16 November 2018
Vientiane, Lao People’s Democratic Republic
Meeting Report
FIRST ANNUAL COUNTRY SURVEILLANCE MEETING TO FACILITATE MALARIA ELIMINATION IN THE
GREATER MEKONG SUBREGION
First Annual Country Surveillance Meeting to Facilitate Malaria Elimination in the Greater Mekong Subregion 16 November 2018 Vientiane, Lao People’s Democratic Republic
WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC
English only
MEETING REPORT
FIRST ANNUAL COUNTRY SURVEILLANCE MEETING TO
FACILITATE MALARIA ELIMINATION IN THE GREATER MEKONG SUBREGION
Convened by:
WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC 16 November 2018
Vientiane, Lao People’s Democratic Republic
Not for sale
Printed and distributed by:
World Health Organization Regional Office for the Western Pacific
Manila, Philippines July 2019 RS/2018/GE/57(LAO)
NOTE
The views expressed in this report are those of the participants of the First Annual Country Surveillance Meeting to Facilitate Malaria Elimination in the Greater Mekong Subregion and do not necessarily reflect the policies of the conveners.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the First Annual Country Surveillance Meeting to Facilitate Malaria Elimination in the Greater Mekong Subregion in Vientiane, Lao People’s Democratic Republic on 16 November 2018.
CONTENTS
SUMMARY ... 1
1. INTRODUCTION ... 1
1.1 Meeting organization ... 1
1.2 Meeting objectives ... 1
2. PROCEEDINGS ... 1
2.1 Opening session ... 1
2.2 Background and objectives of the meeting ... 2
2.3 Priority work areas under RAI2E surveillance grant and examples of country surveillance assessment ... 2
2.4 Updates from GMS countries ... 2
2.5 Surveillance update ... 5
2.6 Surveillance improvement ... 8
3. CONCLUSIONS AND RECOMMENDATIONS ... 9
3.1 Conclusions ... 9
3.2 Recommendations ... 10
ANNEXES ... 12 Annex 1. Programme agenda
Annex 2. List of participants, temporary advisers, representatives, international partnersand Secretariat
Keywords:
Malaria - prevention and control / Public health surveillance / Mekong valley
ABBREVIATIONS DHIS District Health Information System
GMS Greater Mekong Subregion
RAI Regional Artemisinin-resistance Initiative RDSP Regional Data Sharing Platform
WHO World Health Organization
SUMMARY
On 16 November 2018, representatives from the Greater Mekong Subregion (GMS) Member States – Cambodia, China, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – met with partners to strengthen surveillance for malaria elimination in the Subregion. The first annual surveillance meeting was hosted by the WHO Mekong Malaria Elimination (MME) programme in Vientiane, Lao People’s Democratic Republic. During the meeting, representatives exchanged information on surveillance progress and challenges in their countries. Presentations centred around three key topics: surveillance update, surveillance improvements and challenges, and surveillance assessment. The outcomes from these discussions led to recommendations that aim to further strengthen surveillance to accelerate malaria elimination in the GMS toward the shared goal of malaria-free status by 2030.
Conclusions
• Update on the Regional Artemisinin-resistance Initiative (RAI2E) surveillance grant: WHO manages the RAI2E surveillance grant (regional component) with three objectives: 1) monitor progress on malaria elimination in GMS countries; 2) strengthen the national programme’s surveillance capacity; and 3) support GMS countries to address cross-border challenges. GMS countries made significant progress towards strengthening national surveillance capacity and the regional database. Some remaining challenges include: 1) training at national/subnational levels;
2) data review and response; 3) national data repositories (beyond surveillance data); and 4) national surveillance assessment.
• Surveillance assessment: Malaria Surveillance, Monitoring & Evaluation: A Reference Manual emphasizes the importance of conducting national surveillance assessments. WHO provides various resources (e.g. manual and tools) for the assessment. Countries are encouraged to proceed with assessments using available tools. Most countries are routinely monitoring the performance of their surveillance systems (e.g. comprehensiveness, timeliness, utilization of the system) and data quality.
• Lessons learnt from GMS countries: Countries presented the progress and challenges for malaria surveillance. All countries have implemented elimination activities such as case-based and foci investigation (e.g. 1-3-7 activities) in the whole or part of the country. All use the surveillance data for monitoring progress and guiding activities (e.g. distribution of long-lasting insecticidal nets, village malaria worker deployment). The Lao People’s Democratic Republic routinely monitors the number of cases against the historical trend for outbreak detection and has developed a national/subnational dashboard for programmatic actions. Many countries expressed logistical and financial challenges for scaling up case-based investigation in the elimination phase.
• District Health Information System (DHIS2) platform: DHIS2 is an open source surveillance platform, which is used for malaria surveillance in many countries. In the GMS, it is used in the Lao People’s Democratic Republic, Myanmar and Viet Nam as part of the electronic
Communicable Diseases System (eCDS) data repository and the WHO RDSP. The University of Oslo is regularly updating the platform, accommodating new features (e.g. event maps, geospatial analysis, dashboard). If any country or programme is interested, technical support is available from the University of Oslo and/or other partners (e.g. WHO, Clinton Health Access Initiative, United States President's Malaria Initiative).
• Regional Data Sharing Platform (RDSP): WHO has been hosting the RDSP since 2013 to facilitate data-sharing across GMS countries. The countries reiterated their commitment for data- sharing across countries and monitoring the subregional progress towards elimination through the regional surveillance network coordinated by WHO as laid out in the Ministerial Call for Action to Eliminate Malaria in the GMS before 2030, which was signed by the GMS ministers of health in May 2018. The RDSP supports GMS countries by: 1) sharing data among countries which facilitates cross-border activities and response in border areas, and 2) enabling the regular assessment of progress towards malaria elimination. Countries reviewed the proposed and reported data elements to the RDSP. They decided to retain the current elements and requested that WHO revise the list to present to countries for consensus.
• Cross-border collaboration: To date, RDSP data have been utilized in the Cambodia–Thailand cross-border meeting in August 2018, and the discussion is underway to utilize the data in the ongoing China–Myanmar cross-border initiatives. In these meetings, countries review the
epidemiology in border areas and discuss the joint actions (e.g. case management, prevention and screening, data sharing, and reporting of cross-border cases).
Recommendations
GMS countries are encouraged to consider the following:
1) Develop country-tailored plans for comprehensive surveillance assessment, based on specific issues and optimal timing in each country.
