Quarterly Progress Report January 01, 2017 to March 31, 2017

Home , Ann Township, Dawei, Dawei District, Dawei Township, Gwa Township, Kyunsu

DEFEAT MALARIA

Defeat Malaria Quarterly Progress Report January 01, 2017 to March 31, 2017

Submission Date: April 30, 2017

Agreement Number: AID-482-A-16-00003 Agreement Period: August 15, 2016 to August 14, 2021 AOR Name: Mya Sapal Ngon

Submitted by: May Aung Lin, Chief of Party University of Research Co., LLC. Room 602, 6th Floor, Shwe Than Lwin Condominium New University Ave. Rd., Battan Township Yangon, Myanmar Email: [email protected]

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

Table of Contents List of Tables ------3 List of Figures ------4 ACRONYMS AND ABBREVIATIONS ------i 1. Executive Summary ------3 2. Goals and Objectives ------5 3. Implementation Progress ------5 1. Programmatic Management ------5 2. Summary on Key achievements during January 2017 – March 2017 ------6 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. ------7 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 ------11 Objective 3: Enhance technical and operational capacity of the NMCP and other health service providers at all levels of service provision ------22 Objective 4: Promote the involvement of communities, private healthcare providers, private companies and state-owned enterprises in malaria control and elimination initiatives ------23 4. Challenges and Opportunities ------25 5. Annexes ------27

List of Tables Table 1: Project area coverage during October 2016 – March 2017 ...... 4 Table 2: State/Region case finding and management activities (October 2016 – March 2017) ...... 6 Table 3: LLIN distribution at villages of Gwa Township, Rakhine State (October 2016 - March 2017) ..... 7 Table 4: LLIN distribution at worksites (October 2016 - March 2017) ...... 8 Table 5: Summary of case findings and management by approaches (October 2016 - March 2017) ...... 8 Table 6: Summary of case findings and management by State/Region (October 2016 - March 2017) ...... 8 Table 7: Directly observed treatment (DOT) (October 2016 - March 2017) ...... 9 Table 8: Summary of VMW/PP monthly meeting - person-month (October 2016 - March 2017) ...... 10 Table 9: Timeliness of reporting of malaria case data from VMW/PP (January 2017 – March 2017) ...... 12 Table 10: Updating malaria micro-stratification (in line with malaria elimination) ...... 15 Table 11: Active Case Detection through mobile team approach in Project Village (January 17 - March 17) ...... 16 Table 12: Active Case Detection through mobile team approach in Non-Project Village (January 17 - March 17) ...... 16 Table 13: Defeat Malaria Case Finding and Management, Township wise (October 2016 - March 2017) – Mobile Team Approach ...... 27 Table 14: Defeat Malaria Case Finding and Management by township (October 2016 - March 2017) – VMW Approach ...... 28 Table 15: Defeat Malaria Case Finding and Management by township (October 2016 – March 2017) – Private Provider Approach ...... 29 Table 16: Number of VMWs and PPs trained on case management (October 2016 - March 2017) ...... 30 Table 17: Number of VMWs and PPs trained on diagnosis (October 2016 - March 2017) ...... 31 Table 18: Number of VMW/PP supervised and monitored (October 2016 - March 2017) ...... 32 Table 19: Interpersonal communication by VMWs and PPs (October 2016 - March 2017) ...... 33 Table 20: Group Health Talks by VMWs and PPs (October 2016 ‐ March 2017) ...... 34 Table 21: Number of people reached through interpersonal communication (IPC) by Private Providers only. (October 2016 – March 2017) ...... 34 Table 22: Summary of township level advocacy meeting (October 2016 – December 2016) ...... 35 Table 23: Summary of township level advocacy meeting (January 2017 ‐ March 2017) ...... 36 Table 24: Performance Indicators Tracking Table (October 2016 - March 2017) ...... 38

List of Figures Figure 1: Defeat Malaria Geographical Areas ...... 3 Figure 2: Recruitment and reporting of VMW and PP (October 2016 - March 2017) ...... 12 Figure 3: Data verification and assessment dashboard samples ...... 14 Figure 4: Dalett Area, Ann Township for special mobile visit (2) ...... 15 Figure 5: Dalett Area, Ann Township for special mobile visit (1) ...... 15 Figure 6: Distribution of P.f to P.v cases and Malaria Test Positivity Rate by State/Region ...... 17 Figure 7: Time series analysis on case detection and treatment in Tanintharyi Region (October 2016 - March 2017) ...... 18 Figure 8: Time series analysis on case detection and treatment in Southern Rakhine State ...... 18 Figure 9: Accessibility to RDT and proportional malaria cases ...... 19 Figure 10: Pre- and Post-training knowledge assessment score presented as average percentage of each categorized group of Knowledge Assessment with Multiple Choice Questions (MCQ). Data were calculated as percentage based on the number of participants who correctly answer for each question 23 Figure 11: Number of people, disaggregated by gender, reached through IPC by VMWs and PPs (October 2016 - March 2017) ...... 25

ACRONYMS AND ABBREVIATIONS ACT Artemisinin-based combination therapy AOR Agreement Officer’s Representative ARC American Refugee Committee BCC Behavior Change Communication BHS Basic Health Staff CBO Community Based Organizations DMR Department of Medical Research DoPH Department of Public Health DOT Directly Observed Treatment DQO Data quality officer EMMP Environmental monitoring and mitigation plan GMS Greater Mekong Sub IP Implementing partners ITN Insecticide treated net KDHW Kayin Department of Health and Welfare LLIN Long Lasting Insecticide Nets M&E Monitoring and Evaluation MCQ Multiple Choice Questions MHAA Myanmar Health Assistant Association MNMA Myanmar Nurse and Midwife Association MoHS Ministry of Health and Sport MOU Memorandum of Understanding NGO Non-government Organizations NMCP National Malaria Control Program NTG National Treatment Guideline OSDV On-site data verification PCR Polymerized chain reaction PMI President’s Malaria Initiative PP Private Providers QA Quality Assurance RDQA Routine data quality assessment RDT Rapid diagnostic tests RHC Rural Health Center

SOP Standard Operating Procedures SPHD State Public Health Director TPR Test Positivity Rate UMB University of Maryland, Baltimore USAID United States Agency for International Development VBDC Vector Borne Disease Control VBS Village base stratification VMW Village Malaria Workers

1. Executive Summary Considerable progress has been made in reducing the burden of malaria in Myanmar. The number of confirmed cases reported by the National Malaria Control Program (NMCP) has significantly decreased from 480,586 cases in 2012 to 182,452 cases in 2015, representing a 62% reduction in the number of reported cases. However, the malaria burden in Myanmar remains the highest among the six countries of the Greater Mekong Sub region (GMS), accounting for about 75% of the total. Weak health services in remotes areas with high transmission, limited resources and manpower to expand and maintain quality malaria services, internal and cross-border migrations, and evidence of spreading artemisinin resistance along the border areas, represent significant challenges for implementation of malaria control program. Under the leadership of the national program, local and international organizations have collaborated to identify gaps and implement solutions to address these challenges. Defeat Malaria Project, supported by the U.S. President’s Malaria Initiative (PMI) and Figure 1: Defeat Malaria Geographical Areas the United States Agency for International Development (USAID), runs from October 2016 to September 2021 and is implemented by University Research Co., LLC (URC), in partnership with American Refugee Committee (ARC), Jhpiego and the University of Maryland Baltimore’s Institute for Global Health (IGH). Defeat Malaria also involved local partner organizations to deliver needed malaria services while contributing to local capacity building efforts, including Myanmar Health Assistant Association (MHAA), Myanmar Nurse and Midwife Association (MNMA). Defeat Malaria collaborated with various stakeholders from the Ministry of Public Health and Sports (MOPHS), NMCP, local government - respective State/Region Administrations, Township & District Medical Officers (TMO/DMO) and Rural Health Centers (RHCs). In addition, Defeat is working with international and local non-government organizations (NGOs), Regional Artemisinin Initiative (RAI), 3MDG and Global Fund malaria projects, with the administration/local leadership of the target villages in Rakhine State, Kayin State and Tanintharyi Region. In Kayin and Tanintharyi Region, Defeat Malaria is also working with non- state authorities. Defeat Malaria works with the National Malaria Control Programme to build health systems that are responsive and flexible and can respond appropriately to changing malaria

epidemiological trends and emerging threats including multi-drug resistance and insecticide resistance. Defeat Malaria promotes sustainable approaches to support malaria control activities, including community empowerment in malaria control and prevention, evidence- based decision making, engagement of the private sector, and building on existing efforts to engage other agencies and sectors. From January 2017 - March 2017, a series of reorientation workshops were conducted at different levels including partners and staff from the central and State/Region level. Advocacy meetings at State/Region and Township levels were conducted at the launch of Defeat Malaria. After advocacy meetings, village malaria workers (VMWs) were selected and trained on case finding and management. All trained VMWs were provided rapid diagnostic tests (RDTs), antimalarial drugs, and patient registers and case detection and management services were provided by the VMWs and mobile teams. In areas where possible, directly observed treatment (DOT) was provided by VMWs to positive Plasmodium falciparum (Pf)/mixed cases. Interpersonal communication was provided to those 15 years and above who tested positive for malaria parasites. Group health talks were also given to communities. A Data Quality Audit training was conducted at the central level for project staff and on-the-job training was conducted in Dawei District. Routine Data Quality Audits (RDQAs) were also conducted in Tanintharyi Region and Rakhine State. Defeat Malaria supported logistic and technical aspects to the NMCP on conducting Implementing Partners mapping. In March 2017, PMI’s Malaria Operational Plan Team visited Rakhine State together with USAID and the Defeat Malaria Team to assess the situation, performance, achievements and to explore the strategies and activities for the coming year. Geographical coverage as of March 31, 2017 A total of 19 townships are covered by Defeat Malaria (October 2016 – March 2017). The Quarter 1 and 2 expansion will be linked to acceleration and the scale-up of prevention and control activities as the project matures. Table 1: Project area coverage during October 2016 – March 2017 Total State / Townships Total Pop # villages Total Pop Pop coverage Region covered covered covered 1 Tanintharyi 7 256 1,079,810 134,817 12.49% 2 Southern 6 403 740,797 137,334 18.54% Rakhine 3 Northern 6 270 672,674 227,909 33.88% Rakhine Grand Total 19 929 2,493,281 500,060 20.06% During this quarter, Defeat Malaria Implementing Partners, together with a network of 703 VMWs, Private Providers (PPs) and Mobile Teams, provided malaria services to about 500,000 people from 929 villages in 19 townships under Rakhine State and Tanintharyi Region.

