Defeat Malaria

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DEFEAT MALARIA

DEFEAT MALARIA ACTIV ITY

QUARTERLY PERFORMANCE REPORT

FISCAL YEAR 2020 QUARTER 1 (OCTOBER 1, 2019 TO DECEMBER 31, 2019) 2020 QUARTERLY PERFORMANCE REPORT

Submission Date: January 30, 2020

Agreement Number: AID-482-A-16-00003 Agreement Period: August 15, 2016 to August 14, 2021 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., BahanTownship Yangon, Myanmar Email: [email protected]

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 contributing to the long-term national goal of eliminating malaria in Myanmar. Defeat Malaria has four core objectives, including:

 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. DEFEAT MALARIA FY 2020 QUARTER 1 KEY ACHIEVEMENTS

Testing & Case Finding 64,808 people were tested for malaria Health Communication 46,941 people, including 7,112 of whom migrants, were reached through 686 were positive cases interpersonal communication

Total Positivity Rate: 1.06%

Treatment Completion Preventive Commodities

514 individuals were Distributed 34,259 LLINs enrolled in DOT treatment; to villages, worksites, and 97.7% of enrolled cases women attending completed DOT treatment ante-natal care clinics

Diagnostic and Treatment Commodities Capacity Building Distributed 52,400 RDTs 1, 194 health workers and 785 ACTs received initial training to Defeat Malaria storage on malaria diagnostics sites to safeguard and case management continuous and on-time 1,187 health workers delivery of malaria health received training on Integrated Community care services Malaria Volunteers DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT FY 2020 Q1

Table of Contents ACRONYMS AND ABBREVIATIONS ...... III EXECUTIVE SUMMARY ...... 1 INTRODUCTION ...... 3 FISCAL YEAR 2020 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 OBJECTIVE 2: STRENGTHEN THE MALARIA SURVEILLANCE SYSTEM TO COMPREHENSIVELY MONITOR PROGRESS AND INFORM THE DEPLOYMENT AND TARGETING OF APPROPRIATE RESPONSES AND STRATEGIES...... 11 OBJECTIVE 3: ENHANCE TECHNICAL AND OPERATIONAL CAPACITY OF THE NMCP AND OTHER HEALTH SERVICE PROVIDERS AT ALL LEVELS OF SERVICE PROVISION...... 16 OBJECTIVE 4: PROMOTE THE INVOLVEMENT OF COMMUNITIES, PRIVATE HEALTHCARE PROVIDERS, PRIVATE COMPANIES AND STATE- OWNED ENTERPRISES IN MALARIA CONTROL AND ELIMINATION INITIATIVES ...... 18 ANNEX 1: SITUATION OF RAKHINE STATE ...... 21 ANNEX 2: ENTOMOLOGICAL ASSESSMENTS ...... 22 ANNEX 3: QUARTERLY REPORT ON PILOT MALARIA ELIMINATION ACTIVITIES ...... 24 ANNEXES 4.A PMI-USAID ADVOCATE TO HE MINISTER OF MOHS ABOUT PMI SUPPORTS FOR MALARIA ELIMINATION ...... 28 ANNEXES 4.B DEFEAT MALARIA ADVOCATED TO PERMANENT SECRETARY OF MOHS ABOUT PILOT MALARIA ELIMINATION ACTIVITIES ...... 28 ANNEXES 4.C USAID/PMI BOOTH DISPLAYED AT NATIONAL LEVEL MALARIA ELIMINATION LAUNCHING ...... 29 ANNEX 5: KNOWLEDGE TRANSLATION ABOUT COST ANALYSIS AND PROJECTION ...... 30 ANNEX 6: MALARIA CASE CLASSIFICATION CALCULATOR ...... 31 ANNEX 7: SOCIO-BEHAVIOR CHANGE COMMUNICATION ...... 32 ANNEX 8: FACTORS ASSOCIATED WITH ADHERENCE TO PRIMAQUINE 8-WEEK REGIMEN AMONG P. VIVAXI CASES ...... 33 ANNEXES 9: COMMUNITY ENGAGEMENT ACTIVITIES (OCT 2019 – DEC 2019) ...... 34 ANNEX 10: CASE FINDING AND MANAGEMENT OF ALL TOWNSHIPS BY DIFFERENT APPROACHES (OCT -DEC 2019) ...... 35 ANNEX 11: ACTIVE CASE DETECTION BY MOBILE TEAM (OCT-DEC 2019) ...... 36 ANNEX 12: VMWS/PPS MEETINGS (OCT-DEC 2019) ...... 37 ANNEX 13: SUPERVISION AND MONITORING (OCT-DEC 2019) ...... 38 ANNEX 14: REPORTING STATUS OF VMWS AND PPS (OCT-DEC 2019) ...... 39 ANNEX 15: CLINICAL AUDIT (OCT-DEC 2019) ...... 40 ANNEX 16: STOCK OUT MONITORING AT THE TIME OF MONITORING VISITS (OCT-DEC 2019) ...... 41 ANNEX 17: STOCK OUT MONITORING AT MONTHLY MEETING (OCT-DEC 2019) ...... 42 ANNEX 18: CAPACITY BUILDING ON MALARIA DIAGNOSIS (OCT-DEC 2019) ...... 43 ANNEX 19: CAPACITY BUILDING ON CASE MANAGEMENT (OCT-DEC 2019) ...... 44 ANNEX 20: CAPACITY BUILDING ON INTEGRATED COMMUNITY MALARIA VOLUNTEER (OCT-DEC 2019) ...... 45 ANNEX 21: BEHAVIOR CHANGE COMMUNICATION (OCT-DEC 2019) ...... 46 ANNEX 22: PERFORMANCE INDICATORS (OCT-DEC 2019) ...... 47

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Figures: Figure 1: Geographic spread of Defeat Malaria activities in Myanmar as of December 2019 ...... 3 Figure 2: RDT Distribution from the Central Warehouse to State/Region and EHO (Oct - Dec 2019) ...... 5 Figure 3: ACT Distribution from the Central Warehouse to State/Region and EHO (Oct - Dec 2019...... 5 Figure 4: Malaria testing and positive cases by providers ...... 9 Figure 5: Reporting status of VMWs/PPs by State and Region ...... 13 Figure 6: Routine Data Quality Assessment Status (Oct-Dec 2019) ...... 14

Tables:

Table 1: Project area coverage as of December 2019 ...... 3 Table 2: Long lasting insecticide net (LLIN) distribution at villages (Oct 2019 - Dec 2019) ...... 7 Table 3: LLIN distribution at worksites (Oct 2019 – Dec 2019) ...... 7 Table 4: LLIN Coverage and Utilization by Defeat Malaria State/Region (Oct 2019 - Dec 2019) ...... 8 Table 5: Malaria testing by Defeat Malaria covered state/region (Oct 2019 – Dec 2019) ...... 9

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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 ASTMH American Society of Tropical Medicine and Hygiene BCC Behavior Change Communication BHS Basic Health Staff BPHWT Back Pack Health Worker Team CBO Community based organization CDC Centers for Disease Control and Prevention COP Chief of Party cRDT Conventional rapid diagnostic test CSG Community Support Group CSR Corporate Social Responsibility DGHI Duke University, Global Health Initiative DMR Department of Medical Research DOT Directly Observed Treatment DQO Data Quality Officer EHO Ethnic Health Organization EMMP Environmental Mitigation and Monitoring Plan FDA Food and Drug Administration GTS Global Technical Strategy HRP2 Histidine Rich Protein 2 hsRDT Highly-sensitive rapid diagnostic test ICMV Integrated Community Malaria Volunteers IDP Internally Displaced People IEC Information, education and communication INGO International Non-Government Organization IPC Interpersonal communication Jhpiego Johns Hopkins Program for International Education in Gynecology and Obstetrics KDHW Karen Department of Health Welfare KNU Karen National Union LLIN Long-lasting insecticidal nets LNGO Local Non-Government Organization M&E Monitoring and Evaluation MECC Malaria Elimination Coordination Committees MHAA Myanmar Health Assistant Association MMW Mobile Malaria Worker MNMA Myanmar Nurse and Midwife Association