2) Continue and strengthen cross-border initiatives (e.g. China–Myanmar and Cambodia–
Thailand and other similar vulnerable borders) in data sharing, case investigation, etc.
3) Support strengthening of the RDSP by continuing to submit data to MME in a timely manner and providing additional data elements and more detailed data (e.g. age/gender breakdown, community-level data) as agreed at the meeting.
4) Utilize the surveillance data in the RDSP, especially at subnational level for programmatic actions.
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1. INTRODUCTION 1.1 Meeting organization
Under the Regional Artemisinin-resistance Initiative (RAI) 2E from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Health Organization (WHO) Mekong Malaria Elimination (MME) Programme hosts a Regional Data Sharing Platform (RDSP) to strengthen surveillance activities in countries and to facilitate data sharing and collaboration among countries. Currently, all countries in the Greater Mekong Subregion (GMS) – Cambodia, Yunnan Province (only 19 counties along the border) of China, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – are sharing their malaria surveillance data monthly as part of the WHO RDSP initiative.
The First Annual Country Surveillance Meeting to Facilitate Malaria Elimination in the Greater Mekong Subregion was held in Vientiane, Lao People’s Democratic Republic, on 16 November 2018.
WHO hosted the one-day meeting bringing together representatives from malaria control programmes, surveillance focal points from GMS countries, as well as technical experts and partners to review the current status and performance of national surveillance systems and discuss the future priorities for the RDSP.
The main discussion points included challenges in countries regarding surveillance strengthening, the RDSP outputs and their application for strengthening in-country response and cross-border activities.
The group also discussed activities for the coming year strategies on dealing with imported cases, mobile and migrant populations and cross-border issues.
1.2 Meeting objectives
The objectives of the meeting were to:
1) review the status of surveillance systems in the GMS and understand challenges to surveillance strengthening;
2) where applicable, review the outcome of surveillance assessments (e.g. methodological comparisons);
3) discuss the performance of the RDSP and preparation/planning of activities for the coming year as well as the ways to utilize the surveillance data to accelerate malaria elimination;
and
4) brainstorm the future priorities for malaria surveillance in the GMS (e.g. further collaboration in cross-border areas).
2. PROCEEDINGS 2.1 Opening session
Dr Ratanaxay Phetsouvanh, Representative from the Ministry of Health, Lao People’s Democratic Republic, delivered the welcome address to the meeting participants.
Dr Rabindra Abeyasinghe, Coordinator, Malaria other Vectorborne and Parasitic Diseases, WHO Regional Office for the Western Pacific, gave the opening remarks on behalf of Dr Shin Young-soo, WHO Regional Director for the Western Pacific. He emphasized that countries in the GMS have made significant progress toward eliminating malaria since the launch of the Strategy for Malaria
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Elimination in the Greater Mekong Subregion (2015–2030). Over the past five years, the number of malaria cases has declined by 74%, and the number of malaria deaths by 96% in the five GMS countries. However, between January and June of this year, cases increased in Cambodia and some of the border provinces of the Lao People’s Democratic Republic and Viet Nam.
Meanwhile, multidrug resistance of Plasmodium falciparum malaria, including partial resistance to artemisinin and resistance to partner drugs, continues to be a serious health concern in the Subregion.
Therefore, it is urgent to accelerate the elimination in the Subregion even before the 2030 target and remove the threat of drug resistance as quickly as possible.
He also emphasized that surveillance is the key elimination activity to generate information on malaria cases and deaths, which can be used for planning, monitoring and evaluating malaria control programmes. In this context, the recent Ministerial Call for Action to Eliminate Malaria in the GMS before 2030 emphasized the importance of surveillance, calling for countries “to transform malaria surveillance into a core intervention in each GMS country, including effective information collection, analysis and dissemination systems and switch to case-based surveillance for malaria elimination.”
Dr Bouasy Hongvanhthong was nominated as chair for the meeting and Dr Prayuth Sudathip as co- chair. The agenda and the list of participants are presented in Annex 1 and Annex 2, respectively.
2.2 Background and objectives of the meeting
Dr Hiromasa Okayasu, Coordinator, Mekong Malaria Elimination (MME), presented surveillance as a key intervention in GMS malaria elimination. He gave an overview of the Ministerial Call for Action to Eliminate Malaria in the GMS before 2030, which was endorsed by ministers on the sidelines of the World Health Assembly in May 2018. One of the calls for action agreed upon was: TRANSFORM malaria surveillance into a core intervention in each GMS country. He also mentioned the issues and challenges in malaria surveillance in the GMS with regard to data collection and reporting, data use, and assessment. Lastly, he presented the objectives of the meeting with expected outcomes.
2.3 Priority work areas under RAI2E surveillance grant and examples of country surveillance assessment
Dr Noor presented the objectives and activities of the RDSP under the RAI2E surveillance grant. He also mentioned improvements of the RDSP, including data collection and dashboards, as well as country achievements with WHO support. He emphasized the need for GMS countries to conduct surveillance assessments. He demonstrated assessment resources and tools as well as three examples of surveillance assessment, but noted that WHO is working on a standard tool for regions and countries to use. He shared information on the Performance of Routine Information System Management (PRISM) landscaping tool used by the Clinton Health Access Initiative (CHAI) and the WHO Data Quality Report (DQR).
2.4 Updates from GMS countries 2.4.1 Cambodia
As demonstrated by Dr Chea Huch, Cambodia developed an operational surveillance manual for malaria elimination in 2017. The country has introduced an Android app installed in distributed tablets to health facilities for both burden reduction and elimination provinces. All notified cases reported are being entered into tablets and stored in a web-based system called the Malaria
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Information System (MIS), which is an in-house development system. Case investigation and foci investigation modules are now available in the app as well. The presentation introduced work done by the programme to assess performance, including completeness, share of Pf/mix cases investigated and use of surveillance data of some main malaria indicators (e.g. incidence by village in 2014 targeting long-lasting insecticidal nets/village malaria workers), trend of cases by species (top seven provinces), trend of test positivity ratio (top seven provinces), annual blood examination rate in 2017, annual parasitic incidence (API) Pf/mix in 2017, and test positivity ratio in 2017.
2.4.2 Yunnan (China)
Malaria burden was reduced by 97% from 2003 to 2017. Only 325 imported cases were reported in 2017, and 195 imported cases were reported between January and September 2018. Local transmission was interrupted, and no indigenous malaria cases were reported after May 2016: Yunnan was reported as being malaria free. The surveillance system in Yunnan uses health facility-based detection, which is a web-based reporting system. To eliminate malaria and maintain malaria-free status, strategy 1-3-7 has been widely used.