2. Goals and Objectives The overall goal of Defeat Malaria is to reduce the malaria burden and control artemisinin- resistant malaria in the targeted areas, and contribute to the long-term national goal of eliminating malaria in Myanmar. This will be achieved by expanding coverage of community- based prevention and case management services, prioritizing highly endemic and hard-to-reach areas, mobile and migrant populations, and non-state actor areas. Defeat Malaria will strengthen the capacity of local partners to effectively lead, manage and implement interventions towards the goal of malaria elimination. It will also strengthen the malaria surveillance system to better inform and target interventions, and to monitor progress. Defeat Malaria will engage communities and promote the involvement of the private sector. Defeat Malaria will work with the NMCP and key partners to achieve the following 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. Objective 2: Strengthen the malaria surveillance system to comprehensively monitor progress and inform the deployment and targeting of appropriate responses and strategies. Objective 3: Enhance technical and operational capacity of the NMCP and other health service providers at all levels of service provision. Objective 4: Promote the involvement of communities, private healthcare providers, private companies and state-owned enterprises in malaria control and elimination initiatives. 3. Implementation Progress 1. Programmatic Management Defeat Malaria activities started-up in FY17 under the guidance of USAID Agreement Officer’s Representative (AOR), Defeat Malaria worked with the State Public Health Director (SPHD) at Hpa-an, Kayin State, to explore the possible areas of collaboration. Discussions were also held with the Kayin Department of Health and Welfare (KDHW) to explore possibilities to support KDHW and the Back Pack Health Workers Organization. In Kayin State and Tanintharyi Region, Defeat Malaria is being continue implementation in areas covered by CAP-Malaria. ARC, implementing partner of Defeat Malaria in Kayin also discussed with the Kayin State Public Health Director and Tanintharyi Vector Borne Disease Control (VBDC) Team Leaders on area selection and services implementation. After workshop on discussion towards Defeat Malaria work plan held in November 2016, work plan was revised and then submitted to the International Health Relationship Department for final approval. Defeat Malaria’s Monitoring and Evaluation (M&E) Technical Advisor attended workshop on DMS and mobile used in malaria surveillance for malaria elimination conducted by ADB-URC with mHealth and Research Officer on 28th February 2017. Deputy team leader from ADB- URC explained Real time notification of malaria cases were important for strengthening surveillance system and URC-ADB will provide simple ways of mobile used or mobile application if it could be initialized in June 2017. 5

It should be applied only in pre-elimination areas.

2. Summary on Key achievements during January 2017 – March 2017 A large part of the project’s accomplishments from January– March 2017 pertain to:  Advocacy meetings at the State/Region and township levels:  State/Region level advocacy meetings were conducted in 2 sites (Sittwe for N. Rakhine and Thandwe for Southern Rakhine) to orient the Defeat Malaria project. 188 health staff, local government staff and community members (124 Male/ 64 Female) attended the meeting.  Township level advocacy meetings were also conducted in 15 Townships attended by 1,609 people (1,007 Male/ 602 Female).  Training - In 19 target townships, 591 VMWs and PPs were recruited and trained on case diagnostics and management. IPC on case diagnostics and management was also included as part of the training. After training, RDTs and antimalarial drugs were provided to VMWs to conduct case finding and management. o From 20th to 24th February 2017, Malaria Technical Skills Trainings were conducted by Jhpiego in collaboration with URC in Yangon to update malaria knowledge related to epidemiology, community level malaria prevention methods, improve skills on malaria case diagnosis and treatment, supportive supervision and improving data skills. This is the Master Mentor Malaria Technical Skills training and was attended by 17 participants (13 male/ 4 female). o Training Skills Workshop was a continuation training on Technical Skills Training and was conducted on 20th-24th March 2017 to demonstrate effective classroom presentation skills and coaching of participants in clinical skills, and perform clinical skills. A total of 15 (14 male/1 female) participants attended the training.  Interpersonal communication – covering a population of 8,355 (male 3,954, female 4,401) including 454 migrants and group health talks covering 4,927 (male 1,767, female 3,160) including 184 migrants;  A total of 7,230 Long Lasting Insecticide Nets (LLINs) were distributed in Thayetchaung and Gwa Townships covering 50 villages, 2 worksites and 16,572 people residing there.  A total of 15,239 people were tested for malaria parasites through different case finding approaches including mobile outreach, VMWs, and Private Providers. A total of 273 cases were positive and 265 positive cases were treated per National Treatment Guidelines. Table 2: State/Region case finding and management activities (October 2016 – March 2017) FY17 Q1 FY17 Q2 Total Total State / Region Tested Pf Pv Mix TPR% Tested Pf Pv Mix TPR% Positive Positive Tanintharyi Region 2,527 51 19 32 0 2.02% 6,030 55 21 34 0 0.91%

S. Rakhine State 2,843 221 193 26 2 7.77% 8,551 215 199 15 1 2.51% N. Rakhine State 0 0 0 0 0 0.00% 658 3 2 1 0 0.46% Total 5,370 272 212 58 2 5.07% 15,239 273 222 50 1 1.79%

 109 Pf/mixed positive cases were enrolled in and completed directly observed treatment (DOT) during this semiannual period.  Strengthened malaria surveillance system for increasing use of strategic information for decision making at national and local levels: o Build local capacity of health care providers and volunteers, as well as project staff to maintain quality malaria services and malaria information . Orientation training to Defeat Malaria staff on the M&E system . Orientation on how to use existing CAP-Malaria strategic information as a baseline in Defeat Malaria (based on the CAP-Malaria end line survey results and project achievements)  To enhance technical and operational capacity of the NMCP and other health service providers at all levels of service provision. o Logistic and technical support to NMCP on Implementing Partners mapping workshop at the Central level and State/Region level (Tanintharyi Region and Rakhine State). 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. 1.1 Ensure the distribution of LLINs, diagnostics, and quality-assured medicines to the beneficiary populations, health services and collaborating VMWs in the targeted areas 1.1.1 Mass distribution of LLIN (Activity: 1.2.1) Table 3: LLIN distribution at villages of Gwa Township, Rakhine State (October 2016 - March 2017) Indicator FY17 Q2 TOTAL # of Villages 50 50 # of Households (HHs) present 4,453 4,453 # of HHs covered 4,453 4,453 # of Population present 16,502 16,502 # of Population covered 16,502 16,502 Total LLINs Distributed 7,180 7,180 % of HHs covered 100% 100% % of Population covered 100% 100% Net Ownership (Pop per LLIN) 2.30 2.30

1.1.2 LLIN distribution to migrants and mobile populations in collaboration with employers (Activity: 1.2.3) Table 4: LLIN distribution at worksites (October 2016 - March 2017) FY17 Q1 FY17 Q2 Indicator Thayetchaung Thayetchaung Gwa Total # of Worksites 18 1 1 20 # of Households (HHs) present 500 25 0 525 # of HHs covered 500 25 0 525 # of Population present 1,272 25 45 1,342 # of Population covered 1,272 25 45 1,342 Total LLINs Distributed 1,095 25 25 1,145 % of HHs covered 100.0% 100.0% NA 100% % of Population covered 100.0% 100.0% 100% 100% Net Ownership (Pop per LLIN) 1.16 1.00 1.80 1.17

1.2 Ensure early diagnosis and appropriate treatment of all clinical malaria cases 1.2.1 Ensure early diagnosis and appropriate treatment Case detection was done through various approaches such as mobile teams, screening points, and VMWs and PPs in Tanintharyi Region and Rakhine State. During this reporting period, a total of 15,239 people were tested and 273 cases were positive (222 Pf, 50 Pv and 1 mixed). The Test Positivity Rate (TPR) is 1.79%. 99.6% of positive cases were treated, and, among treated cases, 97.4% were in line with National Treatment Guideline. Table 5: Summary of case findings and management by approaches (October 2016 - March 2017)

FY17 Q1 FY17 Q2

Total Total Mi Approach Tested Positi Pf Pv Mix TPR% Tested Positiv Pf Pv TPR% x ve e Mobile Teams 121 3 3 0 0 2.48% 6,503 50 46 4 0 0.77% VMWs 3,860 198 156 40 2 5.13% 7,354 186 149 36 1 2.53% PPs 1,389 71 53 18 0 5.11% 1,382 37 27 10 0 2.68% Total 5,370 272 212 58 2 5.07 15,239 273 22 50 1 1.79% % 2

Table 6: Summary of case findings and management by State/Region (October 2016 - March 2017) FY17 Q1 FY17 Q2 Total Total State / Region Tested Pf Pv Mix TPR% Tested Pf Pv Mix TPR% Positive Positive Tanintharyi Region 2,527 51 19 32 0 2.02% 6,030 55 21 34 0 0.91%

S. Rakhine State 2,843 221 193 26 2 7.77% 8,551 215 199 15 1 2.51% N. Rakhine State 0 0 0 0 0 0.00% 658 3 2 1 0 0.46% Total 5,370 272 212 58 2 5.07% 15,239 273 222 50 1 1.79%

