YANGON UNIVERSITY OF ECONOMICS MASTER OF DEVELOPMENT STUDIES PROGRAMME A STUDY ON FACTORS CONTRIBUTING TO SUCCESS OF MALARIA PREVENTION AND CONTROL PROGRAMME IN BAGO REGION NAY ZAR OO EMDevS - 49 (14th BATCH) AUGUST, 2019 ABSTRACT This study focuses on the “Factors contributing to success of Malaria Prevention and Control Programme in Bago Region". Bago Region is the one of the region of elimination area and five successful regions which has higher rate of reduction of Malaria transmission and incidence in Myanmar. The objectives of study are to analyze Malaria Prevention and Control Programme and to identify the factors contributing to success of Malaria Programme for elimination in Bago Region. Descriptive method is used in this study by qualitative approaches and quantitative analysis based on the primary and secondary data. Primary data are collected from Key Informant Interviews (KII) with focal persons of Malaria in Bago Region and implementing partners. According to the results, key activities contributing of prevention and control activities in Bago Region are Micro-Stratification, Long Lasting Insecticidal Net, Indoor Residual Spraying, Information and Health Education and Communication, Early Diagnosis Treatment, Supervision and Monitoring and Evaluation, Surveillance, Supply and Management. i ACKNOWLEDGEMENTS There are many people to whom I am deeply indebted and whose support made a vital contribution to the completion of this study. First and foremost, I wish to extend my sincere gratitude to my Professor Dr. Tin Win, Rector, Yangon University of Economics, Professor Dr. Ni Lar Myint Htoo, Pro-Rector, Yangon University of Economics for their kind permission, to study EMDevS and support to carry out this thesis. My deep appreciation goes to Dr. Cho Cho Thein, Programme Director and Head of the Department of Economics, Master of Development Studies Programme, Yangon University of Economics and Dr. Thida Kyu, Pro-Rector of Meikhtila University of Economics, former Head of the Department of Economics, Yangon University of Economics for their valuable lecturers and other retired Professors and lecturers who gave me the guidance that I needed. This paper would not have been completed without suggestions, comments and support of my supervisor Daw Phyu Win Ei, Lecturer, Department of Economics, Yangon University of Economics. Moreover, my heartfelt thanks and appreciate to National Malaria Control Programme, Central and Bago Region and Technical Officer (Malaria), WHO which kindly took the technical guidance and data supporting on my thesis paper. And I am also very grateful to Dr Kyaw Zayar Aung (EMDevS 12th batch) who encourage me to attend this programme and supporting throughout the course and on my thesis paper as well. I would also like to thank the face to face interview participats who are from National Malaria Programme Staff and Implementing Partners. I would also like to thank my other colleagues at Master of Development Studies Programme. Also, I would like to extend my gratitude to all the people that have helped me in my research work. Furthermore, I feel that I am deeply indebted to all the people who participated in my thesis. I would like to thank my family and without their love, understanding and support, this research would not have been possible. Finally, I would like to express my deep gratitude to all persons who contribute directly or indirectly to my research paper. ii TABLE OF CONTENTS Page ABSTRACT i ACKNOWLEDGEMENTS ii TABLE OF CONTENTS iii LIST OF TABLES v LIST OF FIGURES vi LIST OF ABBREVIATIONS viii CHAPTER I INTRODUCTION 1.1 Rationale of the Study 1 1.2 Objectives of the Study 3 1.3 Method of Study 3 1.4 Scope and Limitations of the Study 3 1.5 Organization of the Study 4 CHAPTER II LITERATURE REVIEW 2.1 Background History of Malaria 5 2.2 Regional and Global Burden of Malaria 7 2.3 Prevention and Control Strategy for Malaria Elimination 8 2.4 Factors Affecting of Malaria Prevention and Control 9 Programme 2.5 Review of Previous Studies 10 CHAPTER III OVERVIEW OF MALARIA PREVENTION AND CONTROL PROGRAMME IN BAGO REGION 3.1 Overview of Malaria Situation in Myanmar 13 3.2 National Plan for Malaria Elimination in Myanmar 19 (2016-2030) 3.3 Partner Contribution for Malaria Control Activities 27 in Myanmar 3.4 Malaria Situation in Bago Region 31 iii 3.5 Malaria Prevention and Control Programme 37 in Bago Region 3.6 Partner Contribution for Malaria Control Programme 42 in Bago Region 3.7 Review on Malaria Prevention and Control Activities 43 in Bago Region CHAPTER IV SURVEY ANALYSIS 4.1 Survey Profile 48 4.2 Survey Design 48 4.3 Survey Result 49 CHAPTER V CONCLUSION 5.1 Findings 60 5.2 Suggestions 63 REFERENCES APPENDICES iv LIST OF TABLES Table No. Title Page 3.1 Malaria Cases and Death in Myanmar (2007 to 2017) 16 3.2 Malaria Case and Death in Myanmar by State and Region (2017) 17 3.3 Population of Micro-Stratification by Sub-Centre in Myanmar in 24 (2017) 3.4 Funding Figures for Malaria Prevention and Control 30 