Six major challenges were highlighted: 1) difficulty in accessing health facilities in border and remote areas; 2) difficulty in detecting malaria among migrants, especially border-crossers; 3) technical limitation including reduced capacity of microscopy, limitation of rapid diagnostic test (less sensitivity to P. vivax, quality of rapid diagnostic test itself), and PCR only being able to be done at Yunnan Institute of Parasitic Diseases; 4) lack of effective communication between the Chinese Center for Disease Control and Prevention (China CDC) and hospitals; 5) complexity of collecting local primary malaria vectors (Anopheles minimus); and 6) difficulty in finding appropriate sample cases for drug resistance surveillance since some criteria are required for the selection.
2.4.3 Lao People’s Democratic Republic
The previous surveillance and reporting system had gaps in terms of duplication of data, unsecured multiple platforms (Excel and Access), and difficulty to conduct rapid and easy analyses for purposes of planning and response. All health systems now must integrate into the District Health Information System or DHIS2 software according to a ministerial decree in 2017. In the northern provinces (elimination provinces), real-time passive and active case detection case line-listing (event) has started, including case investigation and foci investigation. In the southern provinces where cases are still high, passive case detection case line-listed (event) data are being rolled out. Aggregate passive case detection data are entered monthly but will stop in 2019 throughout the country and will be replaced by line-listed event capture in DHIS2. Offline events-based data are accessible at health centres (real time if Internet is available) in two provinces (Luang Prabang and Saravane). More than 95% of malaria-positive cases are reported from the five southern provinces, and 80% of cases are reported from 18 districts, equivalent to 84 health centres.
Dr Odai presented the core DHIS2 dashboards: National and Provincial Management Dashboards, Outbreak Alert Dashboards, Elimination Monitoring Dashboard, Stock monitoring and management dashboard, public–private mix and facilities dashboard, and Malaria strata dashboard and Community data analysis. He noted the current surveillance challenges, including: 1) lack of human resources at the district antimalarial nuclei (DAMN) in terms of quantity and quality, especially in the northern provinces, and there is frequent staff turnover; 2) need for intensive and ongoing capacity-building at the provincial antimalarial unit (PAMU) and DAMN to extract, analyse, interpret and take action on DHIS2 data analysis; 3) need to change provincial and district management mindset to embrace a more rapid and proactive attitude to surveillance and response; 4) provincial and district coordination
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is not routine, especially for outbreak response; and 5) as DHIS2 moves to the health centre level, Internet access will also need to expand so that uniform real-time data can be collected.
2.4.4 Myanmar
Since 2012, malaria cases reduced by 82%, from 481 204 to 85 019 in 2017. In the same period, the number of malaria deaths fell from 403 to 30 (93% reduction). An operational manual on Malaria Surveillance in Elimination Settings has been developed to support the elimination plan in 2018.
Some key elimination-specific surveillance interventions were emphasized: 1) day 3 P. falciparum positive case management; 2) directly observed therapy (DOT) for P. falciparum and P. vivax malaria cases; 3) case notification, investigation, classification and response; 4) focus investigation, classification and response; 5) malaria death investigation; 6) malaria posts; 7) malaria mobile clinics for intensified malaria surveillance; 8) selective indoor residual spraying; and 9) migrant mapping.
For surveillance system strengthening, Myanmar piloted a case-based DHIS2 system called Malaria Case-based Surveillance (MCBS) in Bilin township in November 2017 and has since expanded it to four other townships of Mon state and one township in Sagaing region. Some challenges related to DHIS2 were addressed: 1) incompatibility between Myanmar Unicode and tablets/smartphones;
2) skill of health facility staff to type Myanmar Unicode properly; 3) Internet connectivity issues of two rural health centres in Bilin and one rural health centre in special area of Ye township; and 4) new (developer) version of DHIS2 released, but not yet working properly. Along with challenges, the way forward with DHIS2 includes: 1) support maintenance of the National Malaria Control Programme server and integrate case-based DHIS2 malaria case-based reporting and surveillance; 2) roll out DHIS2; and 3) assess Bilin DHIS2-MCBS. Major challenges towards elimination are: 1) malaria control and elimination in conflict areas; 2) malaria should be a notifiable disease; 3) sustaining the vector control interventions in the areas with low transmission with decreasing level of funding;
4) limited technical and human resource capacity to carry out elimination case-based surveillance;
5) delay in reporting from partner organizations; 6) defence service and a lot of the private sector still not included in routine surveillance; 7) mobile and migrant populations may be a hurdle to sustain subnational elimination; and 8) transition of paper-based to electronic-based reporting system due to poor Internet connectivity in some areas and non-state actor areas, skills of the staff, as well as hard- to-reach areas.
2.4.5 Thailand
From 2012 to 2018, overall case reduction is 78% (32 672 to 7209 cases), Pf. reduction is 93.5%
(12 229 to 801 cases), and active foci reduction is 66.6% (2376 to 794 clusters (subvillage)).
Surveillance progress includes the 1-3-7 strategy supported with a near-real-time web-based malaria surveillance system. Between October 2017 and September 2018, for case notification, the percentage of malaria cases reported to the malaria database within one day was 59.6% (average; improvement over time: Oct 2017: 40%, Sep 2018: 77.6%). For case investigation, the percentage of malaria cases reported to the malaria database that were investigated was 81.9% (average; improvement over time:
Oct 2017: 70.4%, Sep 2018: 87.4%), and percentage of malaria cases reported to the malaria database completed within three days was 68.9% (average; improvement over time: Oct 2017: 61.6%, Sep 2018: 74.6%). For response, the percentage of reactive case detection events conducted within seven days among reactive case detection that have occurred was 74.2% (average; improvement over time:
Oct 2017: 59.2%, Sep 2018: 95.7%). A few challenges were highlighted: 1) on-time and complete case notification from community, private hospitals, non-health sector and nongovernmental organizations; 2) complete investigation and response to eliminate foci (mobile/migrant and cross- border); and 3) phase-out of the vertical programme.
