Regional: Strengthening Regional Health Cooperation in the Greater Mekong Subregion

Health / Disease control of communicable disease - Health system development

All countries in the GMS are committed to achieving the Sustainable Development Goals for health. While health indicators have generally improved in recent years, communicable diseases remain a constant problem, reflected in rapid transmission rates and high case fatality. Outbreaks in the past decade have had severe economic consequences, (i) severe acute respiratory syndrome (SARS) is estimated to have cost Asian countries $30 billion, (ii) avian influenza A (H5N1) caused $120 million in losses for Viet Nam, and (iii) avian flu-related diseases in Thailand resulted in 1.5% GDP growth loss during 2003 -2004.

Challenging disease control environment. The GMS countries are characterized by increasing populations, dense and highly mobile labor force and inter-connected economies, which make disease control evermore challenging. Poor and marginalized people, including undocumented migrants, indigenous people, youth, and women in border zones disproportionately carry the burden of disease, especially infections such as HIV/AIDS, tuberculosis, malaria, dengue, and neglected tropical diseases. These groups are often excluded from communicable disease control (CDC) programs for a variety of reasons, including economic conditions, cultural beliefs, social acceptability, and perceived affordability. Another major concern in the region is the spread of hospital-acquired infections and drug resistance, particularly of tuberculosis and malaria.

Investing in emerging disease control has a strong public goods rationale. CDC is classed as a regional or global public good, characterized by its non-excludability and non-rivalry. Non-excludability means that once provided, no country can be excluded from consumption and is thus available to all, while non-rivalry suggests that one country's consumption does not impede or limit consumption for another country. These characteristics give rise to free-riding effects, where countries do not want to invest individually and bear the cost while others reap free' benefits. Consequently, the provision of public goods such as CDC is not guaranteed by any one country, and often requires an intervening force to bring relevant stakeholders to invest together. In this sense, global or regional cooperation provides one solution to a collective action problem and is especially important where inter-connected economies allow for movement of people and similarly, diseases. For example, migrants returning with HIV, malaria, or tuberculosis need continuity of treatment to avoid complications and drug resistance. In turn, this requires regional health financing systems and a network of facilities for migrants. Similarly, control of emerging infectious diseases requires both proactive and reactive rapid response, involving multiple actors and cooperation. Regional collaboration also has other benefits such as technology transfer and human resource development, economies of scale, and increased leverage for fund-raising.

The TA serves as a common platform for the GMS health portfolio and synergizes with other ADB health projects and regional collaboration covering Cambodia, the Lao People's Democratic Republic, Myanmar, Viet Nam, Thailand, and the PRC.

The implementation progress under each Output is summarized below.

GMS Working Group on Health Cooperation (WGHC) established

GMS Health Cooperation Strategy developed and implemented

Knowledge development and exchange promoted

Capacity to implement One Health Response to public health threats improved

Output 1:

- Engaged consultants (Public Health; Regional Coordinator for Health Cooperation; Research Team Leader and Migrant Health; Finance; M&E) to support overall TA coordination;

- Prepared the GMS WGHC TORs, membership and reporting arrangements;

- Established the GMS WGHC secretariat;

- Launched the GMS WGHC; conducted WGHC annual meetings in 2017, 2018 and 2019;

- Organized a roundtable discussion on Regional Investment Framework for Migrant Health in the GMS in Thailand, November 2018.

Output 2:

- Finalized and published the 5-year (2019-2023) GMS health cooperation strategy in June 2019;

- Reviewed and updated the GMS Regional Investment Framework (Health and HRD sector);

- Ongoing mapping of regional health projects in the GMS.

Output 3:

- Updated regularly the WGHC page in the GMS website;

- Published the "Greater Mekong Subregion Health Cooperation Strategy 2019-2023";

- Ongoing finalization of the implementation framework for the GMS health cooperation strategy and completion of the regional cooperation-related research.

Output 4:

The regional activities will be broadened to provide immediate capacity building support for One Health implementation. The One Health concept recognizes that the health of people is connected to the health of animals and the environment. It is defined as a collaborative, multisectoral, and transdisciplinary approach working t the local, regional, national, and global levels with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.

In the PRC, the TA will (i) develop recommendations for improved outbreak investigation and response in live animal markets, (ii) develop recommendations for outbreak surveillance and response in rural areas, and (iii) strengthen the health system's resilience and capacity for epidemic response. This includes provision of laboratory equipment to help investigate and combat the outbreak.

The TA has hired five individual consultants to support overall TA coordination. Flexibility to mobilize expertise is provided by determining the terms of reference and selection method during TA implementation and as the WGHC is set up. Possible areas of expertise include national planning, regional cooperation, migration, gender, zoonosis, laboratories, surveillance, drug resistance, financing, and knowledge management.

The increase in TA amount will also support the engagement of a consulting firm to assist the PRC and other GMS countries in preventing outbreaks of emerging infectious diseases and strengthening planning and implementation capacity for One Health in the future.