International, Regional and Gulf Situation
In 1998, WHO reported that malaria constitutes a public health problem in 90 countries allover the world inhabited by 40% of population and malaria infects from 300-500 million person of whom nearly one million die annually; most of the deaths are from children and young people. The global objective for malaria control is to reduce the mortality to half by the year 2010. WHO classified the countries, according to malaria situation, into 4 groups:
Group 1: Malaria Free Countries
Malaria transmission has been interrupted in nine countries. In 2000, eight of those countries were able to maintain malaria-free status: Bahrain, Cyprus, Jordan, Kuwait, Lebanon, Palestine, Qatar and Tunisia.
Group 2: Countries with sporadic malaria transmission in which eradication is feasible, Saudi Arabia belongs to this group.
Group 3: countries with low/moderate malaria endemicity
This group has relatively well established programmes and with a good strategic approach will be able to lower malaria morbidity and mortality to a large extent.
Group 4: countries with severe malaria problems
This group comprises five countries: Afghanistan, Djibouti, Somalia, Sudan and Republic of Yemen, represent 21% of the population of the region but generate more than 90% of the total number of malaria cases.
Control efforts are a real challenge in these countries due to lack of human and financial resources, weakness in the surveillance systems, lack of well trained personnel in the peripheral areas, poor inter-disciplinary partnership.
Efforts of the Executive Board in Malaria control in the GCC States:
These efforts started since the establishment of the Office in 1976 where the Gulf Malaria Control Committee was established and held its first meeting in 1978 with the participation of WHO experts. Malaria was then a problem in KSA, Oman, and UAE. Yemen was not a member of the GCC.
These efforts were centered on the following:
● Strengthening national capacities in the field of malaria control.
● Strengthening cooperation among the GCC States in the control efforts.
● Strengthening cooperation with donor and supportive organizations in the surveillance, monitoring and evaluation of drugs, registering drug-resistant cases as well as pesticides and monitoring parasite sensitivity.
● Establishing Malaria Fund to support malaria control efforts with voluntary donations from the GCC member states (Bylaws were endorsed by the HMC in the 8th conference held in January 1980).
● Translation of scientific booklets, brochures, etc for health education purposes.
● Organizing workshops on malaria in one of the member states every year sequentially.
● Holding training workshops on geographic mapping, statistical enumeration for malaria foci in collaboration with the EMRO.
● Holding a workshop on quality control requirements in malaria laboratories in the countries of the region.
● After proving effectiveness and use of insecticides - impregnated nets, an extensive symposium in collaboration with the EMRO was held in Abha, Saudi Arabia Shaban 1424H (October 2003) for training on the use of these nets in the endemic areas (freely distributed).
● Lately in the KSA, the use of control factors in bringing up fishes and insect growth in malaria control, and the effectiveness of the technology of geographic information system (GIS) in setting maps for distribution of vectors were evaluated.
● Intensive Saudi – Yemenese efforts are currently exerted in the field of control especially in the border areas, as well as in the Sultanate of Oman.
Malaria free Arabian Peninsula:
In view of the fact that malaria is a regional and global problem and it is one of the largest challenges which affect development in the endemic countries including Yemen.
With reference to resolution # 12 issued by the 62nd conference of the Health Ministers” Council for the Cooperation Council States held in Kuwait (23-24/1//2007) which approved all items in the strategic plan of the initiative titled “Malaria -free Arabian Peninsula”.
Based on the meeting that was held in Cairo (March 2005) between H.E. the Minister of Health – Saudi Arabia, H.E. the Minister of Public Health and Population - Republic of Yemen and the Director General of EMRO in which the Regional initiative of freeing the Arabian Peninsula from Malaria was presented and discussed.
The meeting discussed the need for collaboration of all GCC countries and their support to the Malaria Programme in the Republic o Yemen to enable realizing the stated initiative.
In this regard, two proposals were prepared under the context:
1- Concept proposal for freeing the Arabian Peninsula from malaria .
2- Detailed proposal for strengthening Saudi – Yemen collaboration at the border areas.
The Health Ministers” Council for the Cooperation Council States and its Executive Body made in-depth and accurate review of the proposal as well as the action plan.