1.2.2 Directly Observed Treatment (DOT) (Activity: 1.3.7) To prevent the spread of artemisinin resistant malaria and increase drug compliance, DOT has been started to roll out since first quarter of Fiscal Year 2017. DOT is provided by VMWs and PPs in townships where positive cases are eligible to be followed up by DOT. From January 2017 to March 2017, 223 Pf and mixed (81.69%) infections were detected among a total of 273 positive cases. Among these, 109 cases (48.87% of total Pf & mixed) were enrolled in DOT and 100% of patients enrolled in DOT completed the full course. Table 7: Directly observed treatment (DOT) (January 2017 - March 2017)

Sr. Township No.

orksites orksites orksites No. of covered Villages & W No. of DOT Villages & implemented W Total Pf & Mixed positive at township level Total Pf & Mixed positive in DOT implemented villages & worksites DOT enrollment (Pf+Mixed) DOT completed (Pf+Mixed) % of DOT completed (Pf+Mixed) at Township level % of DOT completed (Pf+Mixed) at DOT villages & implemented worksites % of DOT completed among enrollment Tanintharyi 1 Dawei 35 0 1 0 0 0 0.0% - - 2 Kyunsu 49 6 14 13 12 12 85.7% 92.3% 100.0% 3 Palaw 48 1 6 1 1 1 16.7% 100.0% 100.0% Total 132 7 21 14 13 13 61.9% 92.9% 100.0% Southern Rakhine 4 Ann 91 25 139 60 55 55 39.6% 91.7% 100.0% 5 Gwa 50 2 4 4 4 4 100.0% 100.0% 100.0% 6 Kyaukpyu 50 1 1 1 1 1 100.0% 100.0% 100.0% 7 Ramree 88 1 1 1 1 1 100.0% 100.0% 100.0% 8 Thandwe 50 2 12 11 11 11 91.7% 100.0% 100.0% 9 Toungup 74 13 43 24 23 23 53.5% 95.8% 100.0% Total 403 44 200 101 95 95 47.5% 94.1% 100.0% Northern Rakhine 10 Kyauktaw 48 1 2 1 1 1 50.0% 100.0% 100.0% Total 48 1 2 1 1 1 50.0% 100.0% 100.0% Grand Total 583 52 223 116 109 109 48.9% 94.0% 100.0% Note: Number of townships with DOT not yet implemented – 7 Townships with 273 villages. 9

1.2.3 VMW/PP monthly meeting Monthly meetings with VMWs and PPs started November 2016 to monitor performance, collect and verify data, replenish materials and drugs, and discuss case management and migrant activities in their community. Timely reporting is important and monitored monthly. During meetings, township teams performed data collection and ground stock checking. Team Leaders shared some changes in data filling and project activities such as:  Group Health Talk form is used for group health talk sessions with 5 or more participants.  All RDTs and ACTs must be brought to monthly meetings for stock out monitoring depending on weather and road conditions.  Team leaders introduced the new DOT forms to VMWs and PPs, explaining the changes in format.  Team leaders informed VMWs and PPs to notify the office and respective health facilities if 5 or more Pf or mixed cases are detected. Table 8: Summary of VMW/PP monthly meeting - person-month (January 2017 - March 2017) % of Total cumulative # of VMWs/PPs VMW / PP Posts have attended the Male Total

to attend the meeting Female meeting Tanintharyi

1 Dawei 63 10 37 47 74.6% 2 Kyunsu 120 21 80 101 84.2% 3 Launglon 78 18 53 71 91.0% 4 Myeik 92 9 78 87 94.6% 5 Palaw 117 28 79 107 91.5% 6 Thayetchaung 51 12 38 50 98.0% 7 Yebyu 39 17 21 38 97.4% Tanintharyi Total 560 115 386 501 89.5% Southern Rakhine

8 Ann 173 87 52 139 80.3% 9 Gwa 100 31 56 87 87.0% 10 Kyaukpyu 150 100 42 142 94.7% 11 Ramree 215 124 70 194 90.2% 12 Thandwe 50 19 29 48 96.0% 13 Toungup 202 69 99 168 83.2% Southern Rakhine Total 890 430 348 778 87.4% Norther Rakhine

14 Kyauktaw 50 22 26 48 96.0% 15 Rathedaung 50 18 29 47 94.0% 16 Sittwe 32 3 19 22 68.8%

Northern Rakhine Total 132 43 74 117 88.6% Grand Total 1,582 588 808 1,396 88.2%

1.2.4 Monitoring on stock out of RDTs and first line antimalarials (ACTs) To provider better malaria services to communities, Defeat Malaria regularly monitored stock outs of commodities including RDTs and first line antimalarials (ACTs) at service delivery points by checking the commodity balances of VMWs/PPs at monthly meetings and during monitoring visits. If a service delivery point ran out stock or had any expired commodities for one week or longer during last 3 months, that service delivery point faced a stock out. During this reporting period, 2,037 VMWs/PPs received stock out monitoring at monthly meetings and monitoring visits. 99.9% of VMWs/PPs reported no RDT or ACT stock outs. 1.2.5 Establish commodity distribution storage sites at various levels (Activity: 1.1.1) To distribute commodities to service delivery points for malaria case management, including RDTs, ACTs and LLINs, to target communities, distribution storage sites are set up at the district level in Defeat Malaria target areas in Dawei, Myeik for Tanitharyi Region, Toungup for Southern Rakhine State and Sittwe for Northern Rakhine State. Sub grantees also have respective commodity storage sites in their townships (Commodity storage point of MNMA is located at Gwa Township and MHAA point is at Sittwe Township). 1.2.6 Distribution of commodities to all project townships and villages (LLINs, drugs, RDT etc.) (Activity: 1.1.3) During FY17Q2, 109,375 RDTs and 6,740 ACTs were distributed from the central level to district and township level commodity distribution storage sites. From this level, commodities were distributed to service delivery points such as VMWs, PPs and Mobile Teams. The quantity depended on case load and the prevalence of malaria infection in the State/Region. 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 2.1 Recruitment and reporting of VMWs on surveillance data - October 2016 – March 2017 Defeat Malaria recruited and trained 827 VMWs/PPs to cover 7 townships in Tanintharyi Region, 6 townships in Southern Rakhine State and 6 townships in Northern Rakhine State. VMWs/PPs reporting on case management and treatment also increased with 703 VMWs/PPs reporting in March 2017. Monthly reporting status of VMWs/PPs was more than 90%. Reporting rate increased month by month and March 2017 was 97.6%. Timely reporting rate also increased with 100% reporting on time in March 2017.

Figure 2: Recruitment and reporting of VMW and PP (October 2016 - March 2017) Defeat Malaria activities is currently conducting activities in 19 townships. Malaria diagnosis and case management reports were collected monthly and 96.5% of all expected reports were received this reporting period. 99.3% of submitted reports were received on time. Reporting efficiency is very high. Almost all townships had more than 90% of VMWs and PPs reporting on time except Thandwe where only 88.7% of VMWs and PPs reported on time. Table 9: Timeliness of reporting of malaria case data from VMW/PP (January 2017 – March 2017)

Semiannual Total (Jan 17 - Mar 17) Cumulative Number of Number of % of timely number of VMW/PP timely reports of reports to reports % of No Organization Township reports VMW/PP be submitted Reporting submitted among submitted (On-time Status by reports by report + VMWs/PPs submitted VMW/PP Late report) Tanintharyi 1 URC Dawei 99 95 95 96.0% 100.0% 2 URC Kyunsu 120 111 109 92.5% 98.2% 3 URC Launglon 78 75 74 96.2% 98.7% 4 URC Myeik 92 90 89 97.8% 98.9% 5 URC Palaw 117 117 117 100.0% 100.0% 6 URC Thayetchaung 51 51 50 100.0% 98.0% 7 URC Yebyu 39 38 38 97.4% 100.0% Total 596 577 572 96.8% 99.1% Southern Rakhine State

8 URC Ann 173 173 169 100.0% 97.7% 9 MNMA Gwa 150 141 141 94.0% 100.0% 10 URC Kyaukpyu 150 149 148 99.3% 99.3% 11 URC Ramree 215 211 211 98.1% 100.0% 12 MNMA Thandwe 150 133 133 88.7% 100.0% 13 URC Toungup 202 194 192 96.0% 99.0% Total 1,040 1,001 994 96.3% 99.3% Northern Rakhine State 14 URC Kyauktaw 50 50 50 100.0% 100.0% 15 MHAA Rathedaung 50 47 47 94.0% 100.0% 16 URC Sittwe 32 32 32 100.0% 100.0% Total 132 129 129 97.7% 100.0% TOTAL 1,768 1,707 1,695 96.5% 99.3%

2.2 Provided Routine Data Quality Assessment technique to Defeat Malaria staff for further supporting to township NMCP focal person in joint field visits The central M&E team consisting of the M&E Technical Advisor, M&E Coordinator and Documentation Officer visited Dawei, Palaw and Myeik Townships of Tanintharyi Region from February 12 to 18, 2017. Providing hands-on experience on routine data quality assessments (RDQAs) with data quality officer (DQOs) and Defeat Malaria team members, exercising on- site data verification (OSDV) processes and strengthening components of the M&E system. Tanintharyi DQOs, Northern Rakhine State DQOs, ARC’s M&E Surveillance Officer, 3 Township Team leaders, 2 Data Assistants and 15 Team Assistants and Health Facilitators were involved. Firstly, key indicators were selected and then sites (service delivery points) were selected based on case management and progress reports. The assessment was conducted by standardized RDQA and OSDV tools. System Assessment and checking of Data Quality Ratings were done and suggestions and recommendations for improvement were provided to all field staff. Data verification and a system assessment dashboard for Palaw Township is described as an example.