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MoHS Ministry of Health and Sports NGO Non-Government Organization NFPP Non-formal private provider NMCP National Malaria Control Program NRS Northern Rakhine State NSP National Strategic Plan NTG National Malaria Treatment Guidelines PCR Polymerase Chain Reaction PMI President’s Malaria Initiative PP Private providers RDQA Routine Data Quality Assessments RDT Rapid diagnostic tests RHC Rural Health Centers SMT Senior Management Team SRS Southern Rakhine State TES Therapeutic Efficacy Study TPR Test positivity rate UNOCHA United Nations Office for the Coordination of Humanitarian Affairs URC University Research Co., LLC USAID United States Agency for InternationalDevelopment VBDC Vector Borne Disease Control VMW Village Malaria Worker WHO World Health Organization YWEP Yangon Waste to Energy Plant

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Executive Summary Myanmar’s National Malaria Control Program (NMCP) presented about malaria situation at the annual review meeting that 75,234 malaria cases and 19 malaria deaths were reported in 2018. It was also highlighted that 291 out of 330 townships of Myanmar are malaria endemic and approximately 44 million people are living in malaria endemic areas. According to WHO estimates, there were 182,452 malaria cases and 37 malaria deaths in 2015, and 59% of malaria cases and 49% of malaria deaths were found to have decreased during 2015 - 2018. The Defeat Malaria Activity, funded by the U.S. President’s Malaria Initiative (PMI) and USAID, runs from 15th August 2016 to 14th August 2021 and is implemented by University Research Co., LLC (URC), in partnership with American Refugee Committee (ARC), Jhpiego, and the Duke University, Global Health Institute. Defeat Malaria also involves local partner organizations, such as the Myanmar Health Assistant Association (MHAA) and Myanmar Nurse and Midwife Association (MNMA), to deliver needed malaria services while contributing to local capacity building efforts. Defeat Malaria works with the NMCP to strengthen local health systems that are flexible and respond appropriately to a changing malaria epidemiological situation and emerging threats, including multi-drug resistance and insecticide resistance. For the journey to self-reliance and sustainability, Defeat Malaria not only strengthens the supply side by working in collaboration with MoHS for health system strengthening but also sensitizes demand side initiatives by empowering the community. Defeat Malaria also engages and supports ethnic health organization (EHO) and involves private sector stakeholders. Defeat Malaria promotes the governance of health care system for strengthening malaria control and elimination activities by supporting the developments of standard operating procedures, necessary technical guidelines,evidence -based decision making, technical brief, innovative tools, and building on existing efforts to engage other agencies and sectors. Moreover, Defeat Malaria promotes the quality of health management through the expansion of malaria service for ensuring universal coverage by supporting malaria implementation partners mapping; maximizes the efficiency by applying village-based stratification for appropriate interventions and conducting routine malaria surveillance; promotion of access to malaria health services for hard-to-reach populationsthrough the mobilization of mobile malaria workers (MMWs) from the forested worksites, as well as conflict affected populations through local Community Based Organization (CBO); enhancing effectiveness by rigorous reporting and monitoring system; following national treatment guidelines with clinical auditing and directly observed treatment mechanism; and paying great attention to patients’ safety and clients’ centeredness. On the move towards malaria elimination, Defeat Malaria in collaboration with NMCP initiatedelimin ation activities in three pilot townships (Toungup, Ramree, and Munaung), and the achievements and experiences gained have been documented for reporting to NMCP. These findings further support extending Defeat Malaria’s technical and operational support to increase the number of elimination areas, based on the experiences gained from three pilot townships.

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Project Year 4 Quarter 1 Key Highlights (October 2019 - December 2019) • As of December 2019, overall coverage of Defeat Malaria is around 1,570,336 people from 2,934 villages among 36 townships of Rakhine, Kayin, Tanintharyi and Sagaing States/Regions.

• Capacity buildings to 13 VBDC staff/Basic Health Staff for malaria technical trainings by the assistance of Defeat Malaria-Jhpiego and 69 VBDC staff for “Malaria Surveillance System - Web- based Training” were provided.

• Defeat Malaria was actively involved at the national launching ceremony for malaria elimination by displaying booths under USAID PMI umbrella. At annual VBDC meeting, Defeat Malaria presented on malaria elimination experiences based on the three pilot townships implemented collaboratively with the national program in Southern Rakhine State. Higher level policy makers including His Excellency Minister, Permanent Secretary and Director General of Ministry of Health and Sports were advocated about malaria elimination initiatives undertaken by Defeat Malaria.

• Defeat Malaria continues to support the key activities for health system strengthening, private sector engagement and community empowerment, scale up malaria burden reduction activities, and providing capacity building trainings to strengthen surveillance system for malaria elimination.

• Malaria elimination activities will be expanded to another 14 townships through collaboration with NMCP. Cross-visit to pilot malaria elimination townships for learning malaria elimination activities was accomplished by inviting township focal staff and a representative of KDHW-EHO who were from the areas planned for malaria elimination.

• Defeat Malaria continued to strengthen private sector engagement by working closely with 56 private companies in Tanintharyi, Rakhine and Kayin to encourage malaria testing and prevention through the uses of LLINs. In three pilot malaria elimination townships, we continued to encourage 15 general practitioners for appropriate reporting and immediate notification and engaged with 30 drug stores and 16 non-formal private providers for appropriate referral of suspected malaria patients.

• Community meetings and engagements were conducted at 15 villages for the possible establishment of community support groups. Mass LLIN distribution campaigns were conducted at 104 villages/worksites. Defeat Malaria also provided 282 community health talks and 819 supervision visits to VMWs.

• Malaria burden reduction activities could be maintained at all 17 townships of Rakhine State despite prevailing armed conflict situations. The activities and support were undertaken by close vigilance of security conditions, taking staff safety precaution measures and following risk mitigation approach.

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Introduction Defeat Malaria coverage as of December 2019 Defeat Malaria currently covers two States (Rakhine in the west and Kayin in the south-east) and two Regions (Tanintharyi in the south-east and Sagaing in the north-west) of 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 December 2019, the Defeat Malaria project is implementing activities in36 townships. Defeat Malaria continuously engages with the national program and other implementing partners to ensure universal coverage of malaria prevention, diagnosis and case management services in Myanmar, and targeting hard-to-reach populations residing in high malaria risk areas. Malaria services reach beneficiaries through a network of 1,933 Figure 1: Geographic spread of Defeat Malaria activities VMWs/PPs, township mobile teams, and 20 Mobile in Myanmar as of December 2019 Malaria Workers. Our efforts extend to 2,934 villages and worksites. Currently, Defeat Malaria’s overall population coverage is around 1,570,336 beneficiaries. Table 1: Project area coverage as of December 2019 State & Region No. of Total Total Covered Total Total % of VMW/PP Covered Villages/ Population Covered Population /MMW Townships Worksites Population Covered Tanintharyi 492 10 584 1,408,401 309,382 21.97%% Northern Rakhine 748 10 733 1,298,458 446,697 34.40% Southern Rakhine 510 7 1,070 803,656 474,494 59.04% Kayin 215 4 235 1,008,001 145,461 14.43% Sagaing 168 5 312 747,114 194,302 26.0% Total 2,133 36 2,934 5,265,630 1,570,336 29.82%

During FY2020 Q1, Defeat Malaria provided necessary technical and operational capacities to township Defeat Malaria staff working for the malaria elimination activities from 8 townships of Rakhine, 4 townships of Kayin and 2 townships of Tanintharyi region. Defeat Malaria will collaborate with the NMCP

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to support these elimination townships by adoption and adaptation of the experiences gained in pilot elimination sites of Southern Rakhine State. FY2020 Quarterly 1 Summary of Key Achievements ✓ Training activities - Initial and refresher trainings were conducted for 1,092 VMWs (533 males and 559 females), 99 PP (61 male and 38 female) and 3 female MMWs on malaria case diagnostics and management. Integrated Community Malaria Volunteer trainings were conducted for 1,088 VMWs (533 males and 555 females) and 99 PPs (61 male and 38 female).

✓ 64,808 people were tested for malaria through VMWs, private providers and mobile outreach teams.

✓ 686 positive cases were detected and, among them, 673 out of 677 treated cases (98.7%) were in line with National Treatment Guidelines. The other 9 cases were referred to health facilities for further appropriate treatment to be given by township health staff.

