Consultancy for the Development of Multisectoral Action Plan for Malaria Elimination in Zanzibar tender at Swiss Tropical and Public Health Institute (Swiss TPH)

Introduction

The Swiss Tropical and Public Health Institute (Swiss TPH) has been assigned by the Gates Foundations through Population Health International (PSI) to implement a project to accelerate the elimination of local malaria transmission in Zanzibar. The MEZA project (Accelerating Malaria Elimination in Zanzibar) is a comprehensive intervention aiming to speed up the goal of zero malaria transmission in the islands. The campaign includes four separate initiatives. The first initiative, Malaria elimination in Zanzibar (MALIZA – Swahili for finish it), intends to create an enabling environment for managing the elimination efforts. MALIZA is a cross-cutting initiative that include integrated health and non-health sector actions at national, district and community level. The second initiative, Managing Pemba Elimination of Malaria (MAPEMA – Swahili for soon), intends to achieve malaria elimination in Pemba and satellite islands in a short period of time through intensified multisectoral actions towards blocking local transmission and mitigating the importation of new cases. The third initiative, Elimination of Malaria in Unguja (ELIMU – Swahili for education), aims to achieve malaria elimination in Unguja and satellite islands in a relatively longer time period through a two-step concerted actions to initially mitigate urban and seasonal transmission and later stopping local transmission and controlling importation of new cases. A last initiative Joint Tanzania mainland & Zanzibar Malaria (TAZAMA – Swahili for lookup) aims to address the source management of imported malaria cases and to contribute to bring to an end malaria re-introduction.

The Revolutionary Government of Zanzibar through the Ministry of Health in collaboration with partners are dedicated to accelerate malaria elimination agenda across the Islands. The Zanzibar Malaria Elimination Programme (ZAMEP) is mandated to technically guide all implementing actors and document results. Over the decades (since 2007), significant progress has been made culminating in the reduction and subsequent sustaining of malaria prevalence to less than one percent. This National Malaria Strategic Plan (NSP), covering the period 2024 to 2029, aims to accelerate the trajectory of malaria elimination to zero indigenous case and prevent re-introduction.

Current Malaria Epidemiological Trends 

Zanzibar reached and maintained very low malaria prevalence of less than 1% for more than 15 years with zero (0) malaria prevalence (THDS 2022). Cases have been reduced to 813 local and 2937 imported in 2022. Since case classification started in 2019 it is noted that the local vs imported case ratio (a marker for the reproduction rate under control measures, Rc) has been less than 1 every year indicating favourable conditions for malaria elimination with declining receptivity despite high vulnerability. Nevertheless, local transmission, fuelled by local receptivity and introduced cases, still is a reality. Reduction of malaria mortality to an average of <5 deaths per year in 2022 should be as well considered a success.

In the recent years 71%, 63% and 67% of cases were reported respectively in 2020, 2021 and 2022 in the three districts (Mjini, Maghrib A and Maghrib B) of most urbanized areas of Zanzibar, Mjini-Magharibi region. This fact account for special consideration in fighting urban malaria.

Unguja and Pemba islands are at a different epidemiological transmission level and showing different receptivity. Apart from the macro-malaria heterogeneity within the two islands, there is a remarkable micro-heterogeneity within the same island. These two facts need to be taken into account to realistically plan for local transmission elimination.

 Achievements to attain malaria elimination so far 

Zanzibar has been in the forefront of malaria control and elimination since early 2000s by introducing universal coverage of innovative initiatives such as ACTs, mRDTs, ITNs, IRS and Surveillance and Response System. Some interventions have been scaled down (e.g. IRS) from universal to targeted and, ultimately, to focal implementation. Others (IPTp) have been dropped in 2013 due to the evidence of extremely low level of infection among pregnant women.

A robust malaria surveillance system has been established through the Malaria Epidemic Early Detection System (MEEDS since 2008) and the Malaria Case Notification System (MCN since 2012). Attempts to link malaria surveillance with foci identification and coordinated MCM and IMVC response are ongoing.

Multi-Sectoral and Collaborative Efforts

The fight against malaria needs a multi-sectoral joint efforts and commitments from different stakeholders such as; Sectoral Ministries, Zanzibar Malaria Elimination Council, Academia / Research Institutions, Implementing and Developments Partners as well as from Private Sector. In order to accomplish all these, there is a need of having an official joint document to guide implementation of the Multi-Sectoral Collaboration and development of multisectoral action plan.

Rationale

ZAMEP under the MoH is responsible for formulating strategies for implementing malaria preventive and curative interventions in Zanzibar. There are several sectors other than health that impact on malaria sustainability for example through activities that encourage the formation of manmade breeding habitats of mosquitoes or favour population vulnerability due to mobility, occupational exposure, livelihood and behavioural risk. Socio economic inequity increases as well the risk of malaria infection and its complication among the poorest segments of the population if no deliberate control measures are taken. A few examples of interaction between non-health sectors and malaria are listed below:

