLIN.

The uptake of IPT is still considered low with only 66.6% of pregnant women completing 2 doses

of SP (BCC Survey in November 2011). This is partly due to late registration of pregnant women

at antenatal clinics. IPTp is institutionalized and implemented through a DOTS strategy during ANC

clinic visits. Therefore, higher ANC coverage which stands at 61% (The Gambia Health Sector

investment case-page 44) will inevitably lead to increase in uptake of IPTp.

The proportion of pregnant women who slept under either an ITN or a LLIN according to the DHS

2013 was 45%, while 62% of children under-five slept under an ITN the night before the survey in

households with at least one ITNLLIN utilization by the general population was 58%. It should be

noted that this survey was done before the LLIN campaign.

3.2.2.3.5 Advocacy, Communication and Social Mobilization

Health education and promotion is a key component of The Gambia`s Primary Health Care Strategy.

Advocacy, Social Mobilization and Behavioural Change Communication (ASMBCC) is an

important component of malaria prevention and control. ASMBCC increases positive behaviours.

The Malaria Programme Review showed that a gap exists between what the people know about

malaria and their behaviour. This will be addressed by strengthening ASMBCC activities at

community level. The MPR recommended that an ASMBCC Technical Working Group be set up,



and that home-grown short courses and training programmes be conducted for central NMCP staff

and other key actors in ASMBCC; and Focal Person for ASMBCC other than the Programme

Manager be designated to ensure effective supervision and coordination of the activities of frontline

communicators. Periodic operational research should be undertaken with a view to generating

information for planning ASMBCC.

3.2.2.3.6 Malaria Surveillance, M&E and Operational research

The HMIS is the umbrella programme for collecting, analysing, storing and disseminating health

data of the Ministry of Health including the malaria control programme. The HMIS runs on DHIS2,

an open source web-based software which serves to integrate all service data into the HMIS. The

MPR (2013) has identified the need to improve data quality and management particularly at regional

and health facility levels as a priority. It also highlighted the need for improvement in capacity to

handle and manage data generated from large scale studies and surveys and conduct of socio-

economic impact studies. The need to strengthening the surveillance system was emphasized to

provide accurate and timely evidence for targeted interventions as case incidence rate declines

progressively, and the country approaches the phase pre-elimination/elimination of malaria.

3.2.2.3.7. Malaria commodities procurement and supply management

The Ministry of Health has in place Procurement and Supply Management System (PSM) for the

supply of medicines and other medical supplies including LLINs. A Contracts Committee has been

established in accordance with The Gambia Public Procurement Authority Act 2001 and

Regulations 2003. The main challenges to the PSM identified by the Malaria Program Review

include; weak quality assurance processes for medicines and related products; poor prescribing and

dispensing practices in both public and private health facilities and weak national

pharmacovigilance system. The following actions were recommended in the MPR report:

strengthening the mechanism for quality assurance of all malaria medicines and other health

products; ensuring security of essential medicines and other commodities for malaria prevention,

and quarterly updates on essential malaria medicines.

3.3 Current situation of the malaria program.

3.3.1 Policy context

The Programme developed two policies during the period under review. The first policy covered

the period 2002-2007 with strategies focusing on protecting vulnerable groups and minimizing the

health impact of the disease on them. The second policy covers the period 2008-2015 with emphasis

on universal access to malaria prevention and control interventions. Furthermore, the current policy

includes Indoor Residual Spraying and targeted larviciding as part of Integrated Vector

Management. As stated earlier on, Vision 2020 (1996–2020) accords priority to the effective control

of endemic diseases, including malaria. The Malaria Control Policy is linked to the National Health

Policy 2007-2020 ‘’Health is Wealth’’.

The current integrated approach to malaria control involves scaling up treatment with ACTs after

parasitological confirmation, using Rapid Diagnostic Tests (RDTs) or microscopy; provision of



MIP services; universal access to Long Lasting Insecticidal Nets (LLINs) , In-door Residual

Spraying (IRS) and ASMBCC.

3.3.1.1 Organisation

A clearly defined structure for management and co-ordination of the malaria control programme

exists. At central level, there is a Programme Manager, a Deputy Programme Manager and well

established specialized components that correspond to the key malaria control intervention areas.

As can be seen in the Table 2 below, each component is headed by a highly trained focal point who

reports to the Programme Manager. In addition, there is a fully established support system

comprising procurement, financial management and logistics. The Programme has 16 technical

and eight support staff. It has also trained and deployed vector control officers at regional level to

strengthen malaria control activities in communities. There is a National Steering Committee that

supports the Programme for the implementation of Roll Back Malaria (RBM). The Committee

comprises representatives from the MoHSW and partners. Malaria control activities at community

and regional levels are coordinated mainly by Regional Health Teams.

Table 4: Staffing pattern and qualification of staff

Position Number Level of qualification

Programme Manager 1 Masters Degree in Public Health

Deputy Programme Manager 1 Masters Degree in Medical Entomology

Focal Person, Malaria Case

Management

1 Masters Degree in Public Health

Focal Person, Malaria in

Pregnancy

2 Diploma in Community Health, currently

pursuing a Masters Degree on Health

Promotion

Focal Person, Integrated Vector

Management

2 Masters Degree in Public Health

Entomology

Focal Person, IEC/BCC 1 Diploma in Reproductive Health in

Developing Countries

M&E Coordinator 1 Masters Degree in Health Economics and

a Certificate in M&E

M&E Specialist 1 Masters Degree in Demography

M&E Assistant 1 Masters Degree in Health Promotion and

a Certificate in M&E

M&E Data Manager 1 Diploma in Reproductive Health in

Developing Countries

Technical Assistants

(Parasitologist, Entomologist)

2

TA from the Republic of Cuba

Financial Controller 1 ACCA and MBA in Finance

Procurement Officer 1 BA in Accounting & Certificate in

Procurement

Senior Accountant 1 ACCA

Project Accountant 1 AAT Technician

Internal Auditor 1 AAT Technician

Office Administrator 1 BSc in Administration

Drivers 8 All the drivers have been trained by Riders

for Health

Cleaners 2 Not Applicable



3.3.1.2 Guidance

There is a malaria control strategic framework that is consistent with the malaria policy vision “The

Gambia Where Malaria Cease to Be a Major Public Health Problem”. The National Malaria Control

Policy outlines key strategies that address the key issues in malaria control. The strategies are also

aligned with RBM goals and targets.

In addition, the programme has developed several guidelines and manuals to facilitate

implementation of malaria control strategies. These manuals and guidelines cover Prevention and

Control of Malaria during Pregnancy; Case Management; Community Case Management; Indoor

Residual Spraying and Long Lasting Insecticidal Treated Nets.

3.3.1.3 Human Resources, training and capacity development

The programme has a good complement of technical staff. The programme areas are headed by

professional staff who hold master’s degree in their areas of specialisation. However, certain

specialities such as an epidemiologist, statistician and parasitologist are not available.

Over the past 10 years, the programme has trained 4 of its staff to master’s level in public health

and entomology. An additional 33 staff have benefitted from certificate courses in malaria control,

planning and implementation. Staff at the central unit, RHTs, health facilities and partner institutions

have benefitted from diploma and certificate courses outside the country. In-service training

programmes geared towards enhancing skills and competences in different intervention areas

continue to be conducted across the country.

3.3.1.4 Strategic and annual planning

The Strategic plan, 2014-2020 builds on the achievements of the previous strategic plan 2008–2015.

The priorities included in the plan derive from current national and global technical guidance, and

the lessons from preceding years of implementation as identified during the 2013 Malaria

programme review (MPR 2013). Effective interventions such as universal LLIN coverage, IPTp,

SMC and treatment with ACTs will be scaled and/or sustained to ensure attainment of strategic goal

which is to reach pre-elimination phase during the life span of this strategic plan. Operational and

annual plans will be developed to provide more specific guidance for implementation of this

strategic plan.

3.3.2. Partnership and coordination mechanism

Partnership building

The NMCP collaborates with many local NGOs and CBOs in the promotion and distribution of ITN

and social mobilization and behaviour change communication (ASMBCC). These partners include

Action Aid The Gambia (AATG), Catholic Relief Services (CRS), Nova Scotia Gambia Association

(NSGA), Health Promotion and Development Organization (HePDO), National Association of

Women Farmers (NAWFA), Catholic Development Organization (CaDO), Agency for

Development of Women and Children (ADWAC). The Medical Research Council (MRC) and

Centre for Innovation Against Malaria (CIAM) also collaborate with NMCP in the area of research

and surveillance. At community level many, CBOs such as Niamina Youth Association Against

Malaria (NYAAMA), Bill Clinton Youth Association and NaYAFS, are also involved in ITN

distribution and ASMBCC activities geared towards malaria control. Private sector health service

providers are playing an increasingly important role in providing malaria treatment, particularly in

urban areas.



The MoHSW collaborates with bilateral and multilateral agencies in malaria control and prevention,

notably UNICEF, WHO, World Bank and ADB. The Gambia also enjoys bilateral technical

cooperation with the Federal Republic of Nigeria, Republic of Cuba, Egypt, Taiwan and Venezuela.

Through bilateral cooperation between the Governments of the Republics of Cuba and the Gambia,

an entomologist and a parasitologist are provided to support the Programme. In addition, the

programme works closely with both print and electronic media to create more awareness on malaria

prevention and control. This is reinforced by the partnership with the Gambia Radio and Television

Services through the Directorate Promotion and Education. Furthermore, the programme has

established and maintains strong linkages with the Association of Health Journalists (AOHJ) and

network of community radios throughout the country.

