Quarterly Progress Report- Year 2, Quarter 2 January - March, 2018

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

CAMBODIA MALARIA ELIMINATION PROJECT

Cambodia Malaria Elimination Project

Quarterly Progress Report- Year 2, Quarter 2 January - March, 2018

Submission Date: April 30, 2018

Contract Number: AID-442-C-17-00001 Contract Period: October 26, 2016 to October 25, 2021 COR: Rida Slot Alternate COR: Gunawardena Dissanayake

Submitted by: Sharon Thangadurai, Chief of Party University of Research Co., LLC. House #10, Street No. 214, Sangkat Cheychumneas, Khan Duan Penh, Phnom Penh Email: [email protected]

This document was produced by University Research Co., LLC (URC) for review and approval by the United States Agency for International Development (USAID).

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

TABLE OF CONTENTS

Acronyms ...... iv

1. Introduction ...... 1

2. Progress Toward achieving CMEP OBJECTIVES ...... 2 2.1 Objective 1: Develop a scalable, evidence-based elimination model in SPL OD and support its dissemination and replication for malaria elimination in Cambodia...... 2 2.2 Objective 2: Support scale-up of high quality malaria control and prevention interventions in five to eight ODs, where gaps in coverage or quality exist ...... 7 2.3 Objective 3: Strengthen national malaria surveillance systems and M&E appropriate for malaria elimination and control activities ...... 13 2.4 Objective 4: Build capacity of Ministry of Health (MOH) to manage, intensify, and sustain malaria control and elimination efforts particularly at the OD level ...... 15 2.5 Project Management ...... 18 Oversight and Coordination ...... 18 Procurement ...... 19 Financial Management ...... 19 Human Resource Management ...... 20

3. Resolving challenges from FY18 Q1 ...... 21

4. Challenges and actions taken or proposed ...... 21

5. Plans for next Quarter and upcoming events ...... 22

i Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

ACRONYMS

ACT Artemisinin-based Combination Therapies AOP Annual Operational Plan SBCC Social and Behavior Change Communication BKN Bakan BTB Battambang CAP-Malaria Control and Prevention of Malaria CMEP Cambodia Malaria Elimination Project CBO / CSO Community Based Organization / Civil Society Organization CDC Centers for Disease Control and Prevention CNM Cambodia National Malaria Center COP / DCOP Chief of Party /Deputy Chief of Party COR Contracting Officer’s Representative EDAT Early Diagnosis and Treatment EMMP Environmental Mitigation and Monitoring Plan GSSHealth Global Scientific Solutions for Health GUC Grants Under Contract HF Health Facility HPA Health Poverty Action IDQA Internal Data Quality Assessment IPC Interpersonal Communication ITN Insecticide-Treated Net KKR Krakor LLIN / LLIHN Long Lasting Insecticidal Net / Hammock Net M&E Monitoring and Evaluation MC Malaria Consortium MEAF Malaria Elimination Action Framework 2016-2020 MMP Mobile and Migrant Populations MMW Mobile Malaria Worker MoH Ministry of Health MOP Malaria Operational Plan MRS Maung Russey NAMRU-2 Naval Medical Research Unit-2 OD / ODMS Operational Health District / OD Malaria Supervisor PERSUAP Pesticide Evaluation Report and Safer Use Action Plan PHD / PMS Provincial Health Department / Provincial Malaria Supervisor PKV Phnom Kravanh PMI President’s Malaria Initiative PP Private Provider PPM Private Public Mix PMP Performance Management Plan PSK Population Services Khmer RDT Rapid Diagnostic Tests STA Senior Technical Advisor SOP Standard Operating Procedure SPL Sampov Loun TMK Thmar Kaul UNOPS United Nations Office for Project Services URC University Research Co., LLC USAID United States Agency for International Development VMW Village Malaria Worker VHSG Village Health Support Group WHO World Health Organization

i Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

1. INTRODUCTION The USAID | PMI Cambodia Malaria Elimination Project (CMEP), 2016-2021, was launched on October 26, 2016 to support the Cambodian National Center for Malaria Control, Parasitology and Entomology (CNM) to reduce malaria morbidity and mortality and contribute towards malaria elimination goals nationwide by 2025. To reach this goal, the project has set up four strategic objectives to: 1. Develop a scalable, evidence-based elimination model in Sampov Loun OD and support its dissemination & replication for malaria elimination in Cambodia. 2. Support scale-up of high quality malaria control and prevention interventions in five to eight ODs, where gaps in coverage or quality exist. 3. Strengthen national malaria surveillance systems and monitoring and evaluation (M&E) appropriate for malaria elimination and control activities. 4. Build capacity of malaria program to manage, intensify, and sustain malaria control and elimination efforts particularly at the OD level. Quarter 2 of Year 2 activities were implemented in four ODs in Battambang Province (Sampov Loun (SPL), Battambang (BTB), Maung Russey (MRS), Thmar Kaul (TMK)) and two ODs in Pursat Province (Phnom Kravanh (PKV) and Krakor (KKR)). In FY18 Quarter 2 (January to March 2018), CMEP after its modification approval initiated its expansion discussion and spanning to three additional ODs (two ODs in Pursat (Bakan and Sampan Mov) and 1 OD in Pailin) (Figure 1(b) shows the change from 6 to 9 OD’s). CMEP and partners continued full-scale implementation of activities for the 6 OD scenario as follows in Q2 : . Provided support to a network of health facilities (HFs), village/mobile malaria workers (V/MMWs) and private providers (PPs) in case management and malaria surveillance through regular monthly meetings and supervision visits. . Initiated insecticide treated net (ITN) mass distribution to villages with an Annual Parasite Incidence (API) >5 per 1,000 population . Conducted systematic administration of single low dose primaquine for confirmed P. falciparum (Pf)/mixed cases in all 6 target ODs . Elaborated a two-day basic entomology training program for OD/Provincial Health Department (PHD) malaria supervisors . Supported CNM and ODs/HFs to conduct planned supervision visits to VMWs and PPs . Collaborated with partners on supporting implementation of a new surveillance strategy adopted by CNM in FY2017.

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

CMEPindicatorsFY18 Progress against each performance indicator is presented in the file attached . Q2.xlsx

Figure 1. CMEP Summary of Activity Progress (January-March 2018)

2. PROGRESS TOWARD ACHIEVING CMEP OBJECTIVES 2.1 Objective 1: Develop a scalable, evidence-based elimination model in SPL OD and support its dissemination and replication for malaria elimination in Cambodia. Task 1. Pre-implementation situational analysis of current malaria elimination operations in SPL: Rapid Situational Analysis and Needs Assessment Report1: In Q2, the scope of work for a short term technical advisor (to conduct the costing analysis to evaluate the programmatic effectiveness, scalability and cost of the malaria elimination operations in SPL) was finalized. The international consultant was then sourced by URC and was scheduled to arrive in country on 23rd April to carry out the work (for 8 days). An additional local consultant may also be provided to support the work of the international consultant (this

