DEFEAT MALARIA
DEFEAT MALARIA ACTIV ITY
QUARTERLY PERFORMANCE REPORT
FISCAL YEAR 2021 QUARTER 1 (OCTOBER 1, 2020 TO DECEMBER 31, 2020) 2021 QUARTERLY PERFORMANCE REPORT
Submission Date: January 30, 2021 Resubmission Date: February 16, 2021
Agreement Number: AID-482-A-16-00003 Agreement Period: August 15, 2016 to August 14, 2022 AOR Name: Dr. Nu Nu Khin Submitted by: May Aung Lin, Chief of Party University Research Co., LLC. Room 602, 6th Floor, Shwe Than Lwin Condominium New University Ave. Rd., Bahan Township Yangon, Myanmar
CONTACT INFORMATION
Dr. May Aung Lin, Chief of Party, Defeat Malaria [email protected] Office Phone/Fax: + 95 1 559 593, + 011 220 658, Mobile: + 959 7324 1930 Dr. Kyaw Myint Tun, M&E Technical Advisor, Defeat Malaria [email protected] Office Phone /Fax: +95 1 559 593, +011 220 658 Mobile: + 959 503 9861
THIS DOCUMENT WAS PRODUCED BY UNIVERSITY RESEARCH CO., LLC (URC) FOR REVIEW AND APPROVAL BY THE UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID). DEFEAT MALARIA
Defeat Malaria is a USAID-funded project with the goal to reduce the malaria burden and control artemisinin- resistant malaria in the targeted areas, thereby contrib- uting to the long-term national goal of eliminating ma- laria in Myanmar. Defeat Malaria has four core objec- tives, including:
Objective 1: Achieve and maintain universal cover- age of at-risk populations with proven vector control and case management interventions, while pro- moting the testing of new tools and approaches.
Objective 2: Strengthen the malaria surveillance sys- tem to comprehensively monitor progress and in- form the deployment and targeting of appropriate responses and strategies.
Objective 3: Enhance technical and operational ca- pacity of the NMCP and other health service provid- ers at all levels of service provision.
Objective 4: Promote the involvement of communi- ties, private healthcare providers, private companies and state-owned enterprises in malaria control and elimination initiatives. DEFEAT MALARIA FY 2021 QUARTER 1 KEY ACHIEVEMENTS
Testing & Case Finding 65,329 people were tested for malaria Health Communication 47,492, including 7,567 migrants, of whom were reached through interpersonal 812 were positive cases communication
Test Positivity Rate: 1.24%
Treatment Completion Preventive Commodities
545 individuals were Distributed 3,349 LLINs enrolled in DOT treatment; to villages, worksites, and 542 of enrolled cases women attending completed DOT treatment ante-natal care clinics
Diagnostic and Treatment Commodities Capacity Building Distributed 61,425 RDTs 205 health workers and 1,683 ACTs received trainings to Defeat Malaria storage on malaria diagnostics sites to safeguard and case management continuous and on-time 204 health workers delivery of malaria health received training on Integrated Community care services Malaria Volunteers DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. - DEC. 2020)
Contents ACRONYMS AND ABBREVIATIONS ...... 4 EXECUTIVE SUMMARY ...... 1 FISCAL YEAR (FY) 2021 QUARTER 1 SUMMARY OF KEY ACHIEVEMENTS ...... 3 INTRODUCTION ...... 4 FISCAL YEAR 2021 QUARTER 1: ACTIVITIES BY OBJECTIVES ...... 5 OBJECTIVE 1: ACHIEVE AND MAINTAIN UNIVERSAL COVERAGE OF AT-RISK POPULATIONS WITH PROVEN VECTOR CONTROL AND CASE MANAGEMENT INTERVENTIONS, WHILE PROMOTING THE TESTING OF NEW TOOLS AND APPROACHES...... 5 ❖ Ensure the distribution of LLINs, diagnostics, and quality-assured medicines to the beneficiary populations, health services and collaborating VMWs in the targeted areas ...... 5 ❖ Optimize coverage and promote use of proven vector control interventions ...... 6 ❖ Ensure early diagnosis and appropriate treatment of all clinical malaria cases ...... 9 ❖ Strengthen and expand the network of VMWs to improve access to basic diagnostics and treatment services (RDTs and ACTs), particularly for high-risk and hard-to-reach populations ...... 12 ❖ Conduct operational research to pilot promising new tools and approaches to reduce malaria transmission as directed by NMCP, in consultation with the PMI/USAID ...... 12 OBJECTIVE 2: STRENGTHEN THE MALARIA SURVEILLANCE SYSTEM TO COMPREHENSIVELY MONITOR PROGRESS AND INFORM THE DEPLOYMENT AND TARGETING OF APPROPRIATE RESPONSES AND STRATEGIES...... 13 ❖ Strengthen the malaria surveillance system in line with malaria elimination, improve data management capacity at all levels of the health system, from village to central level, and support appropriate information technology to facilitate data collection, reporting, and use in both public and private sectors ...... 13 ❖ Support the implementation and regular updating of village-based malaria stratification ...... 16 ❖ To initiate an elimination strategy for target elimination areas, pilot test and scale-up a system for rapid detection and notification of malaria cases, case and contact investigations, and prompt deployment of appropriate response interventions in three townships in Southern Rakhine State, by improving and strengthening the surveillance system ...... 18 OBJECTIVE 3: ENHANCE TECHNICAL AND OPERATIONAL CAPACITY OF THE NMCP AND OTHER HEALTH SERVICE PROVIDERS AT ALL LEVELS OF SERVICE PROVISION ...... 19 ❖ Improve skills and job performance of staff involved in malaria control, particularly on epidemiology, surveillance, entomology, and vector control through supportive supervision and training at peripheral and national levels ...... 19 ❖ Strengthening surveillance system by supporting the NMCP on tools, equipment, telecommunication cost, capacity building and human resource development ...... 20 ❖ Support the NMCP for entomological training, entomological field assessments and other gaps at the different levels ...... 21 OBJECTIVE 4: PROMOTE THE INVOLVEMENT OF COMMUNITIES, PRIVATE HEALTHCARE PROVIDERS, PRIVATE COMPANIES AND STATE-OWNED ENTERPRISES IN MALARIA CONTROL AND ELIMINATION INITIATIVES ...... 21 ❖ Build the organizational and technical capacity of Universities related to health, Community Based Organizations and EHOs ...... 21 ❖ Strengthen BCC and community mobilization activities to promote the sustained use of preventive methods, the timely use of community and facility-based health services, the adherence to prescribed treatment, and the collaboration in the testing of new tools and approaches ...... 23 ❖ Strengthen and expand training, supportive supervision, and provision of diagnostics and quality- assured antimalarial drugs to private health care providers involved in the management of malaria cases,
DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. - DEC. 2020)
and promote engagement of private companies and state-owned enterprises in malaria control and elimination activities through Corporate Social Responsibility initiatives ...... 24 ❖ Engagement with non-formal private providers, General Practitioners, and drug stores in malaria elimination townships ...... 25
Tables Table 1: Defeat Malaria implementing areas and coverages as of December 2020 4 Table 2: Commodity Procurement Information Request (CPIR) and Received Information (Oct – Dec 2020) 5 Table 3: Long lasting insecticide net (LLIN) distribution at villages (Oct. 2020 – Dec. 2020) 7 Table 4: LLIN distribution at worksites (Oct. 2020 – Dec. 2020) 7 Table 5: LLIN Coverage and Utilization by Defeat Malaria State/Region (Oct. 2020 – Dec. 2020) 8 Table 6: Malaria testing by Defeat Malaria covered State/Region (Oct. 2020 – Dec. 2020) 10 Table 7: Results of three types of malaria diagnostic tests 11 Table 8: Progress of survey activities (Mar. - Dec. 2020) 13 Table 9: Progress of CSG formation and fund proposal submission 23
Figures Figure 1: Geographic distribution of Defeat Malaria activities in Myanmar as of December 2020 Error! Bookmark not defined. Figure 2: RDT distribution from the central warehouse to States/Regions and monthly monitoring on RDT tests and stock-out (Oct. 2020 – Dec. 2020) 5 Figure 3: ACT distribution from the central warehouse to State/Region and monthly monitoring on consumption and stock-out (Oct. 2019 - Dec. 2020) 6 Figure 4: Malaria testing and diagnosis by different approaches (Oct. 2020 – Dec. 2020) 10 Figure 5: Reporting status of VMWs/PPs by State/Region 15 Figure 6: RDQA Coverage of Defeat Malaria by Townships (Oct. 2020 – Dec. 2020) 15 Figure 7: Township-wise positive case contribution (Oct. 2020 – Dec. 2020) 16
ANNEXES ANNEX 1: SUSTAINING DEFEAT MALARIA’S INTERVENTIONS DURING COVID-19 PANDEMIC ...... 26 ANNEX 2: SBCC MATERIALS PRODUCED FOR DISTRIBUTION ...... 30 ANNEX 3: QUARTERLY REPORT ON PILOT MALARIA ELIMINATION ACTIVITIES IN TOUNGUP, RAMREE AND MUNAUNG TOWNSHIPS (OCT. – DEC. 2020) ...... 31 ANNEX 4: EARLY DETECTION AND RESPONSE OF MALARIA OUTBREAK AT PYIN BOKE VILLAGE OF PAUKTAW TOWNSHIP IN RAKHINE STATE ...... 39 ANNEX 5: WOMEN EMPOWERMENT AND COMMUNITY STRENGTHENING THROUGH CSG IN NA KHAN TAW VILLAGE IN LAUNGLON TOWNSHIP OF TANINTHARYI REGION ...... 44 ANNEX 6: SUSTAINABILITY OF ACTIVITIES THROUGH CSG FUND DISBURSEMENT IN ZEE KWIN VILLAGE ...... 46 ANNEX 7: CASE FINDING AND MANAGEMENT OF ALL APPROACHES (PCD, ACD, ALL INCLUSIVENESS) BY TOWNSHIPS (OCT. 2020 – DEC. 2020) ...... 48
DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. - DEC. 2020)
ANNEX 8: PROACTIVE AND REACTIVE CASE DETECTION BY MOBILE TEAM (OCT. 2020 – DEC. 2020) ...... 49 ANNEX 9: VMWS/PPS MEETINGS (OCT. 2020 – DEC. 2020) ...... 52 ANNEX 10: SUPERVISION AND MONITORING OF VMWS/PPS (OCT. 2020 – DEC. 2020) ...... 53 ANNEX 11: REPORTING STATUS OF VMWS AND PPS (OCT. 2020 – DEC. 2020) ...... 54 ANNEX 12: CLINICAL AUDIT (OCT. 2020 – DEC. 2020) ...... 55 ANNEX 13: STOCK-OUT MONITORING AT THE TIME OF MONITORING VISITS (SUPERVISION VISIT AND RDQA) AND ON-SITE DATA COLLECTION (OCT. 2020 – DEC. 2020) ...... 56 ANNEX 14: STOCK-OUT MONITORING AT MONTHLY MEETING (OCT. 2020 – DEC. 2020) ...... 58 ANNEX 15: HEALTH WORKERS TRAINED IN MALARIA DIAGNOSTICS AND CASE MANAGEMENT (OCT. 2020 – DEC. 2020) ...... 60 ANNEX 16: CAPACITY BUILDING ON INTEGRATED COMMUNITY MALARIA VOLUNTEER (OCT. 2020 – DEC. 2020) 61 ANNEX 17: BEHAVIOR CHANGE COMMUNICATION ACTIVITIES (OCT. 2020 – DEC. 2020) ...... 62 ANNEX 18: PERFORMANCE INDICATORS TRACKING TABLE (OCT. 2020 – DEC. 2020) ...... 63 ANNEX 19: COST SHARE PLAN ...... 69
DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. - DEC. 2020)
Acronyms and Abbreviations ABER Annual Blood Examination Rate ACD Active case detection ACT Artemisinin-based combination therapy ANC Antenatal Care API Annual Parasite Incidence ARC American Refugee Committee CBHW Community-Based Health Workers CDC Centers for Disease Control and Prevention COVID-19 Corona virus disease 2019 CPIR Commodity Procurement Information Request CSG Community Support Group DOT Directly Observed Therapy DQO Data Quality Officer EHO Ethnic Health Organization FY Fiscal year ICMV Integrated Community Malaria Volunteers IPC Interpersonal communication ITN Insecticide treated net Jhpiego Johns Hopkins Program for International Education in Gynecology and Obstetrics LLIN Long-lasting insecticidal nets M&E Monitoring and Evaluation MECC Malaria Elimination Coordination Committees MHAA Myanmar Health Assistant Association MMP Mobile and migrant populations MMW Mobile Malaria Worker MNMA Myanmar Nurse and Midwife Association MoHS Ministry of Health and Sports NFPP Non-formal private provider NMCP National Malaria Control Program NSP National Strategic Plan NTG National Malaria Treatment Guidelines P.f. Plasmodium falciparum PLA Participatory learning and action PMI President’s Malaria Initiative PP Private providers PPM Public Private Mixed P.v. Plasmodium vivax Q1 Quarter 1 RACD Reactive case detection RDQA Routine Data Quality Assessments RDT Rapid Diagnostic Test
DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. - DEC. 2020)
SBCC Socio-behavior change communication SC Sub-rural Health Center SMT Senior Management Team SRS Southern Rakhine State TES Therapeutic Efficacy Study TPR Test Positivity Rate URC University Research Co., LLC USAID United States Agency for International Development VBDC Vector Borne Disease Control VBS Village Based Stratification VMW Village Malaria Worker WHO World Health Organization YCDC Yangon City Development Committee
DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Executive Summary Malaria is becoming an increasingly focal disease in Myanmar, where twelve townships in five States/Regions accounted for 64% of the country’s malaria burden according to the National Strategic Plan (NSP, 2021-2025). As of the end of December 2020, the Defeat Malaria project is implementing activities in 2,909 villages of 36 townships for about 1.6 million people by mobilizing the community resources and capacity building to 2,148 Integrated Community Malaria Volunteers (ICMV) and 22 Mobile Malaria Workers (MMW). The Defeat Malaria Activity, funded by the U.S. President’s Malaria Initiative (PMI) and the United States Agency for International Development (USAID), runs from 15th August 2016 to 14th August 2022 and is implemented by University Research Co., LLC (URC), in partnership with American Refugee Committee (ARC), Jhpiego, and Duke University, Global Health Institute. Defeat Malaria also involves local partner organizations including the Myanmar Health Assistant Association (MHAA) and Myanmar Nurse and Midwife Association (MNMA) in contributing to local capacity building efforts. Defeat Malaria currently covers two States (Rakhine and Kayin) and two Regions (Tanintharyi and Sagaing) of Myanmar. October 2019 to September 2020 was the fourth year of the Defeat Malaria project with sustainability as a focal point in the project design and implementation. USAID's definition of sustainability is “the ability of a local system to produce desired outcomes over time. Discrete projects contribute to sustainability when they strengthen the system’s ability to produce valued results and its ability to be both resilient and adaptive in the face of changing circumstances.” (USAID, 2014)1 Defeat Malaria designed the activities not only to meet the strategic objectives but also to sustain desirable outcomes and enable self-reliance among local actors. Defeat Malaria mobilizes community resources and builds the capacity of around 2,200 Integrated Community Malaria Volunteers (ICMVs)/Village Malaria Workers (VMWs)/ Mobile Malaria Workers (MMWs) for providing community- based malaria interventions and serving their own communities. The areas selection were based on the villages under jurisdiction of a sub-rural health center, receiving primary health care services by outreach health care visits and hard-to-access health care areas which were identified by the outputs of malaria implementing partners mapping and consultative meetings with State/Region/Township Health Departments by functional gap analysis aiming for universal malaria health service coverage. Regarding the new tool development, Defeat Malaria supported the National Malaria Control Program (NMCP) for conducting an operational research on the performance of highly sensitive malaria Rapid Diagnostic Test (HsRDT) in reactive case detection. The findings and recommendations have been submitted to NMCP, disseminated at 48th Myanmar Health Research Congress, and evaluated the utility of tool development by integration with the findings of other similar studies conducted in Myanmar during 2020. Regarding the new approach development, Defeat Malaria in collaboration with NMCP have been implementing an operational research on “Impact of mosquito topical repellents and extended standard interventions on malaria control and elimination in Myanmar” which aims to develop malaria preventive service package for vulnerable and marginalized forest goers and recommendation for the integration in the NSP. As the surveillance is the core intervention for malaria elimination, township-wise malaria elimination initiatives were piloted at Toungup, Ramree and Munaung Townships by Defeat Malaria in collaboration with NMCP, Township Health Departments, and State Health Department of Rakhine State. Additionally, Township Malaria Elimination Coordination Committees have been established since 2018 for creation of
1 USAID (2014). Local Systems: A Framework for Supporting Sustained Development
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local network, strengthening of inter-sectoral coordination, and continuous multi-sectoral support to malaria elimination activities. The Defeat Malaria capacity building strategy has been developed and provides cascades of trainings to all levels of the health system, including Master Mentors trainings for State/Region level staff and General Trainers trainings for Township level staff. They have been well trained for further provision of necessary trainings (technical on community-based malaria interventions, malaria elimination and training skills) to basic health staff and VMWs/ICMVs/MMWs. The retention of knowledge and skills were continuously assessed for maintaining their capacities. This mechanism has been put in place for regular on-site coaching during supervisory visits. The training manuals have been developed and the strategy has been documented to support the capacity building strategy of NSP. Defeat Malaria designed and implemented activities for sustainability of institutionalization in the forefront. Community engagement is important for sustainability and local ownership at all phases of the project cycle. The Participatory Learning and Action (PLA) approach was introduced for socio-behavior change communication (SBCC), community behavior impact and promoting community involvement for malaria elimination activities. These activities started in Year 4 and will continue until the end of the project. The PLA approach was developed as a quality improvement output after conducting quantitative and qualitative mixed assessments in Year 3 and 4 through applying segmental analysis. The SBCC strategy intends to meet various needs of different communities and is also based on reducing perceived risks of the communities due to the changing malaria situation. Defeat Malaria areas have experienced zero indigenous malaria transmissions for over a year at around 80% of actioned villages/worksites by the end of Year 4. Over the course of the project, URC has built the capacity of local organizations, including MHAA, MNMA, Ethnic Health Organizations (Karen National Union Department of Health and Welfare and Backpack Health Workers Team), and 143 Private Providers (PP) from the companies and worksites. The project has also engaged with 31 General Practitioners and Medical Doctors from private companies to provide them with updates on the national malaria treatment guideline (NTG), for use of quality assured drugs only after applying standard malaria RDT, immediate notification, timely reporting, and involvement in surveillance activities. 11 Non-Formal Private Providers (NFPP) from hotspot areas were engaged for appropriate referral. And for promoting community empowerment and the journey to self-reliance, 44 community support groups (CSG) have been established in Rakhine State, Kayin State and Tanintharyi Region.
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Fiscal Year (FY) 2021 Quarter 1 Summary of Key Achievements
✔ Training activities – During Quarter 1, trainings to build up the capacity of ICMVs were conducted with 194 VMWs (53 males and 141 females), and 10 PPs (1 male and 9 females).
✔ 65,329 people were tested for malaria by VMWs, PPs, MMWs, and mobile outreach teams.
✔ 812 positive cases were detected in which 807 cases were treated, 4 cases were appropriately referred for being pregnant and another one case was identified with severe Plasmodium vivax (P.v.) infection. 800 out of 807 treated cases (99.1%) were in line with the National Malaria Treatment Guideline (NTG).
✔ Under the Directly Observed Therapy (DOT), a total 545 out of 812 positive cases (67.1%) were enrolled for DOT and 542 out of 545 enrolled cases (99.45%) completed the treatment courses under DOT. - 374 out of 555 P.v. cases were enrolled (67.4%) and 371 out of 374 enrolled P.v. cases (99.2%) completed 14-days treatment courses under DOT; - 3 out of 14 mixed cases (21.4%) were enrolled and all enrolled cases (100.0%) completed 14-days treatment courses under DOT; and - 168 out of 243 Plasmodium falciparum (P.f.) cases were enrolled (69.1%) and all enrolled cases (100.0%) completed 3-day DOT courses.