3.3.3. Malaria Program contribution to the Health System Strengthening

Malaria program has contributed significantly to the strengthening of the health system through the

provision of support for routine data collection, analysis, reporting and management through the

HMIS. In addition, new laboratories have been established at regional level, old ones renovated and

the national public health lab upgraded to provide quality control and assurance for diagnostic

services. All RHT have been supported with trekking vehicles to ensure adequate monitoring and

supervision of health services within their respective regions. The Program has also has supported

capacity building of health staff on M&E, malaria diagnosis, treatment, overall malaria prevention

and control.

3.3.4 Limitations to implementation

Taking into consideration the above main achievements as well as the SWOT analysis from the

MPR bottlenecks to the malaria Program implementation are as follow:

Integrated Vector Control

Lack of storage facilities at health facilities

Low rate of LLINs utilization in some communities

- Complaints from the community about shape and size of LLINs

- Lack of entomological equipment and supplies at regional level

- Lack of consistence data on vector sensitivity to insecticide in use (IRS, LLINs)

- Lack of continuous surveillance data on vector species and distribution

- Unsatisfactory utilization of Insecticidal Treated Nets

- Low coverage for IRS

MIP

- Late booking at Antenatal Clinics

- Low uptake of the second dose of IPTp

SMC

- Inadequate financial resources to scale up SMC;

- Weak Pharmacovigilance

- Inadequate SMC monitoring and reporting (health workers and community

volunteers not trained adequately on SMC, partner levels on SMC)



- Weak logistics management system for SMC drugs at regional health facility and

community levels

- Limited information at community and partner levels on SMC

ACSM

- No health promotion and education policy to provide a framework for the planning,

harmonization, coordination and management of communication programs;

- No scaling up of ASMBCC across the country with a view to promoting positive

attitudes, behaviour and practice in communities;

- Lack in translating into positive change of behaviour in communities despite the

appearance high level of awareness of malaria;

Case Management

- Poor prescribing and dispensing practices in both public and private health

facilities;

- Gap in effective supervision and monitoring of health workers after training;

- Limited access to ACTs and RDTs at community level will help to ensure prompt

and effective treatment of malaria

- Inadequate Pharmacovigilance system (weak national capacity for medicines safety

monitoring)

- Inadequate coverage of CCM services in the context of iCCM (including supply of

ACT and diagnostic tests kits);

- Inadequate Private sector involvement in malaria case management

- Inadequate trained health workers on updated malaria guidelines

Procurement and supply management

- Weak Medicines and related products Quality Assurance;

- Weak national Pharmacovigilance system.

- Inadequate consumption data makes it difficult to quantify and forecast malaria

commodities

- Inadequate storage infrastructure to support good storage practice of medical

products especially at the health facilities

- Low national capacity for quality assurance of anti-malarial medicines and related

medical products

- Inadequate and unreliable consumption data for forecasting and quantification of

community needs for malaria diagnosis and treatment

Surveillance, monitoring, evaluation and operational research

- Absence of qualified human resource on surveillance (Epidemiologist, Statistician);

- Limited capacity for handling and managing data generated from large scale

surveys;

- Weak HMIS to provide information on malaria as the country moves towards pre-

elimination phase

- Gap in regular data quality assurance including laboratory quality assurance

through provision of quality and timely reports on malaria.

- Gap in evidence-based planning to guide decision-making as important ingredient

in effective prevention and control of malaria

Programme Management and Leadership

- Low government budgetary allocation to malaria control

- Weak coordination and management of Malaria Programme at regional level

- Limited capacity of RHT and health facility staff in data and financial management for

proper financial and data management at regional, and health facility levels for service

delivery



- Evidence-based planning cannot be realized in the absence of qualified data analysts and

dissemination personnel



CHAPTER IV: STRATEGIC PLAN FRAMEWORK

4.1. Vision

A Malaria-free Gambia

4.2. Mission

The mission of the National Malaria Program is to ensure universal and equitable access for the

population at risk to malaria prevention and treatment interventions in line with the national health

policy.

4.3 Guiding principles

Universal access for the population at risk

Everyone in the Gambia has the right of access to malaria prevention and control services

Client satisfaction

Malaria prevention and control services should reflect local needs and involve communities and

individuals at all levels of planning and provision of services. Services and technology should be

affordable and acceptable to communities

Equitable access

Malaria prevention and control services must strive to address inequity and prioritize services to the

most needy

Evidence-based

Social, biomedical and health systems research should inform policy and strategy choices in order

to provide effective malaria prevention and control program.

Partnership

Effective alliances with national, sub-regional and international partners should be established for

more effective information sharing, resource mobilization and coordination for malaria prevention

and control interventions

4.4. Strategic Directions and Policy Priorities

The Gambia is signatory to a number of international conventions and resolutions of direct relevance

to malaria control and elimination. The importance of malaria control is stressed in the National

Health Policy 2012-2020 branded “Health is Wealth” and several other national policy documents.

The Health Policy recognizes that malaria is an important cause of morbidity and mortality, and it

places emphasis on strengthening national systems to effectively provide services, including

interventions for the control of malaria. The country is committed to the Roll Back Malaria and the

Abuja Declaration (2000) whose goal is to halve the burden of malaria by 2010 and again by 2015.

In compliance with the Abuja Declaration the country has removed all taxes and tariffs on malaria

control commodities.

The Government of The Gambia believes that every person has the right to access highly effective

malaria curative and preventative services delivered as close to the home as possible. Malaria

control activities are accorded a high degree of priority in the both Vision 2020 (1996-2020), the



national development blueprint, the Program for Accelerated Growth and Employment (PAGE) and

other national and sectoral policies. The malaria control is integrated at all levels of the health

system. It relies on the health sector policy based on the participation and empowerment of the

community according to the national health policy. Given the high political commitment to malaria

control, the President of the Republic of The Gambia declared Operation “Eradicate Malaria” in

February 2008. This move led to the institutionalization of Operation Clean the Nation, introduction

of Indoor Residual Spraying (IRS), and social mobilization campaigns for malaria control.

Consequently, the National Malaria Prevention and Control Policy and Strategic Plan were reviewed

to reflect the aims of the Declaration. A further demonstration of high political commitment for the

health of the population is seen in the Presidential declaration to the effect that all public sector

health facilities shall provide free maternal health services, including malaria control services.

The National Health Sector Strategic Plan has been developed for the period 2010 to 2014 with the

aim of facilitating and guiding the implementation of the national health policy. The strategic plan

is geared towards improving access and quality of health care in the country with a view to reducing

morbidity and mortality rates.

This Strategic Plan is designed for a period of five years (2014-2020). The priorities and objectives

of this strategic Plan are in line with the National guidelines and targets of the Health sector Policy,

and well linked to the international WHO and RBM responses for 2016-2030 namely the “Action

and investment to defeat malaria (AIM) 2016-2030 – for a malaria-free world” which complements

WHO’s Global technical strategy for malaria 2016–2030 and unites the global community for the

achievement of the 2030 malaria goals. The scope of the five-year strategic plan is to consolidate

the recent gains and accelerate malaria WHO-recommended strategies universal access in order to

reduce malaria transmission moving towards having more low transmission areas by 2020. Given

the malaria current situation in The Gambia, specific interventions will be implemented tailored to

specific transmission settings based on epidemiological stratification.

The main interventions of the strategic plan 2014-2020 will focus on the following priorities based

on 2013 MPR recommendations and the current achievements of the Programme:

- Strategic Direction 1: Universal access to malaria vector control prevention package with

free or highly subsidized commodities;

- Strategic Direction 2: Universal access to malaria prevention and control in pregnancy with

free or highly subsidized commodities;

- Strategic Direction 3: Universal access to malaria case Management

- Strategic Direction 4: Strengthening ASMBCC for a strong public health communication

and behavioural change to improve acquisition and usage of malaria prevention and

treatment services;

-

- Strategic Direction 5: Strengthening Procurement and Supply Chain Management

- Strategic Direction 6: Strengthening Surveillance, Monitoring & Evaluation and

Operational research

- Strategic Direction 7: Strengthening Programme structures and systems for planning,

Management, Partnership and coordination mechanisms at all levels (including inter-country

and cross-border collaboration).

4.5. Goals

By 2020, to reduce malaria mortality rates by at least 40% compared with 2013.



By 2020, to reduce malaria case incidence by at least 40% compared with 2013.

4.6. Objectives

By 2020:

- at least 80% of malaria cases at all levels receive prompt diagnosis and effective treatment;

- at least 80% of the population at risk are protected with effective preventive measures;

- at least 80% of the population have appropriate knowledge and practices to use malaria

prevention and management services;

- malaria surveillance, monitoring and evaluation systems at all levels are strengthened;

- malaria programme management capacities at all levels are strengthened

CHAPTER V: INTERVENTIONS AND IMPLEMENTATION STRATEGIES

Over the past decade, major malaria control investments have been made in The Gambia in the

context of the National Malaria Strategic Plans, 2000-2007 and 2008-2015. Though The Gambia

has made significant strides in malaria prevention and control in the last five years, malaria still

remains to be an important cause of mortality among children under the age of five. The disease

has a marked seasonal variation, with about 90% of cases occurring in the rainy season and

immediately after the rainy season. Malaria is both preventable and treatable, but it is a complicated

disease whose prevention and control requires multiple interventions. Preventing malaria requires

creating a malaria-free environment, which involves spraying the inner walls of populated structures

(homes, schools, hospitals, businesses, and other institutions) with efficacious insecticides, always

sleeping under insecticide treated nets (ITNs), and environmental management measures to prevent

the development of mosquito breeding grounds.