1 Activity 1,1.1. was completed in Year 1 and is not applicable to the FY18 Q2 reporting period

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2) will be confirmed in Q3). [Act 1.1.2.] Task 2. Sustain universal Long Lasting Insecticidal Net (LLIN) coverage: Mass distribution: In support of CNM/Global Fund/UNOPS initiative for a nationwide ITN mass distribution campaign, in FY18 Q2, CMEP supported the distribution of ITNs to target populations in 13 villages (API >5) in SPL OD. The distribution is based on the CNM established national ratio (1 net per 1.8 persons for residents, 1 net per 1 worker for MMPs). SPL OD received a total of 23,900 ITNs (18,000 LLINs, and 5,900 LLIHNs) from CNM for mass distribution in 2018 for both residents and MMPs. By the end of Q2, 22,996 ITNs purchased by other partners (17,150 LLINs and 5,846 LLIHNs) were distributed (also mass distribution). The remaining ITNs will be distributed in Q3 (Apr-Jun), when crop plantation begins, which will benefit MMP workers. Ensure continuous distribution of LLINs: In line with the updated list, CMEP’s target for continuous LLIN distribution was 86 villages in SPL OD [Act 1.2.3]. In SPL OD, CMEP had no plan to deploy ITNs as buffer to VMWs in Q2. Therefore, there were no ITNs deployed as buffer stock at the VMW level (0 ITNs versus 0 ITNs planned). CMEP will further deploy them in early Q3, using USG-purchased ITNs. Using remaining ITNs from previous deployment, CMEP distributed 1,038 LLINs (67 LLINs purchased using USG funds, 971 LLIHNs purchased by other partners funds) vs. 0 ITNs planned) to target populations during outreach and response activities [Act 1.2.5]. Net top up and malaria education to households: VMWs conducted 1,836 (119% of Q2 target; 1,548 visits) visits to households for net use monitoring, net top-ups and health education [Act 1.2.6]. As a result, 19,002 household members received health education on malaria prevention and LLIN use. One supportive supervision visit was conducted by the CNM ITN Unit to SPL OD, as planned. [Act 1.2.7]. Task 3. Ensure Early Diagnosis and Treatment (EDAT) and follow up: CMEP activities covered 244 points of care in Q2 [Act. 1.3.1]. In SPL, all 3,359 (100%) suspected malaria cases received a parasitological test. Just over half (55%) of individuals were tested by VMWs, 17% by HFs and the remaining 28% by PPs. Out of all individuals tested, 46 cases (1.2%) were confirmed positive. All 46 cases notified in SPL were imported cases (see Figure 3 for a case distribution map). Six cases (13%) were imported from Pursat, 11 (24%) from Thailand and the rest from other provinces in Cambodia. Eleven Pv cases were linked to old cases that were classified as imported cases during the previous malaria episode (Pv cases may be relapse cases).

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

Out of 46 positive cases, 4 (9%) Figure 2. Map of reported malaria cases by origin in SPL OD, were Pf/mixed and 42 (91%) Jan-Mar 2018 were Pv malaria cases (Figure 4). Most cases (91%) were among males (42 male, 4 female). The highest number of cases were notified in Phnom Prek district (19) compared to Kamrieng (15) and Sampov Loun (12) districts.

Figure 4. Number of confirmed malaria cases in SPL per species in Oct-2016-Mar 2018

Pf/Mix Pv

15 23 21 21 11 9 13 9 11 7 12 8 12 6 11 7 3 5 8 9 4 6 4 4 1 2 0 2 3 2 3 3 3 3 1 0 OCT- NOV- DEC- JAN- FEB- MAR- APR- MAY- JUN- JUL- AUG- SEP- OCT- NOV- DEC- JAN- FEB- MAR- 1 6 1 6 1 6 1 7 1 7 1 7 1 7 1 7 1 7 1 7 1 7 1 7 1 8 1 7 1 7 1 8 1 8 1 8

In SPL, 39 out of 46 positive cases (85% versus 86% for the whole of FY17 Year 1) received three days of directly observed therapy (DOT) (Figure 5) [Act 1.3.2]. DOT completion rate was lowest in Q2 because of the private providers did not notify on time to HF and VMW but just notified 71%. DOT treatment in line with national treatment guidelines completed 90% at HFs and 100% by VMWs. Still improved from Q1 which was 32%, DOT coverage of Pv cases was 83% and 100% for Pf. All 4 Pf/mixed cases were reached through reminder messages via the mHealth application and were automatically transferred to a response team to conduct 28- day follow up. However, due to high mobility, 4 patients did not receive the necessary monitoring. [Act. 1.3.3]- During FY18 Q3, CMEP will intensify its capacity building activities aimed at private providers to eliminate this performance gap. Figure 5. Implementation of DOT in SPL OD per species (*data fully available Pv, partially Pf)

110% 90% 70% 50% 30% Pf/Mix Pv 10% -10% Jan Jan Jun Oct Oct Feb Sep Feb Apr Dec Dec Mar July Mar Nov Nov May August 2016 2017 2018

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

In FY18 Q2, zero patients were hospitalized for second line treatment [Act 1.3.6]. CMEP incorporated the recommendations on use of single low dose primaquine (SLD-PQ) in monthly meetings with VMWs and HF staff. All 4 Pf/mixed cases diagnosed in Q2 received SLD-PQ treatment (100%), but only 3 cases received 7-day follow up (other cases were not available for the 7 day follow up) and no significant adverse event of SLD-PQ was notified. There were no case management trainings for heath facility staff as they were trained in previous quarters (Q2 target 15). Refresher training takes place every two years. [Act 1.3.9a]. 43 VMWs received case management training (Q2 target 54). [Act 1.3.9b]. CNM pharmacy, lab and diagnosis and treatment units completed one supervision visit as planned in Q2. Depending on availability of CNM staff members, additional visits will be rescheduled in quarter 3. [Act. 1.3.10] Task 4. Malaria case reporting, investigation, and response In FY18 Q2, 45 out of 46 cases (98%) were notified within 1 day via the SMS Day-0 mHealth system, and 46 out of 46 cases (100%) were investigated within 3 days and response provided within 7 days [Act.1.4.1-1.4.3]. All HFs and VMWs followed the established 1-3-7 surveillance practice. While up from 37% (7/19) in FY18Q1, delayed case notification by private providers (with 94% or 16/17 of cases notified within day 1) resulted in lower performance against this indicator compared to baseline 100% achieved by the end of Year 1. As private providers need additional guidance on malaria case notification within the 1-3-7 elimination model, performance gaps in this area will be addressed through bi-monthly meetings. Task 5. Strengthen case management, reporting, and response to all malaria cases in the private sector The CMEP team updated the list of private providers in SPL with 63 private providers enrolled in the private public mix (PPM) [Act.1.5.1]. Two bi-monthly meetings were conducted in January and March 2018 as planned with the participation from PPs at 59% (37/63), and at 71% (45/63), respectively [Act 1.5.3]. HF/OD staff provided two bi-monthly supervision visits to all 63 private providers in February and to the rest of the PPs that were absent from bi- monthly meetings in January and March to provide technical feedback, support and collect PPM case data. A total of 20 visits were accomplished (versus 14 planned) for all 63 private providers [Act 1.5.4]. The number of visits are above the target because of additional visits to PPs that were absent during bi-monthly meetings. One supportive supervision visit from CNM’s PPM unit was conducted in February to SPL OD, as planned. Task 6: Build capacity and strengthen systems to manage elimination activities2 Supporting VMWs monthly meetings: Monthly meetings continued in FY18 Q2 to support capacity building of VMWs and HF staff. Meetings were held during the fourth week of January, February, and March. On average, 96% (154/160) of VMWs attended the monthly meetings. In total in Q2, 463 VMWs attended meetings versus 480 planned (96%). [ Act 1.6.1]. CMEP OD teams also visited 32 VMWs at their homes to review progress and provide on-site mentoring (versus 24 planned) [Act 1.6.2]. Integrated supervision from ODs to HFs: Supervision visits were conducted to all 10 HFs in SPL OD using the CNM supervision checklist [Act 1.6.3]. No artemisinin-based combination therapies (ACT) or rapid diagnostic tests (RDT) stock outs or potential stock outs were detected at the time of supervision. Data verification confirmed the accuracy of the reported data. Data verification on total tests, total confirmed cases and total treated cases were also performed. Stock monitoring: There was no need to reallocate stock during Quarter 2, as the stock at HFs