Figure 3: Data verification and assessment dashboard samples Tanintharyi’s DQO conducted a RDQA in Yebyu Township on 7th and 8th March 2017, Launglon township on 9th and 10th March 2017, and Thayetchaung Township on 22nd and 24th of March 2017. On-site data verification was conducted at one selected village from each township. Tanintharyi’s DQO could conduct RDQAs in a similar approach and tools for strengthening routine data quality assurance at the township level. From October 2016 to March 2017, six out of seven townships (86%) in Tanintharyi Region had an internal RDQA. Similar support on RDQA hands-on exercises for DQOs, team leaders, data assistants and team staff in Rakhine and Kayin States will be provided next quarter. 2.3 Quarterly assessment and provide updated knowledge on malaria epidemiology and utilization of strategic information (Activity 2.1.6) During the first quarter, an orientation workshop was conducted from December 5th to 9th, 2016 at the Reno Hotel and Defeat Malaria office. There were 68 participants (Male = 49, Female = 19) including URC staff (45) and staff from partner organizations (ARC = 12, Jhpiego = 3, MHAA= 2, MNMA = 4, University of Maryland, Baltimore (UMB) = 2). The objectives of the workshop were to orient staff to the program, identify lessons learned from CAP-Malaria and end-line survey results and understand baselines for Defeat Malaria. Baselines were set from CAP-Malaria end of project results to guide strategic information for implementation. Donor requirements for M&E, reporting procedures, administrative, financial, procurement and logistics related procedures were also covered. Training methodology appropriate for VMWs using the low-dose high-frequency approach was also introduced. The partner organizations (ARC, Jhpiego, MHAA, MNMA and UMB) also presented their work plans for Defeat Malaria, in line with the overall project work plan. 2.4 Scale-up the use of data at Quarterly health center meetings that engage BHS and Defeat Malaria staff One of the objectives of engaging BHS and Defeat Malaria staff at quarterly RHC meetings was to scale up the use of data and sharing of strategic information and promote collaborative activities at the local level. Usually staff share achievements in malaria prevention, case detection and management activities from the previous quarter.

In this reporting period, 205 BHS and Defeat Malaria staff were engaged at 26 RHC meetings and shared malaria case finding information, test positivity rate, LLIN needs and other strategic information. 2.5 Support the implementation and regular updating of the new village-based malaria stratification framework, mapping high-risk areas and populations and use of data to better plan and target control interventions During CAP-Malaria, the village based stratification (VBS) framework was conducted in all project townships by using village based data on ABER, TPR and API. Based on case load (TPR and API), villages were stratified into high/moderate/low risk areas for malaria. Appropriate interventions were suggested for each strata depending on different epidemiological settings. Now in Defeat Malaria, CAP-Malaria villages were re-stratified into (1) Non-receptive (2) Receptive with no current transmission and (3) Receptive with current transmission. In project villages, there is no non-receptive villages in line with malaria elimination. Receptive with current transmission strata is sub-stratified into high (TPR > 10%), moderate (TPR >5% - <10%) and low (TPR >0% - <5%) transmission. (Defeat Malaria 10 townships of Tanintharyi Region and 7 townships of Southern Rakhine State using latest available information). Table 10: Updating malaria micro-stratification (in line with malaria elimination) Receptivity No. of Receptivity with current transmission with No Sr. State/ Region covered High Moderate Low current villages transmission transmission transmission transmission Tanintharyi 1 717 33 29 166 489 Region Rakhine 2 320 15 20 57 228 (Southern) Total 1037 48 49 223 717

2.6 Active Case Detection through mobile team approach ACD was done in project and non-project area villages with low or no positive cases during CAP-Malaria to assure that the villages are not reinvaded (reintroduction) by malaria parasites. Hard-to-reach areas are also included. During February and March 2017, the Ann Team conducted special mobile activities in Da Lett and Ka Zu Kine RHCs. A total of 44 villages (10 project villages and 34 non-project villages) were selected and mobilization of staff from other Townships (Toungup and Ramree) Figure 5: Dalett Area, Ann was done to conduct this activity. On Figure 4: Dalett Area, Ann Township for special mobile visit (1) Township for special mobile visit March 5, ACD mobile teams were (2) formed by mobilizing the human resources from other Defeat Malaria townships and each team spent 3 to 5 nights in hard-to-reach villages. 15

Table 11: Active Case Detection through mobile team approach in Project Village (January 17 - March 17) Number Test of village Total Total Township Coverage Pf Pv Pmix Total Positivity and population Tested Rate worksite Tanintharyi Dawei 4 1,327 453 34.1% 0 0 0 0 0.0% Kyunsu 8 4,863 844 17.4% 0 0 0 0 0.0% Launglon 4 1,434 278 19.4% 0 0 0 0 0.0% Myeik 4 1,683 334 19.8% 0 0 0 0 0.0% Palaw 12 4,948 711 14.4% 0 0 0 0 0.0% Thayetchuang 4 1,673 416 24.9% 0 0 0 0 0.0% Yebyu 3 1,038 198 19.1% 0 0 0 0 0.0% Total 39 16,966 3,234 19.1% 0 0 0 0 0.0% Southern Rakhine Ann 10 1845 703 38.1% 2 0 0 2 0.3% Toungup 1 247 36 14.6% 2 0 0 2 5.6% Total 11 2,092 739 35.3% 4 0 0 4 0.5% Grand Total 50 19,058 3,973 20.8% 4 0 0 4 0.1%

Table 12: Active Case Detection through mobile team approach in Non-Project Village (January 17 - March 17) Number Test State / of village Total Total Cover- P # Township Pf Pv Total Positivity Region and population Tested age mix Rate worksite 1 Tanintharyi Palaw 1 590 58 9.8% 3 0 0 3 5.2% 2 S. Rakhine Ann 34 6,703 2,467 36.8% 39 4 0 43 1.7% Grand Total 35 7,293 2,525 34.6% 42 4 0 46 1.8%

Malaria case diagnosis and treatment data were continuously reviewed for assessing whether to reach targeted marginalized and vulnerable groups, continuously identifying probable risk groups or areas, paying more attention to limited transmission in an identified high number of malaria positive cases, and collecting experiences and evidential information to contribute in developing SOPs for appropriate response to stratified areas.

2.7 Distribution of P.f & P.v cases and Malaria Test Positivity Rate by State/Region (October 2016 to March 2017)

Figure 6: Distribution of P.f to P.v cases and Malaria Test Positivity Rate by State/Region During January 2017 to March 2017, 15,239 cases suspected for malaria were tested by RDT and 273 malaria cases were identified in which 223 cases (81.69% of all detected cases) were affected by P. falciparum and mixed. Overall malaria test positivity rate was 1.79%. Stratification to State and Region level analysis revealed that a higher percent of P.f cases were identified in Southern Rakhine State (89.64%) and that of Tanitharyi Region was only 9.46%. These findings were not different from CAP-Malaria. Only one month’s data contributed from Northern Rakhine State in this reporting period. Malaria test positivity rate was also higher in Southern Rakhine State (2.51%) than that of Tanintharyi Region (0.91%) and was contributed by Ann Township. Because of high proportion of Pf case load in Southern Rakhine State, NMCP and Department of Medical Research (DMR) closely monitored for any occurrence of potential artemisinin resistant case and Defeat Malaria pay.

2.8 Time series analysis on case detection and treatment (Oct 2016 – Mar 2017) in Tanintharyi Region &Southern Rakhine State

2500 100.0% 100.0% 2181 100.0% 2081 95.0% 2000 95.8% 1768 92.3% 90.5% 90.0% 1500 1256 88.9% 85.0% 1000 643 628 80.0% 500 75.0% 1515 15 15 21 20 24 24 18 18 13 13 0 70.0% October November December January February March

Tested # of Positive # of Treated % of Treated acc NTG

Figure 7: Time series analysis on case detection and treatment in Tanintharyi Region (October 2016 - March 2017)

In Tanintharyi Region, number of RDTs conducted for Q1 FY 2017 was around 630 with a high rate in October due to inclusion of reported cases detected from previous months during the transition of VMWs from CAP-Malaria to Defeat Malaria activities. Number of RDTs conducted in Q2 FY 2017 increased with deployment of more VMWs/PPs in 198 sites. Number of malaria positive cases detected in Q2 FY 2017 was not proportionate to that of Q1 FY 2017 in relation to RDT tests. It could be due to inclusion of more low risk areas among extended villages. Regarding clinical audits, the proportion of malaria cases treated per National Treatment Guideline (NTGs) was around 90% in the last 4 months which suggests the need for close supervision and on-the-job training to newly recruited VMWs/PPs next quarter.

4883 5000 100.0% 4500 100.0% 100.0% 100.0% 97.9% 4000 96.8% 95.0% 95.7% 3500 90.0% 3000 2296 2500 85.0% 2000 1475 1372 1500 80.0% 1000 750 618 75.0% 500 29 29 53 53 139 139 94 94 58 58 63 62 0 70.0% October November December January February March Tested # of Positive # of Treated % of Treated acc NTG

Figure 8: Time series analysis on case detection and treatment in Southern Rakhine State

In Southern Rakhine State, number people tested with RDTs increased with deployment of VMWs/PPs in 373 sites. A higher number of malaria cases in December could be related to the inclusion of 3 more townships namely, Gwa, Kyaukphyu, and Thandwe. The proportion of malaria cases treated per National Treatment Guideline (NTGs) was higher than 95% for all six months. 2.9 Reaching targeted and marginalized populations

Figure 9: Accessibility to RDT and proportional malaria cases Reaching targeted and marginalized populations was analyzed by percent of accessibility to RDTs and proportional malaria cases of specific groups with referencing to national estimates of pregnancy (2.5% of total population) and under-five children (12.5% of total population). It was found that the proportion of those tested with RDTs as well as proportional malaria cases for pregnant women were only 1% which might reflect that nearly 1.5% of pregnant women in the implementing areas could be utilizing other service delivery sites. Proportion of under-five children tested with RDTs was 11% and proportional malaria cases for under-five children was 12%. This may reflect that most could access Defeat Malaria service sites. Proportion of MMPs tested with RDTs was 4% and proportional malaria cases for MMPs was 5%. This may indicate that the selection of target areas should be targeted for migrant dense areas or the approach should have a more mobile and migrant oriented approach. Inclusion of migrants could be increased next quarter by extending into migrant dense areas of Kawthoung and Bokpyin Townships in Tanintharyi Region and migration affected townships of Kayin State. In this reporting period, 49% of those tested with RDTs were male and could reflect equity in access to the male population for malaria diagnosis. But proportional malaria cases for males was 65% demonstrating males are more affected than the female population.