Having reviewed the epidemiological situation and program makers, taking into consideration the

MPR SWOT analysis and priorities, program staging and the planning phases, the following key

interventions and strategies have been identified for achievement of the stated milestones and

objectives.

This current 2014-2020 Malaria Strategic Plan presents a major scale up of key interventions, and

draws from a robust evidence base and the experience in previous years.

5.1 Multiple preventive interventions

5.1.1. Malaria vector control

5.1.1.1. Long Lasting Insecticidal Nets (LLINs)

Ministry of Health will maintain the policy of one LLIN for every two persons. Routine distribution

of LLIN through the RCH services targeting children, mothers and pregnant women will continue.

Nation-wide LLIN distribution campaigns will be conducted periodically (every three years) to

maintain universal coverage for LLIN. LLIN will also be provided for institutions such as Hospitals,

boarding schools, the prisons, social welfare facilities for children and the elderly.

Main activities:

Procurement of LLINs



Distribution of LLINs

Community sensitization on LLINs

Provision of IEC materials on LLINs

Training on LLIN distribution

Promoting consistent use of LLINs

Monitoring and evaluating operations

5.1.1.2. Indoor Residual Spraying (IRS)

IRS intervention is selected for its complementary role to the LLINs and specifically for its

contribution to reducing the vector population and impact on the disease burden. Therefore the IRS

strategy will target three out of the seven regions with high malaria disease burden in the country as

well as preventing vector resistance to insecticide. These regions have been selected and prioritized

based on their high disease burden relative to other regions and entomological data that indicates

the susceptible nature of mosquitos to this intervention.

Main activities:

Procurement and supply of IRS commodities

Distribution of IRS commodities

Community sensitizations on IRS strategy

Training on IRS application

Provision of IRS educational materials

Conducting Indoor Residual spraying

Monitoring and evaluating IRS operations

5.1.1.3. Larviciding

Targeted chemical and biological larviciding will be used as supplementary vector control

intervention to reduce larval densities and adult mosquito populations. Targeted chemical and

biological larviciding will be used as supplementary vector control intervention to reduce larval

densities and adult mosquito populations especially in three regions (URR, CRR and WCR2) but

specific choice of sites will further be informed by evidence from operational research

Main activities:

Procurement of equipment and larvicides supplies

Distribution of larviciding commodities

Community sensitization on larviciding

Training on application of larvicides

Conducting spraying of breeding sites


5.1.1.3. Environment management

This intervention has been undertaken by the department of State for health for many years in the

Gambia in both rural and urban areas. This strategy will address need to eliminate or reduce

mosquito breeding sites in communities with high density of mosquitoes. Emphasis will be placed



on increasing public awareness on the importance of IVM through individual, CBO, community

and stakeholder sensitization.The Government of The Gambia will facilitate and promote

meaningful community participation towards environmental management. Positive behavioural

change communication will be intensified for positive attitudinal change towards the environment.

Main Activities:

Advocacy for the implementation of the environmental management guidelines for malaria

vector control

Adaptation of guidelines for environmental management for malaria vector control in

collaboration with the local government authorities

Community sensitizations on environmental management for malaria vector control

Training on environmental management for malaria vector control

Have increased and sustained the correct and consistent use of long lasting insecticidal nets

to 85% by the population at risk by 2020.

Entomological Monitoring

As dictated by evidence from vector susceptibility studies which showed increasing vector

resistance to DDT, a two-year insecticide rotational cycle will be implemented using Bendiocarb, a

more expensive insecticide selected as part of the resistance management strategy. The risks of

failing to mitigate for insecticide resistance will render the main malaria prevention tools (both IRS

and LLINs) less effective in the long-term. Monitoring of vector resistance status to insecticides

will continue in entomological surveillance sites across the 7 regions as part of insecticide resistance

management.

Main activities

Insecticide resistance monitoring

Assessment of EIR in the Regions

Vector density monitoring

Vector bionamics

Establishment of an insectary

5.1.2. Malaria in pregnancy

Malaria in pregnancy is a common cause of severe maternal anaemia and low birth weight babies,

these complications being more common in primigravidae than multigravidae. Preventative

strategies include, intermittent preventative treatment with antimalarials and consistent use of

insecticide-treated bed nets through close collaboration with the RMNCH. BCC activities targeting

the households will be intensified to increase early ANC registration in order to benefit from early

initiation of IPTp and LLIN.

5.1.2.1 Increase access to and use of IPTp for pregnant women

IPTp with SP is given to every pregnant woman as directly observed treatment at each ANC visit

unless there is good reason not to do so. This intervention will benefit from the continuous

distribution of LLINs to pregnant women during RCH clinics.

Main Activities:

Procurement of IPTp drugs and supplies

Distribution of IPTp drugs and supplies

Provision of MIP reporting tools

Provision of MIP IEC material

Sensitization on MIP



Training on MIP

Monitoring and Evaluation of MIP activities.

Increasing ASMBCC at community level to facilitate early bookings and increase the consistent

uptake of IPTp3

5.1.2.2 Increase access to and use of LLINs for pregnant women

As part of the MIP strategy, pregnant women will continue to receive LLIN during routine ANC

visits. In addition, pregnant women will benefit from the nation-wide LLIN distribution campaigns

conducted periodically. In order to increase actual use of LLINs by those most at risk, pregnant and

lactating women will receive intensive ASMBCC sessions during antenatal, postnatal and child

health clinics

Main Activities:

Provision of LLINs to all RCH Clinics

Distribution of LLINs

LLIN distribution to pregnant women at ANC

Conducting intensive ASMBCC sessions during Antenatal, postnatal and child health clinics

5.1.2.3 Case management of malaria in pregnancy

Oral quinine will be used during the first trimester whilst ACTs will be used for the treatment of

uncomplicated malaria during the second and third trimesters. Parenteral Artesunate will be used as

first line treatment for severe malaria in pregnancy. However parenteral Artemether or quinine will

be used in the absence of the first line treatment. Prompt and appropriate detection, management

and referral of anaemia cases will be emphasized at all levels of service delivery including the

private sector.

Main Activities:

Reviewing and Updating of Malaria Case Management Guidelines to include HIV co-infection

Reviewing and Updating the PMTCT Guideline to include MIP

Reviewing and Updating the MIP Guidelines to include HIV and management of anaemia in

pregnancy

Provision of prompt and effective diagnosis and treatment for malaria in pregnancy

Prompt and effective management of anaemia and other malaria related complication in

pregnant women

Strengthening coordination between RCH and NMCP

Revitalization of the National Task Force on MIP

5.1.3. Seasonal Malaria Chemoprevention (SMC)

The SMC strategy will implemented through campaigns using community health workers within

the Village Health Services (VHS). A complete course of Sulphadoxine-Pyrimethamine plus

Amodiaquine will administered to every child 3 months to 59 months old in the country on monthly

basis up to a maximum of four months during the peak transmission period. Required annual

medicines needs for SMC for each region available in the region by June each year.

Main Activities:

Procurement of SMC medicines and supplies



Training on SMC

Sensitization on SMC

Advocacy on SMC

Implementation of SMC

Provision of reporting tools on SMC

Provision of IEC materials on SMC

Provision of guidelines, training manuals and job aids on SMC

Conduct Pharmacovigilance on SMC medicines

Monitoring of SMC implementation

Evaluating of SMC operations

Monitoring of drug efficacy on SMC medicines

5.2 Case management

Early recognition of the signs and symptoms of malaria and prompt effective treatment is needed to

reduce morbidity and mortality associated with the disease. As a policy, malaria should be

confirmed through parasite-based tools for all suspected cases before treatment for all ages and all

settings. Treatment of malaria will be based on parasite-based diagnosis. Priority interventions

essential for prompt diagnosis and effective treatment of malaria proposed in this strategic

plan are in line with national and global policy guidelines include, Diagnosis, Treatment,

Integrated Community Case management, Monitoring of malaria medicine efficacy and Quality

assurance and quality control of laboratory diagnosis.

5.2.1 Case Management at Health Facilities

5.2.1.1 Diagnosis

To promote parasite-based diagnosis of malaria at all levels of service delivery, laboratory services

will be expanded and strengthened through the provision of adequate equipment, supplies and

personnel. Periodic assessments will be undertaken to ensure high quality of services.

Main Activities:

Procurement of laboratory equipment and supplies

Distribution of laboratory equipment and supplies

Recruitment of personnel for laboratory diagnosis of malaria

Pre-service training of Laboratory personnel

In-service training of laboratory personnel on laboratory diagnosis of malaria

Strengthening monitoring and supervision of laboratory diagnosis of malaria

Provision of reporting tools for laboratory diagnosis of malaria

5.2.1.2 Treatment

Effective treatment will be based on standard treatment guidelines and rational use of medicines.