2 No targets were set for activities 1.6.6. and 1.6.8. Therefore, these are not included in FY18 Q2 report.

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2) was secure [Act 1.6.4.]. Refresher training on 1-3-7- approach: CMEP previously conducted training for OD, HF staff and VMWs on the revised Case Investigation Form in FY17 Q4. On January 9, 2018, the Case Investigation Form was again updated and the mobile application in the smartphone was updated accordingly. For this reason, trainings were provided to ODs, HFs and VMWs. In total, 181 individuals (2 ODs, 22 HFs and 157 VMWs) were trained, 11 tablets were distributed to HFs and 87 smartphones were given to VMWs. District Special Working Group for Malaria Elimination: 3 meetings were conducted in January 2018, in the 3 Sampov Loun administrative districts (Kamrieng, Phnom Proek and Sampov Loun). The meetings enabled the updating of the malaria situation for participants and the discussion of common challenges [Act 1.6.7]. The earlier commitment from the BTB PHD was to conduct in Q2 however due to pressing priorities and changed plan it was not held, but now it has been agreed by CMEP and PHD that the special working group meeting will be held in Q3 on May 23rd – 2018. This activity has already been completed.

Task 7. Social and Behavior Change Communication (SBCC) for malaria elimination3 All 3,359 individuals tested for malaria received IPC for malaria education [Act 1.7.1]. In addition to malaria patients, IPC was provided to 161 people from high-risk groups during case response activities [Act 1.7.2]. At the farms, VMWs organized small group education sessions to deliver malaria key messages by using their IPC skills and job aids developed by CMEP. As a result, 22,926 MMPs were reached at farms with malaria outreach educational activities in FY18 Q2. Task 8. Support civil society organizations (CSOs/CBOs) to complement malaria elimination activities In FY18 Q2, CMEP’s Senior BCC Advisor, Compliance and Sub-Grants Coordinator, and CNM (Health Education Unit) staff conducted three field visits to review activities implemented by AHEAD. The team reviewed how the activities were being implemented and provided technical support to sub-grants to carry out and implement the activities effectively. The Compliance and Sub-Grants Coordinator visited AHEAD to provide financial support and review how money was spent for the village health education campaigns conducted in SPL OD. During the reporting period, AHEAD collaborated closely with local authorities, OD, HCs, VHSGs and VMWs in SPL to identify 49 MMP settlements and organized 15 health education campaigns which covered 682 individuals (Q2 target: 15 sessions). 99 suspected malaria cases were referred to VMWs and HFs for testing. AHEAD provided follow up to find out how many of the referred individuals reached VMWs/HFs (collaborating with VMWs where possible). For all cases (100%), the referral was completed successfully and one case was confirmed positive. A partners meeting will be organized in Q3 to assess the progress made by AHEAD and the challenges they have encountered while delivering the CMEP project. Task 9. Conduct operational research in the context of malaria elimination The CMEP team continued consultations with PMI/USAID on planning the research aimed at evaluating the use of highly sensitive RDTs in the context of re-active case detection in elimination areas. The draft protocol was submitted to USAID/PMI for review and clearance. The protocol was also submitted to URC’s IRB for approval and submission to Cambodian National Ethics Committee for Health Research will be made in Q3 after receiving comments from USAID/PMI. [Act 1.9.1].

3 No target was set for activity 1.7.3 in FY18 Q2

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

Task 10. Refine existing malaria elimination tools, SOPs, and guidelines The Case Investigation Form was first revised in September 2017. Since then, CMEP continued its operations in line with the revised malaria elimination tools. On January 9, 2018, the tools were again revised and the implementation of this last version will commence after the training in March 2018. [Act 1.10.1]. 2.2 Objective 2: Support scale-up of high quality malaria control and prevention interventions in five to eight ODs, where gaps in coverage or quality exist Task 1. Rapid Situational Analysis and Needs Assessment Report As agreed in the CMEP contract modification in February 2018, two new transitional ODs would become part of CMEP: Bakan (BKN) and Sampov Meas (SPM) ODs in Pursat province. OD Situational analysis exercises discussion and planning were undertaken during FY18 Q2 and some preliminary results were used in the updated CMEP work plan and M&E plan in Q2. The full results and reports will be made available to USAID in Q3. Task 2. Ensure universal coverage with LLINs Mass distribution: As described under Objective 1 Task 1, CMEP in collaboration with UNOPS provided support to CNM for ITN mass distribution. CMEP supported the distribution of ITNs to target populations in 253 villages (API > 5) in 4 ODs (BTB=53, MRS=26, PKV=98, KRK=76). The distribution is based on the CNM established national ratio (1 net per 1.8 persons for residents, 1 net per 1 worker for MMPs). A total of 238,850 ITNs (165,650 LLINs and 73,200 LLIHNs) from CNM were planned for mass distribution in 2018 for both residents and MMPs. By the end of Q2, 202,813 ITNs purchased by other partners funds (144,217 LLINs and 58,596 LLIHNs) were distributed. Only PKV OD completed distribution to all villages by March 2018 while the rest will continue the distribution in Q3 (April-June) [Act 2.2.2]. The is due to a delay in ITN transportation from central to OD levels. Continuous LLIN/LLIHN distribution and top up monitoring: In Q2, CMEP did not plan to deploy ITNs to VMWs/MMWs in villages/big companies due to the ongoing mass distribution campaign. Therefore, there were no ITNs deployed as buffer stock at the VMW level (0 ITNs versus 0 ITNs planned). CMEP plans to deploy them to VMW villages, which are not covered by mass distribution (excluded due to an API < 5), in early Q3 using USG-purchased ITNs. Using remaining ITNs from a previous deployment, CMEP distributed 1,357 ITNs ( 390 LLINs purchased by USG funds and 967 LLIHNs purchased by other partners funds, versus 0 planned) to target populations during outreach and response activities [Act 2.2.5]. While there was no deployment of ITNs to VMWs during this period, VMWs/MMWs still conducted outreach visits to households and farms to top up ITNs using remaining nets, along with SBCC activity and EDAT services, when required. 5,026 (104%) visits were accomplished (versus 4,851 planned) by VMWs to households for use monitoring and health education [Act 2.2.7]. 24,261 individuals received malaria education through IPC (versus 36,180 planned). [Act 2.2.8] Task 3. Ensure EDAT and follow up Provide ongoing support in malaria diagnosis and treatment: CMEP activities covered 795 point of care units in FY18 Q2 in the targeted sites (versus 774 planned) [Act 2.3.1]. In the 5 ODs, 10,833 individuals were tested, 2,713 were confirmed with malaria and 2,724 cases were treated during the reporting period (see Figure 6). An observed variance between the numbers of confirmed and treated cases can be explained by under recording of all tested cases. Among confirmed cases, 33% (908) were Pf/mixed and 1,805 cases (67%) were Pv cases. Three-day DOT was provided to 340 Pf/mix cases by VMWs (96% of total 356 Pf/Mix cases confirmed