2.10 Establish village-based reporting in all Defeat Malaria township Starting January 2017, all Defeat Malaria townships are sharing carbonless malaria case registers to respective Rural Health Sub-centers/Rural Health Centers, Township Health Departments, State/Region VBDC teams (one more copy), and respective implementing partners (IPs). One copy is kept with the village malaria volunteer as a source document. 2.11 Develop reporting forms and formats for Defeat Malaria Project and training of Team leaders, Data Quality Officer on new Defeat malaria forms, formats and data management (Activity 2.2.4.) Data Management and M&E Technique training was conducted from 11th to 13th January 2017 at Defeat Malaria Office, Yangon. For this training, 25 trainees (19 male and 6 female) from Defeat Malaria implementing partners attended to understand the consistent utilization of reporting forms, formats, and data management techniques for Defeat Malaria activities. Two trainees from Defeat Malaria staff in Tanintharyi received similar training on the same module from 16th to 18th January 2017. The reporting timelines, surveillance system, data quality dimensions and assessment techniques related to M&E were covered. Orientation package was developed and provided to all the participants for their further multi-plier training to all other existing and newly recruited staff at Townships, State and Region level. All township focal staff were trained and supported with the new template of NMCP (volunteer level and service approach disaggregation) and all townships submitted reports to National Malaria Control Program on time starting January 2017. 2.12 Operational research on “Evaluation of the performance of a highly-sensitive RDT versus conventional RDT, compared with polymerized chain reaction (PCR) as gold standard in reactive case detection of malaria infection (Activity 2.3.1) According to preliminary discussion with the NMCP’s Program Manager, URC submitted nomination of principal investigator and co-investigator from NMCP for the study on “Evaluation of the performance of a highly-sensitive RDTs versus conventional RDTs, compared with PCR as a gold standard in reactive case detection of malaria infection in Rakhine State, Myanmar” on February 23rd, 2017. According to MoHS approval letter dated March 30th 2017, the NMCP nominated Dr. San Kyaut Khine (Assistant Director, NMCP) as Principal Investigator and Dr. Aye Nyein (Team Leader, NMCP) as co-investigator for this study. The protocol has been prepared by UMB and will be submitted to Ethics Review Committee of Department of Medical research. 2.13 Support NMCP to conduct epidemiological surveillance in transmission problematic areas (persistent residual transmission villages) To explore the local epidemiological situation and community behaviors, the M&E Technical Advisor and M&E coordinator visited two villages in Tanintharyi Region where malaria transmission is high. Review of reports from War taw village, Dawei Township revealed that positivity rates were decreasing from 24% (2014), 15% (2015), and 7% (2016) respectively and Kha Na Kha Lal village, Palaw Township revealed decreasing rates of 14% (2014), 11% (2015), and 4% (2016), respectively. Key informants were invited to discuss epidemiological factors related to malaria transmission. During the visit to War taw and Kha Na Kha Lal villages from 14 to 16 February, observations included: 20

 Mostly migrants with one third forest goers and some working with Thai employers  Some work near ethnic controlled areas  Main occupations were forest farming, hunting, and casual work.  Nearly 60-80% of them accessed VMWs for malaria diagnosis.  Previously P.f cases were higher but are now decreasing with P.v becoming more prevalent.  According subjective findings, people perceive the biting rate as low currently but usually higher during the rainy season. Also, perception is most of the are mosquitoes biting and resting outdoors.  LLINs were adequately distributed but only three quarters of people slept under LLINs.  Some thought the bed-net was not needed at the time of low mosquito activity  Slept at 9 pm and there could be possibility of un-protective period during 6 pm to 9 pm at night and 4 am to 6 am in the morning outdoors among forest goers  Severe malaria cases and deaths occured 5 year ago but there was no such incident last year.  Recurrence or re-infection of P.v case was noted in an external migrant worker returning from Thai  Perceived no difference in malaria incidence between male and female. Under-five children were not perceived to be affected more by malaria.  No specific measures undertaken to protect forest goers although some wear long thick clothes.  High mobility and dynamic interaction with forest workers, migrants working near uncontrolled high malarious ethnic areas and external migrants in the village were seen.  Environment favored mosquito breeding and high occurrence of malaria were noted in rainy season.  Suggestive remedial measures included provision of preventive service for their full protection (LLIN utilization among distributed, wearing of long clothes before going to sleep at dark and provision of protective measures for forest goers, screening of malaria among forest goers, and adherence of treatment NTG . 2.14. Discussions between the NMCP and Defeat Malaria are designed to strengthen township data management systems by providing tools (computers), data management training of NMCP staff in Tanintharyi 10 townships next quarter. To establish a computerized data management system, Defeat Malaria will provide (14) computers to the NMCP (10 for Tanintharyi Townships, 2 for Rakhine, 2 for Central).

Objective 3: Enhance technical and operational capacity of the NMCP and other health service providers at all levels of service provision 3.1. 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. 3.1.1 Support NMCP on, “mapping of malaria implementing partners” at central level, 3 State/Region level, and data collection and assessment workshop at 33 townships in 3 State/Region. (Activity 1.3.1.) “Implementing Partners Mapping” is one of the activity that is necessary for the NMCP to have concrete implementation in prevention and control of malaria together with implementation partners. As it is necessary to manage overlapping areas and gaps, the NMCP already conducted a meeting with all partners at the central level and will now do State/Region and Township level meetings with the expectation to have an “Implementing Partners’ Map” with all partners with the lead of State/Regional NMCP. Defeat Malaria agreed to support (technical as well as logistic) State/ Region level IPs Mapping workshops in Tanintharyi, Rakhine and Kayin. Defeat Malaria supported technical as well as logistics on these mapping workshops in Tanintharyi Region on 16th and 17th March at Dawei and Sittwe Rakhine State on 23rd to 25th March, 2017. The Mapping workshop in Kayin State is planned during May 2017 at Hpa-an. The main objective is to identify duplication and gaps of malaria services and implementing areas and to consider the policy on allocation of implementing partners by using the results of Implementing Partners mapping. 3.1.2 To improve skills and job performance of staff involved in malaria control, Defeat Malaria team conducted two trainings of Master Mentors for Defeat Malaria staff, at the Defeat office lead by Jhpiego. (Activity 3.1.2.) The first, on Malaria Technical skills and the second, on training skills. Develop a cadre of Master Trainers that brings together appropriate staff from the national and state/region levels as well as other health providers. Each training took (8hr.x 5days) 40 hours. Pre training knowledge assessments were carried out to identify the participants’ needs. The average score for all categories and the weak areas needing emphasis were identified and informed to all participants then reinforced throughout the training. The knowledge update overtime was assessed through post course questionnaires. The Master Mentor training focusing on Malaria Technical skills was conducted from 20th to 24th February at Yangon Defeat Malaria office. The 17 participants were from five partner organizations: 8 from URC, 3 from ACR, 3 from Jhpiego, 2 from MNMA and 1 from MHAA. According to the pre training assessment, 11.76% of participants reached a passing score (80%) in any categorized group of knowledge assessment questionnaires. But in post training assessment, all participants reached over passing score (80%) for each categorized group of knowledge assessment at the end of the course. The 2nd Master Mentor training focusing on training skills and was conducted from 20th to 24th March, for 15 participants from four partner organizations: 8 from URC, 3 from ACR, 2 from MNMA and 2 from MHAA. Pre training knowledge assessment scores for the category of interactive training technique (33%) and Conducting Effective clinical demonstrations (48%)

22 were the lowest among six categories. All participants reached over a passing score (80%) for each categorized group at the end of the course (Figure: 10).

Figure 10: Pre- and Post-training knowledge assessment score presented as average percentage of each categorized group of Knowledge Assessment with Multiple Choice Questions (MCQ). Data were calculated as percentage based on the number of participants who correctly answer for each question 3.1.3 Provide technical & logistic assistance through the National Malaria Technical Strategic Group and upon request by DoPH (Activity 3.1.8.) On request of NMCP, November 23-26, 2016, Defeat Malaria joined a workshop on the Finalization of Standard Operating Procedures (SOPs) in RAI areas and Evidence-Based Decision Making conducted by the NMCP in Nay Pyi Taw. The Defeat Malaria provided technical inputs, facilitated the workshop and finalized the SOPs especially on Case Investigation and Foci Investigation. As General support to NMCP on enabling environment by providing 2 printers as requested by NMCP(Central) to Defeat Malaria. (Activity 3.1.13.)

3.2. Strengthen the quality of malaria parasitological diagnosis through a Quality Assurance/Quality Control program addressing all diagnostics methods used in the targeted areas: microscopy, RDTs and other potential new techniques

3.2.1 Existing SOPs for laboratory Quality Assurance (QA) that are refined, updated together with URC-ADB project , NMCP, and National Laboratory Department were going to published (700 copies) to provide at Defeat Malaria implementing areas. (Activity 3.2.1.) Objective 4: Promote the involvement of communities, private healthcare providers, private companies and state-owned enterprises in malaria control and elimination initiatives 4.1. Build the organizational and technical capacity of Community Based Organizations (CBO) and ethnic organizations 4.1.1 From October 4-5, 2016, a meeting was held to discuss the Defeat Malaria Project Year 1 Work Plan among Defeat Malaria partners at the Reno Hotel Yangon. The objective was to build up organizational capacity of the Defeat Malaria Partners on PMI requirements,

procedures and tools for data collection, analysis and reporting, and to analyze and agree on the M&E and work plan for the first year of Defeat Malaria, standardization of terminology, research areas, and requirements on environmental monitoring and mitigation plan (EMMP), human trafficking and harassment. Dr. Mya Sapal Ngon (USAID AOR), Dr. David Sintasath (Regional PMI Malaria Advisor), Dr. Feliciano Monti (PMI Malaria Advisor - Myanmar), Dr. Neeraj Kak (URC HQ), URC staff and representatives from all implementing partners attended the meeting and provided inputs.