Threshold for stock levels will be closely monitored to avert stock outs of antimalarials. Capacities

of service providers in malaria case management will be enhanced. Periodic assessments will be

undertaken both in the public and private facilities to ascertain adherence to treatment guidelines as

well as quality of care.



Main Activities:

Procurement of antimalarial medicines and supplies

Provision of antimalarial medicines and supplies at community level.

Distribution of antimalarial medicines and supplies at facility and community levels

Training of health workers including the private sector on malaria case management

Reviewing and updating the treatment guidelines for malaria case management

Strengthening monitoring and supervision of malaria case management at facility and

community levels.

Provision of reporting tools on prompt treatment of malaria

5.2.2 Case Management at Community level

Access to health facilities which provide effective treatment for malaria is still limited in some rural

parts of the country. Equally it is recognized that the majority of children who die from malaria do

so within 48 hours of onset of illness. As such, The Gambia with support from partners adopted

CCM to increase access to early reliable diagnosis with prompt and effective treatment of malaria

to reduce the burden of the disease. Currently CCM is being implemented in some health regions

and this will be reviewed and expanded to include other childhood disease and transformed into

iCCM .The iCCM policy and implementation framework will be developed with technical and

financial support from UNICEF and other partners; iCCM will be implemented countrywide.

Village health workers will continue to receive support (training, supplies and required logistics) to

provide appropriate diagnosis and treatment of uncomplicated malaria and other childhood illnesses

and to undertake IEC/BCC and community mobilization activities. The community referral system

will also be strengthened to facilitate early referral to the next level of care where required

Components of integrated community case management (iCCM)

An effective communication strategy to ensure correct health care seeking behaviour and

appropriate and effective community case management of malaria and other childhood

illnesses

Training community based service providers to ensure that they have the necessary skills

and knowledge to manage the illnesses

Availability and access to effective high quality antimalarial and other medicines at

community level

Supervision and monitoring of ICCM activities at community level

5.2.3. Monitoring of malaria medicine efficacy

Periodic monitoring of antimalarial efficacy will be conducted every two years at the national

malaria sentinel surveillance sites using WHO protocols.

Main Activities

Training on therapeutic efficacy studies

Conducting efficacy studies

Procurement of equipment for molecular laboratory efficacy studies

Training on molecular laboratory efficacy studies



5.2.4. Quality assurance and quality control of laboratory diagnosis

Continuous improvement of laboratory diagnosis for malaria will be ensured through quality

assurance and quality control activities.

Main Activities

Develop a protocol on QC for malaria laboratory diagnosis

Training on Quality assurance and quality control of laboratory diagnosis of malaria

Establish national QA&QC system for RDTs

Strengthen QA&QC for slide microscopy

Provision of reporting tools for QC on malaria laboratory diagnosis

5.3 Integrated Support Systems

5.3.1 Advocacy, Communication and Social Mobilization

Malaria prevention and control requires positive change in behaviour and practices in individuals,

households and communities. With the Advocacy, Social Mobilization and Behavioural Change

Communication strategy, emphasis will be on community- based processes, complemented with

mass media and communication support materials. A set of recommended preventive behaviours

will be promoted through comprehensive approaches.

The essential intervention areas are: Advocacy, Community Outreach, Mass Media and Operational

Research on ASMBCC.

5.3.1.1Advocacy

Advocacy targeting key partners and stakeholders

Training on advocacy

5.3.1.2 Community outreach

Sensitisations on malaria prevention and control

Provision and dissemination of communication materials.

Kabilo and Positive Deviants approaches

Malaria Competence Approach

Peer Health Education Approach

Interpersonal communication


Build capacity at all levels for supporting frontline communicators

5.3.1.3 Mass media

Use of print and electronic media to disseminate malaria messages


5.3.1.4 Operational research on ASMBCC

Conduct operational research to evaluate ASMBCC activities

5.3.2 Procurement and Supply Management (PSM) and Quality Assurance of Malaria

Commodities



Procurement and Supply Management (PSM) is a support service in malaria prevention and control.

Consistent availability and effective management of malaria control commodities are basic

prerequisite to successful programme implementation and achievement of targets. The key

implementation strategies are: Selection and Quantification, Procurement, Quality Control, Storage,

Distribution/Supply, Inventory Control and Stock Management, Supervision and Monitoring.

5.3.2.1 Quality Assurance

Review of market authorizations for malaria medicines and other commodities

Strengthening market surveillance for malaria medicines and other commodities

Strengthening malaria medicines safety monitoring

Random Collection of antimalarials for QC

Identification of QC reference laboratory for antimalarial

Courier services for QC on antimalarials

Develop a reporting format for QC on antimalarials

5.3.2.2 Procurement

Procurement of malaria medicines and other supplies

5.3.2.3 Quality control

Conduct quality control testing on all imports of malaria medicines and diagnostics

Establish level one reference lab for QC

Procurement of equipment for level one reference Laboratory for QC

Training on QC and testing of malaria medicines

5.3.2.4 Storage

Improve storage conditions at national, regional, facility and community levels

5.3.2.5 Distribution

Improved transportation of medical commodities to regional stores, health facilities and

Village Health Services

5.3.2.6 Pharmacovigilance

Review Pharmacovigilance plan

Reviewing and updating guidelines, training manual and reporting tools on

Pharmacovigilance

Training of health personnel on Pharmacovigilance

Provision of guidelines, training manual and reporting tools on Pharmacovigilance

Monitoring of Pharmacovigilance at all levels

Revitalize Pharmacovigilance technical committee at central level

5.3.2.7 Inventory control and stock management

Provision of inventory control and stock management tools.

Recruitment and training of personnel on stock management

Provision of National Guidelines for Good Storage and Supply of medical commodities

Improve stock management at all levels

Building LMIS’s capacity at national, regional and health facility level

Building capacity at all levels for forecasting and quantification

5.3.2.8 Supervision and monitoring



Improve supervision and monitoring of supplies at all levels

Provision of monitoring tools

5.3.3 Malaria surveillance, monitoring, evaluation and operational research systems

5.3.3.1 Malaria surveillance, monitoring, evaluation and operational research systems

A sound system of monitoring and evaluation of malaria control interventions at country level is

critical in demonstrating progress in achieving outcomes and impact of all control efforts. Since

malaria control effort involves several actors, including those outside the formal health ministry, the

information generated by such an M&E system should respond to the information needs of key

stakeholders.

This approach is consistent with the Paris Declaration on Aid Effectiveness and with the "three

ones" concept, which calls for national M&E systems to establish one coordination mechanism, one

M&E framework, and one strategy. Initiatives to harmonize data collection and sharing among the

development partners, technical and implementing agencies with core national M&E framework

will be strengthened.

In view of the rapid nationwide scale up of malaria interventions for impact and move towards pre-

elimination, the surveillance system will be strengthened at all levels with capacity building to

enable it proactively inform the policy and programme planning and activities during pre-

elimination and elimination phases. More specifically, as the program approaches pre-elimination,

the program will gradually shift from passive to active surveillance for timely tracking and response.

The Technical Working Group (TWG) will provide technical guidance on the implementation of

the surveillance, monitoring, evaluation and operational activities (SMEOR). Training of health

workers will be provided to strengthen the capacity on SMEOR using the approved training plan.

Routine programmatic data collection and reporting will be conducted on a regular basis, moving

to active surveillance as pre elimination target is reached. Data quality assurance (DQA) will be

conducted on regular basis to enhance malaria data quality. SME/OR will be conducted on a periodic

basis and as required.

The core intervention areas for SMEOR include M&E systems coordination, Capacity

strengthening, Tracking progress, Data quality assurance, Data demand and use, Supportive

supervision, Measuring out come and impact.

The main milestones are:

- Have in place a Malaria Information System capable of providing accurate, reliable and

timely information to inform pre elimination strategies by 2017

- A National Malaria M & E Work Plan with costs in place by March 2015

- A Malaria Data dissemination Plan available by June 2016

- A Malaria surveillance system strengthened and positioned for pre elimination with new

components including case and focus investigations, active case detection, and laboratory

quality control by 2020

- An improving data quality at all levels

- Strengthening capacity for data analysis and use at all levels

- Developing epidemic preparedness and response plan

Implementation Strategies

M&E systems coordination

Revitalize M&E Technical Working Group

Conduct MESST



Review and update Malaria M & E Plan

Conduct coordination and review meetings

Capacity strengthening

Training staff on M & E

Procurement of computers and accessories for M & E

Recruit and train data entry clerks

Improve networking for M & E

Provision of software for M & E data reporting

Tracking progress

Review and update HMIS data collation and reporting tools

Provision of data collection and reporting tools

Train staff on tools usage

Routine monitoring of data at all service delivery points

Data quality assurance

Review and update QA guidelines and tools

Train staff on QA system

Provision of QA guidelines and tool

Conduct QA at service delivery points

Data demand and use

Development of guidelines and protocol on data demand and use

Train staff on data demand and use

Advocacy on data demand and use

Measuring outcome and impact

Conduct malaria sentinel surveillance

Conducting Review Meetings

Conducting annual work Plan review

Conduct MTR

Conducting Malaria Global Malaria Review (MPR)

Conduct Malaria Operational Research

Conducting surveys on malaria (MIS, DHS, Facility Surveys)

5.3.3.2 Operational Research

Main Activities:

Building capacity on operation research

Develop Malaria Surveys and Research Plan by end June 2016

Operational research in Malaria in pregnancy

Plan and funding for stratification and risk mapping in place by 2016

Conduct stratification and risk mapping by 2017

5.3.4 Strengthening malaria program management at all levels



Malaria prevention and control requires effective programme management and partnership.