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2) during the reporting period). [Act. 2.3.2]4. 177 Pf/mix case received SLD-PQ treatment5. [Act 2.3.3]. There were no severe malaria cases nor any treatment failure requiring hospital treatment in Q2, therefore hospitalization did not occur. [Act. 2.3.4] Figure 6. Confirmed malaria cases in 5 ODs 1000 900 800 700 600 500 400 300 200 100 0 Ma Oct Nov Dec Jan Feb Mar Apr Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Confirmed Malaria Cases Malaria Confirmed y 2016 2017 2018 Battambang 22 16 24 9 31 12 11 29 47 54 43 52 31 35 38 37 32 45 kravanh 112 108 92 76 86 74 83 290 469 465 422 500 796 862 644 565 580 722 Krakor 101 95 81 14 69 46 77 174 371 290 291 250 305 294 222 229 208 224 Thmar Koul 212040155334533484 Maung Russey 9 12 14 6 10 6 17 40 62 52 35 28 39 43 35 13 21 18

Table 1 provides a breakdown of confirmed malaria cases by species in the 5 ODs. Overall, there was a significant increase in Pf and Pv cases from May 2017 onwards (especially in Phnom Kravanh and Krakor ODs). The likely reasons for this included: (i) VMWs were fully functioning by May17, which meant there were more cases detected and reported; (ii) More people went to the forest areas after the plantation season finished who were exposed to high risk areas (especially males); (iii) CMEP/PHD/OD/HCs did start to investigate villages with high reported cases, however the response activities did not work speedily enough to prevent transmission in the forest areas. Understanding the trend of the planning was adequate, however due to non-availability and changed priorities at the OD level the response activities was not as per plan. Secondly, these cases are not from the villages but from the forest, so it thus pose some challenges to respond in the forest due to challenging environments and geographical terrain.

Table 1. Breakdown of confirmed malaria cases by species in 5 ODs

4 In the Transitional ODs, only VMW are supposed to provide DOT. 5The reasons are 2 – In transitional ODs particularly KRK and KRV just recently started SLDPQ in February at touch points. Some cases weight less than 50 Kg

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

SBCC Outreach activities: Seventy (70%) percent of all confirmed malaria cases were in Phnom Kravanh (PKV) and 25% in Krakor (KRK) ODs, with the remaining 5% in the other ODs.

Maps showing village incidence are shown below in Figure 7. Although there were some changes in the number of cases identified in individual villages, the general areas of concern remain the same with most representing areas near the forest. Figure 7. Map of villages with high number of malaria cases in PKV and KRK

Forest interventions: From January to March 2018, CMEP continued supporting forest interventions to increase malaria services coverage to forest workers through 6 selected touch point volunteers (KK:3 and PKV: 3) and 10 peer educators (KK: 5 and PKV: 5). As a result, in Q2 12 bi-weekly meetings were organized in PKV and KK ODs. Based on the information collected during the meetings, 16 touch point and peer volunteers conducted 77 site visits to meet with forest workers, tested 733 suspected malaria patients (212 (Pv+pf/Mx), or 29%, were found positive malaria which is relatively high due to the high number of cases in these ‘hotspot’ areas), distributed 248 ITNs, conducted 787 health education sessions which reached 1,230 forest workers, there are 80% of people having ITNs but there is no data as to how many are sleeping under nets , as it is revealed that they work at night times The inter-provincial meeting and visit was coordinated by the Pursat PHD, attended by the CNM director and PHD from 3 provinces (Pursat, Kampong Speu, and Kampong Chhnang), and chaired by the Pursat Deputy Governor. The aim of this initiative was to learn and understand the transmission dynamics among neighboring provinces (kp Speu and Kp Chhnang) and how to track cases that are mobile in nature. CNM regards these strategic steps as a way forward and wants to draw upon lessons learned that could be replicated in other forest intervention sites. It is not a one-time event - it is a process initiated by 3 provinces to track, test and follow up on cases coming from other forest areas. This forum will have a special status which will be led by the CNM Director and the task force ToR would be signed off soon under leadership of the deputy

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2) provincial governor of Pursat. Capacity building: The CMEP team and PMS provided orientation on SLD-PQ to 100 VMWs in MRS and BTB ODs, who didn’t receive training in Q1. [Act 2.3.7]. In Q2, CMEP conducted case management training in BTB OD for HF staff and VMWs trained under the CAP-Malaria project, who had not received refresher training in the last two years. In Q2, the training was provided to 52 VMWs in BTB ODs. So far total VMWs received case management training were 115 (63 in Q1 and 52 in Q2) (51% of the annual 225 target). CNM supervision: Two supervision visits to TMK, BTB and MRS were made by CNM’s pharmacy and laboratory units in Q2 (a total of 6 OD visits). [Act 2.3.10]. Supervision visits conducted by other CNM units are presented in relevant sections (see Act 2.4.5). Task 4. Strengthen case management and reporting in the private sector: Private Provider Mapping: CMEP continues working with the 236 registered PPs (mapping was updated in Q1) in 5 ODs under Objective 2. [Act 2.4.1]. The project has not provided any sorts of refresher trainings to PPs in this quarter as they were all trained in Year 1 (Act 2.4.2) . Ten bi-monthly meetings (versus 10 planned) were held in these 5 ODs (1 in January 4 in February, and 5 in March) [Act 2.4.3]. 392 PPs attended the meetings during Quarter 2 (some PPs were met twice during the period, and those that were not met in bi-monthly meetings were met during subsequent data collection visits). In addition, HF/OD teams visited private providers to review malaria case recording and reporting, and to collect necessary data and provide feedback. 62, of these visits were accomplished during the reporting period (each HF/OD visited approximately 5 PPs per visit). The achieved target is much above the set target due to the visit that was undertaken by the HF/ODs staff as the PPs in some cases were absent from bi monthly meeting. 12 additional visits to PPs – 3 visits in Jan, 5 in Feb and 4 in March). [Act. 2.4.4] Supervision visits: Three supervision visits were conducted for private providers by CNM in Q2 to the 5 ODs, and two of the planned visits were already conducted in Q1; therefore, all 5 ODs were visited during the last 6 months [Act. 2.4.5]. Similar feedback was observed and reported as that of Q1. No supply stock outs were reported. Reviewers were satisfied with the DOT provision, compliance with national guidelines and timeliness and quality of reporting by private providers into the MIS. Task 5. Build capacity and strengthen systems to manage malaria control activities: CMEP Support to VMWs/MMWs: 69 (18-KRK;18-PKV;9-MRS;24-BTB) monthly meetings for VMWs/MMWs were held in all 4 ODs during January to March 2018 (no VMW network exists in TMK OD) [Act 2.5.1]. During these meetings, VMWs reported information on malaria cases, received supply of RDTs/ACTs from health center staff, received on the job training for case management including SBCC, case registration/reporting, ITN monitoring and top-up reports. The VMWs also shared challenges (including difficulties with DOT completion among MMP and forest-related workers; poor road conditions and long distances to travel and unnecessary demands of topping up ITNs among the residents). On average, the number of VMWs who attended meetings was 329 (compared to FY18 Q1 of 335). In total, 988 VMWs attended meetings versus 1,336 planned (74%). This lower figure can be explained due to only one VMW being required to attend the meeting from a household (often more than 1 VMW lives at the same household and only one of them is required to attend the meeting). The number of VMWs living in the same household was 71 [Act 2.5.2]. In total, 71 VMWs were absent during monthly meeting but visited by the HF staff (versus 179 in Q1 of FY 2018). This was slightly higher than anticipated. During Q3, CMEP teams at OD level will work with VMWs to encourage them to attend meetings to share experiences and build knowledge.

