User:Royshyamal/National Malaria Control Program Bangladesh

National Malaria Control Program | House-239 (2nd Floor), Lake Road Lane-17, New DOHS, Mohakhali, Dhaka-1206| Phone/Fax: 88-02-8861642; E-mail: mpdc_dghs@yahoo.com | Directorate General of Health Services (DGHS), Dhaka, Bangladesh |website: http://www.nmcp.info/

Malaria is one of the major public health problems in Bangladesh. Out of the total 64 districts 13 districts are in the high endemic areas of malaria transmissions.

In these 13 endemic districts there are 70 endemic Upazilas covering 620 unions with the total population of 10.9 million. Over 98% of the total cases in the country are reported from these areas.

At the national level Malaria and Parasitic Disease Control (M&PDC) unit under the Directorate General of Health Services (DGHS) is responsible for malaria control activities. All disease control activities including that of malaria are implemented under the direct supervision of the Director, Disease Control (DC). The Director, Disease Control is the Line Director for Health Nutrition and Population Sector Programme (HNPSP) and bears the responsibilities of implementing communicable and non-communicable disease control programmes. The M&PDC Unit has three main sections Epidemiology (Programme implementation; operations and assessment); Entomology; and Laboratory (Central Malaria Reference Laboratory).

At the district level and downwards, malaria control activities are implemented through the District Health System. Each district is divided into several upazilas (sub-districts), each upazila has 6-10 unions, and each union is divided into 9 wards (Blocks). In each upazila there is a 31 to 50 bed hospital (Lowest level inpatient facility) and a contingent of field staff up to ward level. The Upazila Health Team has one Health Administrator, 9 doctors, Senior Staff Nurse, Laboratory Technicians, Supervisory staff and field staff. The Upazila Health Team plays the pivotal role in delivering curative, preventive and promotive health care services to on an average 250,000 population. In each upazila there are union health centers (Static outpatient facilities) to serve 25,000 to 30,000 populations. Some of the union level static health facilities are staffed with medical doctors and others are run by paramedical staffs (Medical Assistants). Access to diagnosis by microscopy is available up to sub-district level, which is also not available round the clock. RDT for falciparum has been introduced in the country. Both the Government and NGO workers are diagnosing the malaria cases using the RDT at the community level. Quality of malaria microscopy needs improvement and delay in reporting of positive cases needs to be minimized to facilitate early initiation of treatment.

The Upazila Health Complexes (UZHCs) have a contingent of field staff and their immediate supervisors for implementing disease control programme activities at the community levels. The UZHCs are responsible for all field implementations including malaria. The Upazila Health and Family Planning Officer is the responsible manager in the Upazila. Similarly, the district authority coordinates all programme activities at the district level and they report to the M&PDC in DGHS.

Bangladesh secured R-6 GFATM grant and is currently implementing the proposal focused on early diagnosis of uncomplicated P. falciparum malaria by introducing RDT with improved microscopy and introducing treatment with ACT and prevention by promoting use of ITNs/LLINs. BRAC led NGO consortium (composed of 21 NGOs) is implementing the community based activities in partnership with GoB. This partnership supports the increase access to malaria treatment and prevention and increase awareness of the people through providing BCC activities.

The long term goal of the program is “To reduce malaria morbidity and mortality until the disease is no longer a public health problem in the country”. The general objectives of the program are i) To reduce malaria morbidity by 60% of the level in 2005 by 2015, ii) To reduce malaria mortality by 60% of the level in 2005 by 2015, iii) To prevent and contain malaria epidemics, iv) To empower community for malaria control, and promote partnership with NGOs and the private sector. The specific objectives of the program are i) To provide early diagnosis and prompt treatment (EDPT) with effective drugs to 90% of malaria patients, ii) To provide effective malaria prevention to 100% of population at risk in 5 districts (Bandarban, Khagrachari, Rangamati, Cox’s Bazar and Chittagong) and 80% of population at risk in the remaining 8 districts, iii) To provide pre-referral treatment and timely referral of 90% severe malaria cases to the hospital, iv) To strengthen malaria epidemiological surveillance system, v) To establish Rapid Response Team (RRT) at national, district and upazila levels and increase preparedness and response capacity for containment of outbreaks, vi) To promote community participation, and strengthen partnership with research and academic institutions, private sector and NGOs for malaria control, vii) To strengthen programme management capacity, M&E and PSM. The programme strategies are i) Disease prevention, ii) Disease management (diagnosis and treatment), iii) Surveillance, iv) IEC and community mobilization, iv) Research and Training, v) Strengthening district health system, vi) Strengthening partnership in malaria control, vii) Monitoring and evaluation