4.2. Strengthen and expand training, supportive supervision, and provision of diagnostics and quality-assured antimalarial drugs to village malaria volunteers (Community) and private health care providers involved in the management of malaria cases 4.2.1 Capacity building of VMWs /PPs (Activity: 1.3.4) - From January 2017 to March 2017, 591 health workers including 556 VMWs (290 males, 266 females) and 35 PPs (22 males, 13 females) were trained for 3 days on case management (ACTs) and malaria diagnostics (RDT). Annex4. Number of VMWs and PPs trained on case management (October 2016 to March 2017) Please see Annex 5. Number of VMWs and PPs trained on diagnosis (October 2016 to March 2017) 4.2.2 VMW supervision During October 2016 to March 2017, 664 VMWs/PPs received supportive supervision visits by project staff to check for data quality, completeness and validity. There was no stock out among all VMWs/PPs who were supervised during this reporting period. Please refer to Annex 6: Number of VMW/PP supervised and monitored (October 2016 to March 2017) 4.3. Strengthen Behavior Change Communication (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 4.3.1 Strengthen BCC To share malaria preventive messages to at-risk populations, interpersonal communication was done through VMWs and PPs during case finding and management. Figure 11 shows the total number of people, disaggregated by gender, reached through IPC with malaria preventive messages. A total of 8,355 people (3,954 males and 4,401 female) were covered by IPC. Among them, 454 were migrants. 1,056 people (539 males and 517 females) were reached by Private Providers.

Sittwe 4746 Individual IPC Male Individual IPC Female Rathedaung 109 142 Kyauktaw 5046 Toungup 473 413 Thandwe 105 101 Ramree 473 544 Kyaukpyu 246 245 Gwa 196 216 Ann 868 1016 Yebyu 61 110 Thayetchaung 154 179 Palaw 203 264 Myeik 182 227 Launglon 117 172 Kyunsu 395 415 Dawei 275 265 0 200 400 600 800 1000 1200 1400 1600 1800 2000

Figure 11: Number of people, disaggregated by gender, reached through IPC by VMWs and PPs (October 2016 - March 2017) Annex 5 is showing details in number of people reached through interpersonal communication & Group Health Talks by VMWs and Private Providers & IPC by PPs only. 4.3.2 Community mobilization Advocacy on community participation of Defeat Malaria on selection of VMWs/PPs (Activity: 1.4.2) - Advocacy Meetings were conducted at State/Region level and Township level with the key objectives of project orientation to administrative authority people and community. Plan geographical areas, past achievements on CAP-Malaria (evidence to be used as baseline), future strategies and approaches of Defeat Malaria were explained to audience and request suggestion from target audience. Three regional level advocacy meetings were organized at Tanintharyi Region, Southern and Northern Rakhine State and was attended by 203 attendants (male 137 and female 66) from Regional level VBDC staff, implementing partners and sub grantees. Township level advocacy meetings were organized in 17 townships and were attended by 2,047 people including 1,135 male and 912 female. (Annex 9: Advocacy meetings list) 4. Challenges and Opportunities  Start-up (village level) - The project plans to cover 1,974 villages in three States and Regions. From October 2016-March 2017, the project has initiated activities in 929 villages and worksites. Project area coverage is about 43% of planned villages. Delay in approval of

Memorandum of Understanding (MOU) extension is one of the factors for delayed start up in some townships. It was mainly seen in Kayin State and some townships of Tanintharyi Region.  Delay implementation in Northern Rakhine – In new project areas in Northern Rakhine State, there is a delay in start-up due to unstable conditions. With close guidance from local administrative authorities and local health departments, Defeat Malaria is starting activities for initiation of project activities.  Difficulty in finding malaria cases –Because of practicing aggressive and universal coverage of prevention and case management by all implementing partners, malaria prevalence is reducing in most of the geographical areas. This led to low detection of positive malaria cases. Most of the new expansion villages have a low malaria caseload. Through negotiation and collaboration with State/Regional Health Departments/VBDC, Defeat Malaria will work beyond target areas and continue to practice a village-based strategy and introduce intensified case finding activities. In areas where malaria prevalence is low or zero, it is necessary to adapt to the changing epidemiology and utilize appropriate approaches. In these areas, it is difficult to see impact and important to sustain a low or no malaria status in such areas. The surveillance system needs to be strengthened. It is more costly to sustain low status of malaria or prevention of reintroduction.  Existence of parasite reservoirs among uniformed services – In areas of high malaria transmission, such as Ann Township in Rakhine State, there is no proper case finding, management or vector control measures among uniformed services. Uniformed services may serve as a parasite reservoir and a source of infection to re-introduce malaria in areas where infection rates are very low or zero.

5. Annexes Annex 1 – Case Finding and Management Table 13: Defeat Malaria Case Finding and Management, Township wise (October 2016 - March 2017) – Mobile Team Approach

Oct 2016 - Dec 2016 Jan 2017 - Mar 2017 No Township Total Total Tested Pf Pv Mixed TPR% Tested Pf Pv Mixed TPR% Positive Positive 1 Dawei (URC) 0 0 0 0 0 - 453 0 0 0 0 0.00% 2 Kyunsu (URC) 0 0 0 0 0 - 844 0 0 0 0 0.00% 3 Launglon (URC) 0 0 0 0 0 - 278 0 0 0 0 0.00% 4 Myeik (URC) 0 0 0 0 0 - 334 0 0 0 0 0.00% 5 Palaw (URC) 0 0 0 0 0 - 769 3 3 0 0 0.39% 6 Thayetchaung (URC) 0 0 0 0 0 - 416 0 0 0 0 0.00% 7 Yebyu (URC) 0 0 0 0 0 - 198 0 0 0 0 0.00% Tanintharyi Total 0 0 0 0 0 - 3,292 3 3 0 0 0.09% 1 Ann (URC) 121 3 3 0 0 2.48% 3,175 45 41 4 0 1.42% 2 Toungup (URC) 0 0 0 0 0 - 36 2 2 0 0 5.56% Southern Rakhine Total 121 3 3 0 0 2.48% 3,211 47 43 4 0 1.46%

Defeat Malaria Total 121 3 3 0 0 2.48% 6,503 50 46 4 0 0.77% (Mobile)

Table 14: Defeat Malaria Case Finding and Management by township (October 2016 - March 2017) – VMW Approach

Oct 2016 - Dec 2016 Jan 2017 - Mar 2017 No Township Total Total Tested Pf Pv Mixed TPR% Tested Pf Pv Mixed TPR% Positive Positive 1 Dawei (URC) 229 7 0 7 0 3.06% 392 14 1 13 0 3.57%

2 Kyunsu (URC) 529 21 13 8 0 3.97% 636 19 13 6 0 2.99% 3 Launglon (URC) 106 0 0 0 0 0.00% 231 0 0 0 0 0.00% 4 Myeik (URC) 269 1 1 0 0 0.37% 300 0 0 0 0 0.00% 5 Palaw (URC) 418 6 2 4 0 1.44% 306 9 3 6 0 2.94% 6 Thayetchaung (URC) 132 1 1 0 0 0.76% 79 0 0 0 0 0.00% 7 Yebyu (URC) 56 0 0 0 0 0.00% 153 0 0 0 0 0.00% Tanintharyi Total 1,739 36 17 19 0 2.07% 2,097 42 17 25 0 2.00%

1 Ann (URC) 977 120 108 12 0 12.28% 887 89 82 7 0 10.03% 2 Gwa (MNMA) 162 7 2 5 0 4.32% 489 4 4 0 0 0.82% 3 Kyuakpyu (URC) 165 0 0 0 0 0.00% 650 0 0 0 0 0.00% 4 Ramree (URC) 392 1 0 1 0 0.26% 1,387 2 1 1 0 0.14% 5 Thandwe (MNMA) 5 4 4 0 0 80.00% 266 12 11 0 1 4.51% 6 Toungup (URC) 420 30 25 3 2 7.14% 921 34 32 2 0 3.69% Southern Rakhine Total 2,121 162 139 21 2 7.64% 4,600 141 130 10 1 3.07% 1 Kyauktaw (URC) 0 0 0 0 0 - 144 2 2 0 0 1.39% 2 Rathedaung (MHAA) 0 0 0 0 0 - 359 0 0 0 0 0.00% 3 Sittwe (URC) 0 0 0 0 0 - 154 1 0 1 0 0.65% Northern Rakhine Total 0 0 0 0 0 - 657 3 2 1 0 0.46%

Defeat Malaria Total 3,860 198 156 40 2 5.13% 7,354 186 149 36 1 2.53% (VMW)

Table 15: Defeat Malaria Case Finding and Management by township (October 2016 – March 2017) – Private Provider Approach

Oct 2016 - Dec 2016 Jan 2017 - Mar 2017 No Township Total Total Tested Pf Pv Mixed TPR% Tested Pf Pv Mixed TPR% Positive Positive 1 Dawei (URC) 11 0 0 0 0 0.00% 10 0 0 0 0 0.00% 2 Kyunsu (URC) 277 4 1 3 0 1.44% 237 4 1 3 0 1.69% 3 Myeik (URC) 247 1 0 1 0 0.40% 189 1 0 1 0 0.53% 4 Palaw (URC) 181 2 1 1 0 1.10% 114 2 0 2 0 1.75%

5 Thayetchaung (URC) 72 8 0 8 0 11.11% 91 3 0 3 0 3.30% Tanintharyi Total 788 15 2 13 0 1.90% 641 10 1 9 0 1.56% 1 Ann (URC) 370 37 33 4 0 10.00% 254 16 16 0 0 6.30%