✓ Under the DOT strategy, 514 out 686 positive cases (74.9%) were enrolled for DOT and 502 out of 514 enrolled cases (97.7%) completed the treatment courses. 300 out of 410 P.v cases enrolled and 289 out of 300 enrolled P.v cases (96.3%) completed for 14 days DOT course, 8 out of 10 mixed infected cases enrolled and 7 out of 8 enrolled cases (87.5%) completed for 14 days DOT course, and 206 out of 226 P.f cases enrolled and all enrolled cases completed 3 days DOT course.

✓ Interpersonal communication – Defeat Malaria reached 46,941 people (23,275 males and 23,666 females) through interpersonal communication (IPC) including 7,112 migrants. 282 group health talks were conducted reaching 4,611 people (1,960 males and 2,651 females) including 1,122 migrants in targeted areas.

✓ A total of 34,259 LLINs were distributed. 33,646 LLINs were distributed in 109 villages and 13 worksites, 482 LLINs for pregnant women attending antenatal clinics, and 131 LLINs to EHOs were provided.

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Fiscal Year 2020 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 For malaria case management and uninterrupted treatment services for targeted communities, VMWs are provided at least 25 RDTs and 3 ACT strips. However, more RDTs and ACTs are provided according to the population covered and malaria transmission intensity. During FY 2020 Q1, 52,400 rapid diagnostic tests (RDTs) and 785 first line antimalarials (ACTs) were distributed to established commodity storage sites of Defeat Malaria partners and sub grants from the central warehouse in Yangon (see Figures 2 & 3). From those township level storage sites, commodities were delivered to respective village level service delivery points i.e., VMWs/PPs during VMW monthly meetings and monitoring and supervision visits if necessary. The necessary amounts of commodities were adequately provided based on the anticipated use for each site and VMW/PP calculation from data on monthly consumptions over the previous project years.

Figure 2: RDT Distribution from the Central Warehouse to State/Region and EHO (Oct - Dec 2019)

Figure 3: ACT Distribution from the Central Warehouse to State/Region and EHO (Oct - Dec 2019

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RDTs and ACTs were replenished at VMWs/PPs meetings, monitoring visits and report collection from the villages in order to prevent stock-outs. During FY2020 Q1, stock-out monitoring was conducted a total of 6,817 times at the VMWs/PPs meetings (5,859 times), and the supervision visits and on-site data collection (958 times). During this reporting period, RDT as well as ACT stock-out was found once at VMW monitoring visit and the necessary stocks were replenished. ❖ Optimize coverage and promote use of proven vector control interventions Strengthening Behavior Change Communication (BCC) Interpersonal Communication From October to December 2019, a total of 46,941 people (50.4% female), including 7,112 migrants, were reached through interpersonal communication (IPC) activities and received key malaria messages (use of LLINs, access to RDT for any suspects of malaria, and importance of taking treatment completely) from VMWs. Within the IPC activities, private providers reached 3,718 people (48.1% female). 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 this quarter, 282 group health talk sessions were conducted in Defeat Malaria covered villages and work sites, reaching 4,611 people (57.5% female), 1,122 of whom were migrants. Distribution of printed materials During FY2020 Q1, 9,391 pamphlets were distributed to targeted populations in project areas and 126 posters were developed and displayed at VMWs’ posts to promote communities’ malaria control and elimination knowledge, attitudes and practices to prevent transmission. Printed digital media and Defeat Malaria on Social Media A Facebook page (“Defeat Malaria Myanmar”) is uploading the activity updates to disseminate Defeat Malaria’s contribution for community impact, health system strengthening, knowledge translation and also to strengthen online communication among implementing partners, reach local people and groups, and advocate for donor and stakeholders who take interest and invest in malaria elimination. The Facebook content includes knowledge translation posters of Defeat Malaria’s involvement at the 68th annual meeting of American Society of Tropical Medicine and Hygiene, PMI/CDC/NMCP joint entomological visits, universal health coverage day, pilot malaria elimination model displayed at the oothb of the national launching ceremony for malaria elimination, vacancy announcements, and information from USAID Burma and MoHS reaching 32,480 people in this quarter. Long-lasting insecticide net distribution LLIN distribution is a key vector control mechanism and, under Defeat Malaria, LLIN distribution is prioritized in high malaria transmission areas and high-risk groups such as migrants and pregnant women. The team utilizes multiple distribution approaches, including mass distribution once for a three-year period by collaborating with NMCP, and top up distribution at the village level after LLIN monitoring and for the influx of inbound migrants. The objective is to achieve and maintain high level of vector control coverage and LLIN utilization for malaria prevention. Mass distribution of LLINs In this reporting period, 33,142 LLINs were distributed in 109 villages through mass and top up distribution. We could provide for the protection of 60,226 people from 12,405 households. Both household and population coverage weretargeted for 100%. Average population per LLIN is1.82 . Table 2 shows mass LLIN distribution/top up at village level by state/region.

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Table 2: Long lasting insecticide net (LLIN) distribution at villages (Oct 2019 - Dec 2019)

Indicator Mass Distribution Top Up Grand Total # of Villages 99 10 109 # of Households (HHs) present at time of distribution 12,340 65 12,405 # of HHs covered 12,340 65 12,405 # of Population present at time of distribution 59,919 307 60,226 # of Population covered 59,919 307 60,226 Total LLINs distributed 32,986 156 33,142 % of HHs covered 100% 100% 100% % of Population covered 100% 100% 100% Net Ownership (Persons/LLIN) 1.82 1.97 1.82

LLIN distribution to migrants and mobile populations in collaboration with employers In all activities, Defeat Malaria targeted mobile and migrant populations (MMP). To reach migrants with preventive methods, LLINs were distributed at work sites.A total of 504 LLINs were distributed in 13 work sites to cover 1,252 MMPs. All households and populations were covered by LLINs in those worksites, resulting in 100% coverage but average population per LLIN was 2.48. Targeted distribution was applied for pilot malaria elimination areas where malaria transmission has decreased and only 331 LLINs were distributed for 945 population in five worksites of Ramree (see Table 3 below). Table 3: LLIN distribution at worksites (Oct 2019 – Dec 2019)

Mass distribution Top up Grand total # of worksites 5 8 13 # of Households (HHs) present at time of distribution 55 121 176 # of HHs covered 55 121 176 # of Population present at time of distribution 945 307 1,252 # of Population covered 945 307 1,252 Total LLINs distributed 331 173 504 % of HHs covered 100% 100% 100% % of Population covered 100% 100% 100% Net Ownership (Persons/LLIN) 2.85 1.77 2.48

LLIN distribution to pregnant women during Antenatal Care (ANC) in high transmission areas Defeat Malaria continued distributing LLINs to pregnant women by targeting ANC visits in Ann, Gwa, Thandwe, Toungup, Kyauktaw and Minbya townships. In this quarter, LLINs were distributed to 482 pregnant women who came to utilize antenatal careat the health facilities of those townships. Pamphlets on malaria in pregnancy were also supported to ANC facilities with the explanation of the risks related to malaria in pregnancy (anemia, abortion, prematurity, low birth weight, etc.). Although malaria is a biological risk during pregnancy, no malaria cases were reported from those ANC facilities engaged with Defeat Malaria. Jhpiego, in collaboration with NMCP, includes the topic of malaria in pregnancy in the training curriculum of community-based interventions and ICMV. Monitoring on LLIN coverage and utilization Defeat Malaria conducts LLIN coverage and use monitoring in the villages where there are active malaria transmissions or high receptiveness. The mHealth Officer has designed a way to conduct LLIN monitoring by applying the use of mobile tablets. This method will be rolled out in the next quarter after providing

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training to township staff. And while LLIN monitoring was conducted by township staff in most areas, due to restricted access and risk of security in some villages, VMWs/PPs are going to be mobilized in place of township staff as they will not face the same risks. In this quarter, LLIN monitoring for coverage revealed 60 out of 66 villages (90.9%) had an acceptable level of coverage (at least 15 out of 21 households monitored owning enough LLINs to adequately cover 2 people per LLIN) and 62 out of 66 villages (93.9%) met the acceptable level of high utilization (70% utilization). Table 4: LLIN Coverage and Utilization by Defeat Malaria State/Region (Oct 2019 - Dec 2019) State / Region Villages with LLIN Coverage Acceptability Villages with LLIN Utilization Acceptability # Villages # (%) villages # villages with # Villages # (%) villages # villages with monitore with acceptable unacceptable monitore with acceptable unacceptable d LLIN coverage LLIN coverage d LLIN utilization LLIN utilization Tanintharyi 23 22 (96%) 1 23 21 (91%) 2 Rakhine (South) 20 16 (80%) 4 20 19 (95%) 1 Rakhine (North) 0 0 0 0 0 0 Kayin 17 16 (94%) 1 17 17 (100%) 0 Sagaing 6 6 (100%) 0 6 5 (83%) 1 Grand Total 66 60 (91%) 6 66 62 (94%) 4