3.5 Malaria Case and Death in Bago Region from 2007 to 2018 33 3.6 Malaria Morbidity and Mortality in Bago Region by township 35 (2017) 3.7 Malaria Case by Age Group in Bago Region (2017) 37 3.8 Population of Micro-Stratification by Sub-Centre in Bago (2017) 40 3.9 Annual Parasite Incidence Rate and Annual Malaria Blood 45 Examination Rate in Bago Region from 2007 to 2018 4.1 Socio-demographic Characteristic of Respondents 49 4.2 Malaria Prevention Activities by KII Interview 52 4.3 Malaria Control Activities by KII Interview 54 v LIST OF FIGURES Figure No. Title Page 3.1 Trends of Malaria Morbidity and Mortality Rate in Myanmar 14 from 2007 to 2017 3.2 Malaria Cases and Deaths in Myanmar from 2007 to 2017 15 3.3 Confirmed Malaria Cases in States and Regions (2017) 18 3.4 Yearly Trend of Malaria Morbidity and Mortality Rate in Bago 32 Region from 2007 to 2017 3.5 Malaria Cases and Deaths in Bago Region from 2007 to 2017 33 3.6 Malaria Case by Age Group in Bago Region in 2017 37 3.7 Malaria Examination and Positive Cases in Bago Region 43 from 2007 to 2018 3.8 Malaria Annual Parasite Incidence Rate in Bago Region 47 from 2016 to 2018 vi LIST OF ABBREVIATIONS 3MDG Three Millennium Development Goal Fund ABER Annual Blood Examination Rate ACT Artemisinin-based Combination Therapy ANC Ante-natal Care API Annual Parasite Incidence APLMA Asia Pacific Leaders Malaria Alliance BCC Bahaviour Changed Communication BHS Basic Health Staff CBO Congressional Budget Office CFR Case fatality rate CI Confidence interval CQ Chloroquine DFID Department for International Development DMR Department of Medical Research DMS Department of Medical Services ECT Early Diagnosis and Appropriate Treatment FDA Food and Drug Administration GF Global Fund HA Health Assistant IEC Information, Education & Communication IEC Information, Education & Communication INGO International Non-Governmental Organization IP/OP In-patient/Out-patient IRS Indoor Residual Spraying JICA Japan International Cooperation Agency LLIN Long-Lasting insecticidal Net M&E Monitoring and Evaluation MDA Mass Drug Administration MDG Millennium Development Goals Med Tech Medical Technician MHAA Myanmar Health Assistant Association vii MHSCC Myanmar Health Sector Coordinating Committee MMA Myanmar Medical Association MMP Migrant and Mobile Population MOHS Ministry of Health and Sports NFM New Funding Model NGO Non-Governmental Organization NHL National Health Laboratory NMCP National Malaria Control Programme NMEC National Malaria Elimination Committee NMEP National Malaria Elimination Programme NSP National Strategic Plan OP Out-Patient P.f Plasmodium falciparum P.v Plasmodium vivax PMI President’s Malaria Initiative PQ Primaquine PSI Population Services International QA/QC Quality Assessment/ Quality Control RAI Regional Artemisinin-resistance Initiative RDT Rapid Diagnosis Test RHC Rural Health Center SC Sub-Center SME Supervision, Monitoring & Evaluation viii CHAPTER I INTRODUCTION 1.1 Rationale of the Study Malaria remains one public health problems resulting in massive morbidity particularly in developing countries. Globally, half of the world population about 3.4 billion people in 92 countries are significantly exposed to Malaria, and 1.1 billion are at high risk. Worldwide, malaria is the fifth-leading cause of death from infectious disease after infections, HIV/AIDS, diarrheal diseases and tuberculosis. There were 219 million cases of malaria globally in 2017. The malaria deaths were 435,000 representing a decrease in malaria cases and deaths rates of 18% and 28% since 2010, respectively. Globally, there are 3 to 700 million people get malaria each year, but only kills 1 to 2 million. 40% of the world’s population lives in malaria zone. Malaria zone are Africa, India, Middle East, South-east Asia, Central and South America, Eastern Europe, and South Pacific. The WHO African Region carries a disproportionately high share of the global malaria burden. Total funding for malaria control and elimination reached an estimated US$ 3.1 billion in 2017. Contributions from governments of endemic countries amounted to US$ 900 million, representing 28% of total funding. (WHO, 2018) World Health Organization stated that country development involved the systematic healthcare and human resource management to capitalize the development of individual citizens. Nations with less developed basic healthcare access is highly correlated with the less efficient economic output that strained the national development. Regionally, Southeast Asia countries went through economic miracles during twenty century period in parallel with the dramatic improvement in eradicating the major endemic diseases, especially tropical and vector borne diseases like Malaria. In Myanmar, Malaria was one of the priority diseases because of climate changes and ecological changes (Win et al., 2017). The migrant population who seek economic opportunities in forestry, mining, migration, plantations and road-building 1 were one of the vulnerable groups.