Malaria – Current Situation in GCC:
In the Gulf region, Kuwait, Bahrain, and Qatar, United Arab Emirates are malaria free, while Sultanate of Oman is embarking on elimination. Saudi Arabia still has some foci where there is malaria transmission in Jazan province bordering Yemen. In Yemen, which recently joined the GCC countries, malaria remains to be on top of the priority and serious health problems threatening the lives of 60% of its population, with an estimate of more than 2 million malaria cases a year leading to an estimate toll of 15000 to 20000 deaths annually.
Aims of the Initiative:
This initiative aims at :
1- To interrupt transmission from endemic areas in Saudi Arabia and Yemen.
2- To prevent reestablishment of malaria transmission in areas freed from it, and, Interruption of transmission would require strong financial and technical support to the programme in Yemen and the endemic areas in Saudi Arabia as well as border coordination the activities. Prevention of reestablishment of malaria transmission would require a having a network of epidemiological and entomological surveillance a well as coordinated preventive activities.
Partnership with all GCC countries is necessary to avail resources and ensure its better use, makes the control measures more cost-effective and ensure sustainability which is necessary to avoid malaria resurgence.
Rationale behind freeing the peninsula from malaria:
● Elimination is cost effective. The resources that will be used for the time limited activity will be paid off in the future by having healthy generation, more productive work-force with the concomitant positive effect on economic growth in the country. This beside saving the financial costs related diagnosis and treatment of malaria cases.
● Tremendous population movement is a common feature to almost all peninsula countries due to pilgrimage and Omra as well as labor and trade activities. Therefore, eradicating malaria will assist realizing the wide future expectations in term of industry, trade,tourism.
● Other vector-borne diseases such as leishmaniasis, filariasis, Rift valley fever, and dengue fever can be prevented through adult mosquito control measures for malaria.
● Strengthening the malaria programmes for elimination will strengthen the health system and ensure having high coverage by primary health care services, good laboratories and quality assurance system, and strong surveillance system.
● As part of epidemic preparedness and response, malaria epidemiological data are combined with geographical reconnaissance to give a picture of risk areas. The geographic information system (GIS) that will be used for malaria will be shared with other diseases to implement multi-sectoral programmes.
● Freeing the peninsula from malaria would be an example of joint collaboration of activities to reach a specific result and would strengthen capacities in dealing with health partners.
The Proposed plan:
The Health Ministers’ Council for Cooperation Council States suggested that the Gulf countries of Saudi Arabia, Kuwait, Qatar, Bahrain, United Arab Emirates and Oman support the National Malaria Control Programme in Yemen according to a strategic plan during the period 2005-2015. It is proposed that each of these countries commits itself to be a full partners of the government of Yemen in supporting the NMCP in group of governments.
Currently and since 2001 there has been a very strong Saudi-Yemen collaboration to control malaria at the border areas of the two countries. The Yemeni areas covered and protected by this plan of collaboration are Sa’ada and Hajja governorate beside the Tihama areas of Mahweet, Dhamar, Raima and Taiz governorates.
There is also a bilateral cooperation between Oman and Yemen in this respect. The total budget for the Gulf support is estimated to be around $47,250.000 with emphasis on the detailed plan for support of Yemen in the 2007 / 2008 period, with a total budget of about $ 16,000,000
There are many partners for supporting Yemen malaria national control programme, these include WHO, GFATM( GLOGAL FUND FOR CONTROL OF AIDS, TUBERCULOSIS and Malaria) - World Bank, Sultanate of Oman, UAE, Italy, and Japan.
Ministerial resolutions and Technical Committee meetings:
● Resolution # 5 (Conference 60th held in Bahrain, 28-29 /1/1427 H/ 27-28/2/2006 which agreed on principle on the proposals presented by the Eastern Mediterranean Regional Office, and on establishment of a High Committee of Deputy Ministers in the Council States and preparing a detailed work plan in each country.
● Resolution # 6 (conference 61st, held in Geneva, 26/4/1427H 24/5/2006) which decided to call upon a special meeting for the Deputy Ministers and urging the member states to support and give effect to full partnership with Yemen.
● The higher committee held 3 meetings:
- The first and second meetings were held in Cairo throughout the period (4-5/3/1427 H/ 2-3/4/2006) and (8-9 Jumada II,1427 H/4-5 July, 2006) respectively.