Disposal of Medical Waste and LLIN Bags Emptied plastic bags of LLINs are disposed in accordance with the EMMP guidelines. Residents areadvised through appropriate communication on not using LLIN bags for any other purpose to avoid the risk of pesticide poisoning. They are also advised to bury the bags at least 100 meters away from any wells or surface water source and at least 1.5 meters above the water table. If it is not possible to find an appropriate place at the village, it is instructed to send the bags to the township office for further incineration at Yangon Waste to Energy Plant. Used RDT plastic cartridge and other plastic instruments are instructed to be put into specifiedcontainers. These containers are collected by the township teams and transported to Yangon for incineration at the Yangon Waste to Energy Plant (YWEP). The lancets and sharp objects used for taking blood are to be placed into the waste boxes and disposed at the well-designed incinerators of nearby designated township hospitals. The designated hospitals for incineration are Buthidaung and Kyaukphyu townships hospitals for Rakhine State, Dawei hospital for Tanintharyi Region, and Hpa-An 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 FY 2020 Q1 a total of 4 VMWs (100% female) received initial training on malaria diagnosis and case management. To provide quality malaria health care services to targeted communities, refresher trainings were also provided together with Integrated Community Malaria Volunteer (ICMV) trainings in which not only malaria but also other communicable diseases like tuberculosis, dengue, lymphatic filariasis, STD/HIV, and Leprosy were provided to 1,088 VMWs VMW monthly meeting conducted at Buthidaung and 99 PPs.

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VMWs/PPs’ supervision During this reporting period, Defeat Malaria conducted 819 supervision visits to VMWs and PPs. Supervision data was recorded on mobile tablets. The performance of VMWs/PPs, contribution of field supervisors and relevant information on the progress were closely monitored by scoring, which were applied by township supervisors for promoting effective supervision and better scheduling. Clinical audit on treatment of positive cases according to National Malaria Treatment Guidelines (NTG) A clinical audit was carried out by Defeat Malaria township teams on a monthly basis to assess the quality of malaria health care services provided by VMWs/PPs to targeted communities. The treatment provided for positive cases was verified to assess the percentage of cases treated according to National Treatment Guidelines (NTG). In this quarter, 673 out of 677 treated cases (99.4%) received correct antimalarial treatment according to NTG and 9 cases were referred to health facilities for further appropriate treatment. VMWs/PPs who did not treat patients according to NTG were prioritized for on-job training and coaching for malaria diagnosis and case management during VMWs/PPs meetings and supervision visits. Active case detection 47,166 In FY 2020 Q1, Defeat Malaria teams 50,000 1.40% 1.30% conducted active case detection (ACD) 1.20% 40,000 0.99% activities through special mobile mechanisms 1.00% 30,000 in 158 project villages and 118 non-project 0.80% villages in project townships. For project 20,000 0.60% 0.34% 9,096 0.40% villages, ACD was intended to promote 10,000 4,413 0.20% 4,133 0.20% 15 612 41 18 community awareness to utilize VMWs’ - 0.00% service at the time of fever and to understand Mobile VMWs PP Others local epidemiology. ACDs were conducted at Tested Positive TPR% areas without health facilities or volunteer services, of seasonal and dispersed small Figure 4: Malaria testing and positive cases by providers settlements, where malaria transmission is high or threat for malaria outbreak or persistently high in the form of residual malaria transmission. During this reporting period, 64,808 people were tested through approaches such as VMW community- based malaria diagnosis and treatment, Defeat Malaria staff mobile teams, and private sector engagement. 686 positive cases were identified (266 P. falciparum, 410 P. vivax and 10 mixed). The overall Test Positivity Rate (TPR) was 1.06% (see Table 4). More specifically, mobile teams tested 4,413 people in project and non-project villages, VMWs tested 47,166 people, private providers tested 4,133 people, and all other providers tested 9,096 people (see Figure 4). In non-project villages, no positive cases were found among 1,001 tested and in project villages, only 15 positive cases (8 P. falciparum, 7 P. vivax and 0 mixed) were found among 3,412 tested. Table 5: Malaria testing by Defeat Malaria covered state/region (Oct 2019 – Dec 2019) State / Region Tested Total Positive Pf Pv Mix TPR% Tanintharyi Region 13,404 238 19 217 2 1.78% S. Rakhine State 18,773 83 70 12 1 0.44% N. Rakhine State 22,809 283 167 109 7 1.24% Kayin 4,121 60 2 58 0 1.46% Sagaing 5,701 22 8 14 0 0.39% Total 64,808 686 266 410 10 1.06%

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Directly Observed Treatment (DOT) and patients’ compliance to DOT DOT is conducted according to Standard Operation Procedures approved by PMI to prevent the spread of artemisinin-resistant malaria, ensure full adherence to the antimalarial treatment achieving radical cure, and to prevent onward transmission in malaria elimination. Regarding DOT enrolment and completeness, 514 out of 686 (74.9%) individuals diagnosed with malaria were enrolled in DOT and 502 out of 514 (97.7%) patients enrolled in DOT fully adhered to their treatment. In this reporting period, 300 out of 410 P.v cases enrolled and 289 out of 300 P.v cases (96.3%) completed for 14 days DOT courses, 8 out of 10 mixed infected cases enrolled and 7 out of 8 cases (87.5%) completed for 14 days DOT course, and 206 out of 226 P.f cases enrolled and all cases completed 3 days DOT course. Quality Assurance of RDT and ACT RDT is the point of care diagnostic tool for malaria and the quality of RDT plays a vital role for achieving correct diagnosis and effective management of malaria. Qualityof RDT was regularly assessed by sending the samples to Department of Medical Research and eleven townships were selected based on convenient sampling. From each township, three RDT boxes (one from the township store and another two boxes from two different villages were selected). Total six RDT boxes from each state/region were tested. The samples were from Maungdaw, Mrauk-U, Minbya, Toungup, Ramree, Thandwe, Myeik, Kyunsu, Bokpyin, Myawaddy, Pale townships. ACTs were tested for quality assessment by the Department of Food and Drug Administration (FDA). The results of previous six samples (two strips from Kayin, Rakhine and Tanintharyi) sent during FY 2019 revealed 100 % reliability. For maintaining the quality of antimalaria drugs, electronic temperature logger will be procured for monitoring of the drugs storage at optimal temperature especially during the summer season. ❖ 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 Defeat Malaria discussed with State/Region Health Departments about updating malaria implementation partners, and it was suggested to conduct at the township level by conducting township malaria situation assessments after township and State/Region level launching of malaria elimination events. Defeat Malaria plans to support for this mapping activity under the guidance of the respective township health department. Reaching out to forested worksites through the recruitment of Mobile Malaria Workers (MMWs) MMWs were mobilized from migrant workers who worked in the remote forested worksites for provision of malaria prevention, diagnosis and case management services to them. Additional interventions were suggested by the assessments done in FY 2019 to cover remote worksites near persistently high residual malaria transmission areas and linked with repeated and potential malaria outbreak areas. By networking with nearby VMWs for reporting and replenishment of malaria commodities, 13 MMWs in Tanintharyi Region and 7 MMWs in Southern Rakhine State have been deployed. As a result, 8 out of 9 malaria cases were appropriately treated according to NTG by testing 444 forest goers in Tanintharyi Region and Rakhine State. One MMW received supportive supervision for correct prescription of treatment. ❖ Conduct operational research to pilot promising new tools and approaches to reduce malaria transmission as directed by NMCP, in consultation with the PMI/USAID Operational Research as an innovative tool for malaria diagnosis using highly sensitive RDT (hsRDT) URC is collaborating with our partner, Duke Global Health Institute (DGHI), in the implementation of an operational research study entitled “Evaluation of the performance of a hsRDT versus cRDT compared