• Ministry of Agriculture, irrigation, natural resources and livestock is involved in rice fields and other agricultural programs that encourage mosquito breeding. On the other hand, the livestock keepers use significant number of pesticides that may contribute to insecticide resistance such as pyrethroid commonly used in LLINs.
• Ministry of Infrastructure, Communication and Transport is responsible for ports (sea and the airports) link to influx of travelers from different countries. The port and airport authorities are the gatekeepers of potential malaria carriers from endemic areas; the mainland in particular and from neighboring countries. This ministry develop, supervises and regulate large scale civil works like road constructions that are very potential to create manmade mosquitoes breeding habitats.
• The Ministry of Education and Vocational Training links with families through the students. The current malaria school health clubs involving primary school pupils and teachers need to be strengthened and sustained. There is a need to assess whether including malaria issues in education curriculum would positively reinforce students’ behavior. Thus, the students will need to be trained as agents of change in their families and communities towards better health promoting behavior.
• The Ministry of State, Presidents Office, Regional Admiration, Local Government and Special departments is crucial in linking local communities with the National level initiatives. Special departments and the ministry of defense (Union) are potential to play an important role in transforming malaria smart departments and army premises and collaborate in prevention campaign.
• Zanzibar Environmental Management Authority under First Vice President Office (VP1) is also essential to provide support to the essential larval source management that is the most sustainable way to decrease malaria transmission.
• Ministry of tourism and heritage might be involved in creating malaria smart tourism infrastructures and provide safe environment to staff and clients.
• The Zanzibar Urban Municipal Councils and the Stone Town Authority, all located in Mjini Maghrib Region are responsible for the management and maintenance of the surface drainage system. Poor surface drainage, along with inadequate solid waste and sewage management, can create mosquito breeding sites, increasing the risk of malaria transmission within the city.

Now that the country is determined to have a clear framework that guides all responsible sectors in supporting malaria programme efforts. There is a need for better coordination and support, ZAMEP is determined to strengthen its coordination and collaboration with all stakeholders in efforts to liminate malaria. To the heart of this, it is important for ZAMEP to work with the identified sectors and collaborators that are key in implementing malaria control in line with the national strategic plan V (2024 – 2029). It is important to look into current practices and plans and identify which areas / activities need to be supported from other sectors, identify the key sectors and their responsibilities towards achieving elimination goal.

Achievements so far

The Ministry of Health through ZAMEP is engaging a consultant who facilitates the process with malaria stakeholders to develop the multi-sectoral framework to end malaria. Swiss TPH, through its MEZA project facilitates the task. The framework will be ratified by the Second Vice President later in 2025.

The next step is to develop, in the context of the above framework, a costed multi sectoral operational/action plan to guide implementation of activities towards malaria elimination in collaboration with the identified non-health sectors. A consultant will be engaged to facilitate the process in collaboration with MoH, ZAMEP, PO-RALG and selected nonhealthy sectors.  

Roles and Responsibilities of the Consultant

Through a consultative process that includes the organization and facilitation of two workshops and consultations with malaria stakeholders, the consultant will be:

• *Working with the different ministries and sectors to identify knowledgeable focal persons who will be engaged in the development of the malaria multi sectoral operation/action plan (and eventually its implementation). *Activity partly already done by ZAMEP and MEZA team.
• Facilitating a first workshop to guide the different sectors on the process of identifying factors, challenges and success that contribute to increased and decreased malaria transmission in the community
• Documenting each sector’s activities to help in malaria prevention and control in accordance with the national strategic plan V 2024 – 2029.
• Working with all the sectors to provide guidance in prioritization and costing of the identified interventions/activities
• Developing a draft action plan to be disseminated to stakeholders
• Facilitating a second workshop to compile and present the proposed interventions /activities for each of the identified sectors and
• Finalize the development of the second draft operational plan

The process of developing the multi sectoral operational plan will involve a first 3-day workshop and a second 2-day workshop with mapped sectors identified by the consultant in collaboration with the ZAMEP and partners. The workshops will aim at guiding, compiling and presenting information to help in the development of the operational plan. Follow on meetings may be needed for finalization and/or validation of the operational plan. It is estimated that this assignment will take 22 days of work.

Expected Deliverables and timeline

Level of efforts

*Activity partly done by ZAMEP and MEZA team

Deliverables

1. Invitation letters to select focal person for each sector
2. Workshop agenda, facilitation guide and list of references
3. Tools and templates developed for the consultative process
4. Identified focal people to represent each sector involved in multi- sectoral initiative
5. Costed action plan for each sector developed
6. Multi – sectoral costed operational Plan

Qualifications and Competencies of a consultant 

• Postgraduate degree in public health, medical, nursing and/or other health related academic qualification. A PhD in a relevant field will be an added advantage
• Minimum of 10 years working experience in the mainland Tanzania and /or

Zanzibar health sector, with at least 5 years’ experience in Malaria programming.

• Demonstrated experience in program management including stakeholders’ engagement
• Previous experience in developing and/or operationalizing national health strategic documents
• Demonstrated familiarity and experience in working with the Zanzibar MoH, ZAMEP, DHMTs and development partners
• Demonstrated ability to execute consultancy assignments and deliver in time.
• Good organizational skills, including time management and ability to work with teams.
• Strong analytical, strategic thinking and planning skills and ability to work under tight deadlines
• Skills in facilitating consultative meetings and workshops · Good written and oral communication skills

Please send your application to admin.temt@netcell.org

The deadline for submitting the application is 16 April 2025