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WP/RC9 /15 Rev.l
ANNEX 4 TECHNICAL DISCUSSIONS 1 SUBJECT
The subject was "Malaria Eradication", as chosen by the eighth session of the Regional Committee with the intention of discussing the principles upon Which malaria eradication is based and the organization required for carrying it out. Particular emphasis was pJ.a.ced on the social and economic implications of malaria eradication in order to emphasize the importance of fund-raising from every possible source. 2 ORGANIZATION OF THE DISCUSSIONS
The first session consisted of a panel presentation of some of the salient points raised in the working papers which had been prepared for the technical discussion. In the second session the participants were divided into four groups and conducted a free discussion on subjects of their own choice under a group leader, assisted by members of the Secretariat. Each group submitted a report to the Chairman. The third or plenary session started with the presentation of oral reports by each of the discussion groups. Each presentation was followed by a discussion. The meeting then considered the make recommendations. ~ubject
as a whole and proceeded to
A recommendation also was made on the proposed topic for next year's technical discussion. The meeting concluded by each participant completing a questionnaire with the object of evaluating the Technical Discussions.
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PANEL PRESENTATION
The four pOints raised by the panel were the principles of malaria eradication, the methods employed, the need for co-operation and the administration of national malaria programmes. A general description was given of malaria epidemiology, emphaSizing the importance of residual insecticides in reducing the length of life of the vector. The importance of human relations both to gain co-operation and in the administration of malaria projects was also emphasized. After the panel presentation, questions were raised on the subject of contributions to the Malaria Eradication Special Account. It was pointed out that one measure of the success of this account was the matching contribution that governments were stimulated to produce.
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It was pointed out that, although the funds for the ~:f..a Era.d.ication Sp cial Account, thanks largely to the generous contribution of the Un!ted states of America, were adequate for the present, many large contributiOns, particularly from non-malarious countries, would be required before the financing of eradication could be secured.
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GROUP DISCUSSION
The groups met independently but various points of particular interest were discussed by several groups: (a) The progress of various projects within the Region was described; these had reached varying stages; there was a tendency to reach a state of complacency with excellent early results before eradication had been achieved. (b) Stress was laid on the need for a carefully planned programme with a competent director to discharge it without undue interference. In some cases the interests of many agencies in a single project led to considerable delays. (c) Considerable emphasis was placed on the need for health education of the public (and also of governments and local authorities). The first phase was the provision of information on a country-wide scale before the start of the campaign; secondly, the spraymen and surveillance personnel must be so instructed that they can undertake their role as the spearhead of health education. Finally, it was necessary to keep all medical services of the country aware of their responsibilities towards malaria eradication. (d) Legislation in malaria programmes was also discussed; emphasis was laid on the advantages of persuasion over compulsory measures. At the third session, the rapporteur of each discussion group present d the topics of the discussion by his group. The following pOints were discussed: (a) Notification: The agents responsible for notification at different stages of the eradication activities were considered. (b) Integration of malaria eradication into the public-health service: The degree of integration of the malaria activities in the public-health service at different levels and at different stages of the eradication programme was discussed. Opinion was divided - either to begin the integration only during the surveillance period or to retain malaria activities within the local public-health services, especially in countries where malaria does not constitute a serious problem.
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(c) Health education: Pre-planned propa.ga.nda. and health education would expedite the acceptance of the eradication activities by the public. It was stressed that health education must continue through all the stages of eradication, and that groups of public-spirited people should promote understanding of the still continuing malaria problems. (d) Training: Training of auxiliaries should begin at the stage of the initial surveys. The importance of an inter-regional malaria training centre was raised, and it was suggested that a course conducted in French should be included. The training should not be too academic but practical. (e) Staff situation during and after the eradication: It is important to ensure security of tenureof,employment for the workers. It was not considered a difficult problem as there were enough possibilities for their suitable employment in the public-health services after eradication had been achieved. It was important, however, not to release the staff from malaria activities too early. (f) Control versus Eradication: Some confusion seemed to prevail as to the definition of the two activities. One opinion, mainly based on the technical methods employed, seemed to think that they were identical, but of different magnitude, Whereas another opinion based on the principle as outlined in document WP/RC9/TD1, felt that there was a clear distinction between the two activities. (g) Resul.ts: Assessments of results of an eradication campaign were to be based on a social, economic basis in. order to show th benefit gained for the country, and thus encourage the government to continue its support. The influence on the connnunity of the improved health of the people must be taken into consideration in planning for education and other social activities.
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RECOMME~TIONS
The technical discussion group made the following recommendations: (a) Health education should play an important ~rt in all stages of the malaria eradication campaign. - in the preparatory stage, to prepare the general population and to explain the objects and techniques of the campaign; in the attack phase, to train the malaria field personnel as health edao&tora; and in the surveillance stage, to recruit the assistance ot all branches of the publ1chealth service and leaders of lay opinion to help find any foci of residual infection. (b) The importance of stable employment for the staff of the malaria eradication service was emphasized; the utilization of their skills after eradication had been completed should be carefully planned before the end of the campaign.
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(c) Emphasis should be laid on the provision of training courses with special relation to the local needs of the countries in the Region. In particular, the need for a course of training in the French language should be given priority. (d) The spraying of residual insecticides should be recognized as the sheet anchor of malaria eradication. In certain circumstances, antimalaria drugs provide a useful accessory measure. (e) In couutries where malaria is a serious public-health problem, the malaria eradication service Should initially be a primary division of the national public-health service, and sho.uld only be integrated into the general public-health service gradually during the surveillance period. It was .recognized that iu certain cases where the local health services are particularly well developed, the mal.a.ria service can be integrated initially into the public-health service at the periphery. (f) The great economic benefits of malaria eradication were noted, and it was stressed that the initial benefits might result in a state of complacency which would result in a lack of support for the programme before eradication was reached. It was recommended that in all cases careful planning should ensure that support for the programme did not stop short of eradication. (g) It was recommended that the subject for the Tenth Regional Committee Meeting should be liThe Control of Tuberculosis".
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EVALUATION
Of the completed questionnaires received, three rated the Technical Discussions as excellent, twelve as very good, six as reasonably good and nil as either mediocre or poor.