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with PCR as the gold standard, in reactive case detection of malaria infections in Rakhine State.” An abstract was submitted tothe 48th Myanmar Health Research Congress and has been selected for an oral presentation. Defeat Malaria, NMCP and DGHI has organized and presented the results on 15th January 2020. In this quarter, the DGHI team met with URC to explore false positive results obtained by hsRDTcompared to the negative results obtained by PCR. The DGHI will evaluate to confirm the presence or absence of P. falciparum HRP2 in these samples, to enable us to better pinpoint why it occurred. The expected analysis will be accomplished in the next quarter. Operational research on reducing malaria incidence in villages resided by forest-goers An operational research study on malaria prevention for forest-goers, now entitled “Impact of mosquito topical repellents and extended standard interventions on malaria control and elimination in Myanmar,” will be rolled out in collaborationwith PMI, NMCP and Defeat Malaria partners in FY 2020 Q2. The protocol was submitted to Institutional Review Board of University of Public Health according to the guidance of the Ministry of Health and Sports (MoHS). The study will be conducted in Tanintharyi Region and Rakhine State. Ultimately, we hope that this study will influence programming for this vulnerable, high-risk population by targeting forest-goers with optimized control measures to ensure access to care, reduce malaria transmission, and promote inclusivity and equity. The recruitments of the research team, procurement of commodities of standard malaria prevention packages, and thedocuments for submission to IRB are ongoing. 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 Strengthening of surveillance system According to Global Technical Strategy (GTS) and National Plan for Malaria Elimination, overall strengthening of surveillance system has been improved by reviewing of previous and current system, modification and updating of surveillance database design and approach, preparation for capacity building to field implementation staffs, and identifying relevant indicators for monitoring and evaluation. Defeat Malaria surveillance system is designed to be in line with the three pillars of GTS as follow: • To meet the pillar 1 objective of ensuring universal access to malaria prevention, diagnosis and treatment, Defeat Malaria emphasizes LLIN monitoring, ABER checking for time and space coverage, clinical audit for meeting NTG, DOT enrollment and tracking for completeness of activities. • Regarding pillar 3 objective of transforming malaria surveillance into a core intervention by increasing the specificity of surveillance, case-base surveillance and foci-investigation and response activities have been undertaken in the pilot elimination townships. To increase the sensitivity of surveillance, the utility of hsRDT is still under review for detecting asymptomatic malaria, but all-inclusiveness of reports from general practitioners, private hospitals, defense medical service, and non-formal private providers has been supported to NMCP in the pilot elimination townships.

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• Regarding the pillar 2 objective of accelerating efforts towards elimination and attainment of malaria-free status, prevention of reintroduction of malaria by mobility monitoring, screening of migrant carriers and prevention of potential infected mosquitoes from endemic areas were undertaken. Weekly surveillance activity Starting from FY 2020 Q1, the weekly surveillance activity has been organized by the M&E Surveillance Officer through meeting with central technical support staff and partners for timely response activities to be undertaken at the respective areas. Unusually high occurrence of malaria areas, prevention of potential malaria outbreak areas, weekly vigilance and immediate response measures undertaken, and areas in need of additional measures were topics of discussion. It was communicated to respective township teams the need to ensure tracking of activities and situation updates. VMWs/PPs have been instructed for immediate notification and reporting of unusual malaria occurrences to township teams by phone. Township teams submit these unusual events to the M&E Surveillance Officer through mail by using standard reporting forms. Vigilance on increased occurrences of malaria cases During October to December 2019, 6 VMWs/PPs from no/low/very low areas notified the occurrence of malaria cases immediately to township teams. As a result, all 10 cases could be investigated in collaboration with NMCP and the cases were classified as imported (5 cases), relapsed (2 cases), introduced (1 case) and indigenous (2 cases). Defeat Malaria MNMA’s Thandwe team gained experienced on initial foci investigation activities conducted by the Rakhine State level VBDC team comprising entomologists. In this reporting period, unusually high occurrences of malaria cases were found at Mae Phyar worksite near Mae Taung Chay Yin village of Ann township and eight villages of Minbya township. As Mae Phyar is a high receptive area and located far from a health care center, a Mobile Malaria Worker was trained and recruited. As the occurrence of malaria reached 5 cases within a month, the MMW through a VMW notified the Defeat Malaria township team. Defeat Malaria township team leader informed to township health department, after which Defeat Malaria, in collaboration with VBDC staff, conducted a field investigation, LLIN monitoring and distribution visit, and active case finding activities. The MMW was encouraged to do weekly fever surveillance until no more cases appeared. Due to armed conflict and area insecurity, Mae Phyar worksite has moved to Mae Taung Chay Yin village. It was informed to the township health department about unusually high occurrence of malaria cases in Minbya. As there are restriction to field visits in most of the areas in Northern Rakhine State including Minbya township due to armed conflict, Defeat Malaria township team could not conduct epidemiological investigations. According to risk mitigation measures, adequate diagnostics and antimalarials were provided to relevant VMWs at VMWs monthly meeting. VMWs were encouraged to promote awareness to the community about malaria symptoms, early access to RDT testing, and prompt and adequate treatment for positive results. VMWs were also encouraged to do reactive case detection and health education sessions to risk groups whenever they found positive cases. Advocacy, Workshops, trainings and meetings Advocacy meetings, according to the Defeat Malaria workplan, were conducted with health departments at 17 townships. A total of 1,947 participants from authorities from public, private and community sectors attended and among them, 59.5% were female attendants. PMI Team Meeting on Malaria Operation Plan USAID/ PMI team visited the Defeat Malaria office in Yangon on October 24, 2019 and met with Defeat Malaria partners to discussed strategic activities to be prioritized for implementation in FY 2020. Defeat

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Malaria presented and discussed about FY 2019 achievements, the success of MNMA for zero malaria transmission in their implementing areas, EHO engagement activities, experiences of community engagement initiatives of ARC, capacity building strategy of Jhpiego, MHAA’s efforts in reaching hard-to- reach conflicted affected areas, and operational researchplan of topical repellent and extended standard interventions. Defeat Malaria Annual Review Meetings During the first quarter, annual review meetings of MNMA and ARC were accomplished. The annual review meeting of URC will occur in February 2020. Annual review meeting of MNMA was conducted in October 2019 at the University of Nursing, Yangon. During the review meeting, the success of MNMA achievements on stopping malaria transmission in the community-based intervention areas throughout FY 2019 was discussed. Some key recommendations were provided to strengthen the overall surveillance system including case investigation and response, to collaborate with NMCP for malaria elimination activities, to conduct LLIN monitoring through mobile tablets, to prevent the reintroduction of malaria through mobility monitoring at dynamic areas, enhance capacity building of VMWs and empower communities to sustain malaria services, and to utilize data effectively and efficiently. The annual review meeting of ARC was conducted in November 2019 at Bagan, Mandalay Region. The Senior Technical Director and M&E Technical Advisor were present for the meeting and discussion with ARC township staff about the achievements, challenges, overcoming measures undertaken during Year 3 and suggested improvement plans for next year. Participants were updated about the malaria elimination strategy, and its approaches and implementation plan in expanded malaria elimination townships in states and regions. Standard operation procedures related with administrative and financial procedures were reinforced to township staff. Defeat Malaria plan of activities to be implemented in Year 4 and strategic priorities were participatory discussed. Reporting status of VMWs/PPs The VMWs/PPs’ reporting status was continuously monitored to supervise their reporting performance, ensure the inclusions of all reporting units for effective surveillance, and to use as a proxy indicator for effectiveness of supply mechanism to ensure there were no stocks-out of RDT and ACTs for VMWs/PPs. During the reporting period, 6,258 (97.9%) out of total 6,389 reports expected to be submitted by VMWs/PPs were received and, of these 6,210 (99.2%) reports were received in a timely manner.