2 Kyuakpyu (URC) 17 0 0 0 0 0.00% 149 1 1 0 0 0.67% 3 Ramree (URC) 11 0 0 0 0 0.00% 72 0 0 0 0 0.00% 4 Toungup (URC) 203 19 18 1 0 9.36% 265 10 9 1 0 3.77% Southern Rakhine Total 601 56 51 5 0 9.32% 740 27 26 1 0 3.65% 1 Kyauktaw (URC) 0 0 0 0 0 - 1 0 0 0 0 0.00% Northern Rakhine Total 0 0 0 0 0 - 1 0 0 0 0 0.00%

Defeat Malaria Total 1,389 71 53 18 0 5.11% 1,382 37 27 10 0 2.68% (Private Provider)

Annex 2 - Number of VMWs and PPs trained on case management (October 2016 - March 2017) Table 16: Number of VMWs and PPs trained on case management (October 2016 - March 2017)

October 2016 - December 2016 January 2017 - March 2017

Village Malaria Private Village Malaria Private # Township Workers Providers Grand Workers Providers Grand Total Total Sub- Sub- Sub- Sub- M F M F M F M F total total total total 2 Dawei ------9 22 31 - 2 2 33 4 Kyunsu 2 24 26 6 3 9 35 - 2 2 - 1 1 3 5 Launglon 6 19 25 - - - 25 - 1 1 - - - 1 6 Myeik 2 19 21 1 6 7 28 - 2 2 - - - 2 7 Palaw ------7 24 31 4 6 10 41 9 Thayetchaung 2 7 9 - 5 5 14 2 - 2 - 1 1 3 10 Yebyu ------6 7 13 - - - 13 Tanintharyi Total 12 69 81 7 14 21 102 24 58 82 4 10 14 96 11 Ann 24 16 40 4 2 6 46 7 4 11 4 - 4 15 12 Gwa ------16 27 43 - - - 43 13 Kyaukpyu 26 14 40 6 - 6 46 4 - 4 - - - 4 14 Ramree ------51 29 80 3 1 4 84 15 Thandwe ------21 26 47 - - - 47 16 Toungup 11 22 33 8 1 9 42 9 20 29 1 - 1 30 Southern Rakhine Total 61 52 113 18 3 21 134 108 106 214 8 1 9 223 17 Buthidaung ------45 5 50 - - - 50 18 Kyauktaw ------22 26 48 2 - 2 50 19 Maungdaw ------48 - 48 - - - 48 20 Pauktaw ------16 16 32 8 2 10 42 21 Rathedaung ------20 30 50 - - - 50 22 Sittwe ------7 25 32 - - - 32

Northern Rakhine Total ------158 102 260 10 2 12 272 Grand Total 73 121 194 25 17 42 236 290 266 556 22 13 35 591

Annex 3 - Number of VMWs and PPs trained on diagnosis (October 2016 to March 2017) Table 17: Number of VMWs and PPs trained on diagnosis (October 2016 - March 2017)

October 2016 - December 2016 January 2017 - March 2017

21 Rathedaung ------20 30 50 - - - 50 22 Sittwe ------7 25 32 - - - 32 Northern Rakhine Total ------158 102 260 10 2 12 272 Grand Total 73 121 194 25 17 42 236 290 266 556 22 13 35 591

Annex 4 – VMW/PP supervision and monitoring (October 2016 to March 2017) Table 18: Number of VMW/PP supervised and monitored (October 2016 - March 2017)

October 2016 - December 2016 January 2017 - March 2017 Total # of Total # of # of visits to # of visits to VMWs and # of visits to # of visits to VMWs and # Township VMWs PPs PPs VMWs PPs PPs supervised supervised 1 Dawei 0 0 0 30 2 32 2 Kyunsu 0 0 0 26 10 36 3 Launglon 0 0 0 25 0 25 4 Myeik 0 0 0 21 6 27 5 Palaw 0 0 0 27 10 37 6 Thayetchaung 0 0 0 11 6 17 7 Yebyu 0 0 0 13 0 13 Tanintharyi Total 0 0 0 153 34 187 8 Ann 16 4 20 33 5 38 9 Gwa 0 0 0 50 0 50 10 Kyaukpyu 13 2 15 103 10 113 11 Ramree 4 0 4 79 3 82 12 Thandwe 0 0 0 50 0 50 13 Toungup 10 2 12 63 10 73 Southern Rakhine Total 43 8 51 378 28 406 14 Kyauktaw 0 0 0 2 0 2 15 Rathedaung 0 0 0 8 0 8

16 Sittwe 0 0 0 15 0 15 Northern Rakhine Total 0 0 0 25 0 25 Grand Total 43 8 51 556 62 618

Annex 5 – Interpersonal Communication and Group Health Talks by VMWs and PPs Table 19: Interpersonal communication by VMWs and PPs (October 2016 - March 2017) Oct 16 - Dec 16 Jan 17 - Mar 17

Sr Township No. Male Male Male Total Total Total Female Female Female included included Migrants Migrants Migrants 1 Dawei 39 23 62 7 275 265 540 157 2 Kyunsu 63 50 113 1 395 415 810 24 3 Launglon 5 13 18 0 117 172 289 59 4 Myeik 38 68 106 3 182 227 409 5 5 Palaw 31 23 54 6 203 264 467 41 6 Thayetchaung 17 12 29 3 154 179 333 21 7 Yebyu 7 2 9 0 61 110 171 18 Tanintharyi Total 200 191 391 20 1,387 1,632 3,019 325 8 Ann 230 201 431 80 868 1,016 1,884 13 9 Gwa 58 60 118 9 196 216 412 37 10 Kyaukpyu 80 57 137 0 246 245 491 9 11 Ramree 87 98 185 1 473 544 1017 9 12 Thandwe 3 1 4 0 105 101 206 8 13 Toungup 128 78 206 8 473 413 886 38 Southern Rakhine Total 586 495 1,081 98 2,361 2,535 4,896 114 14 Kyauktaw 0 0 0 0 50 46 96 1 15 Rathedaung 0 0 0 0 109 142 251 7 16 Sittwe 0 0 0 0 47 46 93 7 Northern Rakhine Total 0 0 0 0 206 234 440 15

Grand Total 786 686 1,472 118 3,954 4,401 8,355 454

Table 20: Group Health Talks by VMWs and PPs (October 2016 ‐ March 2017)

Oct 16 - Dec 16 Jan 17 - Mar 17

Sr Township # No. # Male Male Male Total Total Female Female Female Sessions Sessions included included Migrants Migrants 2 Dawei 0 0 0 0 0 4 8 15 23 5 4 Kyunsu 0 0 0 0 0 47 188 192 380 3 5 Launglon 0 0 0 0 0 4 12 14 26 0 6 Myeik 0 0 0 0 0 21 59 167 226 13 7 Palaw 0 0 0 0 0 29 61 69 130 5 9 Thayetchaung 0 0 0 0 0 2 7 16 23 0 10 Yebyu 0 0 0 0 0 5 22 54 76 1 Tanintharyi Total 0 0 0 0 0 112 357 527 884 27 11 Ann 0 0 0 0 0 24 285 394 679 1 12 Gwa 0 0 0 0 0 50 408 966 1,374 57 15 Thandwe 0 0 0 0 0 50 646 1,098 1,744 95 16 Toungup 0 0 0 0 0 7 45 98 143 4 Southern Rakhine Total 0 0 0 0 0 131 1,384 2,556 3,940 157 22 Sittwe 0 0 0 0 0 7 26 77 103 0 Northern Rakhine Total 0 0 0 0 0 7 26 77 103 0 Grand Total 0 0 0 0 0 250 1,767 3,160 4,927 184

Table 21: Number of people reached through interpersonal communication (IPC) by Private Providers only. (October 2016 – March 2017) Township Oct 16 - Dec 16 Jan 17 - Mar 17

Sr No. Male Male Male Male Total Total Total Female Female Female included included Migrants Migrants Migrants Migrants 1 Dawei 2 1 3 0 4 4 8 3 2 Kyunsu 21 20 41 0 80 75 155 1 3 Myeik 22 35 57 3 72 86 158 5 4 Palaw 1 4 5 3 34 31 65 14 5 Thayetchaung 13 8 21 3 38 34 72 13 Tanintharyi Total 59 68 127 9 228 230 458 36 6 Ann 45 35 80 2 106 78 184 4 7 Kyaukpyu 8 6 14 0 46 74 120 7 8 Ramree 2 3 5 0 30 29 59 0 9 Toungup 41 17 58 4 128 106 234 30 Southern Rakhine Total 96 61 157 6 310 287 597 41 10 Kyauktaw 0 0 0 0 1 0 1 0 Northern Rakhine Total 0 0 0 0 1 0 1 0 Grand Total 155 129 284 15 539 517 1,056 77

Annex 6 - Township level Advocacy Meeting list Table 22: Summary of township level advocacy meeting (October 2016 – December 2016) Male Female Total Sr. No. Township Date of Advocacy Place of meeting attendants attendants attendants 1 Myeik 30-Dec-17 Myeik Township Hospital 8 53 61 2 Palaw 30-Dec-16 Palaw Township Hospital 14 56 70 Tanintharyi Total 22 109 131 3 Ann 30-Dec-16 Ann Township Hospital 44 75 119 4 Gwa 28-Oct-16 Township Hospital 20 33 53 5 Thandwe 7-Nov-16 Township Hospital 24 33 57 6 Toungup 30-Dec-17 Monestery 18 60 78

Southern Rakhine Total 106 201 307 Grand Total 128 310 438

Table 23: Summary of township level advocacy meeting (January 2017 ‐ March 2017)

Male Female Total Sr. No. Township Date of Advocacy Place of meeting attendants attendants attendants Kyunsu Township Hospital 31-Jan-17 1 Kyunsu Kyunsu Township Administration 71 63 134 28-Feb-17 Office 2 Launglon 31-Mar-17 Ba Htoo Hall (Launglon) 60 32 92 3 Myeik 31-Mar-17 Myeik Administrative Office 37 6 43