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2.4.6 Viet Nam
The surveillance system in Viet Nam is currently paper based and reports aggregated data from the commune to central levels via regions. Viet Nam used to have a web-based reporting system (Malaria Information System or MIS) and is expected to have a new web-based reporting system (Malaria Management System or MMS) in 2019. The new system will be case based with response and stock- out control. The surveillance approach in Viet Nam is that the commune level notifies cases within 48 hours, and cases are then investigated by the district level within four days. Dr Thang said that if a case is classified as local transmission, then foci investigation by the provincial level is done within seven days followed by foci response such as epidemiology and entomology investigation, mass screening of area, net distribution, spraying, and information, education and communication (IEC)/
behaviour change communication (BCC) within 10 days. National standard operating procedures (SOPs) of malaria surveillance were issued by the Ministry of Health on 2 March 2016.
Surveillance data have been used for programmatic actions: to identify endemic areas and the level of malaria transmission and to intensify response to malaria hotspots and high-risk populations.
Assessments of the surveillance system are conducted to strengthen the quality of routine reports, self- assessment by reports, supervision and monitoring, and external evaluation. Some challenges in surveillance strengthening also were noted: resource limitation (human resources, financial support, information technology infrastructure) and technical matters (quality of reports: accuracy, timeline, completeness, data use for decision-making, surveillance system assessment).
2.5 Surveillance update
2.5.1 Overview and update of new features in DHIS2
Dr John Lewis provided an overview of DHIS2 to clarify the system’s background including enhancements for malaria-specific use cases. He also demonstrated new DHIS2 features developed for malaria, including: 1) user interface improvements facilitate use for malaria; 2) data capture and workflow improvements will improve ease of use and data accuracy; 3) changes to the data model allow for tracking and analysing the malaria transmission chain; 4) new map functionalities allow for modelling foci; 5) additional geospatial analytics can strengthen decision-making; 6) buffers in event maps; 7) malaria reporting and non-reporting units; and 8) styling by data item in event maps. Other new features were also noted: 1) DHIS2 Android app; 2) vector tiles/WebGL; 3) offline capture app, which is currently in use in the Lao People’s Democratic Republic.
2.5.2 Regional Data Sharing Platform
The RDSP was primarily established during the time of the Emergency Response to Artemisinin Resistance (ERAR) in 2014. The first version used Business Intelligence (BI) and moved to DHIS2 in 2015. Most data elements and indicators were revised in May 2016 to align with the elimination steps in GMS countries and have been used up to the present. The key roles of the RDSP are:
1) subregional malaria data collection base; 2) main data source to conduct analyses and share data as requested from national malaria control programmes and WHO country office counterparts; 3) main data source for quarterly epidemiology summary and six-monthly bulletin; 4) cross-border information-sharing between GMS countries and key stakeholders; and 5) main data source to deeply analyse to the health facility level and propose clusters by top health facilities to GMS countries to consider focusing on towards malaria elimination. Benefits and advantages of the RDSP to the countries were also emphasized: 1) access to data of neighbouring countries, especially along borders for timely interventions (Thailand–Cambodia, Yunnan–Myanmar); 2) regular updates in the GMS from quarterly epidemiology summary and six-monthly bulletin released by the Mekong Malaria
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Elimination (MME) programme; 3) technical support from MME to train national and subnational levels on how to utilize data in the RDSP; 4) human resource support (data manager/analyst) to national malaria control programmes (Cambodia, Lao People’s Democratic Republic, Thailand); and 5) technical support to strengthen the malaria surveillance system (Myanmar). Ways forward for the RDSP were planned: 1) data collection improvement (standard data elements to be shared by countries recommended by WHO); 2) database improvement (disaggregation of existing data elements by age group, gender, and data sources (health centre, rural health centre, village malaria worker, public–private mix), revision of country and regional dashboard following malaria standard dashboard guidance from WHO headquarters); 3) database expansion (detailed data breakdown to health facility level); and 4) data use improvement (provide user accounts to countries and technical support to national and subnational levels, e.g. RDSP training along the Thailand–Cambodia border;
automatic system alert or notification to relevant key stakeholders in case of abnormal case increase/outbreak).
2.5.3 Standard data elements countries should collect and report to the RDSP to improve malaria surveillance across the region
Before demonstration of the standard data elements that countries should share to improve malaria surveillance in the region, Dr Noor highlighted the Digital Solutions for Malaria Elimination, which is managed by four core partners: WHO, University of Oslo, Clinton Health Access Initiative and Vital Wave. The project aims to: 1) strengthen and roll out integrated surveillance information systems; 2) upgrade core DHIS2 functionality; 3) introduce effective/upgraded mobile tools for case notification/investigation, foci investigation and response support; and 4) apply a set of common goods (e.g. common geo-repository, data dictionary) to support malaria programmes across elimination geographies. Dr Noor then demonstrated standard data elements recommended by WHO in three main categories: burden reduction, elimination, and mobile and migrant populations. Based on these standard data elements with highlighted data elements shared by each country, he involved all GMS country focal points to comment and provide inputs. In the end, all GMS countries still agreed to use these existing data elements for their future sharing base.
2.5.4 Cross-border collaborations China–Myanmar
Malaria remains one of the important infectious diseases on the China–Myanmar border where there are 20 counties in Yunnan province of China and 22 townships in Myanmar spanning 1997 kilometres. Present are similar malaria vectors – A. dirus and A. minimus – with perennial malaria transmission in the economic trade centre with frequent crossing-border populations. There are 13 national and provincial frontier ports, 427 passageways and countless shortcuts. While the malaria burden is decreasing on both sides of the border, the frequent movement of people and inaccessibility along the border greatly inhibits this progress. Both China and Myanmar have prepared a strategic plan to eliminate malaria by 2020 and 2030, respectively. A detailed operational plan for 2018–2019 has been developed. The ultimate goal is to eliminate malaria by 2030 on the China–Myanmar border and to eliminate P. falciparum malaria by 2025: on the China side to eliminate malaria by 2020 and to sustain malaria-free status and prevent re-establishment beyond 2020; on the Myanmar side, to reduce morbidity and mortality due to malaria by 85% and 75%, respectively, by 2020 relative to 2015 baselines as well as to eliminate P. falciparum malaria by 2025 and malaria by 2030. Several strategies were noted: 1) universal access to malaria prevention, diagnosis and treatment to reduce disease burden in moderate to high transmission areas; 2) transforming malaria surveillance into a core intervention to accelerate towards elimination; 3) approaches specifically tailored for mobile and
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migrant populations besides routine interventions; 4) capacity-building and operational research; and 5) strengthening the enabling environment. Some progress and achievements thus far were highlighted: 1) four China–Myanmar cross-border meetings have been held with specific outputs, including the Strategic Plan for Malaria Elimination in China–Myanmar Border (2018–2030) and operational plan 2018–2019 adopted by all participants from both countries as well as a strengthened collaboration mechanism between Muse in Myanmar and Ruili in China as twin cities through a World Malaria Day health campaign; 2) proposal for resource mobilization developed, finalized and submitted to the Chinese Embassy in Myanmar for funding; and 3) regular exchange visits between the countries. The budget for the China–Myanmar cross-border proposal covers some priority areas:
1) outbreak prevention/response; 2) early diagnosis and appropriate treatment; 3) quality control of malaria diagnosis and treatment; 4) strengthening surveillance (1-3-7 strategy); 5) entomological surveillance and insecticide resistance monitoring; 6) addressing mobile and migrant populations;
7) capacity-building and operational research; 8) political commitment and joint fundraising; and 9) regular information exchange. The method of implementation and the division of responsibility are were also emphasized, including the Myanmar Vector-Borne Disease Control Programme/National Malaria Control Programme, China Embassy in Myanmar, China National Institute of Parasitic Diseases, WHO, environmental health officers and Health Poverty Action.