2500 101% 100% 100% 2000 100% 99% 100% 99% 100% 99% 1500 98% 98% 1000 97% 97% 97% 97% 500 96% 0 95% Tanintharyi S. Rakhine N. Rakhine Kayin Sagaing # of VMW/PP reports to be 1489 1529 2230 643 498 submitted # of VMW/PP reported 1442 1525 2168 641 482 # of VMW/PP reported timely 1417 1525 2148 641 479 % of reporting 96.80% 99.70% 97.20% 99.70% 96.80% % of timely reporting 98.30% 100% 99.10% 100% 99.40%

Figure 5: Reporting status of VMWs/PPs by State and Region

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Routine Data Quality Assessment (RDQA) In this quarter, RDQAs were conducted at 20 out of 36 townships. Regarding the overall RDQA status, 3 townships of Southern Rakhine State have excellent status and all other assessed townships have acceptable level. Newly recruited Data Routine Data Quality Assessment Status, Oct-Dec Quality Officer (DQA) for Sagaing 2019 Region (covering 5 townships), the 7 replacement DQA for NRS (covering 7 6 6 6 townships), M&E Officer of MHAA (covering 3 townships), and M&E 5 4 4 4 4 Assistant of MNMA were given 4 orientation training for data quality 3 3 assurance in December 2019 in Yangon. 2 2 They will conduct RDQAs in respective 2 No. Townships of 1 townships in next quarters. 1 0 0 0 0 0 0 0 0 0 0 The central M&E team encouraged the 0 field teams to conduct simplified Tanintharyi S. Rakhine N. Rakhine Kayin Sagaing Excellent Adequate Poor Not done RDQAs at township level if State/Region focal staffs (DQO or M&E) are not available to perform quarterly Figure 6: Routine Data Quality Assessment Status (Oct-Dec 2019) RDQAs. ❖ Support the implementation and regular updating of village-based malaria stratification Modified village-based stratification for strengthening surveillance On the move towards malaria elimination, NMCP has targeted 211 out of 330 townships for implementing malaria elimination activities. It has been discussed and suggested at VBDC annual review meeting for appropriate stratification of the areas for planning, implementation, monitoring and evaluation based on transmission intensity, presence or absence of transmission potentiality,and accessibility of the areas due to security conditions. To be in line with the Global Technical Strategy and the National Malaria Elimination Plan, Defeat Malaria planned to conduct strengthening of surveillance training to all field implementers and prepared for updating village-based stratification based on previous year dataset. According to the modified area classification strategy, it will be categorized as: 1. areas for implementing all three pillars of the Global Technical Strategy (GTS) to no, low and very low recent transmission of malaria (API >0 to 20/manageable caseload); 2. areas for implementing simplified surveillance (based on absolute number of caseload and area situations, and greater involvement of VMWs under supervision through the telecommunication of township team); 3. areas for burden reduction (implementing pillar 1 of GTS) to high malaria burden areas (API >20/high caseload); and 4. non accessible areas (armed attacks with unsafe for security and restricted areas). Three pilot elimination townships (Munaung, Ramree, Toungup) have been practicing township-wise case-based surveillance since 2018 and the areas are now being stratified as foci classification and updated annually. Capacity building of staff from newly expanded malaria elimination townships Defeat Malaria collaborate with National Malaria Control Program (NMCP) for piloting malaria elimination activities in Toungup, Ramree and Munaung townships of Southern Rakhine State since January 2018.

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Defeat Malaria is committed to supporting the NMCP on implementing malaria elimination activities in the additional 4 townships of Kayin State, 8 townships of Rakhine State and 2 townships of Taninthari Region in 2020. Cross visit to learn pilot malaria elimination activities was conducted by a group of 26 participants involving Defeat Malaria partners, National Malaria Control Program, and Karen Development of Health and Welfare (KDHW)-Ethnic Health Field Director explains the application of malaria case classification Organization. calculator at Thandwe.

❖ In persistent residual malaria transmission areas, to determine reasons for persistent transmission and implement appropriate intervention based on assessment findings especially in elimination townships and border townships. The entomological survey was conducted by an entomologist, local VBDC staff and Defeat Malaria township team during 26th October to 6th November 2019 at Yae Byat and Yae Pu villages of Thayetchaung township where high number of malaria cases were reported during 2018 and early 2019. Summary of the assessment methods, findings and recommendations are described in Annex 2. ❖ 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 A documentary report on malaria elimination in pilot threetownships in Southern Rakhine was developed and distributed at the USAID PMI booth of National Launching of Malaria Elimination Event in Naypyitaw. Quarterly performance report on pilot malaria elimination activities are described in Annex 3. Artemisinin resistance monitoring in Myanmar TherapeuticE fficacyS tudy (TES) monitoring in the sentinel site of Tamu township (Myanmar-India border) was visited jointly by WHO, PMI, URC and DMR at the Myanmar-India border in October 2019. Proper conduct of patient recruitment, drugs administration and follow up schedules were supervisedduring the visit. The Senior Technical Director of URC was activelyinvolved in the TES monitoring and the updates of the results were shared at the malaria meetings and workshops.

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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 In this reporting period,Jhpiego developed 13 Master Mentors from Defeat Malaria who received malaria technical skills, malaria elimination knowledge, CBI approach, and knowledge of other ICMV diseases for five-day training in November 2019. Among them 12 participants (except one MHAA staff) could be provided for three-day training on training skills in the same month.

WHO facilitator in collaboration with Defeat Malaria presented about the updates of activities at Township Defeat Malaria provided CBI approach to Coordination meeting in Bokpyin master mentors in Yangon eat Malaria presented about the updates of activities at Township Regarding General Trainers, five-day workshopsCoordination were meeting conducted @ Bokpyin at Myeik in October to develop 22 General Trainers and at Sittwe in December to develop 13 General Trainers. The participants were equipped with the concepts of community participation and ownership in controlling of malaria, about Defeat Malaria presented about the updates of activities at Township ICMV, quality diagnosing skills, prescriptionCoordination of drugs meeting and @management Bokpyin of illness, proper recording and reporting, storage of drugs and commodities at community level, and how to improve training skill for facilitation, demonstration and coaching. Defeat Malaria presented about the updates of activities at Township Cooperatively with NMCP, ICMV refresherCoordination trainings meeting were provided@ Bokpyin to 35 ICMVs (Myawaddy VBDC), 22 ICMVs (Defeat Malaria Myawaddy), 57 ICMVs (Rakhine VBDC), and 211 ICMVs (Defeat Malaria pilot elimination areas). During this reporting period, total 23 ICMV from Hlaingbwe, Kyarinseikgyi, Hpa-an, Toungup, Yebyu and Dawei were supervised and advised to improve their performance on service delivery and data management system. In Year 3, 57 Master Mentors (19 from NMCP and 38 from Defeat Malaria) were trained. Knowledge retention assessments were conducted to 19 out of 38 Defeat Malaria staff in the previous year. According to the discussion with NMCP, 19 Master Mentors of NMCP will be assessed by NMCP supervisors. Twelve Defeat Malaria staff werefound attrition afterthe training before assessment. The remaining 7 staff were planned to be assessed on their knowledge retention at a later date during Year 4. In this quarter, 2 out of 7 Master Mentors could be assessed and both of them were found to retain at least 80% of skill and knowledge of technical and training skills. ❖ Strengthening surveillance system by supporting NMCP on tools, equipment, telecommunication cost, capacity building and HR development Defeat malaria supported web-based surveillance training which was facilitated by central NMCP trainers. It was to be provided for VBDC staffs working in the townships and Kayin State. Defeat Malaria’s partner, ARC, coordinated with KDHW. As a result, two KDHW staffs participated in the training together with 24 NMCP staffs at Hpa-An. At a similar training conducted in Dawei, 24 VBDC staffs attended for web-based