✔ Interpersonal communication – Defeat Malaria reached 47,492 people (24,272 males and 23,220 females) including 7,567 migrants through interpersonal communication (IPC). It also reached 540 people (191 males and 349 females) including 181 migrants by conducting 63 group health talk sessions.
✔ A total of 3,349 long-lasting insecticidal nets (LLINs) were distributed in mass campaigns and in continuous distribution? - 2,802 LLINs were provided in 13 villages and 22 worksites by mass and continuous distribution. - 350 LLINs were provided to pregnant women attending antenatal clinics. - 184 LLINs were distributed during response activities after case investigation and foci investigation. - 13 LLINs were distributed to migrant people by collaboration with the Lutheran World Federation in Ann township.
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Introduction Defeat Malaria coverage as of December 2020 Defeat Malaria currently covers Rakhine State, Kayin State, Tanintharyi Region, and Sagaing Region in Myanmar. Rakhine State is one of the highest malaria burden states in Myanmar (NSP, 2016-2020) and has deep forested mountain ranges. Dawna Mountain Range in Kayin State extends southward, merging with the northern part of Tanintharyi Hill. Sagaing Region stood fourth in high malaria occurrences after Chin, Rakhine, and Kayin States in 2018. Deeply forested areas provide favourable conditions for mosquitoes’ receptivity and contribute to a high malaria prevalence. In addition, the difficult terrain is a significant barrier to access health services in these remote areas. Table 1 provides a summary of villages and populations covered by Defeat Malaria. By the end of June 2020, the Defeat Malaria project is sustaining the implementation of activities in 36 townships. In 2020, the national program, supported by Defeat Malaria in collaboration with other implementing partners, worked to ensure universal coverage of malaria prevention, case detection, and management services in Myanmar by inclusiveness of hard-to-reach populations residing in high malaria Figure 1: Geographic distribution of Defeat Malaria risk areas. Led by NMCP, supported by Defeat activities in Myanmar as of December 2020 Malaria, malaria services reached beneficiaries through a network of 2,148 VMWs/PPs, township mobile teams, and 22 MMWs at 2,909 villages and worksites. Currently, Defeat Malaria’s overall population coverage is around 1,599,148 beneficiaries. Table 1: Defeat Malaria implementing areas and coverages as of December 2020 State & Region No. of Total Total Covered Total Total % of VMWs/PP Covered Villages/ Population Covered Population s /MMWs Townships Worksites Population Covered Tanintharyi 507 10 606 1,408,401 345,538 24.53% Northern Rakhine 741 10 727 1,298,458 452,653 34.86% Southern Rakhine 505 7 1,001 1,065,898 456,643 42.84% Kayin 215 4 241 1,008,001 136,866 13.58% Sagaing 202 5 334 747,114 207,448 27.77% Total 2,170 36 2,909 5,527,872 1,599,148 28.93% During FY 2020, a central level launching ceremony of malaria elimination had been conducted and the subsequent State/Region level and township level launching for malaria elimination is pending due to the COVID-19 pandemic. In the recent virtually conducted malaria implementing partners coordination meeting, the NMCP presented expansion of malaria elimination activities in which 14 townships of Defeat Malaria implementation areas were included. This included 9 Defeat Malaria townships in Rakhine State
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(Thandwe, Gwa, Kyaukphyu, Ann, Sittwe, Rathedaung, Ponnagyun, Pauktaw, and Myebon), 3 townships in Tanintharyi Region (Launglon, Myeik, and Kawthoung), Hpa-An Township in Kayin State, and Pale Township in Sagaing Region. Moving towards sustainability, NMCP will be taking the leading role and Defeat Malaria will further support these elimination townships based on the experiences of project’s pilot malaria elimination implementation in the three townships of Southern Rakhine States. Fiscal Year 2021 Quarter 1: Activities by Objectives Objective 1: Achieve and maintain universal coverage of at-risk populations with proven vector control and case management interventions, while promoting the testing of new tools and approaches. ❖ Ensure the distribution of LLINs, diagnostics, and quality-assured medicines to the beneficiary populations, health services and collaborating VMWs in the targeted areas Commodity distribution and stock monitoring As part of Defeat Malaria’s malaria diagnosis and case management for community-based malaria interventions, the project collaborates with PMI and Chemonics for international procurement and uninterrupted supply of malaria commodities to the targeted communities. In this quarter, there was a commodity procurement information request for 150,000 tablets of Chloroquine. We received 349,950 LLINs and 27,000 artemisinin-based combination therapy (ACT) strips as below: Table 2: Commodity Procurement Information Request (CPIR) and Received Information (Oct – Dec 2020) CPIR Receive Commodity Countin Received Expiratio Specification CPIR Date Quantit d Items g Unit Date n Date y Quantity Deltamethrin treated 27-Aug- 04-Nov- LLINs Piece 300,000 349,950 May 2025 (Yahe) 2019 2020 Artemether 20 mg Strip 27-Aug- ACT 27,000 29-Dec-2020 27,000 Aug 2022 Lumefantrine 120 mg (6x4) 2019 Chloroquine Chloroquine (250 mg base) Tablet 03-Dec-2020 150,000 - - -
Figure 2: RDT distribution from the central warehouse to States/Regions and monthly monitoring on RDT tests and stock-out (Oct. 2020 – Dec. 2020)
Every ICMV retains at least 25 RDTs which are replenished monthly based on consumption. Based on the population coverage, mobility dynamics, hard-to-access areas (not only physical like environmental conditions and remoteness of areas but also social conditions such as conflict sensitivity), and the
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restrictions of movement due to COVID-19 transmission, additional RDTs were equipped for reducing the risk of experiencing stock-out. The remaining RDTs will expire in March 2021 and pipeline RDTs are expected to be received in April 2021. In this reporting period, a total of 61,425 RDTs were distributed from the Yangon warehouse to township warehouses. Although there were around 20,000 RDTs used for malaria diagnosis in the field per month during first quarter of FY 2021, a relatively high number of stocks were distributed from Yangon warehouse to township warehouses in November 2020 at the reopening of transport routes after COVID-19 restrictions were lifted due to lower COVID-19 transmission. Figure 3: ACT distribution from the central warehouse to State/Region and monthly monitoring on consumption and stock-out (Oct. 2019 - Dec. 2020)
Every ICMV is provided at least 3 ACT strips, but more ACTs are provided to those who are working in high malaria transmission areas. The remaining and maximum available shelf-life is 20 months. The existing ACTs will expire in June 2022 and August 2022. In this reporting period, a total of 3,683 ACT strips were distributed from Yangon warehouse. Due to travel restrictions under COVID-19 spread in Rakhine State, NMCP had experienced shortage of ACT and requested URC for support of ACTs to Rakhine State Vector Borne Disease Control (VBDC) teams. Upon the NMCP’s request and the availability of drugs at the Defeat Malaria’s warehouse, Defeat Malaria donated 2,000 strips of ACTs to NMCP of Rakhine State Health Department in December 2020. During Q1 FY 2021, stock-out monitoring was conducted a total of 5,622 times, including 3,575 times at VMWs/PPs meetings, and 2,399 times during supervision visits and on-site data collection. No stock -outs of ACTs and RDTs for VMWs/PPs were experienced in this reporting period. ❖ Optimize coverage and promote use of proven vector control interventions Strengthening Behavior Change Communication Interpersonal Communication and Group Health Talks From October 2020 to December 2020, a total of 47,492 people (49% female), including 7,567 migrants, were reached through IPC activities to share key malaria preventive messages during case management in villages and worksites from VMWs/PPs. Moreover, group health talks were conducted to share malaria preventive messages and to increase utilization of LLINs during mobile team case finding and before LLIN distribution. In Q1 FY 2021, 63 group health talk sessions were conducted in the villages and worksites reaching 540 people (65% female), 181 of whom were migrants. Production of Behaviour Change Communication toolkit During the reporting period, 2,643 pamphlets were distributed to promote correct ways of malaria prevention and treatment measures in community. Moreover, other SBCC materials were produced to
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promote Defeat Malaria branding and awareness of community towards malaria prevention and elimination (see Annex 2 for SBCC materials produced for distribution). Printed digital media and Defeat Malaria on Social Media The Defeat Malaria team leverages social media to strengthen online communication and disseminate project achievements, reach local people and groups, and advocate to donors and stakeholders of interest and investment in malaria elimination. The project’s Facebook page (“Defeat Malaria Myanmar”) is routinely updated with field implementations, health messaging, and participation of Defeat Malaria special events: International day for rural women and Universal Health Coverage Day. In Q1 of FY 2021, Defeat Malaria’s Facebook page reached 25,201 people. Mass and top up distribution of LLINs LLIN distribution is a key vector control mechanism and, under Defeat Malaria, LLIN distribution is prioritized in high malaria transmission areas and high-risk and vulnerable people such as migrants and pregnant women. The project applies multiple approaches for LLINs distribution, including mass and continuous distribution at the villages and work sites, distribution to pregnant mothers at antenatal care (ANC) clinics, and distribution to malaria hotspots through engagement of the ethnic health organizations (EHOs). Mass LLIN distribution activities were prioritized in collaboration with the NMCP and other partner organizations to improve efficiency of vector control interventions. In total, 1,911 LLINs were distributed to get adequate coverage for 3,505 people residing at 793 households in the 13 villages. In these villages, existing LLINs that have been in use for over two and half years were in need of replacement. Table 3: Long lasting insecticide net (LLIN) distribution at villages (Oct. 2020 – Dec. 2020) Indicator Mass Continuous Grand Total Distribution # of Villages 8 5 13 # of Households Covered 720 73 793 # of Population Covered 3,137 368 3,505 Total LLINs distributed 1,717 194 1,911 Net Ownership (Persons/LLIN) 1.83 1.90 1.83
LLIN distribution to migrants and mobile populations in collaboration with employers In all activities, Defeat Malaria targeted to include mobile and migrant populations (MMP) and LLINs were distributed at work sites. During Q1 FY 2021, a total of 891 LLINs were distributed in 22 worksites to cover all 1,640 MMPs residing in 468 households. Average population per LLIN was 1.84 (see Table 5 below). Table 4: LLIN distribution at worksites (Oct. 2020 – Dec. 2020) Indicator Mass distribution COntinuous Grand total # of worksites 9 13 22
# of Households Covered 237 231 468
# of Population Covered 767 873 1,640 Total LLINs distributed 423 468 891 Net Ownership (Persons/LLIN) 1.81 1.87 1.84
LLIN distribution to pregnant women during Ante-natal Care (ANC) in high transmission areas Defeat Malaria, in collaboration with Township Health Departments and Rural Health Centers, provided 350 LLINs to pregnant women at their ANC visits to health centers (areas selection by respective basic health staff) in Ann, Gwa, Thandwe, Toungup, Kyauktaw and Minbya Townships of Rakhine State.
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Monitoring on LLIN coverage and utilization Defeat Malaria conducts monitoring and evaluation of the LLIN distribution after 6 months for tracking and identifying the status of LLIN coverage in accordance to WHO recommendations 2. This is done to assure that coverage is at an acceptable level (at least 15 out of 21 households monitored own one LLIN for every 2 people) or mass or top up of LLIN gaps. Moreover, health awareness sessions were provided to the communities if LLIN utilization was not found to be acceptable (less than 70% of interviewees reported sleeping under an LLIN in the previous night). Since FY 2020, paper based LLIN monitoring activities by Lot Quality Assurance Sampling has been replaced by applying mobile tablets using ODK apparatus to support the users for guiding to take necessary actions in the communities. In this quarter, LLINs monitoring were conducted at 86 villages of which 83 villages (96.5% of total monitored villages) were identified as having acceptable LLIN coverage. Regarding LLIN utilization, 84 villages (97.7% of total monitored villages) were found to have an acceptable level of LLIN utilization and community participatory learning, and actions were undertaken in two villages with low LLIN utilization. During the threat of COVID-19 pandemic and aiming to upkeep the community empowerment process for sustainability, community means of LLIN monitoring activities were encouraged and supervised. ICMVs and communities continued the actions through their active participation. Table 5: LLIN Coverage and Utilization by Defeat Malaria State/Region (Oct. 2020 – Dec. 2020) # Villages LLIN Coverage LLIN Utilization State/Region monitored # (%) of villages # (%) of villages # (%) of villages # villages with with acceptable with with acceptable unacceptable Coverage unacceptable utilization utilization Coverage Tanintharyi 58 58 (100%) 0 58 (100%) 0 Rakhine (South)* 0 0 0 0 0 Rakhine (North)* 0 0 0 0 0 Kayin 28 25 (89.3%) 3 (10.7%) 26 (92.9%) 2 (7.1%) Sagaing* 0 0 0 0 0 Grand Total 86 83 (96.5%) 3 (3.5%) 84 (97.7%) 2 (2.3%) *This activity could not be conducted in Rakhine State due to home stay announcements and travel restrictions, and in Sagaing Region due to the Regional Health Department issuing a letter to not conduct field activities by implementing partners (Sagaing Defeat Malaria team communicated case by case for prioritized actions). Disposal of Medical Waste and LLIN Bags During Q1 of FY 2020, 2,802 emptied plastic bags of LLINs were disposed of by burial in accordance with the Environmental Mitigation and Monitoring Plan guidelines. The environmental hazards of burning plastic bags and materials were explained to communities and the disposal of emptied plastic bags were done by the involvement of communities for promoting the ecosystem of their rural environments. The plastic bags were buried at least 100 meters away from any wells or surface water source and at least 1.5 meters above the water table. Some CareStart RDTs that were expired in October 2020 are currently stored at township offices (64,769 tests) and at Yangon warehouse (27,650 tests). Used RDTs from ICMVs were instructed to be disposed of in waste boxes and used RDT boxes were collected by the township teams and stored at the offices of
2 WHO (2017) Achieving and maintaining universal coverage with long-lasting insecticidal nets for malaria control)
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each townships. Used RDT and expired RDTs will be transported to Yangon for incineration at the Yangon Waste to Energy Plant in coordination with Yangon City Development Committee (YCDC). Some ACT drugs expired in September 2020 are currently stored at the respective townships (6,431 strips) which will later be sent to Yangon. These drugs, together with expired drugs stored at Yangon warehouse (1,289 strips), will be appropriately written off in coordination with YCDC. The lancets and sharp objects used for taking blood were instructed to be placed into the waste boxes and disposed of at the well-designed incinerators of nearby designated township hospitals. The designated hospitals for incineration are Buthidaung and Kyaukphyu Township hospitals for Rakhine State, Dawei hospital for Tanintharyi Region, and Hpa-An hospital for Kayin State. ❖ Ensure early diagnosis and appropriate treatment of all clinical malaria cases Capacity building of VMWs/PPs on diagnosis, case management, RDT use and correct ACT prescription During Q1 FY 2021, 204 ICMVs (194 VMWs and 10 PPs) received the trainings on parasitological tests for malaria and malaria case management for three days, and other integrated diseases for additional two days. Preventive knowledge, common symptoms and presentations related to tuberculosis, dengue, lymphatic filariasis, STD/HIV, and Leprosy were imparted according to the training agenda. The intentions of the annual trainings to ICMVs were to maintain their knowledge and skill for serving quality health care to their own communities, getting direct linkages between supervisor (basic health staff who were trainers) and supervisee (ICMVs who were trainees), creating communication network between BHS and ICMVs, fostering sustainability of community-based malaria interventions beyond Defeat Malaria, and readiness for roll in and uptake to become Community-Based Health Workers (CBHW) after finalization of operationalizing the CBHW policy in 2022. In addition, one Mobile Malaria Worker (MMW) was trained for parasitological testing of malaria and case management to serve malaria health care service at hard- to-reach worksites in the forest near Ma Ei village of Toungup Township in Rakhine State. VMW/PP supervision During this reporting period, ICMVs from Rathedaung, Buthidaung and Maungdaw Townships were coached and supervised at monthly meetings due to restriction of field visits under security conditions. ICMVs from the remaining townships received on-site supervision but virtual supervisions were applied in some areas where travel restrictions were in place due to the threat and spread of COVID-19 transmission. From October to December 2020, Defeat Malaria township teams conducted 637 supervision visits (605 visits to VMWs and 32 visits to PPs). The supervision was in line with the low dose high frequency approach of capacity building strategy, and the intentions of supervision to ICMVs were for promoting patient safety, strengthening data quality assurance, checking the correctness of stock management, recognition of their contributions and performance, and continuous motivation. Clinical audit on treatment of positive cases according to National Malaria Treatment Guidelines Clinical audits were carried out for promoting patients’ safety which Defeat Malaria township teams conduct on a monthly basis to assess the quality of care provided by VMWs/PPs in treating the malaria patients. All the treated cases provided were checked to identify if there were any deviations from the NTG. According to findings of the clinical audit, 807 out of 812 positive cases were treated, and 5 cases were appropriately referred to health facilities according to the guideline. Out of 807 treated, 800 cases (99.1%) received the treatment according to the NTG. The reasons behind not following NTG were explored and identified that 2 Pregnant women and 2 children under 1 year of age were referred to health facilities, but the patients and guardians refused and ICMVs had to provide the treatments upon patients' and guardian's autonomy. Three more patients experienced incorrect prescription of Primaquine and the responsible ICMVs were coached by township supervisors for the appropriate utilization of job aids.
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Active case detection To achieve universal malaria service coverage, no one should be left behind. Defeat Malaria usually provides proactive case detection to small settlements where the recruitment of community health workers is challenging. In this reporting period, proactive case detection was conducted in 12 villages and no cases were identified among 208 people tested for malaria. To prevent onward transmission in low and no malaria transmission areas, Defeat Malaria conducted reactive case detection around the index or primary case. During this reporting period, Defeat Malaria tested 1,580 contacts of106 index or primary cases and yielded additional 25 positive cases (7 P.f., 17 P.v. and 1 mixed case). Testing and diagnosis of malaria by different approaches (Oct. 2020 – Dec. 2020) Figure 4: Malaria testing and diagnosis by different approaches (Oct. 2020 – Dec. 2020)
Total Tested Total Positive TPR%
60,000 1.4% 1.3% 1.50% 51,370 50,000 40,000 1.00% 30,000 0.6% 0.6% 20,000 0.50% cases 8,184 10,000 4,433 1,342 8 700 57 47
- 0.00% (%) Rate Positivity Test
Mobile VMWs PP others Number of tested/positive tested/positive of Number During this reporting period, 65,329 people were tested through various approaches by community-based malaria diagnosis and treatment through VMWs (including the activities of MMW), collaboration with NMCP for conducting active case detection by mobile teams, and the engagement with private sectors. 812 positive cases were identified (243 P.f., 555 P.v. and 14 mixed). The overall TPR was 1.24% (see Table 6). More specifically, mobile teams tested 1,342 people, VMWs tested 51,370 people, private providers tested 4,433 people, and all other providers tested 8,184 people. Passive case detection of malaria service provided by VMWs/MMWs/PPs were found to have higher TPR than all other providers/approaches (see Figure 4). Table 6: Malaria testing by Defeat Malaria covered State/Region (Oct. 2020 – Dec. 2020) State/Region Tested Total Positive P.f. P.v. Mix TPR % Tanintharyi Region 15,294 235 22 208 5 1.54% S. Rakhine State 17,417 85 68 14 3 0.49% N. Rakhine State 21,814 385 133 246 6 1.76% Kayin 4,917 73 0 73 0 1.48% Sagaing 5,887 34 20 14 0 0.58% Total 65,329 812 243 555 14 1.24% Directly Observed Therapy (DOT) and patients’ compliance to DOT Under the DOT strategy, 545 of 812 positive cases (67.1%) were enrolled for DOT and 542 cases (99.5% of enrolled cases) completed the treatment courses; 374 out of 555 P.v. cases (67.4%) were enrolled for DOT and 371 P.v. cases (99.2% of enrolled cases) completed 14-days treatment courses under DOT; 3 out of 14 mixed cases (21.4%) were enrolled and all mixed cases completed 14-days treatment courses under DOT; and 168 out of 243 P.f. cases (69.1%) were enrolled and all enrolled cases completed 3-days treatment courses under DOT.