Through the MoHSW, the Programme has built alliances with partners such as sectoral departments,

NGOs, private sector, civil societies, community, multilateral and bilateral agencies. This

partnership involves joint programme planning and implementation to ensure ownership and

sustainability. Partnership also exists with countries through sub-regional initiatives for the

harmonization of strategies for malaria prevention and control. Cross border collaboration with

neighbouring Senegal will be strengthened as the country moves towards pre elimination. The key

implementation strategies are: Human Resource Capacity, Planning and Coordination, Partnership

Building, Resource Mobilization and Cross border Collaboration.

Implementation Strategies

Human resource capacity

Train staff at central and regional level on Program Management

Train staff in specialized areas such as Entomology Epidemiology, Parasitology, Medical

Statistics and Information Technology

Facilitate staff to undertake WHO international training on malaria management and its planning

Planning and coordination

Planning and coordination Develop a business plan

Revitalize RBM committees and sub-committees at regional and central levels

Partnership coordination

Advocate for Three(3) Ones Principle

Strengthen partnership with stakeholders

Resource Mobilization

Develop advocacy strategy for resource mobilization

Conduct high level advocacy for resource mobilizations

Cross border collaboration

Strengthen collaboration with Senegal

Revitalize existing malaria initiatives e.g Health for Peace, TIME, and Nouakchott Initiative.

Organize cross boarder meeting with the neighbouring countries at central and regional level

Organize study tour with the neighbouring countries on specific intervention

Organize meetings to share research findings among neighbouring countries

5.3.5 Strengthening Health systems in the context of malaria control

The prevention and control of malaria in The Gambia is fully integrated in from the tertiary to the

primary levels of the health system and at the community level. The success of malaria control

depends on strength and efficiency of the health system. This fact influences planning and resource

allocation in malaria control programming the world over. In Gambia, The Malaria Control

Programme has played a key role in attracting resources for health system strengthening.

Health information systems and procurement and supply chain management are two key areas that

have posed significant risks to implementation of malaria control interventions. The NMCP has on

several occasions served as a channel for attracting funding to strengthen PSM and HMIS. On the

other hand, diagnosis and treatment of malaria have in some situations been hampered by the lack



of adequate number of trained personnel and essential support services at facility level. Some of

these issues have been identified for attention through domestic and donor resources.



CHAPTER VI: MONITORING AND EVALUATION OF THE STRATEGIC PLAN

6.1. Performance framework

Disease control and prevention, as well as other health and development programs, have become

grounded in evidence. As such, an effective monitoring and evaluation strategy is needed to

measure the adequacy and timeliness of inputs, progress and assessment to ensure achievement of

the set objectives. This will provide sound evidence for decision making at both program and policy

levels.

A monitoring and evaluation plan for the period 2014 – 2020 has been developed as an

accompanying document to this strategic plan. It highlights the structures, processes and

approaches, as well as an identification of critical stakeholders implicated in the M&E system to

give effect to this strategic plan, particularly as the program moves into the pre elimination phase.

The plan also provides guidance on the core indicators, their definitions and frequency of

acquisition. Table 3 shows planned annual targets for these indicators.

Table 5: Core Impact and Outcome indicators

No. Indicator Definition

Baseline National Malaria Strategic

Plan Targets

Value

Year

Source

2016

2017

2018

###

2020

GOALS: By 2020,

To reduce malaria mortality rates by at least 40% compared with 2013.

To reduce malaria case incidence by at least 40% compared with 2013

Impact Indicators

1 All-cause under-5 mortality rate in highly endemic areas

The probability (expressed as a rate per 1000 live births) that a child dies before reaching five years of age is subject to the current age-specific mortality rate

54/1000

2013

DHS 32.4/1000

32.4/1000

2 Anemia prevalence: Percentage of children aged 6–59 months with hemoglobin measurement of <8 g/d

Numerator: Children aged 6-59 months with a measured haemoglobin content of <8 g/dl Denominator: Children aged 6-59 months who had haemoglobin measured during a household survey

17.10%

2010

MIS 14%

12%

10.3%

3 Parasitemia prevalence: children aged 6–59 months with malaria infection (by microscopy) (percentage)

Numerator: Children aged 6-59 months with malaria infection detected by microscopy Denominator: Children aged 6-59 months tested for parasitemia by microscopy during household survey

4.00%

2010

MIS 1%

0.5%

0.4%

4 Prevalence of malaria parasite infection among general population

Numerator: General population with malaria infection detected by microscopy Denominator: General population tested for parasitemia by microscopy during household survey

0.3 2014

MIS 0.25

0.2 0.15





Plan Targets

Value

Year

Source

2016

2017

2018

###

2020

5 Inpatient malaria deaths per 100,000 persons per year

Numerator: Number of inpatient malaria deaths Denominator: Population at risk of malaria

15/100000

2013

HMIS

12 10.5 9

6 Inpatient malaria cases per 10,000 persons per year

Numerator: Number of inpatient malaria cases Denominator: Population at risk of malaria

58/10000

2013

HMIS

46.4

40.6 34.8

7 Malaria incidence (number of confirmed malaria cases per 1000 persons per year)

Numerator: Number of newly diagnosed malaria cases during a specified time in a specified population Denominator: Total population at risk of malaria

159/1000

2013

HMIS

127.2

111 95.4

8 Malaria test positivity rate Numerator: Number of confirmed malaria cases Denominator: Number of patients receiving a parasitological test (RDT & Lab)

N/A HMIS

10%

7% 4% 3%

2%

Outcome and Output Indicators

Objective 1: At least 80% of malaria cases at all levels receive prompt diagnosis and effective treatment

Malaria Case Management

1.1

Number of health workers trained on case management according to national guidelines

80 2016

Report

160

240

320

400

480





Plan Targets

Value

Year

Source

2016

2017

2018

###

2020

1.2

Number and percentage of public health facilities with no reported stock-outs of nationally recommended antimalarial drugs lasting more than one week at any time during the past three months

Numerator: number of public health facilities with stock out of SP Denominator: Total number of public health facilities

100%

2014

Report

100%

100%

100%

####

100%

1.6

Proportion of people presenting to the village health worker with fever who were tested for malaria using RDTs

NA HMIS

60 70 80 90 100

1.7

Proportion of people presenting to the health worker with fever who were tested for malaria using RDTs

NA HMIS

55 60 70 80 90

1.8

Number of village health workers trained on community case management of malaria

642 2016

Report

642

0 642

0 642

Objective 2: At least 80% of the population at risk are protected with effective preventive measures

Vector Control

2.

1

Proportion of Households with at Least One ITN

Numerator: Number of households surveyed with at least one ITN Denominator: Total number of households surveyed

81.1 2010

MIS 83%

85% 85%





Plan Targets

Value

Year

Source

2016

2017

2018

###

2020

2.

2

Proportion of Households with at least one ITN for every two People

Numerator: Number of households with at least one ITN for every two people/Denominator: Total number of households surveyed

45.3 2014

MIS 60%

80% 80%

2.

3

Proportion of population who slept under an ITN the previous night

Numerator: Number of individuals who slept under an ITN the previous night Denominator: Total number of individuals who spent the previous night in surveyed households

75.3 2014

MIS 78%

80% 80%

2.

4

% of U5 who slept under ITN the night before the survey

Numerator: Number of U5 who slept under an ITN the previous night Denominator: Total number of U5 within surveyed households

83 2014

MIS 84%

85% 85%

2.

5

Proportion of pregnant women who slept under an ITN the Previous Night

Numerator: Number of pregnant women who slept under an ITN the previous night Denominator: Total number of pregnant women within surveyed households

84.8 2014

MIS 84.9%

85% 85%

2.

6

Percentage of HH which received spraying through an IRS campaign in the last 12 months

Numerator: Number of households sprayed with a residual insecticide during an indoor residual spraying campaign in the last 12 months Denominator: Number of households surveyed

21.3 2014

MIS 60%

80% 80%

Objective 3: At least 80% of the population have appropriate knowledge and practices to use malaria prevention and management services

3.1

Percentage of household who know the cause of, symptoms of, treatment for and preventive measures for malaria

Numerator : Number of households who cite the cause of, symptoms of, treatment for or preventive measures for malaria Denominator : Total number of household surveyed





Plan Targets

Value

Year

Source

2016

2017

2018

###

2020

3.2

Percentage of women 15-49 years who know the cause of, symptoms of, treatment for or preventive measures for malaria

Numerator: Number of women 15-49 years who cite the cause of, symptoms of, treatment for or preventive measures for malaria Denominator: Total number of women 15- 49 years surveyed

99.6%

2014

MIS 99.7%

99.7%

99.8%

4 IPTp

4.

1

% of eligible pregnant women attending ANC who receive at least SP-IPTp2 or more (in public and private health facilities)

Numerator: number of pregnant women who received at least 2 doses of IPTp treatment with a recommended antimalarial drug during ANC visits Denominator: Total number of pregnant women at first ANC visits

72.60%

2014

MIS 75%

80% 80%

4.

2

% of eligible pregnant women attending ANC who receive at least SP-IPTp3 (in public and private health facilities)

Numerator: number of pregnant women who received at least 3 doses of IPTp treatment with a recommended antimalarial drug during ANC visits Denominator: Total number of pregnant women at first ANC visits

NA 2014

MIS 60%

70% 80%

4.