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

Integrated supervision from OD to HFs [Act 2.5.3]: 79 supervisory visits were accomplished during the quarter (versus 81 planned). Build capacity and strengthen systems to manage malaria commodities: CMEP provided support in stock monitoring and management to the six target ODs (SPL, TMK, BTB, MRS, PKV, and KRK ODs, (SPL is also included here for this particular reporting on malaria commodities). CMEP used the mHealth application (via laptops) [Act 2.5.4-2.5.5] which automatically geotags facilities and locations to allow close monitoring of places visited. In Quarter 2, 329 visits were conducted to health facilities. The weekly stock monitoring by CMEP in six target ODs revealed RDT ‘potential stock outs’ were reported only once from 1 HF in SPL OD and no ‘stock out’ was detected. For ACTs, no stock out or potential stock outs were reported. ACT distribution: During the reporting period, there was no need to support ACT distribution in CMEP target ODs, However due to increase in cases in Pursat, reallocation of drugs within the ODs and the neighboring provinces were facilitated by CMEP. Visits to selected VMWs from CNM VMW Unit: CNM’s VMW Unit will carry out their visit in Q3 in KRK and PKV ODs. [Act. 2.5.6]. Provincial special working group for malaria elimination [ Act 2.5.7]: Meetings are planned to be conducted in FY18 Q3. The earlier commitment from the PST PHD was to conduct in Q2 however due to pressing priorities and changed plan it was not held, but now it has been agreed by CMEP and PHD that the special working group meeting will be held in Q3 on May 28th – 2018. Task 6. Strengthen BCC interventions for intensified malaria control IPC to tested malaria cases and high-risk groups: All 10,833 tested individuals received IPC in FY18 Q2 (Act 2.6.1). The peer educators provided 787 sessions to 1,230 MMPs in KRK and KRV ODs (Act 2.6.2). Malaria education campaigns at schools: In FY18 Q2, CMEP, in collaboration with Pursat provincial education department (PED) staff and Phnom Kravanh and Krakor Districts education department (DED) staff, integrated malaria health education into 43 primary schools curriculum (for KRK and PKV OD’s), targeting grades 4, 5 and 6. At the same time, PED and DED staff in 2 districts conducted school health education monitoring to monitor the progress, challenges and lessons learned. As a result, all schools completed 5 malaria lessons following the school health department curriculum. In PKV District, 1,818 (female: 942) students received malaria education from their teachers. Additionally, 340 (out of 1,818) students were interviewed to assess their malaria knowledge on causes of malaria, malaria prevention, health care seeking behaviors and treatment compliance; 100% of the students answered the questions correctly. In KK OD, the monitoring activity was conducted in 16 schools where 1,325 students (female: 725) received malaria education from their teachers. Of the 210 (out of 1,325) students interviewed to assess malaria knowledge; 95% of them could respond correctly. Three supervision visits (1 visit for 2 ODs) from CNM health education unit were also conducted to all CMEP target ODs.

Task 7. Support civil society and community-based organizations (CBOs) to implement interventions to transition toward malaria elimination: Provide support to selected CSO partners. In March 2018, the Senior BCC Advisor visited PFDA (previously known as CHADA) in Kasabe annex of Ra Thmey Village, Chhouk Meas Health Center. The purpose of the visit was to assess how the activities are being implemented and in addition to provide technical support.

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

Implement sub-grant activities [Act 2.7.2]: AHEAD (TMK & SPL ): In Thmar Kaul OD, AHEAD worked closely with local authorities (commune and village chiefs), ODs, HCs, VHSGs, and VMWs to conduct 5 village campaigns reaching 170 people (women: 99); including 94 MMPs reached with malaria messages. AHEAD staff worked with local authorities to identify and map 20 MMP settlements in remote villages with bad road conditions. Some villages were accessible by motorbike or car, but some were not. Moreover, AHEAD staff and VMWs/VHSGs identified 39 suspected patients and referred them to health facilities and VMWs for blood tests and treatment. Of those referred cases, 39 (100%) reached VMWs and HCs. None of the referred cases were positive. Table 2a : Summary of AHEAD Results

Indicators SPL OD THK OD Target Actual Target Actual Organize village HE campaign 15 15 5 5 Number of people reached malaria messages 0 682 0 170 through campaign Number of LLINs distributed through Campaign 76 176 50 169

Work with local authorities to map MMP 50 49 15 20 Refer malaria suspect patients to HF/VMW 70 99 40 39 Patients reached VMWs/HCs 99 39 Report any malaria cases or outbreaks 1 0 1 0

Similar Table like PFDA? PFDA (Chadda) (PKV, KK, BTB, MRS) PFDA is fully implementing activities since January 2018. In FY18Q2, PFDA worked closely with OD and HF staff, VMWs and local authorities to implement planned activities including organizing health education campaigns, MMP mapping, referring suspected malaria patients and follow up. PFDA accomplishments are outlined in Table 2 below. Table 2b: Summary of PFDA Results PKV OD KK OD BTB OD MRS OD Indicators Target Actual Target Actual Target Actual Target Actual # of health education campaigns organized in 15 17 10 20 10 20 10 10 target villages # of people reached by 300 302 200 404 250 200 188 210 campaigns # of LLINs distributed (by 350 0 175 0 219 0 219 0 USG funds) # of mobile/migrant 6 6 3 4 4 4 5 4 settlements mapped # of suspected malaria patients referred to 43 65 38 37 36 6 36 21 VMWs/HFs

Sub-grant oversight and management:

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

CMEP team (Compliance and Sub-Grants Coordinator, Senior BCC Advisor and M&E Officer) provided both technical and financial support to sub-grants (PFDA and AHEAD) on a bi-weekly basis. For technical components, they provided technical assistance (i.e. guiding PFDA to selected touch points, providing manuals for touch point training and follow up on targets versus results) to ensure they can reach their intended targets. For financial components, expenditures are monitored to ensure compliance rules and regulations are correctly followed (including reviewing staff and office contracts, reviewing village lists of project performance, and follow up on financial records and supporting documents). The CMEP team conducted monitoring visits at implementation sites and reviewed all technical and financial AHEAD/PFDA quarterly reports, providing feedback and helping to finalize reports as required. At the end of Q2, PFDA were facing challenges around quarterly reporting due to staff resignation, CMEP team assisted PFDA with updating the required quarterly information and AHEAD was able to fulfill their reporting requirements on time. In FY18Q3, CMEP will organize quarterly review meetings with sub-grants to improve their staff performance capacity and provide orientation to their new staff (technical and finance staff). CMEP will also validate their capacity towards implementing and provide ongoing support and in light of the expansion CMEP will also vet partners capability for expansion. Task 8. Operational research A study on highly sensitive RDTs (HsRDTs) will be conducted in Battambang OD during FY18 (initially for a transitional OD). During Q2, the CMEP team continued consultations with PMI/USAID and CNM on planning the research aimed at evaluating the performance of HsRDTs in the context of re-active case detection in elimination areas. The draft protocol was submitted to USAID/PMI for review and clearance and to URC’s IRB for approval. The submission to Cambodian National Ethics Committee for Health Research will be made in Q3 after receiving comments from USAID/PMI. 2.3 Objective 3: Strengthen national malaria surveillance systems and M&E appropriate for malaria elimination and control activities Task 1. Refine and harmonize M&E reporting forms and support consistent use by public and private healthcare providers Work with CNM and partners to harmonize M&E reporting forms: CMEP worked on the revision of the Case Investigation and Re-Active Case Detection forms (with CNM and WHO). [Act 3.1.1] CMEP also supported orientation/refresher training to HF staff in SPL OD on the Case Investigation and Re-Active Case Detection forms. Support consistent use of the harmonized forms by providers: After getting approval from USAID to expand the malaria elimination model from SPL OD to TMK, BTB, MRS and PLN in Q2 and thereafter a formal request from CNM was made, CMEP provided training on the revised Case Investigation Form to HF staff and VMWs for TMK (12-14/03/18), BTB (19- 23/03/18) and MRS ODs (26-30/03/18) (this was not a planned CMEP activity for Q2). In total, 520 staff (4 PHD, 11 OD, 146 HFs and 359 VMWs) received the training (PLN OD staff already received the training from CNM).[Act 3.1.2.] Overall, 91% of providers submitted surveillance data on time (Figure 8) consisting of 99% from health facilities, 93% from VMWs and 86% from private providers. Low performance of private providers should improve in Q3 through further training and supervision. Figure 8: Percentage of HFs, VMWs/MMWs, and private providers in target transitional ODs submitting surveillance data on time per national guidelines.