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Quality Assurance of RDT As there were occasional errors encountered in CareStart RDT testing, the instructions were given to all field teams and VMWs/PPs/MMWs for proper performance of RDT testing and reading according to the standard procedure. a. To add only two drops of diluent for CareStart RDT testing; b. To read RDT result within 20-30 minutes after adding the diluent; c. To store RDT boxes in an appropriate cool and dry place; d. If control line does not appear, repeat with another RDT strip; e. If control line still does not appear, VMWs/PPs need immediate notification to the township team. There was a report of high malaria occurrence in Pyin Boke Village of Pauktaw Township in Northern Rakhine. Starting from 2nd to 30th December 2020, 214 people were tested by VMW in which 27 patients were detected as P.v. infection. Defeat Malaria notified immediately to and collaborated with Township/State Health Department on 3rd December 2020 for appropriate investigation and response actions. The response team led by the State Health Department visited the affected Pyin Boke Village and the initial 15 cases were re-examined by SD Bioline RDT and then by microscopy. The findings showed that there were inconsistent results among the three diagnostic tests as below: Table 7: Results of three types of malaria diagnostic tests Types of tests Positive results Negative results Total CareStart RDT 15 - 15 SD Bioline RDT 5 10 15 Microscopy 4 11 15
Defeat Malaria in collaboration with the VBDC team checked the RDT storage and suggested the VMW of Pyin Boke to demonstrate the RDT testing. It was found that VMW’s performance on RDT testing was found correct for the amount of diluent used and the reading time for the results. RDT boxes were appropriately stored. Control line was also seen. The CareStart RDT samples from the village and township office have been collected by the State level Defeat Malaria team for sending to Yangon for quality check of the test kits at the Department of Medical Research. The inconsistencies of the results were explored and found that VMW used CareStart RDTs on 2nd and 3rd of December 2020 for the initial 15 patients and all those patients were administered Chloroquine treatment immediately after the results obtained. The response team arrived and rechecked to those 15 patients by SD Bioline RDTs on 4th December 2020 and by microscopy on 5th December 2020. It could be assumed that the negative results obtained by malaria microscopy could be due to the disappearance of malaria parasites after the treatment. This scenario was discussed at the recent VBDC annual review meeting and it was under the close supervision of central NMCP and Rakhine State Health Department. Regarding ACT drugs, quality assessments were conducted by the Food and Drug Administration Department, which revealed 100% efficacies consistent in the previous three years and there were no reports about clinical failure after the complete treatment from the field. In FY 2021, quality assessment for ACT drugs were not planned, but Defeat Malaria proceeded to check the quality of ACT drugs through the Promoting Quality of Medicines Program of U.S. Pharmacopeia.
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
❖ Strengthen and expand the network of VMWs to improve access to basic diagnostics and treatment services (RDTs and ACTs), particularly for high-risk and hard-to-reach populations Malaria implementation partners mapping In this quarter, malaria implementing partners mapping was updated by the collaboration with principal recipients of Global Fund (United Nations Office for Project Support and Save The Children), USAID PMI (URC Defeat Malaria), Three Millennium Development Goal (3MDG) Funded Access to Health partners, and Non-Global Fund and Non-3MDG partner (Population Services International). It was identified that there were 13,301 villages in Tanintharyi and Sagaing Regions, and Kayin and Rakhine States and the cumulative sum of villages implemented by malaria implementing partners was 13,225. During the initial year of Defeat Malaria’s implementation, Defeat Malaria supported technically, operationally and financially for conducting malaria implementing partners mapping after conducting effective advocacy to respective State/Region Health Departments and collaborated with all implementing partners including ethnic health organizations. Starting from Year 3 of Defeat Malaria implementations, the mapping updates have been led by NMCP and State/Region/Township Health Departments. Defeat Malaria continued the support financially by collaboration with Global Fund partners. Reaching hard-to-reach forest goers through the recruitment of Mobile Malaria Workers MMWs were mobilized from migrant workers who worked in the remote forested worksites for provision of malaria prevention, diagnosis, and case management services. By networking with nearby VMWs for reporting and replenishment of malaria commodities, 13 MMWs in Tanintharyi Region and 9 MMWs in Southern Rakhine State were trained in malaria diagnosis and case management activities in this quarter. One new MMW was recruited in Toungup in response to the high number of malaria cases detected in the worksite near Chay Taw Yar Village which is under the coverage of Tha Dun rural health sub-center in Toungup Township. As a result, MMWs tested 433 forest goers in their worksites and appropriately treated 2 P.f cases and 26 P.v cases (TPR – 6.5%). The yield in malaria cases contributed by MMWs in term of TPR was much higher than the results obtained by other approaches (VMWs, PPs, and township mobile team) ❖ Conduct operational research to pilot promising new tools and approaches to reduce malaria transmission as directed by NMCP, in consultation with the PMI/USAID The primary objective of this study is to assess the effectiveness of extended standard interventions, namely LLINs, topical repellent, provision of behavioral change communication package and training and supervision of MMWs, in reducing malaria incidence in villages resided by forest-goers. Since March 2020, forest goers have been contacted and invited based on the eligibility criteria, and 2,624 participants have been involved in the study. Malaria data for the study villages from 2017-2019 were already collected from Defeat Malaria as well NMCP sources. Control villages from the same township with similar epidemiology were identified and malaria data were also collected. Interrupted time series analysis will be applied to analyze the effectiveness of intervention, while malaria data from control villages will rule out the effect of natural trend of malaria incidence for valid analysis. From July to December 2020, field research activities for operational research were conducted in line with the original timeline. However, due to unforeseeable challenges such as the advent of COVID-19 and security concerns in Rakhine State, research activities were implemented later than anticipated and some modifications were made to the study sites. Despite challenges due to COVID-19, the study has gained momentum in compliance with social distancing protocols from the Ministry of Health and Sport (MOHS).
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Detailed report on this operational research on topical repellent study will be submitted separately to PMI according to the usual practice of Defeat Malaria reporting bi-annually as suggested by PMI. The progress of survey activities are seen as below:
Table 8: Progress of survey activities (Mar. - Dec. 2020)
Progress Mar'20 Apr'20 May'20 Jun'20 Jul'20 Aug'20 Sep'20 Oct'20 Nov'20 Dec'20 Total RDT Tested 20 49 60 119 162 175 195 252 149 300 1,481 RDT (+) 1 0 1 6 7 4 0 2 3 2 26 P.v 1 0 1 6 6 4 0 2 3 2 25 P.f 0 0 0 0 0 0 0 0 0 0 0 Mixed 0 0 0 0 1 0 0 0 0 0 1 RDT (-) 19 49 59 113 155 171 195 250 146 298 1,455
Interview 0 0 0 3 6 5 1 1 3 4 23 (case) Interview 0 0 0 1 20 15 6 5 8 10 65 (control) Repellent 1 19 108 188 180 214 278 340 325 270 1,923 Replenished Objective 2: Strengthen the malaria surveillance system to comprehensively monitor progress and inform the deployment and targeting of appropriate responses and strategies. ❖ Strengthen the malaria surveillance system in line with malaria elimination, improve data management capacity at all levels of the health system, from village to central level, and support appropriate information technology to facilitate data collection, reporting, and use in both public and private sectors Advocacy, workshops, trainings, and meetings The advocacy meetings were suspended under COVID-19 situation according to the suggestions of township health authorities. VBDC Annual Review Meetings The Chief of Party, Deputy Chief of Party, Malaria Technical Advisor, Senior Technical Directors, Senior Operation Director, Monitoring and Evaluation (M&E) Director of URC Defeat Malaria and Capacity Development Manager of Jhpiego Defeat Malaria attended virtual 2020 VBDC Annual Review Meeting from 21st to 24th December 2020. The Malaria Technical Advisor of Defeat Malaria as well as the Advisor to MoHS and NMCP presented on the pilot malaria elimination activities and experiences of Southern Rakhine State to all participants involving the central NMCP staff, State/Region VBDC focal team, World Health Organization (WHO), PMI, other funding agencies and implementing partners. The recommendations of annual review meeting were to intensify the malaria burden reduction interventions in Hparpun and Paletwa Townships through quarterly mass screening and treatment; build up the capacity of entomologists; strengthen timely notification; surveillance and monitoring system with
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the involvement of VBDC, implementing partners and private sectors; strengthen malaria elimination activities by engaging voluntary health workers and by adapting CBHW policy; to fill 13 vacant microscopist positions in VBDC team; empower Laboratory Technician Grade 1 and 2 with the support from National Health Laboratory; to submit ICMV quarterly report from Google drive to central NMCP; and to update village lists and implementing partners mapping for supporting malaria surveillance system. Defeat Malaria Annual Review Meetings ● Because of COVID-19 spread, annual review meetings were organized virtually by using zoom apparatus and Microsoft Team meeting platforms. ● Annual review meetings of Defeat Malaria were conducted according to the following schedules: o Annual review meeting of MNMA was conducted on 26th November 2020; o Annual review meeting of URC Southern Rakhine State was conducted on 15th December 2020; o Annual review meeting of ARC was conducted on 16th December 2020; o Annual review meeting of URC Tanintharyi Region was conducted on 29th December 2020; and o Annual review meeting of MHAA was conducted on 30th December 2020. ● The Chief of Party, Malaria Technical Advisor, Senior Technical Director, Senior Operation Director, M&E Technical Advisor, M&E Director, PPM Coordinator of URC and Sub-Grant Officer attended the meetings virtually, where township-wise achievements of FY2020, the challenges encountered, and the actions taken were presented and discussed by the township teams. ● Significance of year 2020 and strategic priorities for FY 2021 were presented and discussed by M&E Technical Advisor. Malaria Technical Advisor presented and discussed about the malaria elimination and surveillance activities. The Senior Technical Director presented about socio-behavior change communication for community impact by applying the PLA approach. The Public Private Mixed (PPM) Coordinator presented and discussed the updates and achievements on CSG formation for community sustainability and the importance of private sector engagement for malaria control and elimination. It was also highlighted that all townships have to contribute malaria elimination activities, support for the local system strengthening, apply risk mitigation and management plan for every challenge encountered. It was noted that advocacy, communication, virtual application, and community sensitivity analysis were important for sustaining Defeat Malaria activities. ● The recommendations were made by the Senior Management Team for the application of community participatory malaria mapping, strengthening of migrant and mobility mapping, performing proactive and reactive activities to reduce the risk of disease importation, and to maintain zero indigenous malaria transmission.
Reporting status of VMWs/PPs The VMWs/PPs’ reporting status was continuously monitored for the inclusion of all reporting units for effective surveillance and regular provision of malaria diagnostics and antimalaria drugs to ICMVs to minimize the risks of stock-out. Malaria diagnosis and case management records were collected monthly from VMWs/PPs, and 6,342 (98.5%) out of a total 6,441 cumulative reports expected to be submitted for this quarter were received and of those received, 6,266 (98.8%) reports were timely (see Figure 5). Moreover, disaggregation of data revealed more than 95% of reporting performance and timely reporting proficiency in all States/Regions. The achievement exceeded the desirable target of at least 90% in FY 2021. Reporting performance is an important supporting element for the surveillance pillar of malaria elimination (WHO, 2017. A Framework for Malaria Elimination).
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Figure 5: Reporting status of VMWs/PPs by State/Region 2,500 100% 2,000 95% 1,500 90% 1,000
500 85% NumberReports of
- 80% ReportingPercent Taninthary Southern Northern Kayin Sagaing i Rakhine Rakhine # of reports to be submitted by 1,478 1,488 2,225 645 605 VMWs/PPs # of reports submitted 1,465 1,444 2,189 645 599 # of reports submitted timely 1,430 1,431 2,164 642 599 % of reports submitted 99.1% 97.0% 98.4% 100.0% 99.0% % of timely reports 97.6% 99.1% 98.9% 99.5% 100.0%
Routine Data Quality Assessment (RDQA) Defeat Malaria central M&E team continuously monitored the results of routine data quality assessment to strengthen township M&E system across all channels of reporting. At the start of Fiscal Year 2021, using the Microsoft team platform, a central M&E team led by a Documentation Officer conducted the virtual annual RDQA review meeting with state/regional level M&E focal persons. The meeting was aimed to review the achievements and challenges of last fiscal year (FY 2020) and targeting to identify strategies for improvement. It was agreed that Data Quality Officers (DQOs)/M&E Officers would conduct virtual system assessment to township staff using a simplified RDQA during the ongoing COVID-19 pandemic due to restricted travel across townships in Myanmar. Figure 6: RDQA Coverage of Defeat Malaria by Townships (Oct. 2020 – Dec. 2020) RDQA Simplified RDQA 10 10 8 2 8 6 9 6 4 8 5 4 2 3 5 2 2 0 1 1 0 0 Southern Northern Tanintharyi Kayin Sagaing NumberTownships of Rakhine Rakhine Target 10 7 10 4 5 Simplified RDQA 2 5 9 3 5 RDQA 8 2 1 1 0
In this quarter, RDQA covered all targeted township under Defeat Malaria coverage area with 12 RDQA visits and 24 simplified RDQAs. DQOs/M&E staff also conducted virtual system assessment during simplified RDQA with exception to townships in Northern Rakhine State due to limited or poor internet connection. It was also not feasible to conduct onsite data verifications at village level due to travel restriction, which resulted in only being able to conduct 3 on-site data verifications for 36 RDQAs. The result of RDQAs and simplified RDQAs revealed that all townships had acceptable levels of data quality rating and M&E system.
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
❖ Support the implementation and regular updating of village-based malaria stratification Defeat Malaria applied village-based stratification (VBS) for the malaria burden reduction areas (updated annually) for setting appropriate interventions for a particular village depending on the malaria morbidity which is measured by Annual Parasite Incidence (API; API =0, API >0 to 5, API >5 to 20, API >20), security of the areas feasible for conducting on-site case investigation, and the availability of ICMVs in the villages. Foci classification was applied to describe the malaria situation in these areas implementing malaria elimination activities. On a monthly basis, VBS data was applied for vigilance on unusual occurrence of malaria and early detection of malaria outbreak. Absolute number and cumulative sum data were routinely checked for any deviation. Population data was updated quarterly with township teams but for the population to be referenced in the calculation of Annual Blood Examination Rate (ABER) and API was based on the initial population at the start of each calendar year. For the VBS database, one of the limitations was the compulsory inclusion of all the cases detected by ICMVs in their villages as it is linked with the malaria patients register database. All the positive results were included in the case data of the village, but case classified data of the case investigation is not included. Entomological assessments Entomological assessment activities were suspended in this quarter according to the tailoring malaria intervention during COVID-19 guidance of NMCP. Vigilance on the occurrences of malaria cases In FY 2021 Q1, 812 positive cases were identified in 30 project townships and the remaining 6 (Kawthoung, Launglon, Gwa, Kyaukpyu, Munaung and Thandwe) detected no malaria cases. Among them, 4 townships revealed very low malaria transmission, which included Myeik (3 cases), Rathedaung (2 cases), Hpa-An (3 cases) and Homalin (1 case). Further, more than 80% of total malaria positive cases in this quarter were contributed by 12 townships. Absolute positive number of those listed from top to bottom is as follows: Figure 7: Township-wise positive case contribution (Oct. 2020 – Dec. 2020)
Minbya (URC) 105 Buthidaung (MHAA) 75 Kyauktaw (URC) 73 Toungup (URC) 61 Myawaddy (ARC) 60 Dawei (URC) 56 Palaw (URC) 54 Mrauk-U (URC) 50 Tanintharyi (ARC) 40 Ponnagyun (URC) 38 Kyunsu (URC) 33 Pauktaw (URC) 24 0 20 40 60 80 100 120
Contributing malaria elimination interventions by Defeat Malaria As malaria transmission is heterogenous and malaria interventions were applied differently based on the malaria intensity of the previous year 2019 data, manageable case count, local security conditions, accessibility, and phone connectivity. Basically, all 36 townships are implementing malaria elimination activities. Among these townships, 3 pilot malaria elimination townships have been implementing township-wise full package of malaria elimination interventions and some catchment areas of the
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townships were also implementing similarly as surveillance was the core malaria intervention. According to the framework for malaria elimination (WHO, 2017), surveillance of malaria should be upgraded to a core intervention in national and sub-national malaria strategies. All three pillars of Global Technical Strategy for Malaria elimination (2016-2030) were applied as much as possible in the full package of malaria elimination interventions. According to the 2019 patients record database, the beneficiaries from 6,774 villages were accessed to Defeat Malaria VMWs/PPs/MMWs and mobile clinics. These villages were categorized for appropriate interventions and tracked for performing surveillance activities during 2020. At villages with implementation of full package of elimination interventions From 1st January to 20th December 2020, 310 positive cases were found in 103 (8.4% of entitled villages) out of 1,228 entitled villages for implementing case investigation and response activities. Among those, 185 cases were investigated (60% of positive cases), 51 cases were classified as indigenous, 8 cases were introduced, 92 cases were imported from other villages but within township limit, 23 cases were imported from outside the township, 10 were relapses/recrudescence and 1 induced case. Case intervention and appropriate responses were undertaken as much as possible by the township response team in collaboration with the NMCP. At villages with implementation of simplified surveillance interventions From 1st January to 20th December 2020, 296 positive cases were found in 121 of 785 entitled villages (15.4%) for implementing simplified surveillance interventions. Among those, 175 cases were investigated (59% of positive cases), 85 cases were classified as indigenous, 58 cases were imported from other villages but within the township limit, 28 cases were imported from outside the township, and 4 cases were relapses/recrudescence. Case investigation and appropriate responses were undertaken by ICMVs and communities under the tele-supervision of township response team in collaboration with the NMCP and basic health staff. At villages with implementation of burden reduction interventions From 1st January to 20th December 2020, 1,545 positive cases were identified in 152 villages (36.5%) of 417 burden reduction areas. Among those, 253 cases were investigated (16.4% of positive cases), 95 cases were classified as indigenous, 155 cases were imported from other villages but within the township limit, 1 case was imported from outside township, and 2 cases were relapse/recrudescence. These areas are the hotspots in Defeat Malaria target sites, and burden reduction activities were done according to general and specific approaches as per area and disease situation. Non accessible areas (unsafe restricted security areas due to armed attacks) In inaccessible areas, possible and appropriate interventions through ICMVs were implemented. Monthly/quarterly data analysis and interpretation provided instructions to ICMVs at meetings/trainings. From 1st January to 20th December 2020, 1,078 positive cases were identified in 267 out of 4,344 entitled villages. Among those, 777 cases were investigated (72.1% of positive cases), 327 cases were classified as indigenous, 405 cases were imported from other villages but within township limit, 32 cases were imported outside the township, 1 case was introduced, 12 cases were relapses/recrudescence. Probable and suitable response activities were delivered mainly by ICMVs and by the tele-instruction of township teams. Monitoring of the adequacy of case detection in non-elimination townships In 2020, Defeat Malaria applied malaria surveillance activities not only in the malaria elimination townships, but also in non-elimination townships. Data quality assurance and adequacy of case detection by temporal as well as spatial were continuously analyzed since January 2020. ABER was the monitoring indicator and the annual target was set at least 10% for the areas concerned. Out of 1,957 project villages monitored, 1,727 villages (88.3% of monitored villages) hit the target (at least 10% ABER), 189 villages (9.7%) were at ≥5% to <10% and 41 villages (2.1%) were under 5% ABER. Moreover, for good surveillance
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system monitoring, regular testing every month is monitored. During this implementation period, 1,566 villages (80.0%) showed 12 months testing, 325 villages (16.6%) had 9-11 tested months, 38 villages (1.9%) had 6-8 tested months and 28 villages (1.4%) revealed less than 6 tested months. ❖ To initiate an elimination strategy for target elimination areas, pilot test and scale-up a system for rapid detection and notification of malaria cases, case and contact investigations, and prompt deployment of appropriate response interventions in three townships in Southern Rakhine State, by improving and strengthening the surveillance system Defeat Malaria URC has been collaborating with the NMCP for piloting malaria elimination activities in three townships of Southern Rakhine State (Toungup, Ramree and Munaung) by applying Global Technical Strategy for Malaria (2016-2030) since 2018. The quarterly malaria elimination progress report is found in Annex 3. Artemisinin resistance situation review in Myanmar On 22nd December 2020, the artemisinin resistance situation update was presented by the Deputy Director of the Department of Medical Research. Therapeutic Efficacy Studies (TES) were conducted at Tamu of Sagaing Region in 2019 and at Buthidaung of Rakhine State in 2020 by one-arm prospective study. The Senior Technical Director of URC was also involved and provided technical support to this activity. The study was done according to the WHO standard guidelines for monitoring of drug resistant antimalarials and two artemisinin-based combination therapy drugs such as Artemether-Lumefantrine and Dihydro- artemisinin Piperaquine Phosphate were studied for efficacy and safety for treatment of uncomplicated falciparum malaria. The findings revealed TES status of currently used ACTs were still good, and partner drugs were working well. Artemisinin resistance monitoring through day 3 parasitemia microscopy Although TES is an ideal scientific study to assess the efficacy and safety of ACT, it needs a group of trained research personnel and has a high expenditure cost. Therefore, a simple test using microscopic examination of thick blood smears from the patients with P.f. infection by collecting blood slides at day 0, 3, 7, 14 and 28 were introduced in the Defeat Malaria implementation areas along the Myanmar-Thailand border in August 2020. Although 26 villages in Dawei, Palaw, Tanintharyi and Hlaingbwe Townships were targeted, the initial training to conduct at Hlaingbwe in Kayin State has been suspended under COVID-19. All clinically suspected malaria patients will be tested by VMWs using RDT testing as a routine procedure. Senior Technical Director of URC and Laboratory Consultant provided refresher training on malaria microscopy to 2 Laboratory Technicians (one from Palaw Township Hospital and another from Pae Dae Station Hospital) and 5 microscopists were mobilized as Health Facilitators of URC (from Palaw, Myeik and Dawei) in August 2020 and are functioning well through regular engagement with trained VMWs. During 2020, only 3 P.f. patients (2 patients from Swel Chaung Village and 1 patient from War Yet Village of Tanintharyi Township) detected by RDT were treated with Artemether-Lumefantrine and blood slides were taken on Day 0, 3 and 7 by trained VMWs and sent to Defeat Malaria township office. Trained microscopists examined the blood slides and found initial parasitemia on Day 0 slides were between 1,640 to 4,100 per μl of blood and the parasite counts were within WHO standard parasite count of 1,000 to 100,000 parasite count per μl of blood. All 3 P.f. patients were treated with Coartem (Artemether- Lumefantrine) according to the NTG, and no more parasites were seen on the follow-up blood slides including no more experiences of fever until Day 28. Treatment outcomes for all 3 P.f. patients were classified as adequate clinical and parasitological response and no evidence of artemisinin resistance was found.