- The third meeting was held in Riyadh alongside the 65th meeting of the Executive Body meeting.(Riyadh, 4-6/11/1427H/25-27/11/2006) .
The Gulf technical committee for malaria held 4 meetings:
1- Riyadh (25-26 Rabii I, 1427 H /22-24 April, 2006).
2- Sana’a (12-13 Shaaban 1427 H/5-6 September 2006).
3- Riaydh (7Dhul Qada 1428 H/17 November, 2007) .
4- Sana’a (1 Jumada’I 1430H / April 26, 2009).
Resolution #2 (Conference 62nd , held in Kuwait on 23-24/1/2007 ) which decided :
1- Approval on the components of the strategic plan of the Malaria- free Arabian Peninsula Initiative .
2- The budget of “Malaria- free Arabian Peninsula “strategic plan shall be distributed equally (after deducting the KSA contribution to support the governorates of Hedaida, Hajj and Saada) among the member states (UAU- Bahrain- Qatar-Kuwait-Oman) based on article (18) of the statutes of the Health Ministers’ Council for Cooperation States. Thus, from now on, any amounts of financial contributions provided by the KSA to Yemen will be deducted from the overall sum contribution of Saudi Arabia in the said plan.
3- As followed in international support programmes, the concept of reprogramming the plan according to developments that may take place during the implementation period will be followed. This is to take care of issues like change of prices, need to change some of the pesticides use of new control methods.
4- Emphasis on the necessity to give effect to the Gulf Fund for Malaria Control on condition that the Gulf Technical committee for malaria should be the reference for the fund only in the technical matters.
The Gulf technical committee for malaria shall continue its work at the Gulf level, and all its activities are to be funded from the Gulf Fund for Malaria Control, considering that the work of this committee is part of the strategic plan.
Meeting of the Director General with the Secretary General of the Cooperation Council.
In giving effect to the resolution # 12 (62nd conference) the Director General of the Health Ministers’ Council for Cooperation States (Letter No. 1474, dated 29/2/1427 H-19/3/2007) and held a meeting with HE on the same date to present the strategic plan for making the Arabian Peninsula malaria free including the Gulf support which amounted to (US$ 47,250,000) with emphasis on the detailed plan for support of the Republic of Yemen will be for the first 2 years (2007-2008) with a budget of around 16,000.000 US$ to be presented to the Financial and Economic Cooperation Committee through coordination with the Economic Affairs Sector and the Director General shall take part in such meeting.
The Director General addressed their excellencies the Ministers of Health in the Health Ministers’ Council for Cooperation States by the letter No. 1216 dated 29/2/1428 H/ 19-3/2007 elaborating on the meeting that took place with HE the Secretary General of the Cooperation Council for Arab Gulf countries.
In view of the importance of the subject, it was further discussed in the 66th and 67th meeting of the Executive Body which issued the following recommendations involving :
I- The Executive Board:
1) The Director General of the Executive Board of the Health Ministers’ Council for Cooperation Council States should address HE the Secretary General of the Cooperation Council to request transfer of the allocated budget for the program to the Gulf Fund for Malaria Control in the Executive Office.
2) The Director General of the Executive Office shall address the Chainman of the session (Minister of Health of Kuwait) to address in turn HE the Secretary General of the Cooperation Council to speed up the support of the Gulf project, and inform their excellencies the Ministers of Health in the member states.
3) The Director General of the Executive Board shall address HE the Minister of Health and Population of Yemen towards addressing the Ministry of Planning and International Cooperation to position the Gulf program for making the Arabian Peninsula malaria free a high priority within the development programmes in the General Secretariat of the Cooperation Council.
4) The Executive Board shall advertise for the job of programme coordinator in the member states and then in the Eastern Mediterranean Region in cooperation with EMRO in Cairo after transfer of the allocated budgets to Executive Office for such program from the General Secretariat of the Cooperation Council for the Arab Gulf Countries.
II- Ministry of Health in Yemen
1) The concerned bodies in the MOH, Yemen (Minister of Health) shall address the concerned bodies in the Ministry of Planning and International Cooperation to include the program of making the Arabian Peninsula Malaria- free the topmost priority of the developmental programs in the General Secretariat of the Cooperation Council to be implemented for the year 2008.
2) Review and update of the executive plan endorsed on the part of the Yemeni government in the last period to be sent to the member states after commitment of the Global Fund to support this program.