3

% of health facilities with stock-out of SPs in the last 3 months.

Numerator: number of health facilities providing IPTp services with stock out of SP Denominator: Total number of health facilities providing IPTp services

100%

2014

Monitoring Report

100%

100%

100%

6.2. Tracking progress

The tracking of progress of the malaria interventions will be guided by this strategic plan. For this

purpose, the M & E Plan 2014-2020 will be used to ensure the acquisition and use of

data/information for more effective planning and implementation of the interventions. In this

regard, the programme will support routine reporting by the National HMIS, in addition to

undertaking malaria specific surveys and operational research. The capacity for sentinel

surveillance will be strengthened and additional sentinel sites for therapeutic efficacy testing and

insecticide resistance monitoring will be introduced.

Data for routine implementation will be tracked through quarterly and annual performance reviews.

In this manner, progress will be reviewed on a regular basis both for the MoH as well as all partners

involved in malaria control financing and implementation. Other review mechanisms e. g. malaria

annual work plan review, mid-term and end-cycle reviews will be used to enhance the tracking of

overall progress.

6.3. Measuring impact and outcome

There are core impacts and outcome indicators with targets (see Table 3 above) identified for

measuring progress towards the scaling up of malaria interventions in The Gambia for the period

2014-2020. These indicators are contained in the M&E framework of the M&E Plan 2014-2020

with explicit definitions (numerators and denominators, Data base and targets.

In addition studies on malaria specific topics will be undertaken by various research institutions

(MRC) in collaboration with the NMCP.



CHAPTER VII: GOVERNANCE, PARTNERSHIP AND PROGRAMME MANAGEMENT

7.1. Governance and Program management

The mission of the NMCP is to direct, support, coordinate and manage the national response to

malaria in collaboration with partners. Malaria control interventions are supported by the

Directorate of Health Services and other MoHSW support services. A clearly defined structure for

management and co-ordination of the malaria control programme is in place. At the head of the

structure is a Programme Manager, supported by a Deputy Programme Manager and six sectional

heads, in line with the key malaria control intervention areas, as can be seen in Figure 5. A support

system section comprising procurement, financial management and logistics, complements the

technical units.

As an extension of the Directorate of Health Services, the RHTs are responsible for the coordination

of health services in the region, including malaria control. The RHTs are headed by Regional

Directors of Health who are supported by technical teams.

Public sector health facilities provide comprehensive health care to communities in their catchment

areas. These services include malaria control, with emphasis on case management. Health facilities

are linked to the village heath service network through a well-established referral system. The

private sector health facilities are also actively involved in malaria service delivery and are required

to submit information and reports to the HMIS of the MOHSW.

Malaria control is an integral part of the village health services. Village health workers play an

important role in prevention, diagnosis and treatment of malaria as well as referral of cases.

Community case management is delivered within the context of the primary health care strategy.

Primary health care villages are clustered into circuits of five-six settlements. A community health

nurse is posted in each PHC circuit to oversee delivery of village health services. There is a network

of Village Development Committees across the country and their main role is to oversee and

coordinate all health and development programmes in the village. Regional Health Team and other

partners provide technical support in malaria control at the community level.

Levels of service delivery for malaria control

Malaria control is an integral componenet of the health care delivery system which cuts across central,

regional and community levels.

National level

The mission of the NMCP is to direct, support, coordinate and manage the national response to

malaria in collaboration with partners. Malaria control interventions are supported by the

Directorate of Health Services and other MoHSW support services.

Regional Level

As an extension of the Directorate of Health Services, the RHTs are responsible for the coordination

of health services in the region, including malaria control. The RHTs are headed by Regional

Directors of Health who are supported by technical teams.

Health Facility Level

Public sector health facilities provide comprehensive health care to communities in their catchment

areas. These services include malaria control, with emphasis on case management. Health facilities

are linked to the village heath service network through a well-established referral system. The



private sector health facilities are also actively involved in malaria service delivery and are required

to submit information and reports to the HMIS of the MOHSW.

Community Level

Malaria control is an integral part of the Village Health Services. Village health workers play an

important role in prevention, diagnosis and treatment of malaria as well as referral of cases.

Community case management is delivered within the context of the primary health care strategy.

Primary health care villages are clustered into circuits of five-six settlements. A Community Health

Nurse is posted in each PHC circuit to oversee delivery of village health services. There is a network

of Village Development Committees (VDCs) across the country and their main role is to oversee

and coordinate all health and development programmes in the village. Regional Health Team (RHT)

and other partners provide technical support in malaria control at the community level.

7.2. Planning and implementation

The Strategic plan, 2014–2020 builds on the achievements of the implementation during the last 6

years of the strategic plan 2008 - 2015. An operational plan is critical to the implementation of the

strategic plan 2014-20205.

The implementations of malaria control activities will include other government departments, the

donor community including UN agencies, bilateral partners, research and academic institutions

(MRC), NGOs/CBOs and private sector. The WHO and UNICEF provide technical support to the

NMCP whilst the Global Fund and other funding partners provide financial resources for

programme implementation. Non-Governmental Organizations (NGOs) and private practitioners

contribute significantly to the provision of curative and preventive health care in the country

especially in the urban areas.

Malaria control interventions are supported by the office of the Director of Health Services and

other programmes within the MoHSW, notably the NPS, NPHL, Division of Public Health,

Directorate of Planning, Directorate of Health Promotion and the RCH programme. The Transport

Management Agency (Riders for Health) plays a crucial supportive role in the programme. The

Regional Health Teams provide significant administrative and technical support in the

implementation of the National Malaria Prevention and Control Programme. Communities also

contribute to the implementation of the national programme.

7.3. Human Resource

The programme has a good complement of technical staff. The programme areas are headed by

professional staffs that hold masters’ degree in their areas of specialization. However, certain

specialists such as an epidemiologist, statistician and parasitologist are not available. Over the past

10 years, the programme has trained 4 of its staff to master’s level in public health and entomology.

In addition, 33 staff have benefitted from certificate courses in malaria control, planning and

implementation. Staff at the central unit, RHTs, health facilities and partner institutions have

benefitted from diploma and certificate courses outside the country. In-service training programmes

geared towards enhancing skills and competences in different intervention areas continue to be

conducted across the country.



7.4. Malaria commodities Procurement and supply management system

Procurement and supply management is an important element of malaria control. There is an

established procurement and supply management system within the MoHSW. All PSM activities

are coordinated by the National Pharmaceutical Services (NPS) which is headed by a team of

specialists.

The NPS have overall procurement responsibility for all pharmaceuticals and health products used

in the public sector health service. Procurement needs are identified in consultation with partners

and stakeholders in accordance with set standards and procedures. This process is coordinated by

the Procurement Officer who oversees all procurement activities. The MoHSW has established a

Contracts Committee in accordance with The Gambia Public Procurement Authority Act 2001 and

Regulations 2003. The committee comprises representatives from various technical units of the

MoHSW. Currently, the MoHSW does not have a procurement policy. However, a drug quality

assurance policy has been developed.

7.5. Financial resource management

Malaria control and prevention activities are funded from two main sources, the national health

budget and external sources. Under the national health budget, the programme receives funding for

administration, salary emoluments, antimalarial medicines, logistics and vector control activities.

The Global Fund has been a major source of financing for malaria control and prevention activities

in the country, having contributed 81% of the total funds invested over the period 2004-2007.

Funding opportunities for malaria control have increased over the years, leading to a significant

increase in coverage of key interventions. The programme acquired several grants through the

Global Fund Country Coordinating Mechanism, starting with the Round 3 grant in 2003 that covered

prevention and control interventions in the Western Health Region. The successful implementation

of round 3 grant led to the scaling up of key interventions across the whole country through the

acquisition of additional Global Fund grants including the Round 6 grant in 2006, RCC and Round

9 in 2010. All the malaria grants were subsequently consolidated into a single grant to increase

efficiency in management.

7.6. Partnership mechanism of coordination

Partnership Coordination: Partnership for malaria control will be coordinated through

strengthening of existing structures like the country level Roll Back Malaria partnership and other

program specific working groups.The NMCP will continue to collaborate with local NGOs and

CBOs in the promotion and distribution of ITN and social mobilization and behavior change

communication (ASMBCC). The collaboration between MoHSW and bilateral and multilateral

agencies in malaria control and prevention will be sustained and strengthened.

Cross-border collaboration: The Gambia and Senegal NMCPs have currently discussed the

feasibility of cross-border programming. Areas of collaboration will include joint planning,

surveillance and campaigns (IRS, LLINs, SMC and IEC/BCC). The two national programmes are

exploring opportunities to leverage additional funds to support these cross-border initiatives for

effective malaria control and elimination in border communities.



