Regional Artemisinin Initiative (RAI) Dr Faisal Mansoor Head of the Programme Unit UNOPS Myanmar, PR GFATM MMV meeting Siem Reap 25 Feb. 2015
RAI - overview Artemisinin Resistance is a Regional and Global threat that requires regional coordination and harmonization. In response to the above, in March 2013 the Global Fund Board allocated $100m to address this threat in the Greater Sub-Mekong region. Based on disease burden and financial gap analysis, the funds are allocated as follows: Myanmar Cambodia Vietnam Thailand Laos ICC 40M 15M 15M 10M 5M 15M
RAI Geographical Coverage
Burden of malaria in the GMS region API= 0.51 API= 0.22 Thailand 5% Viet Nam Yunnan 1% 0% Cambodia 7% API= 2.74 Lao People's Democrati c Republic 8% API= 7.09 Myanmar 79% API= 7.88
RAI - overview The Regional Artemisinin Resistance Initiative, or RAI, is the result of a collaborative effort between multiple partners and the Ministries of Health of the five countries, which worked together with great commitment and a strong cross-border spirit. The initiative aims to achieve elimination of P. falciparum malaria. The stakes of the initiative go far beyond the Greater Mekong Sub-region. If resistance were to reach India or sub- Saharan Africa, where most malaria cases occur, the public health consequences could be disastrous (There are already hints of resistance on the western border of Myanmar) The RAI has joined forces with all key partners. A high level Regional Steering Committee that oversee the RAI has all the key stakeholders (national, regional and international) to ensure the initiative builds on efforts currently underway. China will provide technical support to RAI by sharing experience and best practices
Implementation arrangement
RAI-Guiding principles containment of AR malaria can only be assured if the transmission of malaria stops and falciparum malaria is eliminated from the region 5-M approach 1. Migrant and Mobile Populations 2. Monotherapy 3. Monitoring and surveillance 4. Malaria Posts 5. Malaria Parasite
At Risk populations in Tier 1 & 2 Indicator Country 2014 2015 2016 Static Pop Mobile / Migrant Pop ( estimates) Cambodia 9,096,163 9,236,244 9,378,482 Lao, PDR 563,607 9,238,259 9,380,498 Myanmar 5,030,681 8,645,976 11,153,308 Thailand 1,916,104 1,654,105 1,699,381 Vietnam 7,543,454 10,300,081 12,852,689 Total 24,150,008 39,074,664 44,464,359 Cambodia 433,151 439,821 446,594 Lao, PDR 23,420 25,620 25,620 Myanmar 150,920 152,867 154,839 Thailand 156,930 156,930 156,930 Vietnam 115,595 40,000 40,000 Total 880,016 815,238 823,984
LLINs Coverages Country Cambodia Lao, PDR Myanmar Thailand Vietnam Year 1 (2014) Year 2 (2015) Year 3 (2016) 61% 74% 71% 90% 55% 88% 57% 100% 100% 87% 96% 77% 10% 60% 60% 2015 And 2016 are projected % based on current LLIN distribution data
Budget Distribution at Modular level in Concept Note Module Cambodia % Laos % Myanmar % Thailand % Vietnam % VC 26 7 25 5 54 CM 55 38 46 80 23 M&E 11 7 3 10 2 PM 8 48 26 5 20
Budget Distribution at Modular level after Grant making Module Cambodia % Laos % Myanmar % Thailand % Vietnam % VC 47 15 26 26 51 CM 34 28 35 21 27 M&E 6 9 8 12 7 PM 12 47 31 41 15
Budget Distribution at Modular level after Reprogramming Module Cambodia % Laos % Myanmar % Thailand % Vietnam % VC 16 18 21 24 16 CM 50 41 36 26 44 M&E 12 5 7 12 13 PM 22 36 36 38 27
Key Milestones RAI- Up to June 2014 Despite delayed startup, all countries reported achievements on case management indicators as these activities are co-financed from country GF grant and government and other sources; Achievements against new RAI indicators is very low mostly as a delay in starting implementation. Thailand and Myanmar showed good progress; As a result the overall budget absorption including commitments for all countries is less than 25% of the P1 Budget.
All Countries Achievements vs. Targets (Jan- Jun 2014) Suspected Malaria Cases received Parasitological tests 900,000 800,000 801,251 700,000 600,000 531,244 500,000 400,000 300,000 200,000 100,000-300,000 167,081 97,824 96,500 100,671 50,481 - - CAMBODIA LAOS MYANMAR THAILAND VIETNAM Targeted # Actual Reached
All Countries Achievements vs. Targets (Jan- Jun 2014) Confirmed Malaria Cases received treatment 45,000 41,754 40,000 35,000 30,000 25,000 20,000 15,000 10,000 14,469 17,136 14,834 10,136 11,638 11,780 10,604 8,678 5,000 - - CAMBODIA LAOS MYANMAR THAILAND VIETNAM Targeted # Actual Reached
Complementarity& Inter-linkages: ICC, RAI and MCP National Malaria Control Program (National Level) RAI country component (TSPs Level) RAI ICC (3M s) (Village level) MALARIA ELIMINATION Map, Mop and Monitor
INTER COUNTRY COMPONENT - Implementation Update Grant Agreements for Year 1 (July 2014-June 2015) signed with all three selected ICC SRs (SMRU, MAM, CPI); First funds disbursement remitted to all ICC SRs; Processes for procurement of ACT, DHA+PPQ and RDT are completed. Protocol for TME got Ethical Approval in November 14 CPI sent a DMR scientist to University of Maryland to get trained in qpcr and sample collection; MAM - completed Villages identification selections and training of new VHVs completed. Also, conducted advocacy with ethnic partners and community engagement for the implementation of qpcr; SMRU started dynamic mapping.
Next plans Current grants are extended to 31 March 2015 based on current workplans/budgets to avoid interruption of implementation. PR conducted the in country workshops to develop detailed work plans / budgets for April 2015 Dec 2016 Grant negotiations with GF in March 2015, contracts between UNOPS and countries issued by 30 March, and implementation continues 1 April 2015; Selection of new SRs under Phase 2 of ICC is underway. This will target other border areas. Implementation of new ICC can only start in July 15.
Summary of programmatic changes 2015-16 Expansion in the targeted geographical areas and, thus, increase in numbers of the targeted populations except for Thailand. Myanmar has not officially updated the tiers map but RAI activities is planned to be expanded to its western borders. All countries increased their targets for impact and some key output indicators. For Impact indicator most countries aimed for remarkably lower Malaria Morbidity rates e.g. Laos is aiming for 70% reduction by 2016 from 2012 baseline. All countries increased their testing targets
Thankyou