Health / Disease control of communicable disease - Health system development

Improved health of the population in the Greater Mekong Subregion (GMS).

Timely and adequate control of communicable diseases of regional relevance

O1. Proportion of disease outbreaks reported within 24 hours increased from 50% to 80%

Under EWARN, over 84% of outbreaks have been reported with 24 hours during the project.

(EWARN database of NCLE. Includes 17 national notifiable diseases and other conditions)

Target exceeded. 374/444 outbreaks were reported within 24 hours overall in the project, with regular annual improvements identified.

Under EWARN, 69% of outbreaks were also investigated and responded to within 24-48 hours.

O2. Proportion of border outbreaks reported within 24 hours increased from 20% to 50%

82.1% of outbreaks of notifiable diseases reported with 24 hours in border districts.

(EWARN database of NCLE)

Target exceeded. 152/185 outbreaks of notifiable diseases in project border areas were reported within 24 hours overall in the project, with regular annual improvements identified.

O3. Proportion of populations in targeted villages that conduct proper CDC prevention and care increased from 40% to 60%.

Composite indicator from the project Household Survey 2016 indicated 61.2% of households were practicing appropriate CDC prevention and care activities

(Household Survey 2016)

Target achieved. Composite indicator derived from the 8 cleans. Methodology set out in PCR documents dossier as ix.

O4. Proportion of children <5yrs that sleep under bed nets increased from 60% to 80%

94.7% of children sleep under bed nets. This indicator was included in the original RRP from 2010.

(Household Survey 2016)

Bed net use needs to be surveyed in more detail " potential for in depth social research on this topic.

1. Enhanced regional CDC systems

2. Improved CDC along borders and economic corridors

3. Integrated project management

Target was 350 MHVs. At December 2015, project achieved 304 MHVs (87% of target) (Project MHV reports)

MHV roll out proceeded in all project provinces. Two provinces Huaphan and Champasack - achieved 100% target MHV coverage.

Data available on MHV coverage per district over 5 years

80.7% of VHWs assessed as capable and competent Project Competency Survey

(Project Competency Reports, 2015 and 2017)

Refer to Competency Reports developed by the project

Project Household Survey 2016 indicated 44.6% of WRA and 51.8% of children under 5 had been dewormed in the last year

73.1% of children <5 received Vitamin A (up from 65% in 2014)

78.3% of women had received Iron during pregnancy (up from 68% in 2014) (Household Survey 2016)

Provinces were appraised of the low rates for follow up action.

Project on target to achieve 2 joint activities annually. New cross border arrangements in place to continue cooperation and coordination of activities

(Project report on cross border meetings)

Cross border cooperation and joint activities increased under the project from 2013-2016 (2 forums in 2013; 19 in 2014; 28 in 2015; and 7 in 2016). Details available include: participating districts, number and gender, objectives and outcomes (MOUs etc)

Project research (2016) indicated 50% of new VHWs since 2102 were female (453/916)

(Project Competency Reports, 2015 and 2017)

Project conducted surveys on provincial staffing and competency/ training to derive the estimates.

100% of VHWs (total 4416/3670) trained to date.

(Project Competency Report, 2017 and VHW Training report)

Overall, data indicate more than the total VHWs trained (due to potentially multiple trainings). But data do not confirm that all VHWs in all target provinces were trained. Additional research would have been needed. VHW training in x

76.4% of CDC staff trained (2135/2796)

(Project Staff Training and Gender Report, 2017)

Refer to Project Staff Training and Gender Report

65.3% of trained staff female (1395/2135)

(Project Staff Training and Gender Report, 2017)

Refer to Project Staff Training and Gender Report

52% of trained staff is female

Being reviewed as part of current Provincial and Competencies Surveys

87% of CDC staff assessed as capable and competent

(Project Competency Report, 2017)

Refer to Competency Report. Rates varied between staff groups with for example, lab staff reporting high levels of training and capability.

Seven provinces identified cross border plans with neighbouring Cambodia and Vietnam provinces and activities included joint monitoring and evaluation; simulation exercises; and surveillance and response. Activities were focused not solely on malaria and included other processes and diseases.

Estimated that at least 50% of project districts are involved in cross border activity and malaria is defined as one of the conditions to be reported by all Lao provinces as part of the Disease Information sharing arrangement.

Partially achieved.

Details of cross border plans and activities are included in xi in the accompanying dossier.

Focal point for CDC established with senior officer assigned and operating. From 4th quarter 2012 (Project PMU)

Focal Point with TORs functioning, with designated staff and regular meetings and exchanges with CLV and other countries. MOUs, outcomes from regional meetings and joint agreed protocols available.