4 Palaw 31-Jan-17 Kan Yoe Tan Yadanar Hall 88 37 125

5 Thayetchaung 31-Mar-17 Myo Ma Hall (Thayetchaung) 61 17 78 Tanintharyi Total 317 155 472 meeting room of General 6 Ann 15-Feb-17 45 17 62 Administration office District Hospital Hall 7 Kyaukpyu 31-Jan-17 Meeting room of General 122 82 204 Administration Office Township Adminstrative Office 8 Ramree 31-Jan-17 Meeting Hall 91 72 163 Township Hospital Meeting Hall 9 Toungup 16-Jan-17 Township Administrative Hall 63 11 74 Southern Rakhine Total 321 182 503 10 Buthidaung 20-Feb-17 Meeting Hall, Township Hospital 34 21 55 Township Hospital (Meeting Hall) 30-Jan-17 11 Kyauktaw Township Administrative Office 168 80 248 31-Jan-17 (Meeting Hall)

12 Maungdaw 21-Feb-17 Meeting Hall, Township Hospital 38 14 52

15-Feb-17 Township Administrative Meeting Hall 13 Pauktaw 94 57 151 28-Feb-17 Township Hospital Meeting Hall 36

14 Rathedaung 18-Feb-17 Meeting Hall, Township Hospital 27 23 50 Northern Rakhine Total 361 195 556 15 Hlaingbwe 30-Jan-17 Hlaing Bwe General Hospital 8 70 78 Kayin Total 8 70 78 Grand Total 1,007 602 1,609

Annex 7 – Performance Indicators Table 24: Performance Indicators Tracking Table (October 2016 - March 2017) Actual Target Indicators Frequency Baseline October 2016 – January 2017 to Year 1 December 2017 March 2017 TBD after project IP 1: Rate of confirmed malaria cases per 1,000 populations Annual 8 (CAP-M PY4) N/A N/A area profiles are in Defeat Malaria project areas completed 660 in 2015 (from IP 2: Number of severe malaria cases in Defeat Malaria Monthly National M&E 0 0 TBD project areas Plan) 0.08 in 2015 IP 3: Malaria Mortality Rate Monthly (from National 0 0 TBD M&E Plan) 6% in 2015 (from IP 4: Annual Blood Examination Rate Annual National M&E N/A N/A TBD Plan) 9% in 2015 (from IP 5: Case classification rate (in Defeat Malaria elimination Monthly National M&E NA NA Not done in FY2017 target areas) Plan) IP 6: Foci classification (in Defeat Malaria elimination target Monthly N/A NA NA Not done in FY2017 areas) 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 OC 1.1 % of households in targeted areas that own at least N/A N/A 60% one insecticide treated net (ITN) 47% (in Rakhine), Baseline and end line 60,2% (in OC 1.1.1 % of households in targeted areas that own at Tanintharyi), N/A N/A 60% least one ITN for every two persons 65.6% (in Kayin) - from CAP-M

Actual Target Indicators Frequency Baseline October 2016 – January 2017 to Year 1 December 2017 March 2017

OC 1.2 % of individuals in targeted areas who slept under ITN the previous night. (disaggregate by type of net, N/A N/A 55% pregnant women, children under 5

OC 1.2.1 % of local residents in CAP-M targeted areas who slept under ITN the previous night (disaggregate by type of N/A N/A 55% net, pregnant women, children under 5 OC 1.2.2 % of migrants in CAP-M targeted areas who slept under ITN the previous night (disaggregate by type of net, N/A N/A 55% pregnant women, children under 5

OC 1.3.1 % of supplied RDT are distributed as planned Monthly N/A N/A N/A TBD

OC 1.3.2 % of supplied ACT are distributed as planned Monthly N/A N/A N/A TBD

OC 1.3.3 % of service delivery points which report no stock Minimum 85% outs of RDTs lasting more than one week during the past 3 Quarterly 100.0% 99.95% 85% (from CAP-M) months (disaggregate by type of SDP) OC 1.3.4 % of service delivery points which report no stock outs of first line antimalarial medicines (ACT) lasting more Minimum 85% Quarterly 100.0% 99.85% 85% than one week during the past 3 months (disaggregate by (from CAP-M) type of SDP) OC 1.4 % of reported malaria cases in last 3 months which 21.9% (from are confirmed through microscopy or RDTs. (among fever Baseline/End line N/A N/A TBD MARC survey) cases) OC 1.5 % of patients found positive who received Minimum 95% antimalarial treatment according to National Malaria Monthly 97.42% 97.43% 95% (from CAP-M) Treatment Guidelines OC 1.6 % of Pf/mixed Positive cases with DOT having 25% (from CAP- complete observation (disaggregate by sex, age, and resident Monthly 57.48% 48.88% 30% M) status)

Actual Target Indicators Frequency Baseline October 2016 – January 2017 to Year 1 December 2017 March 2017

OP 1.1 Number of insecticide treated net purchased in any Activity implemented 92,986 (From 1,095 7,230 200,000 fiscal year that were distributed (F-indicator) months CAP-M PY5)

OP 1.2 Number of artemisinin-based combination therapy TBD after project (ACT) treatments purchased that were distributed in any Every 6 months NA 2,010 6,740 areas profiles are fiscal year (F-indicator) completed TBD after project OP 1.3 Number of RDTs purchased in any fiscal year that Every 6 months NA 19,125 109,375 areas profiles are were distributed to health facilities (F-indicator) completed OP 1.4. Number of individuals reached with malaria Monthly, semiannual 514,333 (from behavior change messages through interpersonal 1,472 8,355 120,000 and annual CAP-M PY5) communication (counted) OP 1.5 % of training activities for health staff and VMWs are Month of training TBD N/A N/A TBD carried out as planned OP 1.5.1 Number of health workers trained in case 5,155 (from CAP- management with first line antimalarial drugs (Disaggregated Month of training 236 591 1,500 VMWs/PPs M) by male, female, and profession) (F-indicator) OP 1.5.2 Number of health workers trained in malaria laboratory diagnostics (rapid diagnostic tests (RDTs) or 5,443 (from CAP- Month of training 236 591 1,500 VMWs/PPs microscopy) (Disaggregated by male, female, and profession) M) (F-indicator) OP 1.6 Number of malaria tested in Defeat Malaria target 583,518 (from Monthly 5,370 15,239 NA area CAP-M)

OP 1.7 Number of confirmed malaria cases in Defeat 23,512 (from Monthly 272 273 NA Malaria target area CAP-M)

OP 1.8 Number of malaria cases treated in Defeat Malaria 23,394 (from Monthly 271 272 NA target areas. CAP-M) OP 1.9 % of VMWs/PPs received at least two supervisory Annually N/A N/A N/A NA visits per year

Actual Target Indicators Frequency Baseline October 2016 – January 2017 to Year 1 December 2017 March 2017 OP 1.10 % operational research activities and pilot testing of innovative tools and delivery approaches approved in the Annual N/A N/A N/A TBD annual work plans and by the PMI operational research committee are implemented and evaluated as planned 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 targeted areas report Monthly ≥ 80% 93.78% 96.55% 85% monthly data of malaria cases (disaggregate by type of SDP)

OC 2.1.1 % of service delivery points in targeted areas report monthly data of malaria cases on time (disaggregate Monthly N/A 98.27% 99.30% 85% by type of SDP) OP 2.1 Number of Basic Health Staff (BHS) and project Month of training N/A 0 57 TBD M&E staffs trained on malaria database system OP 2.2 % of project villages developed and updated for Annually N/A N/A N/A ≥ 90% Village Based Stratification (VBS) annually OP 2.3 Number of villages with zero incidence of locally contracted malaria positive cases in elimination targeted Semiannually N/A NA NA Not done in FY2017 areas (Toungup and Ramree) OP 2.3.1 Number of indigenous/introduced cases in N/A NA NA Not done in FY2017 elimination target areas OP 2.3.2 Number of imported cases in elimination target N/A NA NA Not done in FY2017 areas OP 2.3.3 Number of villages with active foci in elimination Semiannually N/A NA NA Not done in FY2017 targeted areas OP 2.3.4 % of positive cases notified within 24 hours (in Monthly N/A NA NA Not done in FY2017 elimination targeted areas)

Actual Target Indicators Frequency Baseline October 2016 – January 2017 to Year 1 December 2017 March 2017

OP 2.3.5 % of positive cases investigated within three days Monthly N/A NA NA Not done in FY2017 from notification (in elimination targeted areas)

OP 2.3.6 % of foci investigated and classified within three Monthly N/A NA NA Not done in FY2017 days after notification (in elimination targeted areas) OP 2.3.7 % of foci responded within seven days after Monthly N/A NA NA Not done in FY2017 notification (in elimination targeted areas) OP 2.4 % of sentinel sites complete planned entomological Semiannual N/A N/A 0 TBD monitoring activities Objective 3: Enhance technical and operational capacity of the NMCP OP 3.1 % of targeted health services received at least two Month of supervisory N/A N/A N/A TBD supervisory visits per year. visits OP 3.2 % of the targeted laboratories meeting minimum Month of supervisory N/A N/A N/A TBD quality standards. visits Objective 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 and state owned Month of N/A 0 0 TBD enterprises in malaria activities implementation OP 4.2 Number of advocacy meetings with private Month of N/A 0 0 10 companies and state owned enterprises in malaria activities implementation OP 4.3 % of health education sessions conducted in the targeted areas with participation from collaborating Monthly N/A 0 0 TBD companies and enterprises as planned OP 4.3.1 Number of participants attended at health education sessions conducted in the targeted areas with Monthly N/A 0 0 N/A participation from collaborating companies and enterprise

Actual Target Indicators Frequency Baseline October 2016 – January 2017 to Year 1 December 2017 March 2017 Monthly, Quarterly, OP 4.4 % of community mobilization events performed as Semiannual and N/A N/A N/A 10 planned annual