Thailand–Cambodia
Dr Suravadee showed malaria cases along the Thai–Cambodia border by district/operational district between October 2017 and September 2018. Cases of operational districts on the Cambodia side are very high compared to adjacent districts on the Thailand side. A long history of malaria along this border was noted: outbreaks, drug resistance and efforts to control in the 1980s; the Mekong malaria programme in the late 1990s; containment of malaria multidrug resistance in the 2000s; ERAR in 2013; and MME in 2017.
A two-day workshop was held on 29–30 August 2018 in Pattaya, Thailand, about Thailand–Cambodia cross-border malaria elimination for central and provincial levels. This was organized as a government-to-government meeting between central and provincial staff from Cambodia and Thailand with the Bureau of Vector Borne Disease, Department of Disease Control, Ministry of Public Health of Thailand as host, while WHO Thailand and MME provided technical support. The objectives were: 1) to gain a detailed understanding of the dynamics of malaria transmission within and across the targeted border areas; and 2) to reach consensus among national malaria control programmes of Thailand and Cambodia around access, notification, case investigation and active case detection, case follow-up; foci mapping, response and management; and response, contingency for outbreaks. The workshop consisted of discussions among four groups consisting of adjacent Thai–
Cambodia provinces dealing with: 1) geographical coverage by district and improving access; 2) mobility pattern; and 3) cross-border notification, case investigation, active case detection, case follow-up, special measures (chemoprophylaxis), foci mapping, foci response and management, response and contingency for outbreaks, data sharing and reporting, community mobilization/IEC/BCC, monitoring and evaluation, timelines and domestic funding/Global Fund to Fight AIDS, Tuberculosis and Malaria/Thailand International Cooperation Agency/United States Agency for International Development/United States President's Malaria Initiative, and administrative procedures (focal persons, communication, etc.). The meeting conclusions highlighted four major points: 1) magnitude of cross-border malaria transmission appears not to be a significant problem (given current data from routine surveillance); 2) resources (existing Global Fund or other) should be focused on screening at worksite (plantations, forest reserve, etc.) especially on the Thai side where migrants work as current screening at official points of entry does not yield cases; 3) three out of the
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seven border provinces in Cambodia that border Thailand are still in the transmission reduction phase (compared to all four border provinces in Thailand are in the elimination phase) and as such are unable currently to conduct case investigations and determine travel history with indigenous versus imported cases; and 4) magnitude of imported cases either from/to Cambodia/Thailand in elimination provinces in Cambodia does not seem to be a significant problem (given low number of imported cases reported).
Some recommendations from the meeting were:
1) WHO MME RDSP consolidates key malaria indicators monthly – facility (Cambodia) and provincial (Thailand). It was proposed for Thailand to shares district (or lower level) indicators with MME RDSP and for key indicators to be shared on a dedicated cross- border dashboard on MME RDSP as a tool for provincial- and district-level staff for response, for which MME will provide training.
2) Value of a cross-border subnational level notification by communication tools such as (LINE/short Message/email) should be focused in elimination areas (i.e. imported cases).
3) Establish focal points at provincial and district levels (for Cambodia suggest current operational district CDC focal point). Roles will need to be defined further.
4) Follow up the planning workshop with the district level for cross-border elimination districts.
5) Provincial level staff who participated in the cross-border meeting should follow up on implementation in six months depending on how fast district-level implementation commences.
6) Regular provincial-level quarterly meetings should continue (if not planned, funds should be allocated – CDC, Global Fund, Thailand International Cooperation Agency, etc.) hosted alternatively on either side.
2.6 Surveillance improvement
2.6.1 Group discussion: Proposed mechanism to utilize the RDSP for cross-border collaboration Dr Najibullah Habib led the group discussion on a proposed mechanism to utilize the RDSP for cross- border collaboration. The Platform, which contains necessary data for GMS countries, should be used as a surveillance platform within the Subregion, especially in cross-border collaboration. The RDSP is capable of serving this functionality so long as countries continue to supply data to this platform with the agreed standard data elements proposed by WHO (data elements in the elimination phase) on a monthly basis. Looking at the data from each adjacent country might not be enough to eliminate malaria along the border if no further action takes place. Therefore, joint activities such as case and foci investigation of provinces/districts adjacent to the border by focal points of both countries are critical. Furthermore, rotating the hosting of regular cross-border meetings between the two countries should take place to follow up on issues/pending tasks for which high-level decisions are needed.
2.6.2 Group discussion: Brainstorm the future priorities for malaria surveillance in the GMS
Dr Najibullah Habib also led the group discussion to brainstorm the future priorities for malaria surveillance in the GMS. The status of the surveillance system in each country differs. For example, the surveillance system of two countries (Thailand and China (Yunnan)) serves the malaria elimination phase, while that of other countries (Cambodia, Lao People’s Democratic Republic,
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Myanmar and Viet Nam) is moving/upgrading to elimination. In this context, one of the future priorities for malaria surveillance in the GMS is to strengthen malaria surveillance systems of those countries (Cambodia, Lao People’s Democratic Republic, Myanmar and Viet Nam) that are moving/upgrading their surveillance system to align with the elimination phase. The second priority, after the surveillance system is ready and comprehensive to provide information for elimination, data completeness involving data from all sectors (public, partners, private sector) is needed. The final priority is timeliness of data reporting to the surveillance systems. Having a comprehensive and complete system as well as timeliness of data are important since malaria elimination requires on-time case notification.