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surveillance training. The same training also conducted at Sittwe for all 17 township VBDC staffs, 21 VBDC staffs, and 10 Defeat Malaria staff at Shwe Tha Zin meeting hall in October 2019. ❖ Exchange of informationamong malaria implementing partners VBDC Annual Review Meeting From 17th to 19th December 2019, VBDC Annual Review Meeting was conducted at Nay Pyi Taw. His Excellency Minister of MoHS, Director General, Program Manager (NMCP), WHO, UN agencies, INGO/LNGO and donors attended. Central and State/Regional VBDC teams presented their current malaria situations, and achievements and challenges they’ve faced throughout 2019. In addition, WHO, donors and other partners gave brief presentations about their situations and achievements. The Senior Technical Director, the M&E Director and the Field Director of Defeat Malaria were in attendance. Defeat Malaria achievements and challenges of pilot malaria elimination activities were presented and clarified was given to all comments and questions that arose. National launching of malaria elimination event On December 16th 2019, the national level malaria elimination launching ceremony was successfully conducted. Defeat Malaria was invited as a key partner of NMCP for malaria elimination initiative. Defeat Malaria displayed booths about pilot malaria elimination activities together with other PMI partners for a collective PMI support to Burma under the guidance of USAID and PMI. Dr. Nu Nu Khin (PMI) advocated to His Excellency Minister of MoHS and team about PMI support, and the Senior Technical Director advocated to Permanent Secretary of MoHS about Defeat Malaria’s technical strategy for malaria elimination activities (see Annex 4.A, 4.B and 4.C). ❖ Support NMCP for entomological training, entomological field assessments and other gaps at the different levels PMI/CDC/NMCP and Defeat Malaria partners including entomological staff visited Tanintharyi Region to monitor the initial phase of the mosquito topical repellent study in Tanintharyi township and to conduct entomological assessments. At Chaung La Mu, Aye Thar Yar, Baw Sa Nwin, and Swe Chaung villages of Tanintharyi township, the team met with village elders and household leaders, and discussed openly about the malaria situation, forest goers, availability and utilization of LLINs, and Larva collection by NMCP/PMI/CDC Larva collection by PMI/CDC/Defeat at Aye Thar Yar Malaria at Chaung La Mu village inspected the possible breeding sources of the village. The VMW and mid-wife were also met with to discuss the malaria occurrence in the recent years.

❖ Knowledge translation for decision making The 68th ASTMH conference was conducted from 20th November 2019 to 24th November 2019 at Gaylord National Resort and Convention Center in Maryland, USA. Defeat Malaria (URC and ARC) were actively involved in this meeting and presented about Defeat Malaria activities in Myanmar for knowledge translation for decision making. Four posters were presented and shared on the experiences of Defeat Malaria. The four poster topics were:

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1. Sensitivity analysis and investment of cases for projecting of costs for malaria elimination activities were discussed (see Annex 5); 2. Malaria Case Classification Calculator developed by URC Defeat Malaria for appropriate case classification and responses (see Annex 6); 3. Exploring and narrowing of social gaps are important in socio-behavior change communication among forest goers (see Annex 7); and 4. Factors associated with adherence to Primaquine 8-week regime among P. vivax cases and the importance of treatment completeness for controlling of relapsed cases on the move towards malaria elimination (see Annex 8). From this meeting, Defeat Malaria representatives learned about others and exchanged the experiences on mobile migrant population in the context of malaria elimination, innovative tool to kill the larva by Sirenix Larvae Defeat Malaria shared the experiences of malaria elimination activities at 68th ASTMH Trapper, the use of Tafenoquine drugs for treatment and chemoprophylaxis, and the efficacy of reserved Pyronaridine-Artesunate drug. The molecular diagnostic applicable in the low-level parasitemia in the detection of asymptomatic infections by using Loopamp systems could be known by visiting the exhibition booths. 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, CBOs and ethnic health organizations (EHO) Quarterly Senior Management Team (SMT) Meeting Quarterly SMT meeting was conducted on 23rd December 2019 at Defeat Malaria office in Yangon, and it was attended by 14 participants involving all Defeat Malaria partners. The SMT members, delegates and sectoral directors discussed the need to ensure the accomplishment of Defeat Malaria’s commitments, to make effective coordination and communication among Defeat Malaria partners, and to provide the best appropriate rational decision making by involving all partners.The following topics discussed were Defeat Malaria updates by COP, overview of previous meeting by the Senior Operation Director, strategic direction of Defeat Malaria by the M&E Technical Advisor, the key highlights of national launching event of malaria elimination at Naypyitaw and annual VBDC meeting by the Senior Technical Director, challenges and issues of ARC by the Project Manager of ARC, and the organization reforming updates of MHAA by the Interim Secretary of MHAA. Engagement with EHO Defeat Malaria ARC coordinates regularly with KDHW by sharing of activity updates and the progress which are usually taken place at KDHW Hpa-An office. Defeat Malaria implements malaria prevention and control activities in KDHW controlled areas i.e., 62 villages in Hpa-An township and 17 villages in Hlaingbwe township. As 4 townships of Kayin State where Defeat Malaria implements activities are also

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included in the national plan of undertaking malaria elimination activities, Defeat Malaria invited KDHW to join cross-visit to pilot malaria elimination townships. During the malaria elimination trainingand cross- visit, one KDHW representative (Malaria Information System Officer) attended the training conducted at Yangon and Thandwe during December 2019 and involved in the field visit to Toungup township. Sub-Grant Manager of URC provided 2-days malaria trainings to 63 backpack health workers (male-29, female-34) at Thit Bay Hta camp of EHO area and 78 backpack health workers (male-42, female-36) at Dae Bu Noh camp in Hparpun EHO area. Defeat Malaria supported 140 ICMV manual books, 1,500 RDT test kits, 500 ACT strips, 5,000 tablets of Chloroquine, and 18,000 Primaquine (7.5 mg) in November 2019.

MIS Officer of KDHW discussed about malaria Sub-Grant Manager provided malaria and Road to Dae Bu Noh camp elimination activities to be implemented at ICMV training at Dae Bu Noh camp EHO areas by adoption and adaptation Road to Dae Bu Noh camp Community Engagement Activities According to the township level implementation guide developed as a draft version in the previous year, Defeat Malaria continues to have preliminaryRoad mtoeetings Dae Bu Noh with camp community stakeholders for assessing the interest of community upon community support activities, existing community structures in the villages and the capacity of stakeholders. Road to Dae Bu Noh camp Depending upon the community needs and interest to initiate community-based support mechanisms (either establishment of community support group or village health committee), Defeat Malaria will continue the engagement with local communities by conducting participatory meetings. The intentions of the activities are to get involvement in the malaria control and elimination activities, empower the community for sustainability actions and operationalization of ICMV functions. During community participatory sessions, villagers participated in social mapping exercises, identifying health problems, mapping of village health resources, developed community support action plans and election of CSG management committees. The township project team will continue facilitation for further CSG development processes and incorporation of malaria services in the community support activities. Some of the communities have existing village development committees established by Community Driven Development Program jointly implemented by the Government Department of Rural Development and the World Bank. ❖ Strengthen BCC and community mobilization activities to promote the sustained useof 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 Defeat Malaria applies standard IEC materials for malaria prevention and control activities approved by the national program and health literacy unit of MoHS. Regarding socio-behavior change and communication assessment, a quantitative survey has already accomplished by interviewing with 446

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participants from 30 villages among 19 townships of Defeat Malaria implementation areas of Kayin, Southern Rakhine and Taninthary Region. Although training to internal survey team and data collection was started at Kayin since June 2019, the field data collection activities at Rakhine and Tanintharyi were postponed due to budget restriction and limitation. Data collection to all other areas could be accomplished in September 2019. Data collectionwa s done through mobile tablets using ODK application, and data cleaning and summarization was completed in November 2019. Based on the quantitative results, a segmental analysis will be continued by conducting a qualitative approach. In next quarter, the qualitative data collection will proceed. The findings and results are intended to provide recommendations to national program and partners about the appropriate socio-behavioral change communication approach and strategy. It is planned to present and discussed the results at annual meeting of American Society of Tropical Medicine and Hygiene 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 Promote engagement of private companies and state-owned enterprises in malaria control and elimination activities through Corporate Social Responsibility (CSR) initiatives Engagement with general practitioners (GP) and non-formal private providers (NFPP) The role and involvement of General Practitioners, drug stores and NFPP are important in the malaria elimination setting. Defeat Malaria conducted a semi-annual coordination meeting with NFPP on 6th November 2019 at Toungup township and 16 NFPPs were attended. Eight NFPPs shared their experiences and it was discussed about the importance of all-inclusiveness. From 3 pilot malaria elimination townships, 15 General Practitioners tested 125 suspected for malaria cases and treated 1 Coordination meeting with NFPP at Toungup positive casesP ( .f) in this reporting period. Defeat Malaria also engaged with 30 drug stores for appropriate referral to nearest health services. Regarding NFPPs, 4 out of 16 NFPPs referred 7 suspected for malaria cases to nearest health facilities and VMWs for malaria diagnosis and management. Mapping of non-formal private providers was initiated in some newly extended malaria elimination townships and 54 NFPPs (47 males and 7 females) were listed from Launglon, Myeik and Myebon townships. Engagement with private companies Private sector engagement includes mapping of private companies working in the malaria risk areas, advocacy meetings with owners, managers and supervisors, and identification of malaria service gaps among employees. One of the schemes is to select and train for the recruitment of volunteers from respective companies. Defeat Malaria supported malaria diagnostics and commodities to the companies to perform malaria prevention,and case findings andmanagement services for all mobile migrant workers deployed in the worksites. Mobile visits were conducted for some of the worksites. In this reporting period, Defeat Malaria engaged with 56 companies in 11 townships of Tanintharyi, Rakhine and Kayin. Some of the companies were leaving upon the completion of their works and others were new companies are now working in the areas where Defeat Malaria activities are undertaken. Currently, 101 VMWs/PPs from 56 private companies are well functioning and have tested 2,969 people who were suspected for malaria (1,709 males and 1,260 females), as well as treated 6 malaria cases (all male cases with P.v positive). Regarding malaria prevention, 467 LLINs were distributed and 52 health awareness sessions were conducted.