3) Provision of the Executive Board with periodic reports (every three months) about the progress made in malaria control.
III. World Health Organization
1) Full commitment with participation of a member in the meetings of the technical committee.
2) The WHO should assist Yemen to define promptly the current epidemiological situation through conduction of parasitic and insect surveys.
3) Sustained assistance in control, follow up and evaluation of the plan, study of the financial and logistic needs to ascertain their compliance with the components of the plan.
4) Presenting the proposal to other donor agencies.
5) Provision of detailed training plan for the caders in the Yemeni cities.
6) Setting the priorities in the epidemiologic situation of malaria in the regions and governorates of Yemen before starting the Gulf programme.
As a result of correspondences made, the entire file of the subject had been raised to the Ministry of Planning and International Cooperation on December 5th 2007 to give the project a funding priority within the developmental programmes in the General Secretariat of the Cooperation Council.
Efforts of the General Secretariat of the Cooperation Council:
1- Presentation of the strategy of control of malaria to the economic and financial cooperation committee in its 73rd meeting held in Riyadh in the General Secretariat on May 12, 2007. The committee decided to refer the subject to the joint technical committee to define the developmental needs for Yemen to discuss the possibility of funding the project from the assistance provided by the member states to Yemen. This resolution was presented to the Ministerial Council in its (103rd) session held on July 5, 2007 and it was endorsed.
2- The General Secretariat for the Cooperation Council addressed the concerned bodies for funding the project form the contributions previously announced in the donors conference in London (November, 2006).
3- The General Secretariat called upon holding the 6th meeting of the joint technical committee with Yemen on the 21st January, 2008.
Actions taken to implement the Strategy
● Opening an account in the bank (Malaria Control Fund) in the Executive Board at SAMBA in Riyadh.
● A Board for the Malaria Control Fund had been established, the chairperson is Prof. Tawfik A. Khoja – Director General of the Executive Board, with membership of the Council States.
● A coordinator for the “Malaria – Free Arabian Peninsula” program has been assigned.
● The Executive plan for the years 2010 – 2011 has been put and endorsed. Implementation of the items started.
● Three meetings for the Board of the Malaria Control Fund were held to assess progress made and achievements discussed.
● Program coordinator visited the malaria control program to submit a technical report about the course of activities made accordingly to the endorsed plan.
The following contributions have been received so far:
Oman 3 million US dollars
Qatar 2.2 million US dollars
KSA 4.6 million US dollars
Kuwait agreed to assign 2.4 million dollars for contribution to support malaria control strategy (Kuwaiti Cabinet by resolution # 188, dated 31/1/2010). Kuwait was addressed to speed up transfer of the contribution.
UAE It was agreed – in the Joint Cooperation Committee between Yemen and UAE – to sign a memorandum of understanding between Yemen and Abu-Dhabi Development Fund regarding utilization of the UAE contribution in a number of developmental projects including support of malaria control project.
● To avoid delay in implementation of the strategy, it was agreed, in the first Malaria Control Fund meeting held in Sana’a, 24-25 October, 2009 – to start purchase of the medical supplies needed by the Yemen Republic as well as urging the member states to speed up sending this contributions.
● The amount of 9, 105, 736 US dollars has been transformed to the malaria program account in Yemen from the Executive Board, for financial coverage of the purchases, operational costs of the malaria control program.
National Survey for Malaria Indicators, Yemen, 2009
In view of the need to follow up the progress made (accurately and in details) in various fields of control through monitoring the malaria – related national indicators, the ministry conducted the comprehensive survey for malaria indicators in 2009. The main objective was to assess the current situation in Yemen and to build the database necessary for updating future policies and strategies, and its use in various control activities, and facilitating its regulation and evaluation.
Results of the national survey done in collaboration with WHO, and sponsorship of the Global Fund To Fight AIDS, Tuberculosis and Malaria, showed that a great reduction took place in the prevalence of malaria at the national level in 2009 where infection rate was only 1.5 %.
Using the results of the survey indicators in assessment of the malaria burden of disease, and according to the epidemiological WHO formulas, results indicate that the overall malaria cases in Yemen reached - in 2009 - 265, 074 case only compared to the previous estimations in 2006 which showed that number of cases ranged from 800 – 900 thousand malaria case.
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