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Objective 3: Enhance technical and operational capacity of the NMCP and other health service providers at all levels of service provision ❖ Improve skills and job performance of staff involved in malaria control, particularly on epidemiology, surveillance, entomology, and vector control through supportive supervision and training at peripheral and national levels
Review and update capacity development for ICMV ICMV review workshop was organized virtually by the zoom platform supported by Defeat Malaria Jhpiego and which was attended by malaria implementing partners and donor agencies with the lead of the NMCP on 17th – 18th December 2020. The objectives of workshop were to update ICMV manual to be comprehensive, to add malaria elimination activities, to find the solutions for the bottlenecks faced during the implementation of ICMV activities, to discuss about incentive mechanisms for referral of suspected cases, and to explore reporting proficiency, data interpretation and dissemination. The role of ICMVs on malaria, dengue, lymphatic filariasis, tuberculosis, HIV/STI and leprosy were discussed by relative program personnel from the Department of Public Health. The Global Fund Principal Recipients (United Nations Office of Project Services, Save The Children International), Access to Health, Defeat Malaria and Malaria Consortium presented coverage, achievements, challenges in the performance of ICMV and gave suggestions for revision to the existing ICMV manual. The outputs of ICMV workshop were summarized as follows: ● Selection criteria of ICMV shall be updated (age shall be between 18 to 65 years, ICMV recruitment is restricted to be from the resident village but he/she can cover nearby worksites or migrant community); ● Role of ICMVs shall be revised according to Malaria Elimination Field Implementation Manual in prevention, treatment, and surveillance system of malaria; ● Family DOT shall be applied to malaria treatment by ICMVs; ● ICMVs shall assist mass distribution of LLINs and conduct continuous distribution for MMPs as necessary under the guidance of Township VBDC teams; ● Self-learning tool for self-exploratory exercise curriculum or application for smart phone should be provided to ICMVs; and ● Role of ICMVs shall be updated for regular recording and reporting according to ICMV guideline and manual. Development of Master Mentors for newly recruited staff of Defeat Malaria During this reporting period, Jhpiego organized a 5 day technical skills training in October 2020 and a 5 day training skills training in November 2020 virtually with Zoom application for 10 Master Mentors (6 from URC, 2 from ARC, 1 from MNMA and 1 from MHAA). Technical skills training covered updated malaria technical skill, concept of malaria elimination, community-based intervention, and knowledge of other integrated diseases including dengue, lymphatic filariasis, leprosy, tuberculosis and HIV/STI. Training skills training was intended for the effectiveness of further trainings conducted to General Trainers and ICMVs effectively. A cascade of capacity building strategy strengthening local system Defeat Malaria’s support to the NMCP included capacity building of State/Region level VBDC focal staff (Team Leader, Malaria Assistant, and Township Health Assistant) to become Master Mentors and township level VBDC staff (Malaria Supervisor and Malaria Inspector) to become General Trainers for further provision of on-site trainings to ICMVs in the communities.
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After joint review with the NMCP for capacity building gap analysis, it was revealed that Defeat Malaria should target 16 staff to be trained as Master Mentors (5 staff from Kayin State, 2 staff from Sagaing Region, 5 staff from Tanintharyi Region, and 4 staff from Rakhine State). Up to December 2020, Defeat Malaria had already supported the NMCP for the development of 13 Master Mentors and the remaining 3 Master Mentors will be trained in collaboration with the NMCP. Malaria Assistant in Tanintharyi Region and one vacant Team Leader of Rakhine State. Retention of technical and training knowledge and skills were planned to be assessed after 6 to 9 months of trainings, and 6 out of 13 trained Master Mentors (46% of trained Master Mentors) were assessed during FY 2019 and all Master Mentors were found to retain 80% of knowledge and skills. During Q1 of FY 2021, an additional 5 Master Mentors were assessed, and all were found to have retained a desirable level of at least 80% of knowledge and skills. Two more Master Mentors remain for knowledge and skill retention RetentionRetention of of knowledge knowledge and and skill skill of of trained trained Master Master Mentor Mentor assessment. isis assessed assessed virtually virtually Similarly, 124 township VBDC focal staff were targeted to become General Trainers (18 staff from Kayin State, 34 staff from Sagaing Region, 32 staff from Tanintharyi Region, and 30 staff from Rakhine State). By end of FY 2021 Q1, Defeat Malaria had supported the NMCP for the development of 61 General Trainers. Upon the approval of Sagaing and Tanintharyi Region Health Departments and the COVID-19 situation, the remaining 34 staff from Sagaing, 17 staff from Tanintharyi Region will be provided general trainings. Virtual trainings will be scheduled for only 3 staff of Kayin State and 5 staff of Rakhine State to become General Trainers in this year in collaboration with the NMCP. In collaboration with the NMCP and Global Fund partners, on-site coaching was provided to 2,203 Village Health Volunteers and they have become ICMVs by the end of Q1. Only 71 Village Health Volunteers remain to receive training on ICMV in FY 2021. Further, in this reporting period, Defeat Malaria Jhpiego collaborated with the Rakhine State VBDC team and Tanintharyi Township VBDC team to organize joint supervision activities through conference calls for coaching to 12 ICMVs. Moreover, the Field Capacity Development Officer of Jhpiego visited field sites and organized 8 ICMVs for invitation to Ah Shay Bat Rural Health Center of Toungup Township to conduct joint supervision activities. Capacity building activities of Defeat Malaria also benefited local organizations like MNMA (developed 3 Master Mentors, 14 General Trainers, and 181 ICMVs), MHAA (developed 5 Master Mentors and 227 ICMVs). By the end of Q1, 30 Master Mentors, 82 General Trainers, 1,674 ICMVs were developed from URC and ARC staff. ❖ Strengthening surveillance system by supporting the NMCP on tools, equipment, telecommunication cost, capacity building and human resource development Defeat Malaria collaborated with the NMCP and Public Health Departments at all levels through participatory analysis on the gaps of six building blocks of the health system for the preparation of the annual work plan. Regarding service delivery, Defeat Malaria supported the Township Health Departments and Regional VBDC Officers through timely reporting of potential malaria outbreaks and joined in the township’s investigation for immediate responses (Annex 4).
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❖ Support the NMCP for entomological training, entomological field assessments and other gaps at the different levels As the human resources for medical entomology are scarce at all levels of the NMCP, the MoHS appreciated PMI for the technical support to the entomological sector. PMI, Centers for Disease Control and Prevention (CDC) and the University of California, San Francisco came to visit Myanmar and provided technical assistance to the NMCP including the development of the Entomological Surveillance Planning Tool). The role of medical entomology is more important than ever before as the country is moving towards malaria elimination and strengthening entomological surveillance activities is an area of growing concern. In this reporting period, Defeat Malaria met with the NMCP central team including the Senior Entomologists and State/Region VBDC Officers and to discuss longitudinal entomological surveillance activities, cross-sectional entomological surveys in persistently high residual malaria transmission areas, and the gaps to improve the insectary at Gyo Kone VBDC Office in Yangon Region. State/Region VBDC Officers discussed and selected the appropriate areas for entomological surveillance and field assessments. Defeat Malaria committed to support the requested CDC Light Traps to Central and State/Region NMCP. According to the national guideline for tailoring malaria intervention in COVID-19, field entomological assessments were suspended during FY 2021 Q1. Objective 4: Promote the involvement of communities, private healthcare providers, private companies and state-owned enterprises in malaria control and elimination initiatives ❖ Build the organizational and technical capacity of Universities related to health, Community Based Organizations and EHOs Defeat Malaria aims to build the organizational and technical capacity of the community for overall empowerment and development of the community in general, and particularly for sustaining malaria control and elimination activities through their active participation. Transparency is the key in all phases of community strengthening for sustainability. By this means of community engagement, Defeat Malaria intends to promote the accountability, governance, and equity inclusiveness of the communities. Virtual trainings and meetings on Community Support Groups (CSGs) establishment Community empowerment through formation of CSG is a form of local system strengthening and a component of the journey to self-reliance. During FY 2021 Q1, MNMA also committed to establish CSG committees at the selected 5 villages in Thandwe and Gwa Townships of Rakhine State. The PPM Coordinator provided the virtual training on “CSG establishment” to MNMA Defeat Malaria staff, and 27 participants were included from Yangon office. The PPM Coordinator presented and discussed about the objectives of organizing CSGs, conceptual framework for CSG forming processes, how to conduct preliminary assessments, selection of villages for CSG formation, advocacy through community meetings, roles of CSG committee members, election of CSG committee members, fund proposal for starting up of CSG activities, and due diligence checklist for fund disbursement. Basic Bookkeeping Training The Township Medical Coordinator and Community Facilitator organized the training, and the training was facilitated by the Finance Manager and Field Administrator of URC. A total of 17 participants attended (6 males and 11 females) from 6 CSGs of Dawei and Launglon Townships. In this basic bookkeeping training, the participants were trained on income and expenditures, cash balance, account balance, appropriate documentation, how to fill in vouchers and finance forms, and how to use cash flow on a monthly basis. The participants practiced with 3 scenarios facilitated by the Field Administrator and
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Community Facilitator. The use of the cash flow sheet, the checklist for auditing and how to keep the community funds were explained and actively discussed between the facilitators and the participants. The CSG fund is to be kept safe, maintained appropriately, and made transparent by three key CSG committee members (the Accountant, the Treasurer, and the Auditor). The appropriate utilization of CSG fund will be decided by all CSG committee members according to the proposed plans and activities.
CSG fund proposal reviewing and interviewing with CSG members A virtual meeting on “CSG Fund Proposal” was organized by the PPM Coordinator and attended by the Senior Management Team (SMT) of URC Defeat Malaria and focal staff from Toungup and Dawei Townships in December 2020. During CSG fund proposal reviewing meeting, the SMT team interviewed the township focal staff through the application of due diligence checklist and checked the accomplishment of basic bookkeeping training provided to three key committee members of the CSG, the provision of relevant documents at the hand of CSG committee members, gender composition of CSG committee members, election processes, proposed activities, and allocation of CSG fund. Then the SMT team met with CSG committee members virtually and explained capacity building activities for fund management and organization development; community empowerment through community participation, discussion and learning; encouraging community initiatives for malaria control and elimination; and asked about fundraising consideration and sustainability of community-based malaria interventions beyond the Defeat Malaria project. All CSG members are willing to participate in this group and expressed their gratitude. Table 9: Progress of CSG formation and fund proposal submission Sr. State/Region Township # of CSGs # of CSG proposals # of CSG proposals formed submitted approved 1 Kayin Hpa-An 5 26 15 2 Hlaingbwe 5 3 Kawkareik 5 4 Myawaddy 5 5 Tanintharyi Bokpyin 6 6 Launglon 3 13 13 7 Dawei 3 8 Southern Rakhine Toungup 7 9 Gwa 2 2 - 10 Thandwe 3 3 - Total 44 44 28
Community Facilitator provided on -site coaching on use of Voting for election of CSG committee members at CSG forms and formats at Wartaw Village, Dawei Wel Pyan Chaung Wa Village, Hpa-An Township. Township. 22 | Page
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❖ Strengthen BCC and community mobilization activities to promote the sustained use of preventive methods, the timely use of community and facility-based health services, the adherence to prescribed treatment, and the collaboration in the testing of new tools and approaches Socio-Behaviour Change Communication trainings for community impact To build the capacities of Defeat Malaria staff as trainers and provide multiplier trainings to ICMVs and communities, they were trained on the concept of SBCC, SBCC strategies for community behavior impact, PLA methodologies, promoting community involvement in malaria elimination, and community empowerment. SBCC trainings were conducted in persons at Dawei, Myeik and Myawaddy Townships in the previous quarter. But the rise of COVID-19 transmission again in Rakhine State since August 2020 which spread to the Yangon and other States/Regions, resulted in the consecutive trainings for Southern and Northern Rakhine State and Sagaing Region to be postponed due to stay at home announcements and travel restrictions. After discussion with the SBCC Consultant, the Defeat Malaria SMT decided to continue the trainings through a virtual approach. Defeat Malaria Jhpiego team recommended and assisted for a 3-day virtual training course. Training was conducted virtually using Zoom application with the support of Jhpiego team and a training test drill was conducted on 11th December 2020. SBCC virtual training for Southern Rakhine State was conducted from 16th to 18th December 2020 for a 3 day focus on the application of PLA methods and approaches. The SBCC training was attended by 40 participants (20 males and 20 females) involving MNMA and URC Southern Rakhine State staff. The training session included a 2-day conceptual and group work session and a 1 day role play demonstration. The main topics of the training included: 1. Situation analysis (mapping, pie chart, seasonal diagram, and transect walk); 2. Audience analysis (primary, secondary, and tertiary); 3. Behavior-specific communication plans (problem tree analysis and drawing participatory plan); 4. Strategic communication approaches to be focused on findings, analysis and key messages (respecting community initiatives and community driven actions); 5. Implementation plan (designing the plans to be actionable outputs); and 6. Monitoring and evaluation plan (continuous learning and actions by involving community stakeholders applying visualization maps and diagrams). The trainings to township field staff of Defeat Malaria working in Sagaing Region and Northern Rakhine State will be conducted in January and February 2021.
MNMA staff presents about situational analysis in URC staff from Toungup Township presents on Gwa Township. audience analysis at SBCC virtual training. URC staff from Toungup Township presents on 23 | Page audience analysis at SBCC virtual training.
DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
❖ Strengthen and expand training, supportive supervision, and provision of diagnostics and quality-assured antimalarial drugs to private health care providers involved in the management of malaria cases, and promote engagement of private companies and state- owned enterprises in malaria control and elimination activities through Corporate Social Responsibility initiatives Private sector engagement is an important approach of Defeat Malaria for the following conditions: 1) universal coverage of malaria services reaching hard-to-reach mobile migrant workers; 2) long term persistence of private companies and private service providers in the community creating sustainability; 3) private service providers in the communities are usually primary care providers and they can be clients of first choice for health service; and 4) collaboration of all public and private sectors are important for malaria elimination activities, especially in notification, timely reporting, and surveillance. Mapping of private companies was updated in this reporting period. There were 17 large companies (>250 employees), 21 medium-sized companies (50-250 employees), and 11 small companies (10-49 employees). Out of 49 private companies, the common types of companies are Palm Oil Plantation (12), Rubber Plantation (9), Mining (8), Fishery (7), Forest Camp (4), Beach (2), Construction (2), Elephant Camp Virtual presentation on community participatory malaria mapping facilitated by SBCC Consultant involving MNMA and URC Southern Rakhine State team. (2), Hydropower (1), Salt production (1), and Timber extraction (1). For engagement, there were 17 companies in Dawei, 8 in Kawthoung, 5 in Bokpyin, 5 in Thandwe, 4 in Gwa, 3 in Toungup, 2 in Kawkareik, 2 in Kyunsu, 2 in Tanintharyi and 1 in Munaung Townships respectively. Defeat Malaria engaged with 44 companies in 9 townships of Tanintharyi, Rakhine, and Kayin State/Region. Due to restriction of movement under COVID-19 situation, township teams could not conduct the mobile visit and health awareness sessions. Some of the companies were seasonal and left upon the completion of their works. Currently, 98 VMWs/PPs from 44 private companies were engaged for malaria control and elimination, 4,237 people (2,357 males and 1,880 females) were tested for malaria diagnosis, and treated 6 malaria cases (5 males, 1 female). All positive cases were P.v. and all were from
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Tanintharyi Region. Regarding malaria prevention, 672 LLINs were distributed in 3 areas (Kawthoung, Bokpyin and Dawei) and 4 health awareness sessions were conducted. Most of the beneficiaries from private companies are migrant workers (4,184 workers) rather than local (52 workers). ❖ Engagement with non-formal private providers, General Practitioners, and drug stores in malaria elimination townships
The role and involvement of General Practitioners, drug stores, and NFPP are important in the malaria surveillance for elimination. Regarding private providers in elimination townships, a total of 22 private providers tested 351 suspected cases where there were 7 positive cases (all P.f. cases). Although there were 15 general practitioners’ clinics in 3 elimination townships, only 9 clinics were regularly opened under the COVID-19 situation. General Practitioners tested 94 suspected cases for malaria where 4 P.f. cases were found in this quarter. The number of NFPPs was reduced and the project could not conduct quarterly meeting with them for sharing of updated information. However, 6 out of 11 NFPPs had contact with the Defeat Malaria team. The two NFPPs (Myay Ni Taung and Tha Dun Villages) referred regularly for 28 suspected malaria cases to the nearest health facilities and VMWs for malaria diagnosis and management. During this period, many malaria cases and referral cases were increased in the 3 elimination townships.
Monthly report collection from General Practitioner Doctor at Toungup Township by NMCP staff and URC staff.
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Annex 1: Sustaining Defeat Malaria’s Interventions During COVID-19 Pandemic Starting from 23rd March 2020, Defeat Malaria monitored the COVID-19 situation daily and the activities were performed in accordance with the announcements of the Central Committee for Prevention, Control and Treatment of COVID-19, the orders of Coronavirus Disease 2019 (COVID-19) Control and Emergency Response Committee, the guidance of Ministry of Health and Sports (MoHS), the restrictions imposed by local authorities, and the sensitivity of the communities. As of 31st December 2020, Myanmar has identified 124,630 cases and experienced 2,682 deaths affecting mainly Yangon, Mandalay, Bago, Ayeyarwaddy Regions, and Rakhine State. Community-based malaria intervention activities were well sustained despite the spread and threat of COVID-19 in Myanmar. Case finding and management activities of malaria were tracked monthly by comparison with the same months of previous years and the achievements under year 2020 revealed the activities were remarkably sustained (as seen in the below graphs). Graph 1: Monitoring Monthly Malaria Case Detection by RDT Tests (2017 – 2020)
Case finding among migrants has increased consistently comparing 2019 to 2020 case finding results. These gains have been maintained despite the COVID-19 pandemic, as shown in the figures below, for the project in general and specifically in Rakhine state.
