Regional : Malaria and Communicable Diseases Control in the Greater Mekong Subregion

Health / Health sector development and reform

System for laboratory quality insurance in place; SOPs and guidelines approved by the Union Health Minister and adopted by MOHS to be used nation-wide

Inter-agency (National Health Laboratory, National Malaria Control Program and Communicable Disease Control Department) working arrangements for laboratory quality insurance forged and carried over to the GMS Health Security Project;

Piloting of mobile digital management system for disease surveillance;

Government adoption of working definition of MMPs;

Interventions for MMP to address malaria needs adopted by National Malaria Programs and post-TA continuity by governments and development partners (Global Fund and USAID)

Inter-sectoral collaboration on malaria among MMPs established in CLM

Regional cooperation initiatives sustained by Cambodia, Lao PDR, Myanmar and Viet Nam and carried through in the GMS Health Security Project.

Myanmar malaria surveillance and diagnostic systems improved

MMPs' specific needs for malaria prevention and treatment

Regional coordination on malaria and CDC among GMS countries strengthened

Myanmar malaria surveillance and diagnostic systems improved

1. Engagement of INGOs to implement (i) improvement of Myanmar surveillance and diagnostics systems and (ii) addressing MMP needs for malaria prevention and treatment are ongoing.

2. The TA focused on strengthening data management systems for malaria surveillance including the upgrading of analytical tools for decision-making, scale-up and maintenance of data management systems, cooperation with volunteer malaria workers (VMW) on routine reporting, and real-time reporting. The assistance also focused on upgrading laboratory diagnostic quality assurance by implementing a proficiency testing and cross-checking system in project townships based on the revised malaria quality assurance (QA) manuals and SOPs and through training on expanded malaria microscopy.

3.The National Malaria Control Programme (NMCP) with support from partners developed a mobile Data Management System (mDMS) piloted in the Mawlamyine, Belin and Hkamti townships to strengthen the quality of monthly malaria data reporting and to establish real-time notification of malaria positive cases from VMWs, basic health staff (BHS), hospitals and the private sector. Surveillance equipment for the mDMS were procured and distributed to village volunteers. Trainings on mDMS were provided to basic health staff and volunteers at township level.

4. The TA targeted 27 laboratories in both project sites. Commodities for surveillance were procured and distributed to the central health offices, regional and state and township medical offices: central server at NMCP, 31 laptops, 200 mobile phones for village health workers, 21 external hard disk drives, 11 printers and 44 cartridges, eight projectors and screens, and 12 SIM card routers. Laboratory equipment were also procured and distributed: 31 microscopes with four for the National Health Laboratory (NHL), 10 for Sagaing and 17 for Mon, microscope with digital camera for NHL, five-headed multi-viewing teaching microscope for NHL, lab equipment and reagent for malaria microscopy, cabinets and benches for the labs, 13 desktop computers and four printers, and 10 generators for Sagaing region.

5. Different trainings were conducted after the distribution of lab equipment, namely: on lab QA and microscopy for lab technicians, on lab quality control crosschecking by NMCP, panel testing by NHL, and on-the-job/refresher courses.

6. The SOPs and manual on Microscopy and Laboratory QA were approved by the Union Minister of the MoHS in April 2017, and the manual was approved by the MoHS-NMCP in September 2017 for nationwide use. These materials have been distributed nationwide and used for training MoHS staff in the project areas. Likewise, a malaria microscopy algorithm and malaria reference slide posters were developed for use by lab technicians nationwide.

7. Video documentation for Myanmar and Lao PDR RCDTA started August 2017 and completed on October 2017. The video was launched during the International Malaria Week in Nay Pyi Taw in December 2017.

8. Lab and surveillance initiatives under the project will be replicated by NMCP in other parts of the country supported by the DEFEAT Malaria project of USAID.

MMPs specific needs for malaria prevention and treatment

1. A malaria vulnerability and risk assessment tool (health facility and malaria services mapping, migration and mobility profile and movement, behavior and awareness assessment) was developed and used in project sites in Cambodia, Lao PDR and Myanmar. Results were shared during the Global Malaria Week in Nay Pyi Taw in December 2017. In Lao PDR, tracking of MMP movement was conducted in target villages to monitor the trend in movement of MMPs including forest and host communities, and to identify the locations in which they stay.