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

95% 98%94% 95% 100% 97% 99% 98% 94% 97% 95% 94% 96% 100% 86% 87% 86% 90% 87% 80% 83% 80% 60% 40% 20% 0% Battambang Thmar Koul Maung Russei Kravanh Krakor

FY17 Q3 FY17 Q4 FY18 Q1 FY18 Q2

The main reason is with VMW and PP submitting the report on time in many cases it has been experienced that the PP don’t attend bi-monthly meeting and when visited at home they are not present. Similar is the case with VMWs. (90% is still a good percentage given that PP are not accountable and have other priorities, this will be more an issues when now the PRAKAS will be implemented.

Task 2. Provide technical assistance on data management and us Conduct IDQA at OD and selected HFs by ODMS/PMS and CMEP [Act 3.2.2]: The CMEP ‘IDQA’ report was submitted to COR/USAID in January 2018 (it detailed the results and findings of the FY18 Q1 IDQA work in 2 ODs). After feedback was provided, report recommendations were agreed between CMEP and COR. To summarize, these recommendations were: . CMEP would only be required to conduct and report on one annual IDQA exercise (and no longer formally report on any partial DQAs) . CMEP would develop and use a similar tool to the USAID DQA tool (i.e. the DQA tool used in FY18 Q1 by the COR team to conduct their data quality work on CMEP) Provide TA to CNM on village based stratification and facilitate use of stratification tools [Act 3.2.3]: CNM conducted meetings in Pursat in February 2018 to announce a new arrangement strategy for the allocation of VMWs and LLIN distribution for Battambang and Pursat provinces based on API criteria. Provide TA to CNM on data visualization and outbreak module development for MIS [Act 2.3.4] CMEP staff along with representatives from CNM and PHD OD staff and the Deputy Provincial Governors from the 3 provinces (Kg. Chhnang, Kg. Speu and Pursat) attended a touch point meeting in Kravanh district in March 2018 to define approaches to provide malaria services to groups of forest workers (MMPs) along with developing a strategy for MMPs. The CNM and provincial teams plan to have a follow up meeting in May 2018 after the World Malaria Day event in Pursat. CNM supervision [Act 2.3.5]: Two visits to 4 ODs were undertaken by CNM M&E and epidemiology central units in Q2. The visits involved the verifying of data on malaria cases, checks on ITN distribution along with some staff training. Task 3. Support further development and implementation of electronic data reporting and use platform CMEP and CNM revised the malaria elimination surveillance mobile application (Day-0 SMS) in February 2018 [Act 3.3.1. The revisions involved the updating of the investigation and active case detection forms on the app. All health facility and VMW staff in target elimination ODs

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2) received training on the mobile application and how to use the tablets/smart phones for malaria reporting [Act 3.1.2]. Task 4. Entomology Training 6 Conduct entomology training for OD and PHD staff [Act 3.4.1.]: . CMEP supported CNM to provide a 2-day training on basic entomology to 16 PHD/OD malaria staff in BTB and Pursat provinces in January 2018 . CMEP worked with CNM to finalize the entomology manual with approval by the CNM Director in February 2018 . CMEP started working with CNM in late March 2018 to prepare a 5-day training curriculum and training tools for entomology technicians at OD/HF/Community levels 2.4 Objective 4: Build capacity of Ministry of Health (MOH) to manage, intensify, and sustain malaria control and elimination efforts particularly at the OD level Task 1. Develop and implement a plan to strengthen technical and management capacity at National, PHD and OD levels7 From March 5-9, 2018, CMEP conducted a workshop in Battambang for the updating of theCMEP Year 2 modified Work Plan, OD annual operational plans (AOPs) for 9 ODs, CMEP’s 5-year M&E Plan and finalization of all Technical Strategies. On March 9, 2018, 3 PHDs and 9 ODs’ counterparts attended the meeting where they went through the project briefing and OD AOP development (approx. 20 staff attended from 3 PHD’s and 9 OD’s). OD AOP development [Act 4.1.4.]: Continuing from the March 9th workshop, OD AOPs will be further refined and finalized for implementation in FY 18 Q3 and Q4. Once the CMEP Year 2 Work Plan is approved by COR, CMEP will finalize and begin implementing activities in all ODs per the Y2 AOP. It is envisioned that this will start in May 2018. Laboratory quality assurance [Act 4.1.8]: Provincial malaria supervision for lab assessments was conducted in four health centers in malaria endemic areas in BTB OD. The assessment found that although 8 HCs have microscopes, lab materials, and staff trained in microscopy, they generally do not use them and instead rely on RDTs for malaria diagnosis. CMEP continues to encourage use of microscopes at HFs where staff aretrained and equipment/materials are available. CMEP helps ensure regular supervision from PHD/CNM on lab services at HFs, and that RDTs are monitored for adequate supply, expiration date and storage condition. CMEP recruited a lab supervisor to be based in BTB province, he will work with lab experts in the provinces (after completing the ‘National Competency Assessment’ conducted by CNM) to establish a QA system with support from the CNM lab and CMEP PP team for microscopy QA at provincial/OD levels and provide regular supervision and on the job trainings. In Q3, the CMEP team will work with CNM and WHO TA to upgrade the national quality assurance system of malaria diagnosis to include SOPs based on the current situation in using microscopy for diagnosis in the field (selected HFs) and the need for malaria elimination in target ODs. On the job training and mentoring by CNM units (Regional task forces and entomology) [Act 4.1.9] CNM conducted field visits to malaria endemic areas in Pursat and BTB provinces to select sites suitable for entomology surveillance, health facilities and community groups to be trained as entomology technicians for field work (to support vector surveillance and foci investigation). CMEP will work with CNM to prepare a 5-day training curriculum and

6 No targets were set for activities 3.4.2-3.4.4 in Q1 FY 2018 7 Activities 4.1.1-4.1.3 and 4.1.5.-4.1.6. are not applicable to the reporting period

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2) necessary training materials. List of Entomology Training PST_PKV and KRK ODs No PKV OD HCs Villages Remarks Phnom 1 Kravanh Mol Chas (Patchnang) Veal Vong (Ou Da) Doung Pul (Ampil and Ouchrov) Ksaing Cheu Reang kvav 2 Samrong Tades Veal Roveang 3 Prognil Say 4 Pramoy Trapong Pung Chhrok Preal Chheuteal Chhrum Pcheck Chhrum 5 Along Reap Talok Baek Steung Khiev Krakor OD HC name Village Remark 6 Chheutom Stoeng Preal Damnakchheukram Chamkar Kroch Kbal Teahean Bamnak Chamchas 7 Svay Sar Ansachambak 8 Chhouk Meas Ra thmey Dambok 100 Roleap Srangaim