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Graph 2: Malaria Case Finding, % Change from 2019 to 2020, Monthly View
Graph 3: Malaria Case Finding, % Change from 2019 to 2020, Monthly View, Rakhine State
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Graph 4: Monitoring Monthly Malaria Positive Results (2017 – 2020)
Test positivity has increased drastically among migrants comparing 2019 to 2020 and has remained relatively constant among residents, comparing 2019 to 2020. In the context of relatively stable (or increased) blood examination rate, increased test positivity among migrants suggests that while testing coverage remains strong, a larger proportion of migrants have tested positive for malaria in 2020 compared to 2019. Test positivity has decreased among residents, suggesting that while blood examination rate has remained relatively constant comparing 2019 to 2020, the proportion of residents testing positive for malaria has decreased comparing 2019 to 2020. Graph 5: Malaria Test Positivity, % Change from 2019 to 2020, Monthly View, Migrant vs Resident populations
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Graph 6: Malaria Morbidity Trend in Defeat Malaria Areas (2017 – 2020)
ABER has been well maintained at around 16% in 2020. Malaria morbidity in term of AP) has been reduced from 4.3 per 1,000 population in 2017 into 2.2 per 1,000 population in 2020 within the action performed by Defeat Malaria (49% reduction of malaria morbidity). Defeat Malaria continuously makes an effort to reach vulnerable and marginalized forest goers by various means including the deployment of MMWs, resulting in more access to, detection of, and appropriate treatment of malaria cases in hard-to-reach worksites in 2020. Based on the data mentioned in the above graphs, it could be said that Defeat Malaria activities were resilient and adaptive in the face of challenging circumstances under the threat and spread of COVID-19 transmission, and the conflicts in Rakhine State and some parts of Kayin State throughout the months of 2020. Defeat Malaria continued the strategic activities without derailment to pursue the committed goals of reducing malaria morbidity and mortality, containing artemisinin resistance, and contributing to malaria elimination activities. Defeat Malaria applies service-oriented virtual entity for various purposes which reduces time and cost to retrieve information; reduces learning curve; improves knowledge creation, sharing and distribution; enables innovation and creative thinking; reduces rework and reinvention; provides access to knowledge, skills and experience; and builds stronger internal and external alliances, contacts and networks.
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Annex 2: SBCC Materials Produced for Distribution Number Distribution # Materials Target audience Objective Key message produced sites Defeat Malaria Defeat Defeat Malaria’s Staff/ICMVs Defeat To visualize Defeat Malaria 2,800 goal, objectives, 1 /General Malaria Malaria branding Notebook Units project area map, Practitioners/VB Townships and activities (2021) office address DC focal staff Defeat Defeat Malaria Staff and Defeat To visualize Defeat Malaria 2,800 Activity photos and 2 Implementing Malaria Malaria branding Calendar Units malaria prevention partners Townships and activities (2021) key messages Use of LLINs at night To promote in the forest. Seek Poster - 2,200 ICMV awareness on 3 Forest goers blood testing Forest goer Units villages malaria among immediately at the forest goers onset of fever. To promote Poster - To increase 2,200 Community ICMV community 4 Malaria awareness towards Units beneficiaries villages involvement in Elimination malaria elimination malaria elimination To promote Sleep under LLIN, Poster - Key 4,350 Community ICMV awareness on key Blood test within 24 5 messages Units beneficiaries villages messages about hours of onset of malaria fever To promote Poster - Life cycle of malaria 4,350 Community ICMV awareness on 6 Malaria parasite; Prevention Units beneficiaries villages malaria transmission methods transmission
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Annex 3: Quarterly Report on Pilot Malaria Elimination Activities in Toungup, Ramree and Munaung Townships (Oct. – Dec. 2020) Key Achievements in Malaria Elimination Activities (Oct. – Dec. 2020) Number of malaria cases detected 74 Number of notifications for malaria cases 71 (%) Number of malaria cases notified within 24 hours of detection 66 (%) Number of cases investigated 73 Number of foci investigated 28 Number of cases classified as indigenous 6 Number of active foci 6 Percent of indigenous cases among cases investigated 8.2% Active foci response rate (all 6 active foci were investigated and appropriate 100% response measures were initiated within 7 days) In this quarter, 73 cases (63 P.f, 8 P.v and 3 Mixed) were investigated and the cases were classified as 6 indigenous, 63 imported, and 4 introduced cases. Among 63 imported cases, 60 cases from forested areas within township and 3 cases were from other townships. Malaria Elimination Coordination Committee (MECC) meetings The Quarterly MECC meeting was postponed due to restriction of gatherings at the advent of COVID-19 pandemic. The last MECC meeting was conducted in February 2020 in Toungup Township. Monthly collaborative meetings with Township VBDC and Defeat Malaria staff Monthly township collaborative meetings were conducted regularly except for the month of December 2020 as VBDC staff had been quarantined after primary contact with a COVID-19 patient. These meetings were conducted for the following objectives: 1. Collaborative data verifications between VBDC and Defeat Malaria; 2. To track and supervise non-reported villages; 3. To tackle operational challenges for overcoming and taking appropriate solutions; and 4. To schedule for supporting mobile migrants’ worksites. Table 1: Monthly Township Collaborative Meetings Sr. Month of Township Date of Meeting Participants No. 2020 Male Female Total 1 October Toungup 19-Oct-20 6 0 6 2 Ramree 20-Oct-20 8 0 8 3 Munaung 26-Oct-20 6 0 6 4 November Toungup 16-Nov-20 6 0 6 5 Ramree 19-Nov-20 10 1 11 6 Munaung 25-Nov-20 7 0 7 7 December Ramree 22-Dec-20 10 1 11 8 Munaung 29-Dec-20 7 0 7
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Table 2: Reporting proficiency of three townships (Oct.-Dec. 2020) Township Number of reports to be Number of Number of zero submitted reports received reports or non-reports Toungup 720 (240 villages * 3 months) 606 (84%) 114 (16%) Ramree 684 (228 villages * 3 months) 533 (78%) 151 (22%) Munaung 417 (139 villages * 3 months) 413 (99%) 4 (1%) Oct.-Dec. 2020 1,821 (607 villages * 3months) 1605 (85%) 216 (15%)
Defeat Malaria practices monthly reporting of ICMVs by holding monthly meetings and Township VBDC encourages monthly reporting of ICMVs by sending through basic health staff on a quarterly basis (supported by Global Fund). Unfortunately, travel restrictions were put in place at the time of the regular quarterly meetings, due to the rise of COVID-19 transmission in Rakhine State. This also resulted in more late reporting than before in FY 2021 Q1. Moreover, VBDC focal staff from Toungup were in quarantine in December. Defeat Malaria in collaboration with Township VBDC analyzed and tracked zero-reported villages and late reported villages for scheduling of prioritized supervision. If the reports received from previously non- reporting units after follow-up supervision, late reports are incorporated in the later months. Reporting from all 3 townships were less in this quarter than previous quarters (91% in Q3 and 88% in Q4 of 2020). But due to the isolated nature of Munaung Island with little effect by COVID-19 transmission compared to other townships of Rakhine State, high reporting status was maintained. No reports from Taik Kyun Village for three consecutive months were due to the absence of assigned Midwife for this village. Another late report was tracked for the month and no more late reports were experienced in Munaung Township. Table 3: Provider Based Surveillance Report (Oct.-Dec. 2020) Toungup Ramree Munaung Total Types of Providers Tested Positive Tested Positive Tested Positive Tested Positive
Basic Health Staff 2,333 15 1,443 0 2,501 0 6,277 15
Hospital 71 17 0 0 16 0 87 17 General 43 4 7 0 40 0 90 4 Practitioner NFPP* 305 7 37 0 0 0 342 7
VMW** 1,339 21 1,687 3 0 0 3,026 24
DMS*** 0 0 0 0 9 0 9 0
Mobile Teams**** 626 5 187 2 33 0 846 7
Total 4,717 69 3,361 5 2,599 0 10,677 74 *No Non-Formal Private Provider (NFPP)** **Village Malaria Worker (VMW) in Munaung Township ***No Defense Medical Service (DMS) in Ramree Township
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****Mobile teams conducted Reactive Case Detection and Proactive Case Detection Figure 1: Malaria diagnosis trend in 3 Malaria Elimination Townships (Jan.-Dec. 2020) 3200 2800 2400 1779 1836 2000 1592 1607 1653 1549 1376 1451 1332 1600 1165 1347 1348 1030 1200 1216 900 1305 1229 1063 1148 1199 1187 1069 1065 1067 800
Number of RDT Tests RDT of Number 941 961 838 818 805 802 836 400 651 695 750 772 735 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Toungup Ramree Munaung The RDT testing trends revealed the two major declinations. The first declination during April and May coincided with the first attack of COVID-19 in Myanmar, and the second declination during September and October also coincided with the second attack of COVID-19 starting from Rakhine State. Some ICMVs could not report to the township VBDC team due to COVID-19 travel restriction and home stay announcements. Figure 2: Malaria cases trend of Toungup Township (Jan. – Dec. 2020)
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16 11 8 6 3 1 2 2 3 2 3
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Number cases malaria Number of Year 2020, Toungup Township
Time series analysis of malaria cases for the township revealed a significant rise of malaria occurrence in the last quarter of 2020. Spatial variation of malaria cases was also analyzed, and the hot spots were at the forested worksites near headwaters of 4 streams (Toungup, Kin Taung, Lamu, and Ma Ei streams) which flow across Toungup Township. It was also identified that forest goers were the hot population group. In this quarter, 42 malaria cases were detected in November and geographic distribution by village- wise analysis can be seen in Figure 3. Among 42 cases identified, the highest number of malaria cases (15) were detected at Tha Dun Village. Midwife from this village notified the township VBDC whenever she found a malaria positive case. Township response team conducted case investigation, foci investigation and response activities to 41 out 42 cases notified together with health catchment area focal basic health staff. Although timely notification on one malaria case was made by a surveillance agent, case investigation, foci investigation and response could not be conducted to the patient who had been quarantined for contact with a COVID-19 patient. This patient was from Ma Ei Ward -2 and he received treatment from Ma Ei hospital according to the NTG.
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Most of the patients contracted malaria from hard-to-reach remote forested areas which were non- accessible due to their illegal work related to logging. Figure 3: Village wise distribution of malaria cases in Toungup Township (November 2020)
18 15 15 12 9 6 2 2 2 3 3 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
0
Tar Tar Ye
Sa Don Sa
WetYa
Ma Sa Li MaSa Dun Tha
Sa DwaySa
Ta La Bar La Ta
Zee Kaing Zee
Thein Taung Thein
Ma Ei Ward 2 MaWard Ei 4 MaWard Ei
Number of malaria cases cases malaria ofNumber
Eain Twin Pone Eain
La Mu Ward (1) Ward LaMu (5) Ward LaMu
HpaungThaung
Kyuk Ro Ta Mar Ta KyukRo
KoutTamar Yoe
Pa Dar Ywar Thit Dar Pa Ywar
Chaung Thone Kwa Chaung Kyauk Ta Gar (Lower) KyaukGar Ta Kyauk Ta Gar (Upper) KyaukGar Ta Name of Villages
Based on the results of case investigation and foci investigation, township response team explored the possibility of recruiting MMWs. Fortunately, one of the patients who worked in this worksite was a VMW of CAP-Malaria Project from Gwa Township of Southern Rakhine State. He migrated to Tha Dun Village and worked in this worksite since last year. During case investigation, he agreed to serve as MMW, and he was provided a 3-days malaria diagnosis and case management training in November 2020. He was updated on RDT testing procedures and received an updated job aid of the NTGs. He was instructed to notify as soon as possible for further case investigation, foci investigation, and response activities to be undertaken. Commodity supplies were provided by Defeat Malaria and a Midwife from this village will supervise him closely for coaching, motivation, and communication. In December 2020, he reported to the Midwife as he provided malaria diagnosis for 9 forest goers, but no positive cases were detected. Table 4: Summary of Surveillance Report (Oct.-Dec. 2020) Surveillance Report – Case Detection, Notification, Investigation, and Classification in 3 Elimination Townships (Oct. – Dec. 2020) # of # of # of # of # of cases # of case imp indi relapsed/ notifi intro Posit Mix s ort gen recrudescen Township Tested P.f. P.v. ed duce ive ed inve ed ous ce/ withi d stiga cas cas induced/Cry n 24 case ted e e ptic hours Toungup 4,717 69 63 3 3 66 68 62 1 5 0 Ramree 3,361 5 0 5 0 5 5 1 3 1 0 Munaung 2,599 0 0 0 0 0 0 0 0 0 0 Total 10,677 74 63 8 3 71 73 63 4 6 0
❖ During 2020, no malaria cases were detected in Munaung Township and only 5 malaria cases were detected in Ramree Township. Regarding Ramree Township, 5 P.v. cases were detected from a single village, Htaut Kyant Taw (4 cases in November and 1 case in December). All 5 cases were notified
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within 24 hours of onset of fever and classified as imported from forest worksite outside of the village but within township and there were epidemiological links with this index case and additional 4 cases. The middle 3 cases occurred during November 2020 and classified as introduced cases and the last case occurred in December 2020 was classified as indigenous. Township response team visited 3 times to this village in this quarter and appropriate and feasible responses were conducted in collaboration with focal basic health staff through the involvement of the community. During foci investigation activities, the team found larval habitats at the back of the house of the last case. It was a banana tree which was cut in half and created a larval development site. There were also plenty of larval habitats in the middle of the village which were formed by the footsteps of the cattle and near the village’s main water storage reservoir. Those habitats were already cleared with the involvement of the community. ❖ Malaria positive cases were mostly notified within 24 hours of onset of fever, but 2 cases detected by a recently graduated mobile private Medical Doctor and 1 case detected by Township Hospital Laboratory Technician were notified late. Defeat Malaria in collaboration with township VBDC engaged a private Medical Doctor and explained about the role of private health care providers in malaria elimination. Late notification of township hospital laboratory was explored, and the necessary laboratory register books were provided. Defeat Malaria organized a meeting with central NMCP including State/Region focal Laboratory Technician for strengthening of hospital laboratories. Defeat Malaria discussed the importance of internal quality control and external quality assessment for strengthening of township hospital laboratories and committed to support to NMCP by avoiding the duplication of fund support from Global Fund. ❖ Five indigenous cases were from previous active foci areas classified in 2019 (Kyuk Ro Tamar, Upper Kyauk Ta Gar, Ta Pun and Myo Gyo Villages, and Ma Ei Ward-4). ❖ There were 62 imported cases in which 3 cases were contracted from Ann Township and the other 59 cases were outside of the villages (mainly from the hard-to-reach forested areas) within the same Toungup Township. ❖ There was late reporting of some ICMVs due to travel restriction under COVID-19 infection and insecurity situations (although data for malaria cases were already fixed, malaria tested data would change after receiving late reports). Reducing the risks of importation of malaria parasite from mobile migrant population Vulnerability monitoring plays a significant role in low malaria transmission settings with the aim of reducing the risks of importation of malaria parasites from mobile migrant populations. Defeat Malaria in collaboration with the township health department conducted proactive cases detection, migrant monitoring, screening of malaria and provision of malaria prevention services at seasonal mobile migrant worksites. Table 5: Mobile malaria service provision to migrant peoples Sr Name of worksite/ RDT Positive Date Remark . Township Tested Results 1 Hospital construction 13 Nov 18 0 Provided malaria key messages worksite, Ramree 2020 2 Sawmill worksite (1) & (2), 25 Dec 11 0 Provided 4 tubes of repellents, Htauk Kyant Taw village, 2020 5 LLINs, and malaria key Ramree messages 4 Ka Ei Hotel Zone, Munaung 28 Dec 5 0 Provided malaria key messages 2020
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During this quarter, the township malaria team explored 3 migrant worksites in Ramree to conduct timely proactive case detection for prevention of reintroduction of malaria. Similarly, in Munaung Township, proactive case detection to mobile migrant workers who came to work at Ka Ei Hotel Zone. They were from Thanlyin Township of Yangon which is a malaria free area. Due to their long travel en route through malaria transmission areas, the township malaria team decided to screen all inbound migrants and provided malaria key messages. Due to travel restriction to the field under COVID-19 threat and announcement orders, some elimination related activities could not be conducted but township response teams did continuous telecommunication with respective ICMVs to perform interruption of further onward malaria transmission as much as possible. One malaria positive case was not possible to do case investigation, foci investigation and response activities due to the patient being quarantined at Ma Ei Hospital. No malaria cases were detected in Munaung Townships in this quarter. Weekly Regular Active Case Detection (ACD) Round Monitoring and Interpretation (Oct.-Dec. 2020) Monthly BHS meetings in Toungup and Ramree could not be held due to COVID-19 travel restriction. So, Defeat Malaria Field staff called weekly regular ACD assigned basic health staff and gather as much data from them as possible. Among them, only data from 16 reporting unit (out of 22) were submitted to the Toungup team but other township teams collected all rounds. To Defeat Malaria’s pleasure, ACD rounds in this quarter were more than the previous quarters. So, Defeat Malaria teams encouraged basic health staff to keep up the good practice. Table 6: Weekly Regular Active Case Detection Rounds (Munaung Township) Beneficiaries Tested Estimated Beneficiaries disclosed beneficiar percent of disclosed actual tested Months of Total tests ies met validated actual tested in 2020 but Year 2020 reported and tests in specified not in interview among month specified ed reported month October 135 107 86 15 94.4% November 50 37 21 7 75.7% December 48 33 17 5 66.7%
Total 233 177 124 (70.0%) 27 (15.3%) 85.3%
Defeat Malaria in collaboration with Township Medical Officer and Malaria Elimination Management Team, beneficiaries’ interviews were conducted for monitoring weekly ACD activities of assigned basic health staff. Among 177 beneficiaries’ interview, 151 beneficiaries (85.3%) disclosed that they actually tested for malaria RDT. The Township Medical Officer provided feedback information and motivated respective surveillance agents at monthly meetings. Controlling of Residual Malaria Transmission Residual malaria transmission areas of Toungup and Ramree Townships were continuously monitored and provided additional measures based on the assessment findings. Four residual malaria transmission areas (3 villages from Toungup and 1 village from Ramree) were identified and initial assessments were already conducted in 2017 and 2018. Mobilizing MMWs, mobility monitoring for forest goers and distribution of mosquito repellents to nighttime forest workers were continued as previously done in previous quarters.