3. CONCLUSIONS AND RECOMMENDATIONS
Dr Hiromasa Okayasu, Coordinator, Mekong Malaria Elimination Programme, WHO, summarized the major discussion points of the meeting. Recommendations were developed with comments and feedback from country representatives and partners.
Dr Premaratne, Egodahettiarachchige Don Risintha Gayan, Acting Regional Adviser Malaria, WHO Regional Office for South-East Asia, gave the closing remarks of the meeting. He thanked the Government of the Lao People’s Democratic Republic for kindly hosting the meeting and also thanked the GMS country participants and partners for their comments and support.
3.1 Conclusions
• Update on RAI2E surveillance grant: WHO manages the RAI2E surveillance grant (regional component) with three objectives: 1) monitor progress on malaria elimination in GMS countries;
2) strengthen the national programme’s surveillance capacity; and 3) support GMS countries to address cross-border challenges. GMS countries made significant progress towards strengthening national surveillance capacity and the regional database. Some remaining challenges include:
1) training at national/subnational levels; 2) data review and response; 3) national data repositories (beyond surveillance data); and 4) national surveillance assessment.
• Surveillance assessment: Malaria Surveillance, Monitoring & Evaluation: A Reference Manual emphasizes the importance of conducting national surveillance assessments. WHO provides various resources (e.g. manual and tools) for the assessment. Countries are encouraged to proceed with assessments using available tools. Most countries are routinely monitoring the performance of their surveillance systems (e.g. comprehensiveness, timeliness, utilization of the system) and data quality.
• Lessons learnt from GMS countries: Countries presented the progress and challenges for malaria surveillance. All countries have implemented elimination activities such as case-based and foci investigation (e.g. 1-3-7 activities) in the whole or part of the country. All use the surveillance data for monitoring progress and guiding activities (e.g. distribution of long-lasting insecticidal nets, village malaria worker deployment). The Lao People’s Democratic Republic routinely monitors the number of cases against the historical trend for outbreak detection and has developed a national/subnational dashboard for programmatic actions. Many countries expressed logistical and financial challenges for scaling up case-based investigation in the elimination phase.
• DHIS2 platform: DHIS2 is an open source surveillance platform, which is used for malaria surveillance in many countries. In the GMS, it is used in the Lao People’s Democratic Republic, Myanmar and Viet Nam as part of the electronic Communicable Diseases System (eCDS) data
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repository and the WHO RDSP. The University of Oslo is regularly updating the platform, accommodating new features (e.g. event maps, geospatial analysis, dashboard). If any country or programme is interested, technical support is available from the University of Oslo and/or other partners (e.g. WHO, Clinton Health Access Initiative, United States President's Malaria
Initiative).
• RDSP: WHO has been hosting the RDSP since 2013 to facilitate data-sharing across GMS countries. The countries reiterated their commitment for data-sharing across countries and monitoring the subregional progress towards elimination through the regional surveillance network coordinated by WHO as laid out in the Ministerial Call for Action to Eliminate Malaria in the GMS before 2030, which was signed by the GMS ministers of health in May 2018. The RDSP supports GMS countries by: 1) sharing data among countries which facilitates cross-border activities and response in border areas, and 2) enabling the regular assessment of progress towards malaria elimination. Countries reviewed the proposed and reported data elements to the RDSP.
They decided to retain the current elements and requested that WHO revise the list to present to countries for consensus.
• Cross-border collaboration: To date, RDSP data have been utilized in the Cambodia–Thailand cross-border meeting in August 2018, and the discussion is underway to utilize the data in the ongoing China–Myanmar cross-border initiatives. In these meetings, countries review the
epidemiology in border areas and discuss the joint actions (e.g. case management, prevention and screening, data sharing, and reporting of cross-border cases).
3.2 Recommendations
3.2.1. Recommendation for GMS countries
GMS countries are encouraged to consider the following:
1) Develop country-tailored plans for comprehensive surveillance assessment, based on specific issues and optimal timing in each country.
2) Continue and strengthen cross-border initiatives (e.g. China–Myanmar and Cambodia–
Thailand and other similar vulnerable borders) in data sharing, case investigation, etc.
3) Support strengthening of the RDSP by continuing to submit data to MME in a timely manner and providing additional data elements and more detailed data (e.g. age/gender breakdown, community-level data) as agreed at the meeting.
4) Utilize the surveillance data in the RDSP, especially at subnational level for programmatic actions.
3.2.2. Recommendation for WHO
WHO is requested to consider the following:
1) Provide technical support to GMS countries to develop a plan and tools for surveillance assessment in collaboration with the relevant partners.
2) Continue to provide technical support for scaling up case-based surveillance and national/subnational capacity-building.
3) Ensure each GMS country focal point has an account and access to the RDSP and provide necessary training and guidance to facilitate data-sharing across countries.
4) Support the strengthening of cross-country collaboration initiatives by facilitating the sharing surveillance data from border areas.
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5) Update the list of recommended data elements to be shared with the WHO RDSP and seek consensus for the update with GMS countries based on country needs and the outcome of the collaboration.