Joint strategies and plans (e.g. Schisto; IHR; Dengue; APSED) were developed and reviewed at various Regional Workshops and Forums. Regional coordination enhanced through the Focal Points (Regional Workshop reports)

Regional technical forums (Regional Workshops and national technical workshops) allowed joint review and strategy development across a range of CDC areas. Workshop reports involved follow up actions and interventions for each CLV country.

Lao organised and hosted five regional technical workshops, a Knowledge Management forum and two Regional Annual Workshops (KM product reports on project website)

Schisto; Laboratory Services; Dengue; APSED; and Malaria Workshops were organised in Lao PDR and attended by regional and other international participants.

Knowledge products (survey results, reports and guides/manuals etc) presented on the project website

New agreed protocols (2015) between CLV countries and Focal Points ensures regular weekly, monthly - exchange of information on 13 notifiable diseases and conditions covering check points, health centres and health facilities (RCU Information Sharing form and database)

Standard exchange forms agreed by all three CLV countries

IHR compliance increased from 28% in 2012 to 80% in 2015

Under the new WHO Joint External Evaluation process, extensive review in February 2017 indicated an overall 67% compliance.

IHR Compliance Reports shows calculation of a composite IHR compliance score. Scores were:

- 61.3% in 2014

- 55.6% in 2013

- 28.6% in 2012

(Project IHR Compliance Report, 2017 and JEE report, 2017)

Annual WHO reviews assess status and progress in IHR compliance. Using a weighted composite indicator, overall compliance (excluding Radiation and Chemical components under the IHR core areas) was assessed annually from 2012 2015, indicating progressive improvement. External assessment in February 2017 indicated significant progress. JEE report available.

New CLV protocols will ensure regular exchange of information on 13 diseases and conditions covering check points, health centres and health facilities (RCU Information Sharing form and database)

Standard exchange forms agreed by all three CLV countries operational from 2016.

Project emphasised gender including training places for females in all province planning (Project Training Reports)

At project end, of the 28,000 staff trained under CDC II 36% were female. Gender disaggregated data on training and persons affected by outbreaks were reported monthly

Project has conducted numerous neighbouring cluster province cross border meetings (Supplementary Appendix C provides details of results of meetings) involving Phongsaly, Oudomxay, Huaphan, Xieng Kuang, Bolikhamsay, Khammuane, Attapeu and Champasack provinces as well as Luang Prabang. Joint plans developed with these provinces and Cambodia, Vietnam and Thai provinces. Plans cover: joint simulation, training, referrals, joint outbreak investigation, RRTs and disease reporting. Malaria is included as a priority communicable disease in these plans.

Achieved.

Regular cluster province workshops develop joint plans activities malaria is one focus in these plans

Regional Workshop on Malaria conducted in June 2017.

Achieved.

Over 150 participants from CLV countries, Myanmar, Malaysia and Thailand attended the workshop.

Project conducted initial training in procurement, financial management and planning (2012)

(Project provinces' AOPs)

Provincial staff developed annual plans and budgets competently and built on year to year experience

Household (baseline) Survey conducted in March 2014. Follow up survey (outcome) conducted in March-April 2016

(Household Surveys, 2014 and 2016)

Household Surveys enabled project impact assessment i.e. improvements in a range of indicators attributable to project interventions

Project AOPs were produced annually and consistent with the overall project AOP. AOPs addressed gender, IP and training issues

(Project provinces' AOPs)

Project ensured consistent annual plans according to a standard format. AOPs were produced following project annual review workshops to identify priority issues and specific interventions for each province.

AOPs available

Project developed GAP and ethnic groups plan and monitored results regularly. Gender experts were involved in setting targets and compiling data

(GAP and IPAP, 2017)

Project GAP and IP plans available indicating achievements in many GAP/IP Action Plan targets

All 27 project QRs to date produced and submitted to ADB within 20 days after quarter end

(Project QRs)

ADB commended the project on the prompt and comprehensive QRs submitted consistently in the target timeframe.

Additional Financing:

All provinces identified malaria targets and activities. Targets included:

Improved malaria surveillance and response and preparedness

Increased cross border collaboration for malaria prevention and control

Improved lab capacity in diagnosis and malaria case management

Increased IEC on malaria prevention and control

Increased community mobilisation for malaria (and dengue) prevention, including vector control, community surveillance and health education

Achieved.

Overall targets are decreased incidence of new cases and improved surveillance and reporting in target districts.

Provincial malaria activities and related funding set out in AOPs

Level of consultation and participation envisaged are information sharing, Consultation,Collaborative decision making and empowerment. Existing organizational structures down to the village level will be used, no need for a separate system. However, participation will be monitored.

All consultants will be recruited according to ADB's Guidelines on the Use of Consultants. Nine positions of individual consultants and one consulting firm are provided for the duration of the project.