Microplanning Manual for Malaria Elimination in the Region of the Americas. Version for field personnel

Abstract

The purpose of this manual is to provide guidance on how to implement Pan American Health Organization (PAHO) recommendations for malaria elimination at the local level. It is a streamlined, more operational version of the Manual for Stratifying Malaria Risk and Elimination of Foci, aimed primarily at operational teams working in the field. The content has been prioritized and the steps of the process organized to facilitate greater understanding by local teams. Adjustments have also been made to underscore its versatility for all malaria transmission scenarios in the Region of the Americas. The adopted approach (which can be adapted to any transmission scenario) is based on microplanning to achieve malaria elimination. In countries with very few cases, microplanning addresses active foci, which are usually small, while ensuring adequate surveillance across the rest of the territory. In countries where transmission is still widespread (endemic areas of South America, certain countries in Central America, and Haiti) the approach is to divide territories into operational units: in these ‘microterritories’, foci, or ‘microareas’, interventions can then be tailored to interrupt transmission. Malaria elimination is a field operation in which the geographical scope must be clearly defined. This handbook calls for recognition of the importance of establishing operational units for interventions aimed at malaria elimination. All malaria-endemic countries in the Region of the Americas have taken on the challenge of eliminating the disease and taking actions to steer their health programs and strategies in that direction. This document is based on the need to identify and define operational areas (foci or microareas) where specific diagnosis, treatment, investigation, and response (DTI-R) interventions should be implemented. However, while these interventions may be standardized at the national level, they must be guided above all by a clear understanding of the transmission dynamics at local levels. A fundamental concept in the shift from a malaria control to a malaria elimination strategy is the need to constantly reformulate and adjust local operations in response to changes in transmission dynamics. Operations to combat malaria should not be viewed as a task to be performed, but as a problem to be solved. It is essential to have local information and a team with the necessary interest and training to clearly understand the problems and adapt the solutions accordingly.