7.7. Risks and threats for the implementation of the strategic plan

Risks and threats to the implementation of NMSP 2014-2020

1) Need to strengthen capacity for management capacity and coordination of the

program at all levels, in the context of malaria Pre-elimination and elimination

2) Funding gap for implementation of malaria strategic plan 2014-2020 especially

increase gradually domestic resources in the perspective of pre-elimination;

3) Resources and processes to ensure universal access and sustainability of malaria

key prevention measures and case management services (T3) both at public, private

and community level;

4) Need to address gap in knowledge and behaviour of population at risk of malaria

through the implementation of a communication strategy adapted to the context of

malaria pre-elimination;

5) Verification of the reported decline in malaria cases and the observed age shift

regarding the disease burden in the country through routine surveillance, surveys

and quality data audits;

6) Need to establishment of a national baseline for Test Positivity Rate (TPR) through

routine data from health facilities;

7) Need of stratification of malaria endemicity up to the district level (including

different malaria parasites, vector and risk mapping in the country)

8) Capacity to monitor parasite prevalence and malaria transmission as well as

possibility of climate change effect on malaria transmission and epidemiology

9) Inadequacy in routine data quality collection and reporting (epidemiological,

commodities) in order to better inform on malaria burden and commodities

consumption at health facilities (trends);

10) Address effective demand and use of data for evidence-based planning to guide

decision-making, including making the Virtual Private Network (VPN) fully

functional



CHAPTER VIII: BUDGET AND FINANCIAL PLAN

8.1. Budget summary by Component

Table 6: Budget Summary by Component

Budget Component 2016 2017 2018 2019 2020 2016-20

Commodities $3,815,454 $8,283,268 $3,751,878 $3,986,795 $8,893,659 $28,731,054

Operational Plan $4,040,827 $5,207,810 $5,190,275 $4,875,198 $4,997,662 $24,311,773

Grand Total $7,856,281 $13,491,078 $8,942,153 $8,861,993 $13,891,321 $53,042,826

Figure 7: Total Budget By year

8.2. Budget summary by strategic Direction and Objectives

Table 7: strategic Direction and Objectives

STRATEGIC DIRECTION 2016 2017 2018 2019 2020 2016-20

Strategic Direction 1: Universal access to malaria vector

control prevention package with free or highly subsidized

commodities;

$2,036,382 $7,965,507 $4,109,816 $3,412,535 $8,647,994 $26,172,234

Strategic Direction 2: Universal access to malaria

prevention and control in pregnancy with free or highly

subsidized commodities;

$572,976 $622,192 $573,672 $578,599 $578,596 $2,926,036

Strategic Direction 3: Universal access to malaria case

Management $2,702,762 $2,381,069 $2,308,390 $2,349,016 $2,218,341 $11,959,578

Strategic Direction 4: Strengthening ASMBCC for a

strong public health communication and behavioural

change to improve acquisition and usage of malaria

prevention and treatment services;

$173,758 $158,999 $183,560 $167,323 $183,560 $867,201

Strategic Direction 6: Strengthening Surveillance,

Monitoring & Evaluation and Operational research $359,556 $363,666 $260,756 $354,875 $263,185 $1,602,037

Strategic Direction 7: Strengthening Programme

structures and systems for planning, Management,

Partnership and coordination mechanisms at all levels

(including inter-country and cross-border collaboration).

$2,010,846 $1,999,645 $1,505,959 $1,999,645 $1,999,645 $9,515,740

Grand Total $7,856,281 $13,491,078 $8,942,153 $8,861,993 $13,891,321 $53,042,826



Figure 8: Budget by Strategic Direction

Strategic Direction 149%








Table 8: Budget by Objective

OBJECTIVES 2016 2017 2018 2019 2020 2016-20

1. By 2020 at least 80% of malaria cases at all levels receive

prompt diagnosis and effective treatment; $2,702,762 $2,381,069 $2,308,390 $2,349,016 $2,218,341 $11,959,578

2. By 2020 at least 80% of the population at risk are

protected with effective preventive measures; $2,609,358 $8,587,699 $4,683,488 $3,991,135 $9,226,590 $29,098,270

3. By 2020 at least 80% of the population have appropriate

knowledge and practices to use malaria prevention and

management services; $173,758 $158,999 $183,560 $167,323 $183,560 $867,201

4. By 2020 malaria surveillance, monitoring and evaluation

systems at all levels are strengthened; $359,556 $363,666 $260,756 $354,875 $263,185 $1,602,037

5. By 2020 malaria programme management capacities at

all levels are strengthened $2,010,846 $1,999,645 $1,505,959 $1,999,645 $1,999,645 $9,515,740

Grand Total $7,856,281 $13,491,078 $8,942,153 $8,861,993 $13,891,321 $53,042,826

Figure 9: Budget by Objective



1. By 2020 at least 80% of malaria cases at all levels receive prompt

diagnosis and effective treatment;

22%

2. By 2020 at least 80% of the

population at risk are protected with

effective preventive measures;

55%

3. By 2020 at least 80% of the population have appropriate knowledge

and practices to use malaria prevention and management services;

2%

4. By 2020 malaria

surveillance, monitoring

and evaluation systems at all

levels are strengthened;

3%

5. By 2020 malaria

programme management capacities at all levels are strengthened

18%

8.3. Budget summary by cost category

Table 9: Budget summary by cost category

Cost Category 2016 2017 2018 2019 2020 2016-20

Communication Materials $501,039 $463,091 $429,091 $481,684 $477,690 $2,352,593

Health Products and Health Equipment $1,576,402 $7,306,275 $2,843,832 $2,893,620 $7,856,035 $22,476,163

Human Resources $7,320 $25,200 $43,200 $61,200 $61,200 $198,120

Infrastructure and Other Equipment $371,721 $305,635 $290,353 $275,835 $262,044 $1,505,588

Monitoring and Evaluation (M&E) $387,261 $523,862 $412,388 $524,500 $414,817 $2,262,828

Overheads $1,811 $1,751 $1,751 $1,751 $1,751 $8,815

Pharmaceutical Products (Medicines) $1,725,995 $1,704,007 $1,683,716 $1,665,405 $1,651,119 $8,430,242

Planning and Administration $2,033,329 $1,868,675 $1,981,726 $1,878,071 $1,881,503 $9,643,305

Procurement and Supply Management Costs $614,153 $783,500 $756,521 $504,782 $747,912 $3,406,868

Training $637,250 $509,083 $499,576 $575,144 $537,253 $2,758,306

Grand Total $7,856,281 $13,491,078 $8,942,153 $8,861,993 $13,891,321 $53,042,826

CHAPTER IX: RESOURCE MOBILI ZATION

9.1. Budget gap analysis

The financial gap analysis taking into account the sources of funding is done to facilitate discussion

for resource mobilization.

Table 10: Summary financial gap analysis

9.2. Donors mapping

Figure 10: Summary potential donors supporting the NMCP

MALARIA FINANCIAL GAP ANALYSIS 2016 2017 2018 2019 2020 2016-20

A.Total national strategic plan Budget (Needs) $7,856,281 $13,491,078 $8,942,153 $8,861,993 $13,891,321 $53,042,826

B. Actual and Expected domestic resources $999,225 $1,141,571 $1,170,110 $1,199,363 $1,229,347 $5,739,614

C. Total Actual and Expected external

Resources non-GF

$1,623,504 $621,015 $499,083 $505,810 $512,705 $3,762,117

D. Total Actual and Expected external

resources Global Fund (existing Global Fund

grants)

$1,700,000 $0 $0 $0 $0$0

E. Total Actual and expected resources (B

+C+D)

$2,622,729 $1,762,586 $1,669,193 $1,705,173 $1,742,052 $9,501,731

F. Financial Gap = A-E$5,233,552 $11,728,493 $7,272,961 $7,156,820 $12,149,270

$43,541,095

Malaria InterventionsG

oG

GFATM

WH

O

UIN

CEF

CRS

CRS A

CCESS

SM

C

Case Management

Integrated Vector Control

Malaria in Pregnancy

Seasonal Malaria Chemoprevention

IEC/BCC

Surveillance Monitoring and Evaluation

Program Management



REFERENCES

Ceesay SJ, Casals-Pascual C, Nwakanma DC, Walther M, Gomez-Escobar N, et al. (2010)

Continued Decline of Malaria in The Gambia with Implications for Elimination. PLoS ONE 5(8):

e12242. doi:10.1371/journal.pone.0012242.

Department of State for Health and Social Welfare, NMCP-National Malaria Policy, 2002-2007

Evaluation of the progress of setting up a National Sentinel Surveillance System in The Gambia,

2010

Gambia Bureau of Statistics, (2003). Government of The Gambia. The 2003 Population and

Housing Census, Mortality Estimates, Gambia Bureau of Statistics.

Gambia Bureau of Statistics, (2011), The Gambia Multiple Indicator Cluster Survey 2010 report,

Banjul

Health Policy, Health is Wealth 2011-2020, Ministry of Health and Social Welfare. National Malaria

Control Work Plan 2010.

MICS (2002). The Gambia Multiple Indicator Cluster Survey 2000. The Gambia Bureau of

Statistics: 1–116.

MOH, (2004). The Gambia Routine Health Information Systems Report.

Serign J Ceesay, Climent Casals-Pascual, Jamie Erskine, Samuel E Anya, Nancy O Duah, Anthony

J C Fulford, Sanie S S Sesay, Ismaela Abubakar, Samuel Dunyo, Omar Sey, Ayo Palmer, Malang

Fofana, Tumani Corrah, Kalifa A Bojang, Hilton C Whittle, Brian M Greenwood, David J Conway

(2008) Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis.

WHO. 2008c. WHO position statement on integrated vector management. Weekly epidemiological

record 20: 177–184. for IVM

AU Conference of Ministers. Fight malaria: Africa goes from control to elimination by 2010.