List of Entomology Training PHD BTB No BTB OD HCs Villages Remarks

1 Tasanh Ou Krouch Svay Chrom Phnom Rey Ou Treng Ou Ronong Peam Ta Veal rolim Ta tok 2 Kam Pong Lpov Ou Cham leu Prey Tom ( Crok Chong eath

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

3 Boeung Run Ou Tatoeung Slav Pailin OD Krachap Phnom Damborng Slav

E-Payment [Act 4.1.10]: The e-payment system is used to pay per diems, transportation and other allowances through mobile payments. During Q2, CMEP set up e-payments for 125 VMWs in 8 Health Centers in Sampov Loun OD (Kamrieng HC, Trang HC, Pich Chenda HC, Barang Thlak HC, Takrey HC, Takrey HC, Sereymeanchey HC and Sampov Loun HC). E- payment accounts were also opened for the remaining two HCs in SPL (Bur HC and Trav Chhou HC). During Q3, CMEP will initiate e-payments to 36 VMWs in these 2 Health Centers, completing set-up of e-payments to all HCs in SPL. Task 2. Support CNM and MOH to develop and maintain a system for on-going technical and management capacity development Provide technical assistance to CNM [Act 4.2.1] NTG Dissemination Workshop: CMEP provided technical support to CNM for a dissemination workshop on updates to the National Treatment Guidelines for all national hospitals in Phnom Penh (including the military and police hospital in March 2018). CNM training on Surveillance for Malaria Elimination: CMEP, with CNM, provided training on malaria elimination surveillance for PHDs/ODs/HCs and VMWs for 4 ODs in BTB province in March 2018. Five-hundred and twenty trainees (161 from HFs and 359 VMWs) attended the training carried out in three separate events. CMEP progress review [Act 4.2.2.]: The progress review would happen in Q3. National Annual Conference [Act 4.2.3]: Six CMEP central and field level staff joined the 2-day annual seminar of the Cambodia Malaria Program in Siem Reap from February 22-23, 2018. The SPL ODMS provided a presentation on CMEP’s work in SPL OD. At the exhibition booth, CMEP shared project BCC materials and implementation tools together with CNM and other partners. Discussions involved the current malaria situation in CMEP OD’s and ways forward. Task 3: Improve malaria policies and guidelines [Act 4.3.1] In March 2018, CMEP provided direct support to CNM for the delivery of a ‘Training of Trainers’ on case management for health facilities in 5 provinces. Also in March 2018, CMEP met with the WHO team to discuss preparation for upgrading the malaria diagnosis national quality assurance system, including SOPs (planned for April-June with CNM) (this is also in line with activity 4.1.8). Orientation to PHD, OD malaria supervisors and CMEP OD teams on updated national policies, strategies and guidelines was conducted in Pursat by CNM staff. CNM’s Chief of the Technical Bureau provided the training with active participation from all attendees. There were 31 people from 2 PHDs (Battambang and Pursat) and 8 ODs. Training topics covered the MEAF 2016-2020, Elimination Phased Approach, Surveillance for Elimination, Implementation Arrangement for the Malaria Core Package, PPM Implementation, New Target Stratification Arrangement (ITN distribution and VMW), RAI2E Fund Allocation, Work Packages in Global Fund RAI2E 2018-2020, Fund Flow, VMW E-payment, etc. CNM BCC strategy development: [Act 4.3.1] CMEP supported CNM to organize BCC strategy development workshop during which CMEP also supported in the content development and played a very crucial role. CMEP also supported in designing the CNM

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

BCC strategy in English, this was accepted by CNM, currently CMEP is supporting in the doing a Khmer version of the BCC Strategy. Six CMEP technical strategies, including CMEP’s BCC strategy were cleared by USAID/PMI in March 2018. The 5 other technical strategies are MMP, EDAT, Surveillance, Capacity Building, and Sustainability and Exit strategies.

2.5 Project Management Oversight and Coordination CMEP Field Visits: During Q2, several visits from key and non-key staff (including CMEP’s technical, M&E, programmatic and financial teams), COR, and Senior Technical Advisor (STA) from Phnom Penh, visited target ODs. The visits were to provide quality support, assess CMEP’s progress and provide guidance and advice on quality improvement of the project. More importantly, the field visits consisted of working with the CMEP team to sharpen and better link OD malaria initiatives. Additional visits from the Chief of Party (COP) focused on reviewing AOPs and targets and learning what worked well. On March 9, 2018, the COP and CMEP team met with PHD and OD staff to develop all 9 OD AOP’s as part of the expansion. On March 12, the COP and CMEP team accompanied the PMI Malaria Operational Plan (MOP) team to Pailin PHD and two health facilities, and met with VMWs. The COP also visited all three provinces along with the STA, met the PHDs and 4 OD Directors, and visited health facilities in KRK, KRV, SPL, BTB. Regular visits to ODs has proven to be successful in keeping the CMEP team engaged and on track. Sub-grant oversight and management: CMEP’s M&E Officer, Compliance and Sub-Grants Coordinator and Senior BCC Advisor conducted orientation to sub grantees (AHEAD and PFDA) on procurement and financial management (details are provided under activity 2.7.1) CoP planned visit is in Q3. The identification for new CSO’s for year 3 will be initiated from Q3. Meetings with USAID, CNM, Implementing Partners, and Others: (1) Meetings with the USAID COR Team During Quarter 2, the CMEP team had a series of meetings with the COR team, CO, and others at USAID. Meetings included: introduction of the new COP and M&E/SI Advisor and the handover process on January 23rd, discussion on CPARS results and how to improve performance on January 26th, and discussion on the content of the OD bulletin development on January 30th. The CMEP team also met with the COR team on February 20, 2018 to discuss the IDQA conducted by CMEP. The outcome of the meeting helped in getting the process clearly defined and it was also important to learn the various tools that are useful and can be adapted (see Act 3.2.2). On March 2nd, CMEP staff attended a meeting with the PMI technical team and representative from ‘VectorLink’ to initiate discussions to understand entomological surveillance needs for malaria. All the meetings with COR team were specific in nature and gave an opportunity to discuss progress but also to look at challenges and future planning and areas for improvement. (2) Meetings with CNM and Other Partners Meeting with CNM Director and technical bureau chief: The COP, STA and Policy/Technical Advisor met the CNM Director to discuss CMEP’s work and learn about areas that need attention. During the meeting for the approval of OD elimination expansion, he recognized the work of CMEP and publicly announced the work in SPL is to be expanded. In a follow up meeting with the CNM Director, CMEP shared the plan for the SPL costing

