Malaria has been a major cause of poverty and low productivity accounting for about 32.5 percent of all OPD attendances and 48.8 percent of under five years admissions in the country. (NMCP annual report, 2009)
The attempt to control malaria in Ghana began in the 1950s. It was aimed at reducing the malaria disease burden till its no longer of public health significance. It was also recognized that malaria cannot be controlled by the health sector alone therefore multiple strategies were being pursued with other health related sectors. In view of this, interventions were put in place to help in the control of the deadly disease. Some of the interventions applied at the time included residual insecticide application against adult mosquitoes, mass chemoprophylaxis with Pyrimethamine medicated salt and improvement of drainage system. But malaria continued to be the leading cause of morbidity (illness) in the country.
Ghana then committed itself to the Roll Back Malaria (RBM) initiative in 1999 and developed a strategic framework to guide its implementation. Overall, the Ghana RBM emphasizes the strengthening of health services through multi and inter-sectoral partnerships and making treatment and prevention strategies more widely available. The goal was to reduce malaria specific morbidity and mortality by 50% by the year 2010. To achieve the goal, four main strategies were being pursued. These were to:
- Promote multiple prevention which includes promotion of treated bed nets usage; chemoprophylaxis in pregnancy and environmental management.
- Improve malaria case management at all levels(from household to health facility);
- Encourage evidence-based research to come up with effective interventions and
- Improve partnership with all partners at all levels.
Though Ghana has been making progress implementing its National Malaria Control
Programme, there are still gaps in achieving the targets in the previous plan. Lessons learnt from the implementation of the previous strategic plan have informed it current strategies.
Ghana is now implementing a malaria control programme with a goal that generally aims at reducing death and illness due to the malaria disease by 75% by the year 2015 in line with the attainment of the Millennium Development Goals (MDGs). This goal is to be achieved through overall health sector development, improved strategic investments in malaria control, and increased coverage towards universal access to malaria treatment and prevention interventions.
The specific objectives of the plan are as follows:
The plan covers the areas of improving multiple prevention, improving access to prompt and effective treatment, strengthening health systems at all levels, and creating and sustaining partnership. The specific objectives are as follows:
- 100% of households will own at least one ITN
- 80% of the general population will sleep under ITNs
- Increase the number of children under-five and pregnant women sleeping under treated net from current levels to 85%
- 100% (All) pregnant women shall be on appropriate Intermittent Preventive Treatment
- (Receive at least two or more doses of sulphadoxine-pyrimethamine under DOT)
- 90% of all structures in targeted districts will be covered through indoor residual spraying
- All (100%) health facilities will provide prompt and effective treatment using ACTs
- 90% of all patients with uncomplicated malaria will be correctly managed at public and
- private health facilities using ACTs
- All (100%) communities will have access to community-based treatment for uncomplicated malaria
- 90% of caretakers and parents will be able to recognize early symptoms and signs of
- 90% of children under five years of age with fever will receive an appropriate ACT within 24 hours of onset.
Strategies to achieve these objectives include:
- Equiping all health facilities with malaria diagnostic facilities (microscopes or RDTs) and
- provide effective antimalarial drugs.
- Strengthening human resource through in-service training of laboratory technicians and
- Scaling-up community based treatment of malaria in all districts through the home base care of malaria targeting children under five years living in rural areas and areas with limited access.
- Insecticide Treated materials (ITM) scale-up access to Long Lasting Insecticide Nets to achieve universal coverage -:Access to Insecticide treated nets.
- Indoor Residual Spraying (IRS) will be scaled up rapidly, building on the models of IRS campaigns in Obuasi and the Northern Region.
- Strengthening the routine data collection system to capture reliable information, and undertake regular operational researches to provide evidence for decision making.
- Forge functional partnerships and mechanisms between departments, programmes within and outside the health sector.
When these strategies are implemented it is expected that the following outcomes will be achieved:
1. Improved Malaria Prevention
- Increased use of ITMs by children and pregnant women
- Improved drainage, mosquito-proofing of houses and general sanitation
- Reduction of mosquito population through in-door residual spraying and larviciding
2. Improved access to Prompt and Effective Treatment
- Early recognition of fever and early treatment with Artesunate-Amodiaquine especially at the home
- Appropriate referral of severe cases assured
- Quality of treatment for malaria improved
- Basic services accessible to the sick
3. Strengthened Monitoring and Evaluation, and Operational Research
- Increased availability of funds for research and monitoring
- Capacity in malaria research and monitoring improved
- Routine monitoring of programme activities and outputs strengthened
- Operational research into malaria undertaken and results disseminated and utilized to
- improve program planning
- Periodic evaluation of programme outcomes and impact institutionalized,
- Safety and efficacy of drugs and insecticides monitoring institutionalized and strengthened
- Annual programme reviews conducted
4. Strengthened Health Systems at all Levels
- Human resource capacity built to deliver health (including malaria) interventions at all
- Infrastructure, logistics and communication systems improved
- Financial management improved at all levels
- Improved procurement and supply management
- Community systems strengthened
5. Create and Sustain Partnerships for Malaria Control
- Functional partnerships and mechanisms between departments and programmes within health
- Functional partnerships and mechanisms with and between development agencies
- Functional partnership and mechanisms with and between government sectors
- Functional partnership and mechanisms with and between NGOs, private sectors and informal sectors
The Government of Ghana supports the Programme financially with the main funding for its activities from the Global Fund which is set aside to support the control of Malaria TB and HIV/AIDS. NMCP also receives support directly or indirectly from other partners such as WHO, UNICEF, USAID/PMI, DFID, etc. in the implementation of its activities