African launch of the Africa malaria elimination campaign, 3rd Session of the AU Conference

of Ministers of Health, Johannesburg, South Africa. 2007

MOH, 2004. The Gambia Routine Health Information Systems Report

Vision 2020 (1996 – 2020)

PER, 2001

Malaria Programme Review Report 2013

ANNEXES



ANNEX 1: Organizational structure for malaria control program



ANNEX 2: Program Gap Analysis 2016-2020



ANNEX 3: Implementation plan 2014-2020 (planning chronogram)



ANNEX 4: Performance framework 2014-2020

2014-2020 Malaria Programme Performance Measurement Framework



ANNEX 5: Commodities needs 2016-2020



ANNEX 6: Budget details 2016-2020



ANNEX 7: Malaria SWOT analysis

STRENGTHS WEAKNESSES OPPORTUNITIES THREATS

PROGRAMME MANAGEMENT AND PARTNERSHIP

High level of political

commitment to health;

National Health Policy

and Strategic Plan are

available

National Malaria Policy,

Strategic Plan and M&E

plan are available HR

strategic plan 2012 -2016

updated and available

Existence of structures to

support policies, planning

and service delivery.

Availability of guidelines

and tools for supervision

and monitoring;

Existence of HR unit at

MoHSW;

Existence of structures at

all levels for the

management and delivery

of malaria control

interventions;

Allocation of funds to

malaria in the recurrent

budget;

Increased funding from

Global Fund

Malaria policy and

strategic plan are not

aligned with the Global

Malaria Action Plan

(GMAP) targets and

strategic objectives;

New WHO recommended

strategies (SMC and

IPTi) are not included in

the malaria policy

Lack of a business plan

for implementation of

strategies

Resource mobilization is

not explicitly featured in

Health Master Plan 2007

to 2020;

Limited capacity at

regional and community

levels for effective

management of malaria

control activities

Inadequate staff

motivation

Inadequate budgetary

allocation for malaria

within the health sector

budget;

No Public expenditure

reviews done;

Limited human resource

capacity at service

delivery level

High level of motivation

in communities with

regard to malaria

prevention and control

Availability of health

training institutions

including the

University of The

Gambia;

Internal and external

technical assistance and

cooperation in capacity

building.

The Vice President

launching of the IHP+;

Commitment to

developing an IHP+

country compact

Availability of a draft

health financing policy;

Global Fund

commitment to

supporting malaria

interventions

Limited adherence to

some policies related

to malaria control by

private sector health

facilities.

High staff attrition

rate;

Heavy dependence

on technical

assistance;

High donor

dependence

Resource mobilization

is not explicitly

featured in Health

Master Plan 2007 to

2020


allocation for malaria

within the national

health sector budget;

PROCUREMENT SUPPLY MANAGEMENT

Existence of integrated

sector-wide PSM

Availability of a range of

tools (manuals, forms,

guidelines, ) and

resources designed to

facilitate and streamline

PSM

Existence of contracts

committee at the Ministry

of Health

Inadequate consumption

data for forecasting and

quantification Non-

adherence to standard

treatment guidelines

Inadequate transport

facilities for distribution

Weak pharmacovigilance

system

Absence of a National

Medicines Formulary

Existence of GPPA Act

and Regulations

Existence of a National

Medicines Regulatory

Authority

Availability of WHO

list of pre-qualified

suppliers of ACTs and

RDTs

PSM Management

team

Uncertainty of donor

funding

Potential parasite

resistance to

antimalarial

medicines.

Potential vector

resistance

High cost of RDTs

and ACTs



Existence of Gambia

Public Procurement

Authority

Existence of physical

infrastructure at Central

and regional levels for

storage of medical

commodities

Existence of PSM Officer

within NMCP


allocation for medicines

and other medical

products PSM

Ineffective system for

monitoring the

importation and use of

antimalarials in the

private sector

Occassionalstockout of

medicines and

commodities

Availability of

WHOPES publications

and recommendations.




INTEGRATED VECTOR MANAGEMENT

The National Health

Policy, National Malaria

Policy and National

Malaria Control Strategy

recognizes vector control

as a central component of

malaria control.

Positive community

response to vector control

measures

Regional vector control

officers available at RHT

level

Limited national capacity

for environmental control

of vectorsConsistent

utilisation of LLINs

during the dry season in

some places

Larviciding is limited to

Banjul city

Inadequate facilities for

storage of vector control

commodities

An established and

trained vector control

team at central and

regional level

Presence of volunteer

spray operators in

communities

Availability of

WHOPES publications

and recommendations

High dependency on

donor funding

Vector resistance to

insecticides

MALARIA DIAGNOSIS AND CASE MANAGEMENT

There is capacity for

parasitological diagnosis

in all public sector health

facilities.

Case management is fully

integrated in the national

RCH services

Staff at health facility and

village health service

levels trained in case

management

Service delivery points are

within ‘easy’ reach

Up-to-date malaria

treatment guidelines

available

Malaria Surveillance and

monitoring system in

place

Availability of capacity to

conduct efficacy testing of

anti-malarial medicines

Parasitological diagnosis

not optimally available at

village health service level

Adherence to the national

treatment guidelines by

the private sector is weak

Antimalarial medicines in

private sector/NGO are

not routinely tested for

efficacy.

Case management is

integrated in curricula of

Nurse Training

Institutions;

Donor interest in

malaria control;

There is collaboration

between the Programme

and private sector health

care providers;

Malaria is perceived in

communities as a

dangerous disease on

the part of children and

pregnant women;

Partnership with MRC

well established in

medicines efficacy

testing;

Prospect of

collaboration with the

UTG in medicines

efficacy testing

High dependence on

donor support

High attrition rate

among professional

health staff

High cost of ACT in

the private sector

Risk of malaria

parasite developing

resistance to the

medicines

MALARIA PREVENTION AND CONTROL IN PREGNANCY

MIP is fully integrated

into RCH services

MIP module Integrated

into the curricula of Nurse

training institutions

A critical mass of health

workers in public and

Weak coordination

between RCH Unit and

NMCP:

IPTp service not delivered

at some private clinics;

Collaboration with the

private sector is weak;

Integration of MIP

module into Nurse

training Institutions

High level of attendance

at RCH clinics by

pregnant women across

the country

High dependence on

Donor Funding

High attrition rate

among professional

health staff in the

public sector



private sector trained in

MIP

MIP is given prominence

in all malaria-related

strategy and policy papers

The linkage with malaria

and HIV-prevention is not

featured in the malaria

policy

National Task Force on

MIP is weak

Limited operational

research on the impact of

IPTp on pregnancy

outcomes

Inadequate data on malaria

mortality in pregnancy

Non-availability of recent

data on mortality related to

MIP

Late Antenatal Booking

resulting to low uptake of

IPTp 2

Existence of TBAs to

deliver MCH services at

community level;

The existence of Health

workers Training

Schools

Participation of

NGO/private sector

health care providers in

delivery of maternal

health services

Ongoing research in

MIP by MRC

Prevalence of negative

customs and practices

in communities




ADVOCACY SOCIAL MOBILIZATION BEHAVIOURAL CHANGE COMMUNICATION

ASMBCC featured in both

National Malaria Control

Policy and Strategy

ASMBCC delegated to

NGO to provide services

Rapid expansion of

communication

infrastructure in the

country

Existence Health

Communication Task

Force

Lack of ASMBCC Policy

and Strategy

Limited ASMBCC Skills

among health workers at

regional and community

level

Planning and

programming of

ASMBCC is not always

based on operational

research

Supervision and systems

for supporting frontline

communicators are weak

Limited coverage in

ASMBCC at community

level

There is no ASMBCC

focal point person within

NMCP

Existence of Health

Education and

Promotion Directorate

in MOHSW

Lessons learnt from the

MPR on ASMBCC

Active participation of

media, CSO and NGOs

in health and nutrition

communication

High level of client

health workers contact

at RCH clinics

Highdependence on

single donor such as

GF for funding

Commercialization of

electronic mass media,

high cost of air time

High attrition rate

amongst professional

health workers

SURVEILLANCE MONITORING, EVALUATION AND OPERATIONAL RESEARCH

Established M& E Unit

Availability of M&E

plans, tools, guidelines

and other instruments

Trained M&E Team at

Program Management

Level

Availability of data bank

and information

Partnership established

within and outside MOH

Strong Operational

research partnership

Existence of HMIS of

MOHSW

Poor data quality

Delays in production and

submission of survey

reports and service data

Limited coordination of

survey /studies within the

National Statistical

System (NSS)

Limited capacity for

handling and management

of large surveys

Non availability of

epidemics preparedness

plans

Slow pace of

implementation of health

emergency plan

Inadequate number and

low skills of data entry

clerks

Limited capacity for data

analysis and use

Irregular data reporting

from hospitals

Existence of MRC

contribution to provide

data on malaria

epidemiology and

evaluation of new

interventions

Existance of data from

the Gambia Bureau of

Statistics (GBoS) on

malaria prevention and

control

Availability of DHIS 2

and LMIS

Donors and partners

interest in M&E

WHO –MOHSW

Biennial plan

UNICEF-MOH Plan of

Work

Limited number of

people with

competency in DHIS 2

and LMIS

Inadequate funding for

M&E



ANNEX 8: Participants List

republic of the gambia · 2017-03-31 · national malaria strategic plan 2014-2020 a malaria free...

Documents