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2) analysis and the hsRDT study, in which CNM expressed interest, providing CMEP with positive feedback.. Meeting with Procurement Supply Management (PSM): The in-country representative of PSM met with the COP and STA to understand current supply and commodity management issues. It was a good opportunity to learn about PSM’s work in Cambodia during their presentation with the MOP team in CMEP’s office on March 15, 2018. Meeting with UNOPS: The COP met with UNOPS to learn about the geographic scale of the GF funded malaria project, in lieu of the CMEP project working in the 2 provinces, it was evident that UNOPS still has challenges and issues with some partnerships. The COP shared CMEP’s upcoming events and provided an open invitation for them to learn from SPL elimination OD. Procurement CMEP initiated procurement of two vehicles to support project operations. Required documents were approved by USAID on February 20, 2018. During Q2, CMEP submitted a purchase order to the supplier, and the two vehicles are expected to arrive in Q4. The list of procured items within CMEP in FY18 Q2 can be found in Table 3 below. Table 3 CMEP Procured Items FY18 Q2 No. Item Unit Purchased date 1. Laptops (for CMEP staff) 3 January 10,2018 2. Camera (CMEP BTB) 1 January 29, 2018 3. LCD Projectors (CMEP BTB and Pursat) 2 January 30, 2018 4. External Hard Drive Disk (CNM) 2 January 30, 2018 5. Window License (CNM) 1 January 30, 2018 Financial Management

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

Human Resource Management Two Key Personnel, one Health Facility Coordinator, Finance Assistant, and M&E Manager joined CMEP during the reporting period:

Table 4: Overall CMEP staffing progress from FY18 Q1 to FY18 Q2 60 60 50 50 50 40 46 40 30 30 20 20 10 10 0 0 FY18 Q1 FY18Q2

Key Staff Total Number of Staff Required Key Staff Required Total Number of Staff

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

3. RESOLVING CHALLENGES FROM FY18 Q1 Continued management related challenges and the need for organizational change: Most of the issues that were highlighted in the last quarter around management level challenges have being resolved and CMEP has taken a progressive path in team engagement, management oversight and demonstrating leadership at all levels. However, the position of DCOP still needs to be filled, which has led to other key staff taking on DCOP responsibilities and increased workloads. The non-approval of the preferred DCOP candidate based on lack of field experience from the mission led to another round of recruitment the reason of non –approval was shared to URC through CO letter, but a repeated recruitment process is underway. With expansion of the three new ODs, it will be a challenge to get additional staff on board as soon as possible, meaning that existing OD staff need to cover new ODs to kick off the activities. In regard to subgrant component the process and implementation was done, CMEP were able to select 2 partners and introduced the implementation in late Q1 and start of Q2. The new selection of CSO to expanded ODs would happen in Q3. The ITN distribution issues highlighted in Q1 was resolved with the support from UNOPS and CNM. Also CMEP supported on an ongoing basis the CSOs on continuous mapping and LLIN distribution. 4. CHALLENGES AND ACTIONS TAKEN OR PROPOSED Improving CMEP management and quality of work: The CMEP senior management team is aiming to improve the management setting at the OD level. There remain some capacity gaps at the OD level. CMEP held a bi-quarterly meeting with the entire team of 46 CMEP staff on January 15-16, 2018 in Phnom Penh. During the meeting, the team provided updates on progress made against the project work plan, lessons learned, challenges encountered, solutions taken/proposed and future plans. It was also an opportunity for the central team to build capacity of the OD teams. These events provided an opportunity to learn and have a shared understanding of CMEP activities and goals. CMEP’s COP initiated a meeting between the Phnom Penh team and team leaders from the 6 target ODs in Phnom Penh on February 6, 2018. The meeting covered: . New structure, leadership and management within CMEP . A review of the CPARS findings and highlighted areas of concern and action for improvement. . CMEP’s activity tracker, targets set versus actual results and the year 2 work plan. . A review of monthly budgeting versus actual expenses Q1/Y2. . Brainstorming session on how to engage CSOs and the process of identification and capacity development of CSOs . Mapping sheet to identify and map out the CSO’s capabilities and capacity and expanding on what CSOs can contribute to CMEP. . Monthly Reporting format for OD teams revisited and a more analytical section added. Having senior members across the project participate in these meetings allows them to take up ownership and leadership responsibilities. On February 28, 2018, CMEP’s internal team meeting was conducted in Pursat City with participation from the Phnom Penh team and all 6 CMEP OD team leaders. The meeting discussed contract modification, CMEP overview, situational analysis for expanded ODs, CSO identification and preparation for the AOP and work plan development workshop on March 5- 9, 2018 in Battambang. From March 5 to 9, 2018, CMEP conducted a workshop in Battambang on updating the CMEP year 2 modified Work Plan, developing the OD AOPs for 9 ODs/2 PHDs, updating the 5-year M&E Plan and the finalization of all Technical Strategies and year 2 Budget. PHD and OD

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2) counterparts were invited to join the project briefing and OD AOP finalization on March 9, 2018. The participatory process undertaken in Q2 is a way forward to strengthen CMEP staff capacity. These initiatives provide staff confidence to assess task performance and will ultimately lead to a transformation in the quality of work and management responses. 5. PLANS FOR NEXT QUARTER AND UPCOMING EVENTS In line with the modification approval to expand to new ODs, CMEP’s Year 2 work plan was revised to continue elimination activities in SPL OD, replicating them to 3 ODs in Battambang province and one OD in Pailin province and to implement intensified control activities in all 4 transitional ODs in Pursat province. According to the approved modification, CMEP will expand its elimination model to 5 ODs including SPL, BTB, TMK, MRS and Pailin under objective 1 and will cover 4 ODs (KRK, PKV, SPV and Bakan) under objective 2 with the malaria control package. The implementation of the revised year 2 work plan is expected in Q3 and Q4, starting to a full-scale target from May 2018. A major focus for CMEP implementation will be to achieve planned targets for Year 2 Quarter 3, including training, supportive supervision, ITN distribution, IPC and small group education sessions among high-risk groups, malaria diagnosis and case management, case follow up and surveillance in all 9 ODs. The Quarter 2 activities that were delayed and postponed by relevant counterparts (reasons provided in a separate sheet to COR and team) would be implemented in Q3 – these activities are as follows: Activity 1.6.8 and 2.5.7: Support provincial special working group for malaria elimination in Battambang and Pursat. Activity 2.8.1: In close collaboration with CNM, WHO and other partners conduct an annual meeting to discuss research needs and identify topics for operation research to be conducted in FY 2018. Activity 4.1.3: Provide technical assistance to CNM in setting up an outbreak response system at OD level and conduct 4 training sessions for outbreak response capacity building Activity 4.1.8: Lab Quality Assurance conducted by PLS in Sampov Lun and Battambang (5 trips in this Q2). Activity 4.2.2: CMEP progress review at central level twice a year. Activity 3.4.1: conduct entomology training for 16 PHD/OD staff in Q3 and Q4. Below are upcoming events in Q3 FY18 (April-June 2018): . World Malaria Day commemoration on April 25, 2018 in all 3 CMEP target provinces. The largest event is organized in Veal Veng district in PKV OD, Pursat Province with presence of the Minister of Health and Minster of Environment. . Costing analysis of the malaria elimination model in SPL to start on April 23, 2018 the report shall be finalized by June 2018 . Completing OD situational analyses for new elimination and transitional ODs. . Setting up new CMEP OD teams and offices. . Organize the meeting with CNM and OD Pailin to learn and understand the different support from other donors and plan the start up of the CMEP activities in addition to strategies the intervention so that overlap by GF and CMEP could be avoided. . Joint visit to be undertaken by WHO and CMEP staff to understand the increased cases in Pursat province (specifically Phnom Kravanh and Krakor OD’s) . Hs-RDT protocol submission in June 2018. . Interprovincial special working group meeting in Pursat in May 2018.

Cambodia Malaria Elimination Project Quarterly Report (FY18Q2)

. Visit of the WHO Regional Director for Program Management on April 27, 2018 to Pursat Provincial hospital, Krakor OD, Cheutom HC and two VMW villages in Cheutom. Ends,