Regional : Strengthening Regional Health Cooperation in the Greater Mekong Subregion
The proposed technical assistance (TA) addresses the need for improved Greater Mekong Subregion (GMS) regional health cooperation. The TA will provide a platform for a more coherent policy environment at both national and regional levels, which is supportive of cross-border collaboration and targeting vulnerable populations. The TA will also produce innovative ideas for a regional portfolio.
Elfving, Rikard N.
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|Project Name||Strengthening Regional Health Cooperation in the Greater Mekong Subregion|
|Country / Economy||Regional
Lao People's Democratic Republic
China, People's Republic of
|Project Type / Modality of Assistance||Technical Assistance
|Source of Funding / Amount||
|Strategic Agendas||Inclusive economic growth
|Drivers of Change||Gender Equity and Mainstreaming
Governance and capacity development
|Sector / Subsector||
Health / Disease control of communicable disease - Health system development
|Gender||Effective gender mainstreaming|
|Description||The proposed technical assistance (TA) addresses the need for improved Greater Mekong Subregion (GMS) regional health cooperation. The TA will provide a platform for a more coherent policy environment at both national and regional levels, which is supportive of cross-border collaboration and targeting vulnerable populations. The TA will also produce innovative ideas for a regional portfolio.|
|Project Rationale and Linkage to Country/Regional Strategy||
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.
Healthy lives ensured and well-being promoted for all at all ages (Sustainable Development Goal 3)
|Description of Outcome||
Regional health cooperation in GMS strengthened
|Progress Toward Outcome||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.|
|Description of Project Outputs||
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
|Status of Implementation Progress (Outputs, Activities, and Issues)||ADB approved the knowledge and support TA on 22 August 2018 for $1 million, of which $500,000 is financed on a grant basis by TASF-6, and $500,000 is financed on a grant basis by the Regional Cooperation and Integration Fund (RCIF). The original completion date was on 30 September 2020. ADB is the executing agency. One or more departments of each country's health ministry serve as implementing agencies. In response to the coronavirus disease (COVID-19) pandemic as it started spreading regionally in January 2020, ADB approved an increase of $2 million in the TA amount on 7 February 2020. The TA was also extended by 24 months, from 30 September 2020 to 30 September 2022.The TA aligns with the impact, healthy lives ensured and well-being for all at all ages promoted (Sustainable Development Goal 3). The TA's outcome will be regional health cooperation in the GMS strengthened, expected to be achieved through the following outputs: (i) GMS working group on health cooperation functioning, (ii) GMS health cooperation strategy developed and implemented, and (iii) knowledge development and exchange promoted. A new output 4 was added when the $2 million TA increase was approved in 2020 (para. 3), to reflect the objective of improved capacity to implement the One Health response to public health threats. The TA provides regional platform for the GMS health cooperation and synergizes with other ADB and development partners health projects. The TA has completed about 60% of its planned activities. Under output 1, the GMS Working Group on Health Cooperation (WGHC) has organized three meetings and is planning to hold its fourth meeting in Q4 2021. Since February 2020, the secretariat of the GMS WGHC has facilitated and organized webinars on policy-making and response to COVID-19.6 Under output 2, the TA has supported GMS countries to (i) procure supplies and equipment for strengthening national health system response to COVID-19, (ii) conduct COVID-19 case management training and contingency planning workshop, and (iii) engage experts to support the countries' COVID-19 response, e.g., digital health experts, virologist, epidemiologist, etc. The five GMS countries (Cambodia, Lao People's Democratic Republic, Myanmar, Thailand, and Viet Nam) were allotted $100,000 each for COVID-19 prevention and management. Under output 3, the GMS Health Cooperation Strategy and the Strategic Results Framework were published, uploaded in the GMS website, disseminated to the relevant GMS ministries, and currently being translated to key GMS languages. Under output 4, Nossal Institute for Global Health was engaged in June 2020 to enhance the regional networking and capacity building on One Health across sectors and establish a regional technical support network to support GMS countries on One Health implementation. The firm is now conducting country consultations and regional dialogues to complete deliverables under its contract by Q3 2022. The TA team is currently preparing an ADB working paper on One Health Action: Practical Approaches to Operationalize One Health in Projects. This paper will be launched in Q4 2021, in partnership with the GMS environment, health and natural resource management, and rural development working groups. In August 2021, ADB approved Three new activities are proposed, aligned with the TA's original outcome of strengthening regional cooperation in the GMS. It will scale-up the region's commitment to health security through new partnerships with the International Organization for Migration (IOM) and the Association of Southeast Asian Nations (ASEAN)'s Health Division. It will strengthen the capacity of the GMS countries to address health threats posed by emerging and reemerging diseases, including those linked with regional connectivity and human mobility: (i) Population mobility mapping in the GMS; (ii)Developing an institutional partnership arrangement with the ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED); (iii) Assessing the need for national centers for disease control public health emergencies and emerging diseases in GMS countries. The TA was increased from $3 million to $4 million and its closing date extended from 30 September 2022 to 31 March 2024.|
|Geographical Location||Cambodia - Nation-wide; China - Nation-wide; Lao People's Democratic Republic - Nation-wide; Myanmar - Nation-wide; Thailand - Nation-wide; Viet Nam - Nation-wide|
|Summary of Environmental and Social Aspects|
|Stakeholder Communication, Participation, and Consultation|
|During Project Design|
|During Project Implementation||A GMS working group on health cooperation is functioning and has held three regional meetings in 2017, 2018 and 2019. The latest meeting held in December 2019 convened participants from all six countries and representatives from other development partners, civil society organizations, private sector and ADB. The next regional meeting is being planned to be held in December 2021. Webinars on (i) One Health in the GMS: Where are we now and where next?; and (ii) Digital Health Solutions for COVID-19 Vaccinations in the GMS were held in June 2021 and September 2021, respectively.|
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.
|Procurement||The increase in TA amount will allow (i) immediate procurement of the laboratory equipment, and (ii) engagement of a consulting firm including technical experts and resource persons, to provide capacity development and advisory support. The firm will 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. The additional support complements ongoing ADB assistance through the regional health security project.|
|Responsible ADB Officer||Elfving, Rikard N.|
|Responsible ADB Department||Sectors Group|
|Responsible ADB Division||Human and Social Development Sector Office (SG-HSD)|
Asian Development Bank
|Concept Clearance||21 Jun 2017|
|Fact Finding||03 Jul 2017 to 07 Jul 2017|
|Approval||22 Aug 2018|
|Last Review Mission||-|
|Last PDS Update||30 Sep 2021|
|Approval||Signing Date||Effectivity Date||Closing|
|22 Aug 2018||-||22 Aug 2018||30 Sep 2020||31 Mar 2024||-|
|Financing Plan/TA Utilization||Cumulative Disbursements|
|4,000,000.00||0.00||0.00||0.00||0.00||0.00||4,000,000.00||09 Sep 2023||2,915,563.03|
Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.
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|Title||Document Type||Document Date|
|Strengthening Regional Health Cooperation in the Greater Mekong Subregion: Technical Assistance Report||Technical Assistance Reports||Aug 2018|
Safeguard Documents See also: Safeguards
Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.
None currently available.
Evaluation Documents See also: Independent Evaluation
None currently available.
|Title||Document Type||Document Date|
|Greater Mekong Subregion Health Cooperation Strategy 2019–2023||Policies, Strategies, and Plans||Jun 2019|
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