Malaria Control activities are on ground since the formulation of Health Services provision fundamentals outlined in Bohr’s commission in the Sub-continent; and in Pakistan these are functional since 1950s through succession of different approaches. The most ambitious program was the Malaria Education Campaign, spearheaded by USAID since 1961. Then the global approaches was changed due to health priorities and draw backs encountered with wide spread drug and insecticide resistance. Then as a strategy WHO initiated global malaria control program aiming to reducing the malaria burden to manageable levels. Pakistan program was also directed toward control approaches through the decentralization process and other funding difficulties during post this era did not allows successful transformation of the operations.
Malaria personnel cadres were amalgamated and Malaria Control program was made a Provincial transferred subject, leveling an apical set up at the Federal level, for the purpose of policy formulation and maintaining coordination. Further the implementation responsibilities were transferred to respective district government in line with the devolution plans. In 1977 Malaria control activities were integrated with the Communicable Disease Control Selection the Province
Owing the two major failures in the endemic countries control programs, in 1998, Roll Back Malaria (RBM) initiative was coordinated and started by WHO, UNICEF, UNDP and the World Bank. Pakistan being the signatory to the effect, started RBM implementation in the phased manner by earmarking 273 million from PSDP allocations for 5 years since FY 2001-02, supplemented by the provincial PC-1 allocations while 658 million have been approved for the next 5 years 2007-2012 to support provincial programs.
Under 18th amendment in the constitution Federal Ministry of Health along with its attached departments including Directorate of malaria Control were devolved on 30th June 2011.
Keeping in view the important role played by the Directorate of malaria Control, the honorable Prime Minister of Pakistan approved the revival of this Directorate with effect from 1st July 2011 and placed under the administrative control of Ministry of IPC with following functions and TORs:
To act as Principal Recipient for all Global fund supported Health initiatives.
- Preparation of proposals and liaising with international agencies for securing support of such partner agencies.
- Providing technical and material resources to the provinces for successful implementation of disease control strategies and disease surveillance.
Pakistan has a population of 180 million inhabitants of which 177 million are at risk of malaria. With 3.5 million presumed and confirmed malaria cases annually.
Malaria in Pakistan is typically unstable and major transmission period is post monsoon i.e. from August to November. Major vector species are Anopheles culicifacies and A. stephensi, both still susceptible to the insecticides currently being used. The widely distributed causative organisms are Plasmodium falciparum and Plasmodium vivax. Vivax malaria still dominates the transmission though significant rise in the more lethal form falciparum is observed in Balochistan and Sindh. There is significant drug resistance (chloroquineand Fansidarresistance) prevalent throughout the country where the levels in the western border areas are very significant.The malariogenic potential of Pakistan has a negative impact on its socio-economic growth and productivity, as the main transmission season is spiraled with the harvesting and sowing of the main crops (wheat, rice, sugar cane).
The key underlying risk factors for malaria endemicity and outbreaks in Pakistan include; unpredictable transmission patterns, low immune status of the population in lowest endemicity areas, poor socioeconomic conditions, mass population movements within the country and across international borders with Iran and Afghanistan, natural disasters including floods and heavy rain fall in a few areas, lack of access to quality assured care at the most peripheral health settings, low antenatal coverage and internally displaced population (IDPs) crisis in the agencies and districts along western border. About 700,000 people (National Disaster Management Authority) have recently been displaced from high endemic zone of North Waziristan to neighboring districts of KPK due to conflict situation.
Epidemiologically, Pakistan is classified as a moderate malaria endemic country with a National API averaging at 1.08 (MIS, 2015) and wide diversity within and between the provinces and districts. Plasmodium Vivax and Plasmodium Falciparum are the only prevalent species of parasites detected so far, with P.vivax being the major parasite species responsiblefor >80% reported confirmed cases in the country.