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No positive cases were detected in those villages during this quarter. Functional and reporting status of VMWs from those villages were highly satisfactory. A total of 64 people suspected of malaria were tested by VMWs in 3 residual malaria transmission areas of Toungup and 1 P.v. case was detected at Wet Ya Village. In Ramree Township, a VMW from Htaunt Kyant Taw Village tested a total of 80 people suspected for malaria in this quarter and found 2 P.v. cases. A total of 38 forest goers were tested by 2 MMWs and no positive cases were detected during this quarter. A total of 4 mosquito repellent creams were distributed to nighttime forest workers by respective VMWs. Engagement with Non-Formal Private Providers The roles and involvements of NFPPs are somewhat important in a particular situation in malaria elimination areas. Advocacy to and engagement with NFPPS for their involvement in malaria elimination activities were conducted since March 2019. NFPPs were encouraged for referring any malaria suspected patients to basic health staff and VMWs as soon as possible. They were also encouraged for submission of referral reports to respective village tract leaders at the end of every month. Some NFPPs followed the instructions and some did not. Defeat Malaria Team monitored and follow-up the reporting status of NFPPs through monthly and regular phone calls to remind them to submit reports to village chiefs. A maximum of 6 out of 11 NFPPs reported monthly through phone communication. Among them, only 1 NFPP reported for referral of patients and the remaining 6 NFPPs sent zero referral reports. A total of 28 people suspected of malaria were referred by NFPPs to VMWs but only 21 people were able to access the VMWs and no malaria positive cases were detected. Engagement with General Practitioners In this quarter, mappings of General Practitioners were updated. General Practitioner Doctors were engaged for their involvement in malaria elimination activities. RDTs and antimalarials drugs were supplied by Township VBDC teams and advocated for immediate notification and timely reporting of malaria diagnosis and case management reports. A total of 15 private General Practitioners existed in 3 townships and among them a total of 7 General Practitioners opened their clinics and reported for this quarter. A total of 94 malaria suspected cases were tested, and 4 P.f. positive cases were found. Those 4 cases were detected by one newly graduated Medical Doctor who opened his private clinic at La Mu Maw Village which is about 30 miles away from Toungup town. The Defeat Malaria Team advocated him to get his commitment and he has been actively involved in malaria elimination activities since October 2020. Most of the people from nearby high malaria risk villages came to seek treatments from him. He tested every malaria suspected patient and detected 3 P.f. cases in November and 1 P.f. case was detected in December 2020. He notified Township VBDC team on a timely basis to perform case investigation, foci investigation and response activities. Challenges ● Local security instabilities and recent kidnapping around Ma Ei areas affected malaria surveillance activities; ● Monthly ICMVs meeting at Ma Ei Rural Health Center could not be conducted in November 2020 due to the restrictions for containment of COVID-19 transmission; ● Quarterly ICMV meetings scheduled by Township VBDC Team could not be conducted for 3 consecutive quarters. Motivation allowances could not be provided to them which might affect the motives of some ICMVs; and ● Conducting foci investigation and response at remote hard-to-reach (physical as well as socio- political) forested worksites is still challenging.
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Activities Photos
Elimination Coordinator (NMCP) distributes LLINs to Malaria Elimination Coordinator (URC) provided on malaria positive patient during case investigation, job Training to Mobile Malaria Worker at Tha Dun foci investigation, and response activities. village in Toungup Township.
Drawing Participatory Malaria Seasonal Calendar On the way to Htaunt Kyant Taw Village to conduct at Htaunt Kyant Taw Village, Ramree Township. case investigation, foci investigation and response visit in Ramree.
Larval source finding and management activities at On the way to malaria positive patient’s house for Htaunt Kyant Taw Village, Ramree Township. case investigation activity in Toungup Township.
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Annex 4: Early Detection and Response of Malaria Outbreak at Pyin Boke Village of Pauktaw Township in Rakhine State Topography Pyin Boke village is one of the 24 villages of Pumpkin Island, located (Latitude- 19.914190, Longitude- 93.005447) at the outermost part of the island. It can only be accessed by boat for about one and half hour and then by 2 hours motorbike from Pauktaw Town. There are 232 people residing in 55 households, and population mobility is geographically limited. The main occupations are farming, betel plantation, and fishery. There were paddy fields at the outskirts of the villages and the forest fringe and forested areas are also surrounded on the other side of the sea beach. A small stream flows around the village and one large pond (80 feet in diameter) is located at the entrance of the village. Although the village is close to sea, freshwater is also available from rainwater sources and surface runoff water through streams. Figure 1: Maps of Pyin Boke Village in Pauktaw Township
Health coverage and quality of health care service It is under the coverage of War Lan Sub-Rural Health Center (SC) of Sin Tet Maw Rural Health Center. The nearest health facility is War Lan SC which is about 12 miles away from the village or about one-hour by motorbike to be able to access health care. One ICMV trained and supervised by Defeat Malaria has been providing community-based malaria interventions through the coordination with respective SC since March 2017. According to the 2019 data, the village was stratified as receptive with no current transmission. Adequate blood testing rates were noted every year and no positive case was detected until the end of November 2020. One LLIN was distributed per household by the township VBDC team in 2016. Population behavior During daytime, most of the male villagers go to the sea and field for fishing and cultivation. Most of the female villagers go to the foothill and forest to search for bamboo shoots and other forest products. Sometimes, their teenage children accompany them. Villagers usually sleep around 8 PM at night and some watch television in their homes or at their neighbors. The common illnesses are diarrhea, acute respiratory infection, and skin infection. Mosquito activity is usually high between July to October with the onset of mosquito biting starting from 5 PM. Houses are generally poorly constructed with rudimentary walls and floors. The family members usually sleep under LLINs or ordinary (non-insecticide treated) nets.
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Identification of first and second malaria cases On 2nd December 2020, Pyin Boke ICMV notified Defeat Malaria Pauktaw team that he found 2 P.v. cases in the morning when he tested 2 villagers with malaria suspected malaria symptoms by using CareStart RDT in accordance with the precautions of COVID-19. The initial two positive patients were living in the same household and they suffered from an on and off fever for about 26 days. They used to live mostly in the paddy field and not in the village. The husband moved from the Thapyae Seik Village in Rathaedaung Township a year and half ago as the wife was the native to Pyin Boke. Thapyae Seik Village is also receptive with no current transmission area. They have not received a blood test for malaria and did not have history of malaria before. Pauktaw team instructed the ICMV to repeat RDT testing and revealed P.v. results again. Defeat Malaria supervisor suggested to the ICMV to provide DOT to both patients and to proceed with simplified case investigation activities and conduct reactive case detection (RACD) as much as possible with COVID-19 precautions and supported necessary commodities. Identification of more cases and serial intervention by the lead of township VBDC On 3rd December 2020, Pyin Boke ICMV detected an additional 8 P.v. cases during RACD to 33 neighbors, co-workers and co-travelers. The ICMV was instructed to take necessary actions and to activate daily reporting. Then, Defeat Malaria township staff notified the unusually high occurrence of malaria to the Township Medical Officer and VBDC staff. By the lead of township VBDC, the response team conducted cross-checking of patients’ results by applying SD Bioline RDT and malaria microscopy. Table 1: Cross-checking of patients’ results obtained by CareStart RDT with SD Bioline RDT and Microscopy Date of Tested by Tested by Case Tested by SD Fever (+/-) Testing CareStart RDT Malaria Number RDT (VBDC) (ICMV) Microscopy 1 + 2-Dec-20 + (P.v.) (-) (-) Blood smear 2 + 2-Dec-20 + (P.v.) (-) was taken after 3 + 3-Dec-20 + (P.v.) + (P.v.) completion of 4 - 3-Dec-20 + (P.v.) (-) Chloroquine treatment and 5 + 3-Dec-20 + (P.v.) (-) microscopy 6 - 3-Dec-20 + (P.v.) (-) results were 7 - 3-Dec-20 + (P.v.) (-) negative and 8 - 3-Dec-20 + (P.v.) (-) could not 9 + 3-Dec-20 + (P.v.) (-) confirm 10 - 3-Dec-20 + (P.v.) (-) inconsistency. 11 + 8-Dec-20 + (P.v.) (-) (-) 12 + 8-Dec-20 + (P.v.) + (P.v.) + (P.v.) 13 + (high) 8-Dec-20 + (P.v.) + (P.v.) ++(P.v.) 14 + 8-Dec-20 + (P.v.) + (P.v.) + (P.v.) 15 + 8-Dec-20 + (P.v.) + (P.v.) + (P.v.) 16 + 11-Dec-20 + (P.v.) 17 - 11-Dec-20 + (P.v.) 18 + 11-Dec-20 + (P.v.) 19 + 11-Dec-20 + (P.v.) 20 + 11-Dec-20 + (P.v.) 21 + 11-Dec-20 + (P.v.) 22 + 12-Dec-20 + (P.v.)
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23 + 13-Dec-20 + (P.v.) 24 + 20-Dec-20 + (P.v.) 25 + 30-Dec-20 + (P.v.) 26 + 30-Dec-20 + (P.v.) 27 + 30-Dec-20 + (P.v.) After detecting first and second cases, RACD was done with the use of CareStart RDT to 33 people and 8 more cases were found by the ICMV. On 4th December 2020, the township response team conducted mass screening and treatment and tested 155 people by RDTs and malaria microscopy and no positive cases were found. Among, 27 cases, 15 were confirmed by microscopy and 4 cases showed positive in the blood film. Sliding to the first 10 cases was available only after taking Chloroquine treatment. As blood slides for microscopy was made only after Chloroquine treatment, negative results obtained by microscopy could not be applied for cross-checking and it did not suggest inconsistency with the results tested by RDTs. All these 27 P.v. cases were detected within December 2020 and the township response team could cross- check for the initial 15 cases. Additional 12 positive results were identified after the township response team left. RDTs were replenished adequately for new ones from township sub-stocks. Case investigation, foci investigation, and entomological assessment were conducted by the township response team. According to the township VBDC team conducted case investigation results, all cases have no history of travel during their incubation period and the two initial cases detected on 2nd December 2020 were the husband and wife residing in the same house and working as farmers. They had no history of malaria illness before. No epidemiologic link could be identified with the index case as there were no occurrence of malaria since 2017. All the cases detected were local people only. All cases were investigated again by the township response team including VBDC and Defeat Malaria staff and all cases were classified as “indigenous cases.” There were no epidemiological linkages with index case, introduced case, imported, relapsed, or induced case. The entomologist and the team from the State Health Department conducted an entomological assessment by using CDC Light trap outdoor collection and found the adult forms of An. minimus, An. annularis, An. sundaicus, and An. aconitus around the households of malaria positive cases which were close in contact with the rice field, the betel plantation areas, and the brackish pond. The collected anopheles mosquitoes were sent to Gyokone VBDC Department for sporozoite check by ELISA.
Response team conducts case investigation activity Checking for the possible larval breeding places around the households of malaria positive cases
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Figure 2: Epidemic curve based on date of onset of malaria symptoms Epidemic Curve Based on Date of Onset of Malaria Symptoms 5
4 The first 3 cases were within the minimum 3 intrinsic and extrinsic
2 incubation period detected 1
0
symptoms symptoms whobecame malaria and
Number of cases Numbercases of experienced malaria of
02-Dec-2020 04-Dec-2020 06-Dec-2020 08-Dec-2020 10-Dec-2020 12-Dec-2020 14-Dec-2020 16-Dec-2020 18-Dec-2020 20-Dec-2020 22-Dec-2020 24-Dec-2020 26-Dec-2020 28-Dec-2020
18-Nov-2020 02-Nov-2020 04-Nov-2020 06-Nov-2020 08-Nov-2020 10-Nov-2020 12-Nov-2020 14-Nov-2020 16-Nov-2020 20-Nov-2020 22-Nov-2020 24-Nov-2020 26-Nov-2020 28-Nov-2020 30-Nov-2020 Axis Title
Figure 3: Community participatory household mapping revealing scattered malaria infected households
The village is surrounded by the brackish sea, rice field, betel plantation, and forests, which favor the breeding of various species of anopheles mosquitoes.
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Table 2: Socio-demographic characteristics of the patients (N = 27) Malaria Patients Male Female Total Age Group 16 (59%) 11 (41%) 27 <1 0 0 0 (0.0%) 1-4 0 3 3 (11.1%) 5-9 1 1 2 (7.5%) 10-14 8 4 12 (44.4%) 15+ 7 3 10 (37.0%) Occupation 16 11 27 Farming 8 3 11 (41%) Dependent 8 8 16 (59%) Out of 27 cases, 59% of the patients were male and there were higher involvements of under 15 children (63%) and dependent (59%). Defeat Malaria distributed 123 LLINs (LLIN coverage was 1.89 person per LLIN) during outbreak investigation and reactive case detection by collaboration with the State/Township Health Department in December 2020. Key malaria messages were also provided to the villagers. Impressions and way forwards ⮚ ICMV and the community were advised to continue daily fever surveillance and daily reporting by phone until no more detection of malaria cases for 28 days; ⮚ Although malaria transmission has been interrupted for more than 3 years, highly receptive areas like Pyin Boke Village are susceptible for occurrence of malaria outbreak; ⮚ By the lead of VBDC, field operational activities will be conducted in nearby 13 villages of Pyin Boke to prevent onward transmission to other villages and contain the earliest. Every vulnerable person, like pregnant mothers and under 5 children, should be prioritized for malaria prevention. LLIN monitoring and supply should be conducted as necessary; ⮚ Defeat Malaria had the opportunity to advocate to Rakhine State VBDC about the importance of mass LLIN distribution to the areas like Pyin Boke where malaria transmission had been free for three years but highly receptive. Vector control through LLINs distribution is still important for prevention of reintroduction of malaria and similar malaria outbreak. We were not allowed to distribute LLINs to this village before. ⮚ Widespread conflicts and displaced people with malaria carriers can be the risk of malaria reintroduction; and ⮚ High mobility conditions like traditional events during new year period might need thorough management of fair and festival for prevention of malaria spread from one area to another.
Mass screening and treatment done by Township response team Distribution of LLIN to positive patient
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Annex 5: Women Empowerment and Community Strengthening through CSG in Na Khan Taw Village in Launglon Township of Tanintharyi Region During the past decade, Myanmar had the greatest malaria incidence among the Greater Mekong Subregion with greatest impact on the rural and remote areas of the country. In collaboration and cooperation with the government and local and international non-governmental organizations, the burden of malaria has declined dramatically and WHO reported 82% reduction of malaria cases between 2012 and 2017 in Myanmar. VMWs play an important role in reducing the burden of malaria in their communities. Ms. Moe Moe Swe is one of the 2,200 outstanding and high-performing VMWs supported by the USAID- funded Defeat Malaria project. Defeat Malaria is implemented by URC as the prime implementing partner, in partnership with ARC, Jhpiego, MNMA, and MHAA, and works in close collaboration at all levels of the MoHS. She had undertaken the role of VMW in Na Khan Taw Village in Launglon Township in Tanintharyi Region since 2013 during the Control & Prevention of Malaria project which was also funded by PMI-USAID. She said that in the past years, many people had suffered from malaria and tuberculosis that convinced her to take responsibility as a community health worker in her village. Since then, she has been working efficiently in malaria activities regarding testing, treating malaria patients, and giving health education sessions by groups and individually. Moving towards malaria elimination under the leadership of NMCP, all VMWs including Ms. Moe are suggested to test all persons with suspected malaria and high-risk migrant workers and notify immediately to the township health department if positive cases were identified in the village. She is always proud to be a VMW contributing to malaria control and elimination activities in her village with relentless efforts. In the last two years, she attended ICMV training to take more responsibilities for her community related to training on dengue, tuberculosis, HIV, lymphatic filariasis, and leprosy. During the pandemic of COVID- 19, she has been raising COVID-19 awareness in the community and continuing the responsibilities of VMW and ICMV. Recently, she has been elected as a village leader that escalated her role in promoting health and development of the village. “I want to say many thanks to URC Defeat Malaria project funded by USAID because my dream to help the community was not fulfilled unless there was technical and financial support. Consequently, villagers trust me and elected as a leader and pleasing as woman village chief among those who discourage female environment,” told by Ms. Moe Moe Swe, a Village Malaria Worker (VMW) of Na Khan Taw Village in Launglon Township of Tanintharyi Region. For her great commitment and organizing effort, the Na Khan Taw Village has been selected to establish a community support group (CSG) by URC Defeat Malaria. The intentions of establishment of a CSG are to attain community participation, involvement and empowerment leading to self-reliance as the Defeat Malaria project begins to phase out. Ms. Moe has also been elected as a chairperson of the CSG committee by the community members due to her services and sacrifice to the community in promoting community driven actions and support activities including referral of emergency patients to the township hospital, community involvement in environmental manipulation, migrants’ vigilance, prevention of onward
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malaria transmission, and reducing the risks of importation risks for strengthening the surveillance for malaria elimination.
“I am happy when helping people with tuberculosis disease, leprosy patients and urgent medical cases who do not afford for the transport cost to access the health facilities and attend the township hospital. Now we have start-up fund to carry out those activities to support needy people. So, let me call this as an “Efficient Medical Funding.”
Chief of Na Khan Taw Village, Moe Moe Swe, conducts household visit for providing information to pregnant mother on malaria in pregnancy care
One community elder also commented, “When we know Ms. Moe Moe Swe was being elected for the village chief, we feel proud of our village as a woman village leader is very rare in our Tanintharyi Region. We believe her ability, courage, and ideas to lead the village for fruitful benefits, the greatest impact and overall development of our village. As CSG fund proposal was now being successful and it is about to receive start-up fund for the village, we all will support her for appropriate allocation of the start-up fund and use effectively for the benefits of the village by working together with CSG committee members and community representatives.”
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Annex 6: Sustainability of Activities through CSG Fund Disbursement in Zee Kwin Village Defeat Malaria facilitates Community Support Groups (CSG) in local communities to empower communities and private healthcare providers in their malaria control and elimination activities. Beginning in Year 4 of the project, Defeat Malaria supported for the establishment of CSGs by providing trainings, facilitating for the drawn-up of health plans, initiated discussions on community health needs, and community driven activities with the goal of building community ownership for sustainable actions. Up to the end of December 2020, a total of 44 CSGs have been organized in 10 townships under Defeat Malaria. In the northern part of Toungup Township in Southern Rakhine, rests Zee Kwin Village which is an hour and a half drive by motorcycle and between Toungup and Kyaukphyu Townships. The total population of the rural village is 776, including 145 households who partake in agricultural work such as growing rice, bamboo cutting and farming. The Zee Kwin Village CSG was organized in June 2020 with 15 members under the facilitation of Defeat Malaria. The villagers decided to use “Cherry” for the name their CSG and all the members were selected by the agreement of the villagers.
Ms. Khin Mar Tun, Community Facilitator, discussed about the importance of community involvement in malaria elimination and suspected referral of integrated diseases in Zee Kwin village, Toungup Township (November 2020) Even though there are many present development groups such as the PLAN, Chan Myae Mitta, Community Development Action and Swan Yae for children and agricultural development, there are no health-related community support group in this village. During preliminary stage of CSG, all the villagers were appreciative and expressed their willingness to organize the group for health
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support. The CSG was organized before COVID-19 touched the village. After organizing, the CSG members and villagers gained awareness on COVID-19 with the help of the Community Facilitator. They conduct COVID-19 prevention activities such as practicing of hand washing, and distribution and wearing of masks in their local community. Moreover, they can conduct vector borne disease prevention such as dengue prevention activities in collaboration with health workers. U Wai Tin Aung, a village leader as well as a chairman of the “Cherry” CSG Committee, said that “We cannot avoid the health issues of our village. We need to work together with URC Defeat Malaria to improve our village’s health status.”
U Wai Tin Aung, a village leader expressed his feeling of thankfulness to URC Defeat Malaria for organizing CSG at Zee Kwin Village, Toungup Township (December 2020)
TheDecember chairman 2020 of CSG also said that “Our rural people are mostly low in education and our village is underdeveloped. However, because of the previous development projects and with the newly established CSG committee, the villagers can identify the community problems as well as the needs of health development, and now we know how to apply the knowledge we have gained for community support activities. Thank you so much to URC Defeat Malaria for the invaluable supports.”
