|
1. Preparatory
Phase (Duration: Two years, 2005-2006)
The preparatory phase begins after the plan has been
prepared and approved by the three countries and includes preparations for
operations (including a pilot total coverage spraying operation and
establishment of diagnosis and treatment facilities) in selected districts in
endemic countries and monitoring (including passive and active case detection
and vector monitoring). This will be useful in identifying constraints and
operational difficulties. The lessons learnt during this phase can be useful
in the attack phase of elimination.
The main activities proposed include the following;
 Development/review
of national policy and strategic plans. National plans should include
regulation, standards and norms (Member States). The policy should cover
issues relating to intercountry cooperation.
Regulations should cover uniform standards relating to diagnosis and
treatment, insecticides to be used in IRS, tax exemptions, and making the
disease notifiable in endemic areas (Member
States).
Development
of operational plans to implement the national plan for elimination of kala-azar.
Development
of advocacy plans that include advocacy kits, donor profiles, and highlighting
the close nexus of kala-azar with HIV/AIDS, TB and
leprosy. Advocacy plans should showcase the importance of elimination of kala-azar as a strategy for poverty reduction and to
enhance socioeconomic development in affected areas (Member States).
Preparation
of national plans that include budget and resource gaps (Member States).
Consolidation
of national plans into project document for mobilizing resources (WHO/SEARO).
Constitution
of a national coordination committee and task force/working group
(Member States).
Signing
of memorandum of understanding for intercountry
cooperation and cross-border collaboration (WHO, Member States).
Formation
of regional alliance/partners forum for resource mobilization, advocacy and
assisting in periodic review for elimination of kala-azar
(Member States, WHO and other partners).
Mobilization
of additional resources (Member
States and WHO).
Geographical
information system, RS and information system for integrated vector
management (WHO Support to Member States).
Validation
of disease burden/cases of kala-azar (WHO support
to Member States).
Development
and adaptation of technical guidelines and reporting formats (WHO and
Member States).
 Technical
guidelines (diagnosis and treatment of kala-azar
and PKDL, IRS and ITNs);
Training
package (doctors, nurses, health workers and spraying teams, supervisors);
Surveillance guidelines (disease surveillance, vector
surveillance) ;
Reporting
system, reporting formats ;
Supervisory
system, quarterly monitoring and checklists;
Country
programme and review guidelines.
Development
of materials for behavioural change communication
including guidelines for home care (Member States).
Training
of personnel (doctors, health workers, staff for IRS, survey team, laboratory
staff, data management staff, supervisors) with assistance from WHO.
Identification
of research priorities and initiation of research on estimation, GIS,
RS for IRS, development of new products (research on diagnostics and drugs)
with assistance from WHO.
Establishing
a system of procurement, logistics and supplies (drugs and equipment) with
support from WHO.
Intensive
implementation in selected districts (Member States).
Development
of partnerships in the health sector (HIV/AIDS, TB, leprosy, malaria and
other vector-borne diseases, nutrition, anaemia
etc.) and outside the health sector (environment, poverty reduction).
2. Attack
Phase (Duration: Five years, 2007-2011)
The attack phase will begin in 2007 when the preparatory
phase has ended, provided that all the tasks of the preparatory phase have
been completed. This phase will include implementation and monitoring.
The main activities proposed during this phase include the
following:
Indoor
residual spraying in all the affected areas for five consecutive years in
collaboration with the vector-borne disease control programme
(Member States). This should be according to the agreement reached
among the three endemic countries.
Integrated
vector management including ITNs and environmental
management. Monitoring expansion and coverage of ITNs
(Member States).
Access
to early diagnosis and complete treatment (Member States).
Passive
case detection, active case detection and vector surveillance, case-based
diagnosis and monthly feedback (Member States).
Community
mobilization for vector control and for seeking early treatment (Member
States).
Monitoring
of treatment completion and analysis of treatment failure (Member
States).
Intercountry
task force meeting to review progress and exchange information (Member States and WHO).
Quarterly
monitoring, annual review (input, process, output and outcome indicators) to be
carried out by Member States. Annual reporting to WHO
on an agreed reporting format.
Household
and health facility survey once every 2-3 years (Member States with support
from WHO).
External
country evaluation (Member States with support from WHO).
Increasing
research capacity and networking among research institutions through a research
coordination mechanism (WHO and partners with Member States).
Active
case search at least once a year in rural and urban areas (Member States).
3. Consolidation
Phase (Duration: Three years, 2012-2014)
The consolidation phase will begin when total coverage by
spraying has concluded i.e. at the end of the attack phase. This phase will
end after the period of three years of active surveillance has shown no
increase in the incidence rate at district and subdistrict
levels in endemic countries.
The main activities to be carried out during this phase
include the following:
Limited
indoor residual spraying based on geographical location of cases, and in
areas with high vector density (Member States).
Intensified
active case detection (Member States).
Early
diagnosis and complete treatment to be sustained with focus on co-infections
(Member States).
Treatment
adherence (Member States).
Continued
activities of the attack phase such as monitoring, research, review
meetings and periodic evaluation (Member States).
4. Maintenance
Phase (At least 2 to 3 years)
During this phase, surveillance against re-introduction of
kala-azar will be the responsibility of the disease
control programme in the country until kala-azar is no longer a public health problem. During this
phase, the case incidence at district/sub-district or upazila
level should be less than 1 per 10 000 population. An international review
commission should verify the achievements of the programme.
Countries or affected districts in the countries where elimination targets
have not been reached would require corrective measures. The maintenance
phase will be followed by certification of the elimination status. The
partners will decide the duration of this phase.
|