2. Training on baseline assessment research and data collection techniques was conducted in Cambodia, Lao PDR and Myanmar. Village health volunteer and peer educator training was also conducted in the project sites in Lao PDR and Myanmar with 110 volunteers participating.

3. Mobilization of migrant workers and/or their family members trained as _malaria volunteers_ as a common approach was adopted as agreed with the MoH of Cambodia, Lao PDR and Myanmar. Volunteer training and outreach activities for MMPs have been conducted. The training informed on malaria vectors, symptoms, diagnosis, treatment, and prevention.

4. There were 1,956 outreach participants in Lao PDR (1,082 in Khong district and 874 in Phouvong district) while in Myanmar there were 13,760 participants in the three project townships. Volunteers have carried out IEC sessions in worksites as well as project sites in project areas. Malaria events, campaigns and World Malaria Day celebrations were held to attract public's attention on the work of volunteers and availability of RDT services and treatment.

5. The worksite project in Myanmar distributed long-lasting insecticidal nets provided by the National Malaria Control Program. The project in Lao PDR on the other hand, guided by the recommendations of the situational assessment, distributed hammock nets, mosquito coils, sprays and patches targeting forest-goers and MMPs.

6. Technical input to Cambodia's MoH Operational Guidelines for Mobile, Migrant and other Underserved Populations in the Context of Malaria Elimination was provided through the project. Agreement was also reached by the MoH of the three countries on the definition of MMPs.

7. Lao PDR's central and provincial health offices committed to sustain (i) the training and mobilization of Laotian and Vietnamese mobile traders, who ply around the district, as malaria peer educators and can effectively reach MMPs; (ii) the identification and training of the cam/worksite managers/directors as volunteers, effective approach to engage the private sector in malaria prevention and treatment; (iii) development of innovative information and education/behavioral change communication materials for specific MMP targets, (iv) systematic identification and monitoring of MMPs through outreach activities of the trained volunteer health workers; and (v) development and use of reporting forms for MMPs that can inform the national malaria reporting system.

8. In Myanmar, similar approaches were conducted where 55 worksite managers were engaged as volunteers and village health volunteers in plantations, gold and jade mines trained and mobilized.

Regional coordination on malaria and CDC among GMS countries strengthened

1. The TA supported various regional cooperation activities that served to improve regional coordination and cross-border collaboration. Among these were:

" Country Consultation on ADB Health Strategy in the GMS, Ha Noi 8 -9 Dec 2015

" Workshop on Malaria Control for Mobile and Migrant Population at Border Areas, Da Lat, Viet Nam, 2-3 March 2017.

" Regional Meeting on Reinforcing Health Security in Bangkok, Thailand on 5 July 2017 participated by officers from Disease Control Departments of Cambodia, Lao PDR, Myanmar, PRC, Thailand and Viet Nam.

" GMS Malaria Workshop (Orienting health systems towards effective control and elimination of malaria in the GMS in Vientiane, Lao PDR co-hosted by the Department of Communicable Disease Control, MOH, Lao PDR on 28-30 June, 2017.

" Health Project Managers Meeting Regional and Cross-Border Activities in the GMS in Luang Prabang, Lao PDR on 10-11 December 2017

" GMS Joint Simulation Exercise and Cross-Border Information Sharing Workshop, Siem Reap, Cambodia, June 2018

" 2nd Project Managers Meeting on 10-11 May 2018 in Yagoon, Myanmar

" Regional Knowledge Workshop on Malaria Interventions among MMP in Bangkok, Thailand on 17-18 May 2018

" Regional Workshop on Improving Laboratory Services and Infection Prevention Control in the GMS in Mandalay, Myanmar on 4-5 June 2018

2. The TA also supported the of CDC and malaria health officials of Cambodia, Lao PDR and Myanmar in the Prince Mahidol Awards and Conference (PMAC) in 2017 and in 2018 in Bangkok, Thailand.