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 7: Case Finding and Management of all Approaches (PCD, ACD, All Inclusiveness) by Townships (Oct. 2020 – Dec. 2020) No Township Tested Total Positive P.f. P.v. Mixed TPR% 1 Bokpyin (ARC) 1,873 16 0 16 0 0.85% 2 Dawei (URC) 898 56 0 56 0 6.24% 3 Kawthoung (ARC) 3,069 0 0 0 0 0.00% 4 Kyunsu (URC) 1,806 33 4 29 0 1.83% 5 Launglon (URC) 927 0 0 0 0 0.00% 6 Myeik (URC) 916 3 0 2 1 0.33% 7 Palaw (URC) 1,319 54 3 51 0 4.09% 8 Tanintharyi (ARC) 1,575 40 10 27 3 2.54% 9 Thayetchaung (URC) 888 12 0 12 0 1.35% 10 Yebyu (URC) 2,023 21 5 15 1 1.04% Tanintharyi Total 15,294 235 22 208 5 1.54% 11 Ann (URC) 2,382 20 14 6 0 0.84% 12 Gwa (MNMA) 1,227 0 0 0 0 0.00% 13 Kyuakpyu (URC) 408 0 0 0 0 0.00% 14 Munaung (URC) 2,796 0 0 0 0 0.00% 15 Ramree (URC) 3,560 4 0 4 0 0.11% 16 Thandwe (MNMA) 2,082 0 0 0 0 0.00% 17 Toungup (URC) 4,962 61 54 4 3 1.23% Southern Rakhine Total 17,417 85 68 14 3 0.49% 18 Buthidaung (MHAA) 6,509 75 29 44 2 1.15% 19 Kyauktaw (URC) 4,244 73 24 49 0 1.72% 20 Maungdaw (MHAA) 915 4 3 0 1 0.44% 21 Minbya (URC) 1,371 105 50 52 3 7.66% 22 Mrauk-U (URC) 1,865 50 16 34 0 2.68% 23 Myebon (URC) 1,645 9 2 7 0 0.55% 24 Pauktaw (URC) 1,008 24 0 24 0 2.38% 25 Ponnagyun (URC) 2,083 38 9 29 0 1.82% 26 Rathedaung (MHAA) 966 2 0 2 0 0.21% 27 Sittwe (URC) 1,208 5 0 5 0 0.41% Northern Rakhine Total 1,814 385 133 246 6 1.76% 28 Hlaingbwe (ARC) 1,115 5 0 5 0 0.45% 29 Hpa-an (ARC) 1,686 3 0 3 0 0.18% 30 Kawkareik (ARC) 1,185 5 0 5 0 0.42% 31 Myawaddy (ARC) 931 60 0 60 0 6.44% Kayin Total 4,917 73 0 73 0 1.48% 32 Banmauk (URC) 1,270 14 10 4 0 1.10% 33 Homalin (URC) 1,181 1 1 0 0 0.08% 34 Indaw (URC) 1,152 10 6 4 0 0.87% 35 Pale (URC) 1,155 4 2 2 0 0.35% 36 Pinlebu (URC) 1,129 5 1 4 0 0.44% Sagaing Total 5,887 34 20 14 0 0.58% Defeat Malaria Grand Total 65,329 812 243 555 14 1.24%
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 8: Proactive and Reactive Case Detection by Mobile Team (Oct. 2020 – Dec. 2020) Proactive Case Detection by Mobile Teams (Oct. – Dec. 2020) Total No Township Tested P.f. P.v. Mixed TPR% Positive 1 Bokpyin 0 0 0 0 0 0% 2 Dawei 0 0 0 0 0 0% 3 Kawthoung 0 0 0 0 0 0% 4 Kyunsu 0 0 0 0 0 0% 5 Launglon 0 0 0 0 0 0% 6 Myeik 0 0 0 0 0 0% 7 Palaw 0 0 0 0 0 0% 8 Tanintharyi 30 0 0 0 0 0% 9 Thayetchaung 10 0 0 0 0 0% 10 Yebyu 0 0 0 0 0 0% Tanintharyi Total 40 0 0 0 0 0% 11 Ann 0 0 0 0 0 0% 12 Gwa 0 0 0 0 0 0% 13 Kyaukpyu 0 0 0 0 0 0% 14 Munaung 60 0 0 0 0 0% 15 Ramree 29 0 0 0 0 0% 16 Thandwe 0 0 0 0 0 0% 17 Toungup 0 0 0 0 0 0% Rakhine (South) Total 89 0 0 0 0 0% 18 Buthidaung 0 0 0 0 0 0% 19 Kyauktaw 0 0 0 0 0 0% 20 Maungdaw 0 0 0 0 0 0% 21 Minbya 0 0 0 0 0 0% 22 Mrauk-U 0 0 0 0 0 0% 23 Myebon 0 0 0 0 0 0% 24 Pauktaw 0 0 0 0 0 0% 25 Ponnagyun 0 0 0 0 0 0% 26 Rathedaung 30 0 0 0 0 0% 27 Sittwe 0 0 0 0 0 0% Rakhine (North) Total 30 0 0 0 0 0% 28 Hlaingbwe 0 0 0 0 0 0% 29 Hpa-an 0 0 0 0 0 0% 30 Kawkareik 0 0 0 0 0 0% 31 Myawaddy 49 0 0 0 0 0% Kayin Total 49 0 0 0 0 0% 32 Banmauk 0 0 0 0 0 0% 33 Homalin 0 0 0 0 0 0% 34 Indaw 0 0 0 0 0 0% 35 Pale 0 0 0 0 0 0% 36 Pinlebu 0 0 0 0 0 0% Sagaing Total 0 0 0 0 0 0% Grand Total 208 0 0 0 0 0%
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Reactive Case Detection by Mobile Team (Oct. – Dec. 2020) Reactive Case Detection during Case Investigation, Reactive Case Detection Only (No Case Investigation, Foci Investigation and Response Foci Investigation and Response) No Township Total . Notifie Total Notified Total Total positiv P.f. P.v. MIXED P.f. P.v. MIXED d cases test cases test positive e 1 Bokpyin 0 0 0 0 0 0 5 45 1 0 1 0 2 Dawei 0 0 0 0 0 0 1 8 0 0 0 0 3 Kawthoung 0 0 0 0 0 0 0 0 0 0 0 0 4 Kyunsu 0 0 0 0 0 0 0 0 0 0 0 0 5 Launglon 0 0 0 0 0 0 0 0 0 0 0 0 6 Myeik 0 0 0 0 0 0 0 0 0 0 0 0 7 Palaw 0 0 0 0 0 0 0 0 0 0 0 0 8 Tanintharyi 0 0 0 0 0 0 13 45 6 2 3 1 9 Thayetchaung 0 0 0 0 0 0 0 0 0 0 0 0 10 Yebyu 0 0 0 0 0 0 3 204 2 1 1 0 Tanintharyi Total 0 0 0 0 0 0 22 302 9 3 5 1 11 Ann 0 0 0 0 0 0 0 0 0 0 0 0 12 Gwa 0 0 0 0 0 0 0 0 0 0 0 0 13 Kyaukpyu 0 0 0 0 0 0 0 0 0 0 0 0 14 Munaung 0 0 0 0 0 0 0 0 0 0 0 0 15 Ramree 3 156 2 0 2 0 0 0 0 0 0 0 16 Thandwe 0 0 0 0 0 0 0 0 0 0 0 0 17 Toungup 52 631 5 4 1 0 0 0 0 0 0 0 Southern Rakhine Total 55 787 7 4 3 0 0 0 0 0 0 0 18 Buthidaung 0 0 0 0 0 0 14 189 1 0 1 0 19 Kyauktaw 0 0 0 0 0 0 0 0 0 0 0 0 20 Maungdaw 0 0 0 0 0 0 3 30 0 0 0 0 21 Minbya 0 0 0 0 0 0 1 6 0 0 0 0 22 Mrauk-U 0 0 0 0 0 0 0 0 0 0 0 0 23 Myebon 0 0 0 0 0 0 3 38 1 0 1 0
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
24 Pauktaw 1 40 0 0 0 0 1 28 7 0 7 0 25 Ponnagyun 0 0 0 0 0 0 0 0 0 0 0 0 26 Rathedaung 0 0 0 0 0 0 0 0 0 0 0 0 27 Sittwe 0 0 0 0 0 0 2 108 0 0 0 0 Northern Rakhine Total 1 40 0 0 0 0 24 399 9 0 9 0 28 Hlaingbwe 0 0 0 0 0 0 1 2 0 0 0 0 29 Hpa-an 0 0 0 0 0 0 1 6 0 0 0 0 30 Kawkareik 1 19 0 0 0 0 0 0 0 0 0 0 31 Myawaddy 0 0 0 0 0 0 0 0 0 0 0 0 Kayin Total 1 19 0 0 0 0 2 8 0 0 0 0 32 Banmauk 0 0 0 0 0 0 0 0 0 0 0 0 33 Homalin 0 0 0 0 0 0 0 0 0 0 0 0 34 Indaw 0 0 0 0 0 0 0 0 0 0 0 0 35 Pale 1 25 0 0 0 0 0 0 0 0 0 0 36 Pinlebu 0 0 0 0 0 0 0 0 0 0 0 0 Sagaing Total 1 25 0 0 0 0 0 0 0 0 0 0 Grand Total 58 871 7 4 3 0 48 709 18 3 14 1
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 9: VMWs/PPs Meetings (Oct. 2020 – Dec. 2020) Sr VMW/PP Posts % of VMWs/PPs No Township have to attend Male Female Total attended the . the meeting meeting 1 Bokpyin 156 34 105 139 89.1% 2 Dawei - - - - - 3 Kawthoung 62 26 27 53 85.5% 4 Kyunsu 129 25 88 113 87.6% 5 Launglon 32 3 25 28 87.5% 6 Myeik 64 4 59 63 98.4% 7 Palaw 85 23 62 85 100.0% 8 Tanintharyi 177 37 134 171 96.6% 9 Thayetchaung 90 14 70 84 93.3% 10 Yebyu 68 14 54 68 100.0% Tanintharyi Total 863 180 624 804 93.2% 11 Ann 201 135 58 193 96.0% 12 Gwa 195 75 120 195 100.0% 13 Kyaukpyu 50 38 12 50 100.0% 14 Munaung - - - - - 15 Ramree 231 151 76 227 98.3% 16 Thandwe 348 129 219 348 100.0% 17 Toungup 273 118 110 228 83.5% Southern Rakhine Total 1,298 646 595 1,241 95.6% 18 Buthidaung 305 278 19 297 97.4% 19 Kyauktaw - - - - - 20 Maungdaw 72 65 3 68 94.4% 21 Minbya - - - - - 22 Mrauk-U - - - - - 23 Myebon - - - - - 24 Pauktaw - - - - - 25 Ponnagyun - - - - - 26 Rathedaung 108 42 63 105 97.2% 27 Sittwe - - - - - Northern Rakhine Total 485 385 85 470 96.9% 28 Hlaingbwe 81 13 68 81 100.0% 29 Hpa-an 172 42 130 172 100.0% 31 Kawkareik 147 61 81 142 96.6% 33 Myawaddy 72 18 54 72 100.0% Kayin Total 472 134 333 467 98.9% 34 Banmauk 114 27 87 114 100.0% 35 Homalin 90 58 25 83 92.2% 36 Indaw 105 18 87 105 100.0% 37 Pale 123 39 84 123 100.0% 38 Pinlebu 174 81 93 174 100.0% Sagaing Total 606 223 376 599 98.8% Grand Total 3,724 1,568 2,013 3,581 96.2%
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 10: Supervision and Monitoring of VMWs/PPs (Oct. 2020 – Dec. 2020)
No # of visits to # of visits to Total supervision visits to Township . VMWs PPs VMWs/PPs 1 Bokpyin 28 3 31 2 Dawei 24 1 25 3 Kawthoung 30 2 32 4 Kyunsu 20 2 22 5 Launglon 23 - 23 6 Myeik 11 3 14 7 Palaw 18 6 24 8 Tanintharyi 32 - 32 9 Thayetchaung 16 1 17 10 Yebyu 32 - 32 Tanintharyi Total 234 18 252 11 Ann 13 4 17 12 Gwa 39 - 39 13 Kyaukpyu - - - 14 Munaung - - - 15 Ramree - - - 16 Thandwe 69 - 69 17 Toungup 23 4 27 Southern Rakhine Total 144 8 152 18 Buthidaung - - - 19 Kyauktaw - - - 20 Maungdaw - - - 21 Minbya - - - 22 Mrauk-U - - - 23 Myebon - - - 24 Pauktaw - 2 2 25 Ponnagyun - - - 26 Rathedaung - - - 27 Sittwe 1 - 1 Northern Rakhine Total 1 2 3 28 Hlaingbwe 26 - 26 29 Hpa-an 51 2 53 30 Kawkareik 29 2 31 31 Myawaddy 15 - 15 Kayin Total 121 4 125 32 Banmauk 10 - 10 33 Homalin 13 - 13 34 Indaw 22 - 22 35 Pale 30 - 30 36 Pinlebu 30 - 30 Sagaing Total 105 - 105 Grand Total 605 32 637
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 11: Reporting Status of VMWs and PPs (Oct. 2020 – Dec. 2020) # of Cumulative # of # of VMW/PP % of % of N VMW/PP Township VMW/PP reports reported (on reportin timely o reported on to be submitted time & late) g reporting time 1 Bokpyin 182 182 171 100.0% 94.0% 2 Dawei 96 96 92 100.0% 95.8% 3 Kawthoung 188 182 178 96.8% 97.8% 4 Kyunsu 189 189 189 100.0% 100.0% 5 Launglon 98 96 93 98.0% 96.9% 6 Myeik 96 96 96 100.0% 100.0% 7 Palaw 156 154 151 98.7% 98.1% 8 Tanintharyi 177 176 170 99.4% 96.6% 9 Thayetchaung 90 90 89 100.0% 98.9% 10 Yebyu 206 204 201 99.0% 98.5% Tanintharyi Total 1,478 1,465 1,430 99.1% 97.6% 11 Ann 291 275 264 94.5% 96.0% 12 Gwa 195 195 195 100.0% 100.0% 13 Kyaukpyu 150 134 134 89.3% 100.0% 14 Munaung - - - - - 15 Ramree 231 231 231 100.0% 100.0% 16 Thandwe 348 348 348 100.0% 100.0% 17 Toungup 273 261 259 95.6% 99.2% Southern Rakhine Total 1,488 1,444 1,431 97.0% 99.1% 18 Buthidaung 429 423 407 98.6% 96.2% 19 Kyauktaw 381 381 381 100.0% 100.0% 20 Maungdaw 72 68 68 94.4% 100.0% 21 Minbya 222 219 219 98.6% 100.0% 22 Mrauk-U 225 225 225 100.0% 100.0% 23 Myebon 234 234 234 100.0% 100.0% 24 Pauktaw 126 126 126 100.0% 100.0% 25 Ponnagyun 222 220 213 99.1% 96.8% 26 Rathedaung 191 170 168 89.0% 98.8% 27 Sittwe 123 123 123 100.0% 100.0% Northern Rakhine Total 2,225 2,189 2,164 98.4% 98.9% 28 Hlaingbwe 156 156 153 100.0% 98.1% 29 Hpa-an 270 270 270 100.0% 100.0% 30 Kawkareik 147 147 147 100.0% 100.0% 31 Myawaddy 72 72 72 100.0% 100.0% Kayin Total 645 645 642 100.0% 99.5% 32 Banmauk 114 114 114 100.0% 100.0% 33 Homalin 89 83 83 93.3% 100.0% 34 Indaw 105 105 105 100.0% 100.0% 35 Pale 123 123 123 100.0% 100.0% 36 Pinlebu 174 174 174 100.0% 100.0% Sagaing Total 605 599 599 99.0% 100.0% Grand Total 6,441 6,342 6,266 98.5% 98.8%
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 12: Clinical Audit (Oct. 2020 – Dec. 2020) Total % of Positive Total Total positive % of Sr. Total patients who Positiv Positiv cases treated No Township referre was treated e cases e cases treated positive . d cases according to found treated according cases NTG to NTG 1 Bokpyin 16 16 16 0 100.0% 100.0% 2 Dawei 56 56 55 0 100.0% 98.2% 3 Kawthoung 0 0 0 0 - - 4 Kyunsu 33 32 32 1 97.0% 100.0% 5 Launglon 0 0 0 0 - - 6 Myeik 3 3 3 0 100.0% 100.0% 7 Palaw 54 54 53 0 100.0% 98.1% 8 Tanintharyi 40 40 40 0 100.0% 100.0% 9 Thayetchaung 12 12 12 0 100.0% 100.0% 10 Yebyu 21 21 19 0 100.0% 90.5% Tanintharyi Total 235 234 230 1 99.6% 98.3% 11 Ann 20 20 18 0 100.0% 90.0% 12 Gwa 0 0 0 0 - - 13 Kyaukpyu 0 0 0 0 - - 14 Munaung 0 0 0 0 - - 15 Ramree 4 4 4 0 100.0% 100.0% 16 Thandwe 0 0 0 0 - - 17 Toungup 61 61 61 0 100.0% 100.0% Southern Rakhine Total 85 85 83 0 100.0% 97.6% 18 Buthidaung 75 75 74 0 100.0% 98.7% 19 Kyauktaw 73 73 73 0 100.0% 100.0% 20 Maungdaw 4 3 3 1 75.0% 100.0% 21 Minbya 105 105 105 0 100.0% 100.0% 22 Mrauk-U 50 49 49 1 98.0% 100.0% 23 Myebon 9 9 9 0 100.0% 100.0% 24 Pauktaw 24 23 23 1 95.8% 100.0% 25 Ponnagyun 38 38 38 0 100.0% 100.0% 26 Rathedaung 2 2 2 0 100.0% 100.0% 27 Sittwe 5 5 5 0 100.0% 100.0% Northern Rakhine Total 385 382 381 3 99.2% 99.7% 28 Hlaingbwe 5 4 4 1 80.0% 100.0% 29 Hpa-an 3 3 3 0 100.0% 100.0% 30 Kawkareik 5 5 5 0 100.0% 100.0% 31 Myawaddy 60 60 60 0 100.0% 100.0% Kayin Total 73 72 72 1 98.6% 100.0% 32 Banmauk 14 14 14 0 100.0% 100.0% 33 Homalin 1 1 1 0 100.0% 100.0% 34 Indaw 10 10 10 0 100.0% 100.0% 35 Pale 4 4 4 0 100.0% 100.0% 36 Pinlebu 5 5 5 0 100.0% 100.0% Sagaing Total 34 34 34 0 100.0% 100.0% Grand Total 812 807 800 5 99.4% 99.1%
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 13: Stock-out Monitoring at the time of Monitoring Visits (Supervision Visit and RDQA) and On- site Data Collection (Oct. 2020 – Dec. 2020) Total # % of sites which % of sites which % of sites which No Township Total # of % of sites which experienced of visited experienced NO experienced NO experienced NO . (Organization) visited PP NO ACT stock out VMW RDT stock out ACT stock out RDT stock out 1 Bokpyin (ARC) 50 100.0% 100.0% 5 100.0% 100.0% 2 Dawei (URC) 85 100.0% 100.0% 6 100.0% 100.0% 3 Kawthoung (ARC) 125 100.0% 100.0% 14 100.0% 100.0% 4 Kyunsu (URC) 22 100.0% 100.0% 3 100.0% 100.0% 5 Launglon (URC) 53 100.0% 100.0% - - - 6 Myeik (URC) 11 100.0% 100.0% 4 100.0% 100.0% 7 Palaw (URC) 22 100.0% 100.0% 8 100.0% 100.0% 8 Tanintharyi (ARC) 32 100.0% 100.0% - - - 9 Thayetchaung (URC) 18 100.0% 100.0% 1 100.0% 100.0% 10 Yebyu (URC) 44 100.0% 100.0% - - - Tanintharyi Total 462 100.0% 100.0% 41 100.0% 100.0% 11 Ann (URC) 13 100.0% 100.0% 4 100.0% 100.0% 12 Gwa (MNMA) 39 100.0% 100.0% - - - 13 Kyaukpyu (URC) ------14 Munaung (URC) ------15 Ramree (URC) ------16 Thandwe (MNMA) 69 100.0% 100.0% - - - 17 Toungup (URC) 10 100.0% 100.0% 2 100.0% 100.0% Southern Rakhine Total 131 100.0% 100.0% 6 100.0% 100.0% 18 Buthidaung (MHAA) ------19 Kyauktaw (URC) 375 100.0% 100.0% 6 100.0% 100.0% 20 Maungdaw (MHAA) ------21 Minbya (URC) 216 100.0% 100.0% - - - 22 Mrauk-U (URC) 192 100.0% 100.0% 33 100.0% 100.0% 23 Myebon (URC) 219 100.0% 100.0% 15 100.0% 100.0% 24 Pauktaw (URC) 99 100.0% 100.0% 27 100.0% 100.0% 25 Ponnagyun (URC) 192 100.0% 100.0% 21 100.0% 100.0%
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Rathedaung 26 ------(MHAA) 27 Sittwe (URC) 123 100.0% 100.0% - - - Northern Rakhine Total 1,416 100.0% 100.0% 102 100.0% 100.0% 28 Hlaingbwe (ARC) 26 100.0% 100.0% - - - 29 Hpa-an (ARC) 56 100.0% 100.0% 8 100.0% 100.0% 30 Kawkareik (ARC) 29 100.0% 100.0% 2 100.0% 100.0% 31 Myawaddy (ARC) 15 100.0% 100.0% - - - Kayin Total 126 100.0% 100.0% 10 100.0% 100.0% 32 Banmauk (URC) 10 100.0% 100.0% - - - 33 Homalin (URC) 13 100.0% 100.0% - - - 34 Indaw (URC) 22 100.0% 100.0% - - - 35 Pale (URC) 30 100.0% 100.0% - - - 36 Pinlebu (URC) 30 100.0% 100.0% - - - Sagaing Total 105 100.0% 100.0% - 0.0% 0.0% Grand Total 2,240 100.0% 100.0% 159 100.0% 100.0%
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 14: Stock-out Monitoring at Monthly Meeting (Oct. 2020 – Dec. 2020)
Total # % of sites which % of sites which % of sites which No Township Total # of % of sites which experienced of VMWs experienced NO experienced NO experienced NO . (Organization) PPs met NO ACT stock out met RDT stock out ACT stock out RDT stock out 1 Bokpyin (ARC) 126 100.0% 100.0% 13 100.0% 100.0% 2 Dawei (URC) ------3 Kawthoung (ARC) 47 100.0% 100.0% 6 100.0% 100.0% 4 Kyunsu (URC) 99 100.0% 100.0% 14 100.0% 100.0% 5 Launglon (URC) 28 100.0% 100.0% - - - 6 Myeik (URC) 52 100.0% 100.0% 11 100.0% 100.0% 7 Palaw (URC) 72 100.0% 100.0% 13 100.0% 100.0% 8 Tanintharyi (ARC) 171 100.0% 100.0% - - - 9 Thayetchaung (URC) 66 100.0% 100.0% 18 100.0% 100.0% 10 Yebyu (URC) 68 100.0% 100.0% - - - Tanintharyi Total 729 100.0% 100.0% 75 100.0% 100.0% 11 Ann (URC) 140 100.0% 100.0% 53 100.0% 100.0% 12 Gwa (MNMA) 195 100.0% 100.0% - - - 13 Kyaukpyu (URC) 44 100.0% 100.0% 6 100.0% 100.0% 14 Munaung (URC) ------15 Ramree (URC) 219 100.0% 100.0% 2 100.0% 100.0% 16 Thandwe (MNMA) 348 100.0% 100.0% - - - 17 Toungup (URC) 180 100.0% 100.0% 48 100.0% 100.0% Southern Rakhine Total 1,126 100.0% 100.0% 109 100.0% 100.0% 18 Buthidaung (MHAA) 297 100.0% 100.0% - - - 19 Kyauktaw (URC) ------20 Maungdaw (MHAA) 68 100.0% 100.0% - - - 21 Minbya (URC) ------22 Mrauk-U (URC) ------23 Myebon (URC) ------24 Pauktaw (URC) ------25 Ponnagyun (URC) ------
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Rathedaung 26 105 100.0% 100.0% - - - (MHAA) 27 Sittwe (URC) ------Northern Rakhine Total 470 100.0% 100.0% - - - 28 Hlaingbwe (ARC) 81 100.0% 100.0% - - - 29 Hpa-an (ARC) 172 100.0% 100.0% - - - 30 Kawkareik (ARC) 136 100.0% 100.0% 6 100.0% 100.0% 31 Myawaddy (ARC) 69 100.0% 100.0% 3 100.0% 100.0% Kayin Total 458 100.0% 100.0% 9 100.0% 100.0% 32 Banmauk (URC) 114 100.0% 100.0% - - - 33 Homalin (URC) 83 100.0% 100.0% - - - 34 Indaw (URC) 105 100.0% 100.0% - - - 35 Pale (URC) 123 100.0% 100.0% - - - 36 Pinlebu (URC) 174 100.0% 100.0% - - - Sagaing Total 599 100.0% 100.0% - 0.0% 0.0% Grand Total 3,382 100.0% 100.0% 193 100.0% 100.0%