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ANNEX 1 PROGRAMME AGENDA
Date and Time
Agenda Speaker/s
Friday 16November 2018 Opening Ceremony 08:30-09:00 Registration
09:00-09:30 Welcome address by Representative from Ministry of Health, Lao PDR
Remarks by World Health Organization (WHO) Representative Lao PDR
R Phetsouvanh (CDC, Lao PDR)
R Abeyasinghe (WHO) 09:30-09:40 Introduction of participants
09:40-9:50 Objectives of the surveillance meeting, nomination of chair
Administrative announcements
H Okayasu (WHO)
9:50-10:15 Group Photo/Coffee Break Background and updates
10:15-10:45
Priorities work areas under the RAI 2E surveillance grant and examples of country surveillance assessment
A Noor (WHO) 10:45-12:45 Updates from GMS countries:
National Standard Operating Procedures (SOP) of
malaria surveillance
Assessment of surveillance system and
performance
Use of surveillance data for programmatic actions
(e.g. stratification)
Challenges in surveillance strengthening
1. Cambodia (20mn) 2. China (20mn)
3. Lao People’s Democratic Republic (20mn) 4. Myanmar (20mn)
5. Thailand (20mn) 6. Viet Nam (20mn)
CNM YIPD CMPE NMCP BVBD NIMPE 12:45-13:45 Lunch
Surveillance update
13:45-14:00 Overview and update of new features in DHIS2 J Lewis (HISP VN) 14:00-14:15 Regional data sharing platform (RDSP) R Try (WHO) 14:15-14:45
Standard data elements countries should collect and report to RDSP to improve malaria
surveillance across the region
A Noor (WHO)
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14:45-15:25 Cross-border collaborations
China-Myanmar (20mn)
Thailand-Cambodia (20mn)
NMCP, Myanmar BVBD, Thailand Surveillance Improvement
15:25-16:00 Proposed mechanism to utilize the Regional data sharing platform (RDSP) for cross border collaboration
Group discussion
16:00-16:40 Brainstorm the future priorities for malaria surveillance in the GMS
Group discussion 16:40-17:00 Coffee/tea break
Conclusion and closing
17:00-17:30 Conclusions and recommendations Chair of the meeting
17:30 Closing Remarks R Premaratne (WHO)
18:00 – 19:30 Reception (Hotel venue) All participants
14
ANNEX 2
LIST OF PARTICIPANTS, TEMPORARY ADVISERS, REPRESENTATIVES, INTERNATIONAL PARTNERS AND SECRETARIAT
Dr Chea Huch, Deputy Director, National Center for Parasitology, Entomology and Malaria Control Corner Street 92-93, Trapeng Svay Village, Phnom Penh, Cambodia, Tel.No.: +855 10 316 306, Email: [email protected]
Dr Lek Dysoley, Deputy Director, National Center for Parasitology, Entomology and Malaria Control Corner Street 92-93, Trapeng Svay Village, Phnom Penh, Cambodia, Tel.No.: +855 12 523 150, Email: [email protected]
Dr Shuisen Zhou, Professor, Chief of Malaria Department, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Ruijin Er Road, Shanghai 200025, China, Tel.No.: +86 21 64673302, Email: [email protected]
Vientiane, Lao PDR, Tel.No.: +856 214040, Email: [email protected]
Dr Aung Ye Kyaw, Team Leader, Sagaing Regional, National Malaria Control Programme, Myanmar, Tel.No.: +95 979 717 037 9, Email: [email protected]
Dr Prayuth Sudathip, Public Health Technical Officer, Senior Professional Level, Bureau of Vector- borne Diseases, Department of Disease Control, Ministry of Public Health, 125/111, M.# T.Sai-Ma, Muang, Nonthaburi 11000, Bangkok, Thailand, Tel.No.: +66 2 590 3114,
Email: [email protected]
Dr Suravadee Kitchakarn, Public Health Technical Officer, Practitioner Level, Bureau of Vector- borne Diseases, Department of Disease Control, Ministry of Public Health, 88/21 Tiwanon Rd.
Muang, Nonthaburi 11000, Bangkok, Thailand, Tel.No.: +66 2 590 3114 Email: [email protected]
Dr Ngo Duch Thang, Head of Epidemiology Department, National Institute of Malariology, Parasitology and Entomology , 245 Luong The Vinh street, Hanoi, Viet Nam
Tel.No.: +84 906 20 53 88, Email: [email protected]
Dr Ngo Hoang Long, Deputy Director, National Institute of Malariology, Parasitology and Entomology, 245 Luong The Vinh street, Hanoi, Viet Nam, Tel.No.: +84 4 3553 15 04 Email: [email protected]
Dr John Lewis, Senior HIS Expert, University of Oslo, Informatics Department, Gaustadalleen 23B, N-0373 Oslo, Norway, Tel.No.: +84 98 600 381 7, Email: [email protected]
Dr Xu Jianwei, Professor, Yunnan Institute of Parasitic Diseases, 6 Xiyuan Road, Puer City, Yunnan, 665000 Yunnan, China, Tel.No.: +86 18987921137, Email: [email protected]
Dr Bouasy Hongvanhthong, Deputy Director , National Malaria Control Program, Center for Malariology, Parasitology and Entomology, 365, Unit 22, DongDok village, Xaythany district,
Dr Odai Sichanthongthip, Technical Staff for Sur, Center for Malariology, Parasitology and Entomology, 365, Unit 22, DongDok village, Xaythany district, Vientiane, Lao PDR, Tel.No.: +856 214040, Email: [email protected]
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Ms Cecilia Hugo, Executive Coordinator, ACT Malaria Foundation, Inc., 12th Floor Regus Centre, Times Plaza Bldg., Corner UN and Taft Avenue, Ermita, Manila, Philippines, Tel.No.: +632 790 4034 Email: [email protected]
Kylie Mannion, Senior Programme Advisor, SRWG Coordinator, Malaria Consortium, Street 95, Boeung Trabek, Chamcar Morn, Phnom Penh, Cambodia, Tel.No.: +855 (0) 92 523 241,
Email: [email protected]
Myo Min, Programme Manager, Asia Pacific Malaria Elimination Network, 04-01 11 Biopolis Way, Singapore, Singapore, Tel.No.: + 65 88385938, Email: [email protected]
Prof. Arjen M. Dondorp, Deputy Director, Mahidol Oxford Tropical Medicine Research Unit, 420/6 r Oxford Tropical Medicine Research Unit, Bangkok, Thailand, Tel.No.: +66 22 036 333 Email: [email protected]
Inessa Ba, Regional Malaria Manager, Clinton Health Access Initiative, Inc., Global Malaria Team, Greater Mekong Subregion, No. 93 (SI building), Preah Sihanouk Blvd (274), 12207, Phnom Penh, Cambodia, Tel.No.: +1 617 429 6770, Email: [email protected]
Tel.No.: +1 508 380 5273, Email: [email protected]
Ronaldo Estera, Country Director, Health Poverty Action, P.O. Box 5628,No. 381, Unit 16, Ban Phonthan-Neua, Saysettha District, Vientiane, Lao PDR, Tel.No.: +856 21 264 960 Email: [email protected]
Faisal Mansoor, Head of Programme. Principal Recipient for the Global Fund, to Fight AIDS, Tuberculosis and Malaria, UNOPS Asia Region, Tel.No.: +95 1 657281~7, #211,
Email: [email protected]
Eisa Hamid, Regional Senior Programme, M&E and Health Systems Specialist, Principal Recipient for the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNOPS Asia Region,