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 15: Health Workers Trained in Malaria Diagnostics and Case Management (Oct. 2020 – Dec. 2020)
Sr Village Malaria Workers Private Providers Grand Township No. Total Male Female Sub-total Male Female Sub-total 1 Bokpyin ------2 Dawei ------3 Kawthoung ------4 Kyunsu 1 19 20 1 4 5 25 5 Launglon 3 26 29 - - - 29 6 Myeik ------7 Palaw ------8 Tanintharyi ------9 Thayetchaung 5 15 20 - 5 5 25 10 Yebyu ------Tanintharyi Total 9 60 69 1 9 10 79 11 Ann ------12 Gwa ------13 Kyaukpyu ------14 Munaung ------15 Ramree ------16 Thandwe - 1 1 - - - 1 17 Toungup* ------Southern Rakhine Total - 1 1 - - - 1 18 Buthidaung ------19 Kyauktaw ------20 Maungdaw ------21 Minbya ------22 Mrauk-U ------23 Myebon ------24 Pauktaw ------25 Ponnagyun ------26 Rathedaung ------27 Sittwe ------Northern Rakhine Total ------28 Hlaingbwe ------29 Hpa-an ------30 Kawkareik ------31 Myawaddy ------Kayin Total ------32 Banmauk 9 29 38 - - - 38 33 Homalin 18 6 24 - - - 24 34 Indaw 6 29 35 - - - 35 35 Pale ------36 Pinlebu 11 16 27 - - - 27 Sagaing Total 44 80 124 - - - 124 Grand Total 53 141 194 1 9 10 204 *One MMW from Toungup Township was trained for malaria diagnosis and case management
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 16: Capacity Building on Integrated Community Malaria Volunteer (Oct. 2020 – Dec. 2020)
Sr Village Malaria Workers Private Providers Township Grand Total No. Male Female Sub-total Male Female Sub-total 1 Bokpyin ------2 Dawei ------3 Kawthoung ------4 Kyunsu 1 19 20 1 4 5 25 5 Launglon 3 26 29 - - - 29 6 Myeik ------7 Palaw ------8 Tanintharyi ------9 Thayetchaung 5 15 20 - 5 5 25 10 Yebyu ------Tanintharyi Total 9 60 69 1 9 10 79 11 Ann ------12 Gwa ------13 Kyaukpyu ------14 Munaung ------15 Ramree ------16 Thandwe - 1 1 - - - 1 17 Toungup ------Southern Rakhine Total - 1 1 - - - 1 18 Buthidaung ------19 Kyauktaw ------20 Maungdaw ------21 Minbya ------22 Mrauk-U ------23 Myebon ------24 Pauktaw ------25 Ponnagyun ------26 Rathedaung ------27 Sittwe ------Northern Rakhine Total ------28 Hlaingbwe ------29 Hpa-an ------30 Kawkareik ------31 Myawaddy ------Kayin Total ------32 Banmauk 9 29 38 - - - 38 33 Homalin 18 6 24 - - - 24 34 Indaw 6 29 35 - - - 35 35 Pale ------36 Pinlebu 11 16 27 - - - 27 Sagaing Total 44 80 124 - - - 124 Grand Total 53 141 194 1 9 10 204
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 17: Behavior Change Communication Activities (Oct. 2020 – Dec. 2020) Individual IPC Group Health Talk Sr Township Migrants Sessio Migrants No. Male Female Total Male Female Total included ns # included 1 Bokpyin 914 717 1,631 1,061 2 4 12 16 16 2 Dawei 392 305 697 124 - - - - - 3 Kawthoung 1,379 1,248 2,627 2,587 2 5 5 10 10 4 Kyunsu 555 557 1,112 114 - - - - - 5 Launglon 256 437 693 25 - - - - - 6 Myeik 302 418 720 15 - - - - - 7 Palaw 410 417 827 75 - - - - - 8 Tanintharyi 544 565 1,109 138 2 5 8 13 8 9 Thayetchaung 366 510 876 201 - - - - - 10 Yebyu 627 814 1,441 95 - - - - - Tanintharyi Total 5,745 5,988 11,733 4,435 6 14 25 39 34 11 Ann 1,031 880 1,911 1,158 - - - - - 12 Gwa 1,018 1,215 2,233 44 - - - - - 13 Kyaukpyu 263 346 609 17 - - - - - 14 Munaung ------15 Ramree 398 445 843 181 10 10 27 37 33 16 Thandwe 1,727 2,180 3,907 1 - - - - - 17 Toungup 528 389 917 294 36 128 238 366 114 Southern Rakhine Total 4,965 5,455 10,420 1,695 46 138 265 403 147 18 Buthidaung 4,227 1,488 5,715 103 - - - - - 19 Kyauktaw 1,337 1,410 2,747 168 10 34 43 77 - 20 Maungdaw 458 310 768 46 - - - - - 21 Minbya 531 398 929 140 - - - - - 22 Mrauk-U 699 618 1,317 58 - - - - - 23 Myebon 520 555 1,075 69 - - - - - 24 Pauktaw 416 377 793 31 - - - - - 25 Ponnagyun 639 646 1,285 110 - - - - - 26 Rathedaung 356 357 713 11 - - - - - 27 Sittwe 360 491 851 3 - - - - - Northern Rakhine Total 9,543 6,650 16,193 739 10 34 43 77 - 28 Hlaingbwe 372 465 837 35 - - - - - 29 Hpa-an 574 899 1,473 43 - - - - - 30 Kawkareik 357 636 993 22 1 5 16 21 - 31 Myawaddy 630 636 1,266 211 - - - - - Kayin Total 1,933 2,636 4,569 311 1 5 16 21 - 32 Banmauk 439 550 989 134 - - - - - 33 Homalin 545 372 917 20 - - - - - 34 Indaw 380 554 934 46 - - - - - 35 Pale 385 487 872 134 - - - - - 36 Pinlebu 337 528 865 53 - - - - - Sagaing Total 2,086 2,491 4,577 387 - - - - - Grand Total 24,272 23,220 47,492 7,567 63 191 349 540 181
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
Annex 18: Performance Indicators Tracking Table (Oct. 2020 – Dec. 2020) Frequenc Indicators y of Baseline Q1 Progress Target Achievement % Remark reporting IP 1: Annual Parasite Incidence (API) Annual 8 (CAP-M Annual Indicator 1.2 in Defeat Malaria villages PY4) Number of confirmed malaria cases 812 Mid-year population at risk of N/A targeted areas IP 2: Annual Blood Examination Rate Annual 6% in 2015 Annual Indicator 10% (National Number of parasitological tests M&E plan) carried out in Defeat Malaria target 65,329 areas Mid-year population at risk in Defeat N/A Malaria targeted areas IP 3: Percent of indigenous cases Quarterly 9% (from among cases investigated (in National 6% 10% elimination areas) M&E plan) Number of cases classified as 4 indigenous Number of cases investigated 64 IP 4: Percent of active foci among Monthly N/A 25 foci were investigated. foci investigated (in elimination 16% 16% 60% There were 4 active foci, and areas) 21 residual non-active foci. Number of active foci investigated 4 4 Number of foci investigated 25 25 IP 5: Proportion of villages with zero Annual 18.5% Annual Indicator positive cases in a fiscal year (CAP-M database) Number of villages with ≥10% ABER N/A reported zero positive case reporting Total number of Defeat Malaria covered villages with ≥10% ABER in N/A assessment year Objective 1: Achieve and maintain universal coverage of at-risk populations with proven vector control and case management interventions, while promoting the testing of new tools and approaches
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OC 1.1 % of households in target Baseline & To be measured by end line N/A 85% areas that own at least one ITN end line survey. OC 1.2 Percentage of households in Baseline & 47% in To be measured by end line target areas that own at least one end line Rakhine, survey. insecticide-treated net for every two 60.2% in persons TNT, & N/A 80% 65.6% in Kayin (CAP- M) OC 1.3 % of individuals in targeted Baseline & TBD after To be measured by end line areas who slept under ITN the end line baseline survey. previous night. (disaggregate by type N/A 80% of net, pregnant women, age and gender) OC 1.4 % of service delivery points Quarterly Minimum which report no stock outs of RDTs 85% (from 100.0% 100.0% 90% 111% lasting more than one week during CAP-M) the past 3 months (disaggregate by 5,974 5,974 type of SDP) 5,974 5,974 OC 1.5 % of service delivery points Quarterly Minimum which report no stock outs of first 85% (from 100.00% 100.0% 90% 111% line antimalarial medicines (ACT) CAP-M) lasting more than one week during the past 3 months (disaggregate by 5,974 5,974 type of SDP) 5,974 5,974 OC 1.6 % of patients found positive Quarterly minimum 2 Pregnant women and 2 who received antimalarial treatment 95% (from under 1 children were 99.1% 99.1% 95% 104% according to National Malaria CAP-M) referred to health facilities, Treatment Guidelines but they refused and ICMVs Number of patients found positive had to provide treatments who received antimalaria treatment 800 800 upon patients' /guardian's according to NTG autonomy. 3 more patients were given incorrect Number of patients found positive 807 807 prescription for Primaquine. who received antimalaria treatment OC 1.7 % of Malaria Positive cases Quarterly 25% (from with having completed the CAP-M 99.4% 99.4% treatment under DOT
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Number of total positive cases with FY15 542 542 DOT having complete DOT report) Number of total positive cases 545 545 enrolled for DOT Number of P.f. positive cases with 168 DOT having complete DOT 100% 95% 105% Number of P.f. positive cases enrolled 168 for DOT Number of mixed positive cases with 3 DOT having complete DOT 100% 95% 105% Number of mixed positive cases 3 enrolled for DOT Number of P.v. positive cases with 371 DOT having complete DOT 99% 70% 142% Number of P.v. positive cases 374 enrolled for DOT OP 1.1 Number of insecticide treated Activity 92,986 LLINs distribution plans are net purchased in any fiscal year with implement (From CAP- mainly targeted in Q2 and 3,349 3,349 275,000 1% USG funds that were distributed in ed months M PY5) Q3. this quarter (PMI required indicator) OP 1.2 Number of artemisinin-based Quarterly N/A ACT distribution will be combination therapy (ACT) continued in next quarters. treatments purchased in any fiscal 1,683 1,683 15,600 11% year with USG funds that were distributed in this reported fiscal year (PMI required indicator) OP 1.3 Number of RDTs purchased in Quarterly N/A any fiscal year with USG funds that 61,425 61,425 246,000 25% were distributed (PMI required indicator) OP 1.4 Number of individuals Quarterly 514,333 reached with malaria behavior (from CAP- change messages through M PY5) 47,492 47,492 120,000 40% interpersonal communication (individual talks) OP 1.5 Number of health workers Quarterly 5,155 204 VMWs/PPs and 1 MMW trained in case management with (from CAP- were trained in Q1. Trainings ACTs with USG funds (Disaggregated M) 205 205 2,290 9% to VMWs/PPs will be linked by male, female, and profession; PMI with ICMV trainings, and required indicator) SBCC approach applying PLA
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OP 1.6 Number of health workers Month of 5,443 for 5 to 6 days in next trained in malaria laboratory training (from CAP- quarter. In Q1, SBCC diagnostics (rapid diagnostic tests or M) trainings were provided to 205 2,290 0% microscopy) with USG funds township staff. (disaggregated by male, female, and profession; PMI required indicator) Annual N/A Annual Indicator OP 1.7 % of VMWs/PPs in Defeat N/A 90% Malaria target areas received at least two supervisory visits per year
Objective 2: Strengthen the malaria surveillance system, improve data management capacity at all levels of the health system, from village to central level, and support appropriate information technology to facilitate data collection, reporting, and use in both public and private sectors OC 2.1 % of service delivery points in ≥ 80% targeted areas report monthly data Monthly 98.5% 98.5% 90% 109% of malaria cases (disaggregate by type of SDP) Number of SDP reported 6,342 6,342 Number of SDP posted 6,441 6,441 OC 2.2 % of service delivery points in N/A targeted areas report monthly data Annual 98.8% 98.8% 90.00% 110% of malaria cases on time (disaggregate by type of SDP) Number of SDP reported on time 6,266 6,266 Number of SDP reported 6,342 6,342 OC 2.3 % of positive cases notified Quarterly N/A within 24 hours in elimination 100% 100% 100% 100% targeted townships Number of positive cases notified within 24 hours in elimination 62 62 targeted townships Number of positive cases notified in 62 62 elimination targeted townships OC 2.4 Foci investigation rate Quarterly N/A 39.1% 39.1% 95% 41% 25 foci were investigated in FY 2021 Q1. There were 4 Number of foci investigated in 25 25 active foci and 21 residual elimination targeted townships non-active foci. Number of cases investigated in 64 64 elimination targeted townships. OC 2.5 Active focus response rate Quarterly N/A 100% 100% 95%
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Number of confirmed active foci investigated in which an appropriate 4 4 response was initiated within 7 days in elimination targeted townships. Number of confirmed active foci in 4 4 elimination targeted townships OP 2.1 Number of townships that Quarterly N/A have been developed and updated and Annual N/A 31 0% VBS annually OP 2.2 Number entomological Semi- N/A Pending according to the surveys conducted in persistent annual tailoring malaria intervention 0 0 8 0% transmission areas during COVID-19 guide of NMCP. Objective 3: Enhance technical and operational capacity of the NMCP and other health service providers at all levels of service provision OP 3.1 % of targeted health services Annual TBD with Quality Assurance/Quality Control system received quarterly N/A 70% internal assessments of the QA system in collaboration with NHL/NMCP OP 3.2 Number of trainings on Quarterly N/A Virtual trainings were malaria technical skill and training scheduled to be conducted 2 2 20 10% facilitation skill supported by Defeat in next quarters. Malaria OP 3.3 Number of trainers Quarterly N/A developed through Defeat Malaria 10 10 84 12% OP 3.4 Number of people trained Quarterly Pending under COVID-19 and through on-site training supported 0 200 0% it will continue in next by USG program (Defeat Malaria) quarters. OP 3.5 Percentage of trainers Quarterly N/A 10 Master Mentors and 0% 0% 50% 0% supervised during trainings General Trainers were Number of Master Mentors and planned to be supervised General Trainers supervised by during their multiplier Jhpiego/Defeat Malaria 0 0 24 0% courses or on-site trainings. during multiplier and on-site No on-site trainings were trainings. conducted in Q1 according to respective Township Number of Master Mentors and 10 10 84 12% Health Departments’ General Trainers developed suggestions.
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
OP 3.6 Percentage of master Quarterly N/A 15 Master Mentors were mentors retaining at least 80% of 100.0% 33.3% 80% targeted to be trained during acquired skills and knowledge Defeat Malaria activities. Number of Master Mentors who In Q1, 5 Master Mentors retain at least 80% of acquired skills were assessed and all 5 were 5 5 12 and knowledge 9 months after found to retain at least 80% receiving training of acquired knowledge and skills. Number of Master Mentors trained 5 15 15 OP 3.7 Number of joint supervision Quarterly N/A visits to VMW for data quality 12 12 30 40% assessments OP 4: Promote the involvement of communities, private healthcare providers, private companies and state-owned enterprises in malaria control and elimination initiatives OP 4.1 Number of private companies Annual N/A and state-owned enterprises 44 44 60 73% involved in malaria activities OP 4.2 Number of health education Monthly N/A The activities were pending sessions conducted in the targeted in most of the townships areas with participation from 4 4 100 4% according to local health collaborating companies and authorities' suggestions. enterprises
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Annex 19: Cost Share Plan
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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT (OCT. – DEC. 2020)
DEFEAT MALARIA PARTNERS University Research Co., LLC (URC) as a prime with partners: American Refugee Committee (ARC) | Myanmar Health Assistance Association (MHAA) | Myanmar Nurse and Midwife Association (MNMA) | Jhpiego | Johns Hopkins Program for International Education in Gynecology and Obstetrics |
Room 602, 6th Floor, Shwe Than Lwin Condominium New University Ave. Rd., Bahan Township Yangon, Myanmar
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