Tel.No.: + (95) 1 657281~7, #212, Email: [email protected]
Ioana Badescu, Programme Coordinator, Principal Recipient for the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNOPS, Vientiane, Lao PDR, Tel.No.: +856-20-55717200
Email: [email protected]
Yu Nandar Aung, Programme and Monitoring & Evaluation Specialist, Principal Recipient for the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNOPS Asia Region, Vientiane, Lao PDR Tel.No.: +856 209545 7730, Email: [email protected]
Naeem Durrani, Programme Coordinator, Principal Recipient for the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNOPS, Cambodia, Samdech Sothearos Blvd (3) corner
Sihanouk (St. 274), Center 6th Floor Room 628 12301, Phnom Penh, Tel.no.: +855 95 666 162 Email: [email protected]
Christopher Lourenço, Technical Advisor, Clinton Health Access Initiative, Inc., Global Malaria Team, Greater Mekong Subregion, Km.12 Thadeua Road, Hatsayfong District, Vientiane, Lao PDR,
Arnaud Le Menach, Director, Malaria Analytics and Surveillance, Clinton Health Access Initiative, Inc., Global Malaria Team, Greater Mekong Subregion, 383 Dorchester Avenue, Suite 400
Boston, MA 02127, USA, Tel.No.: +1 617 312 9213, Email: [email protected]
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Patrick Dugan, Regional Migration Health Adviser, International Organization for Migration for Asia and Pacific, Rajanakam Building, 18th floor, 3 South Sathorn Road, Bangkok, Thailand,
Tel.No.: +66 2 343 94 00, Email: [email protected]
Somphao Bounnaphol, National Project Officer, International Organization for Migration for Asia and Pacific, UN House, Lane Xang, Vientiane, Lao People's Democratic Republic,
Tel.No.: +856 21 267 734, Email: [email protected]
Emily Dantzer, Program Manager, Lao PDR Malaria Elimination Research Partnership
Global Health Group / UCSF Institute of Global Health Sciences, Vientiane, Lao People's Democratic Republic, Tel.No.: +856 20 99 431 332, Email: [email protected]
Valerie Scott, Program Manager, RAI2E Partnership, Global Health Group / UCSF Global Health Sciences, Vientiane, Lao People's Democratic Republic, Tel.No.: +1 704 651 3770
Email: [email protected]
Jonathan Cox, Senior Program Officer, Malaria, Bill and Melinda Gates Foundation 500 Fifth Avenue North Seattle, WA 98109, Washington, United States of America, Tel.No.: +1 206 427 5664, Email: [email protected]
Dr Abdisalan Noor, Team Leader , Global Malaria Programme, World Health Organization 20 Avenue Appia, Geneva, Switzerland, Tel.No.: + 41 795 006 593
Email: [email protected]
Dr Premaratne, Egodahettiarachchige Don Risintha Gayan, Technical Officer ( Malaria), Department of Communicable Diseases, World Health Organization, World Health House, Indraprastha Estate, Mahatma Gandhi Road, New Delhi, India, Tel.No.: +91 96 508 9842 2
Email: [email protected]
Dr Rabindra Abeyasinghe, Coordinator, Malaria, Other Vectorborne and Parasitic Diseases World Health Organization, P.O. Box 2932, 1000 Manila, Philippines
Tel.No.: +63 908 8862539, Email: [email protected]
Dr James Kelley, Technical Officer, Malaria, Other Vectorborne and Parasitic Diseases World Health Organization, P.O. Box 2932, 1000 Manila, Philippines
Tel.No.: +63 908 8808746, Email: [email protected]
Dr Hiromasa Okayasu, Coordinator, Mekong Malaria Elimination Programme, World Health Organization, No. 61-64, Preah Norodom Blvd. (corner Street 306), Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia, Tel.No.: +855 12 465 163
Email: [email protected]
Dr Katie Fitzpatrick, Consultant, Mekong Malaria Elimination Programme, World Health
Organization, No. 61-64, Preah Norodom Blvd. (corner Street 306), Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia, Tel.No.: +44 75 545 563 00
Email: [email protected]
Mr Rady Try, Consultant, Mekong Malaria Elimination Programme, World Health Organization, No.
61-64, Preah Norodom Blvd. (corner Street 306), Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia, Tel.No.: +855 17 891 415, Email: [email protected]
David Sintasath, Regional Malaria Advisor, President's Malaria Initiative, Greater Mekong Subregion USAID / Regional Development Mission for Asia, Athenee Tower, 25th Floor, 63 Wireless Road, Bangkok, Thailand, Tel.No.: +66-89-811-0126, Email: [email protected]
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Dr Jean-Olivier Guintran, Medical Officer, Malaria, Other Vectorborne and Parasitic Diseases, World Health Organization, No. 61-64, Preah Norodom Blvd. (corner Street 306), Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia, Tel.No.: +855 12 465 169
Email: [email protected]
Ms Severine Calza, Technical Officer, Regional Artemisinin-resistance Initiative, Regional Steering Committee (RAI-RSC), World Health Organization, No. 61-64, Preah Norodom Blvd. (corner Street 306), Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia,
Tel.No.: +855 12 443 993, Email: [email protected]
Ms Kim Leang Nhoeuk, Assistant, Regional Artemisinin-resistance Initiative, Regional Steering Committee (RAI-RSC), World Health Organization, No. 61-64, Preah Norodom Blvd. (corner Street 306), Sangkat Boeung Keng Kang I, Khan Chamkamorn, Phnom Penh, Cambodia,
Tel.No.: +855 92 580 889, Email: [email protected]
Ms Yao Ruan, National Professional Officer, Malaria, Other Vectorborne and Parasitic Diseases World Health Organization, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie, Chaoyang District, Beijing, China
Dr Matthew Scott Shortus, Medical Officer, Malaria, Other Vectorborne and Parasitic Diseases World Health Organization, 125 Saphanthong Road, Unit 5, Ban Saphangthongtai, Sisattanak District Vientiane, Lao People's Democratic Republic, Tel.No.: +856 21 353-902
Email: [email protected]
Dr Rahman Md., Technical Officer (Surveillance), World Health Organization Country Office, Myanmar, No. 403 (A1), Shwe Taung Kyar Street, Bahan Township, Yangon, Myanmar Tel.No.: +95 92 645 524 38, Email: [email protected]
Dr Deyer Gopinath, Medical Officer, Malaria and Border Health, World Health Organization 4th Floor ,Permanent Secretary Blvd 3, Ministry of Public Health, Nonthaburi, Bangkok, Thailand, Tel.No.: +66 92 264 273 1, Email: [email protected]
Dr Najibullah Habib, Medical Officer, Malaria, Other Vectorborne and Parasitic Diseases
World Health Organization, 304 Kim Ma Street, Hanoi, Viet Nam, Tel.No.: +84 (0) 4 38 500 100 Email: [email protected]