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Annex 1: Situation of Rakhine State

Seven out of ten townships in the Northern Rakhine State are under restriction of movements to the villages since April 2019 and have not been released until December 2019. High malaria transmission areas like Maruk-U, Buthidaung, Kyauktaw, and Minbya were found to have higher number of IDPs according to recent displacement figures reported by UNOCHA as of December 2019. The armed conflict between government military and the Arakan Army (AA) continued until December 2019. The various forms of attacks were prevailing in many areas of Northern Rakhine State and some part of Southern Rakhine State. The attacks included land mines, ambushes, and raids into police outposts. Security staff and some government staff were arrested. The damages have affected to villages, state-owned buildings and historical sites. Source: OCHA Myanmar created on 5th Dec 2019

(www.unocha.org/myanmar)

DueSource: to intense OCHA fightings, Myanmar the created NGO onstaff 5th from Dec Kyauktaw 2019 township were evacuated to Sittwe township. In the(www.unocha.org/myanmar) Seik Ta Ra village of Minbya township, the village administrator, a sister of a village malaria worker (VMW), and two other villagers died during the armed conflicts in December 2019. The villagers from these villages had left their homes. Launcher attacks and gun fires were heard almost everyday. Military forces frequently watched the villages and investigated people on the move. There were also several attacks near Lay Thwin and Sa Nyin villages of Myebon township were villlagers were hurt. The VMW of that village had to leave along with other villagers. There were repeated launching attacks from downtown military compounds in Mrauk-u Township to mountainous areas everday during the day and at night. Armed activities were more intensive near Eain Shay Village on the Eastern bank of Laymyo River and Paunk Taw Pyin village. As of December 2019, 78 villages of Defeat Malaria implementation areas have been affected and some are displaced at the moment. Risk analysis and mitigation exercises for each township were conducted by reviewing level of likelihood, consequences and existing risk treatment actions in place. Additional risk treatment actions to mitigate risks were continuously explored. Community based malaria intervention for malaria case finding and management activities through village malaria workers could be maintained. Although field visits of township staff were restricted, adequate supply of malaria commodities could be provided at village malaria workers’ monthly meetings. High reporting proficiency could be maintained as long as the VMWs reach out to attend monthly meeting. Some Bengali VMWs could not come to attend monthly meetings and thus on-site report collection were supported.

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Annex 2: Entomological Assessments An entomological survey was conducted by entomologist consultant, local VBDC staff and Defeat Malaria township team during 26th October to 6th November 2019 at Yae Byat and Yae Pu villages of Thayetchaung township where high number of malaria cases were reported during 2018 and early 2019. These two assessments were performed for fulfilling the previous year target which was pending due to budget constraint. Yae Byat village is located in a dense, forested and hilly area with streams and small creeks which run across the village and has relatively high humidity. It favors vector survival throughout the year. The temperature was around 24 ͦ to 35◦ ͦC and relative humidity was around 65% to 80% during survey. Most of the villagers are forest workers and working at mountainous farms, betel nut plantation,and searching of the bamboo shoots and forest products. The VMW recorded a total of 547 fever episodes (clinically suspected malaria) from October 2018 – September 2019. The annual malaria parasite incidence of Yae Byat village was around 16 per 1,000 population and mainly caused by P. vivax. The cases were distributed at 9 months of the year and it could be assumed as year-round transmission. As the survey was conducted at post monsoon season, most of the breeding grounds were dry in the village. But the Anopheline larvae were collected along the banks of streams. Indoor and outdoor human landing methods were applied by 16 person- night from October to November 2019 to know the biting behavior of mosquitoes and biting rate was 1.4 pp/night. All facts indicate that it is a highly endemic area. Yae Pu village is thinly forested at the forest fringe area. The village is clean and there is not much covering of big trees and bushes. Some villagers work mainly at nearby farms and betel nut plantations. The temperature was around 24 ͦ to 35◦ ͦC and relative humidity was around 65% to 80% during survey. The weather was cold at night, and most of the breeding grounds were dry. The VMW of the village recorded a total of 525 fever episodes during FY 2019. Annual malaria parasite incidence is 0.095 per 1,000 population and mainly affectedby P. vivax. The cases were detected only during two months in 2019. No specimen was collected by both indoor and outdoor human landing catches. which were made by 16 person- nights from October to November 2019 (biting rate - 0). The biting cycle on cattle showed that An. dirus and An. minimus bite in first to second quarter of the night and An. maculatus was throughout the night. All facts indicate that the village is a low endemic area. Location Method Findings 1. Human landing outdoor Only one An. dirus was collected. Density per man hour of An.

dirus was 0.013 2. Human landing indoor (3) Anopheles species were collected, including the primary vectors (An. dirus, An. minimus) and secondary vector, An. maculatus. Density per man hour of An. dirus and An. minimus were (0.04) and (0.09) and that of An. maculatus was (1.6). 3. Light trap indoor and No Anopheles mosquito was collected by CDC Light trap in

outdoor both indoor and outdoor collection. village, Thayetchaung Thayetchaung village,

4. Animal baited net traps(1) (9) different Anopheles mosquito species were collected, (Cattle-bait) including the primary and secondary vectors An. dirus (4.7%), An. minimus (2.3%), An. maculatus (84%), and An. annularis

Township, Tanintharyi Region. Tanintharyi Township, Yae Byat Yae (0.3%) respectively. The dominant and highest species was An. maculatus.

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5. Larval collection (Source: Late 3rd Insta & 4th Instar larvae were identified. Along the bank of Yae Only Culex larvae were collected from wells. Byat, Tan Kyo, Yae Phan At Yae Byat -> (3) An. maculatus and (2) An. barbirostris streams, in turbid water) At Tan Kyo -> (10) An. maculatus and (5) An. barbirostris At Yae Phan -> (3) An. maculatus and (2) An. barbirostris 1. Human landing outdoor. No anopheles mosquito was collected 2. Human landing indoor No anopheles mosquito was collected. 3. Light trap indoor and(2) Only one An. annularis was collected by CDC light trap. outdoor 4. Animal baited net traps(3) (9) different Anopheles mosquito species were collected

hip, Tanintharyi Tanintharyi hip, (Cattle-bait) including the primary vectors (An. dirus, An. minimus) and secondary vectors (An. maculatus, An. annularis). The relative

percent of total caught were An. dirus (1.8%), An. minimus (0.4%) and An. maculatus (22%), An. annularis (12.5%) and An.

barbirostris (43.3%) respectively. Region 5. Larval collection (Source: An. babirostris larvae were collected from Yae Pu and Nga Yant Wells and along the bank of Ni stream. Only An. maculatus larvae were collected from Yae Yae Pu, Nga Yant Ni and Yar Pu stream and no anopheles larvae from wells. Ba Thaung streams and At Yae Pu stream → (3) An. maculatus & (2) An. barbirostris

seepage stream with At Nga Yant Ni stream→ (1) An. barbirostris & (5) An. village, Thayetchaung Towns Thayetchaung village, vegetation, clear, shallow,

Pu barbirostris at two different sites sunlit but partly shaded)

At Yar Ba Thaung stream→ (3) An. barbirostris & (2) An. Yae Yae barbirostris at two different sites Recommendations based on assessments: • Regarding Yae Byat village, regular top -up and correct utilization of LLIN should be promoted to reduce man-vector contact as the village has year-round transmission. Early diagnosis and prompt treatment by VMWs should be encouraged for space and time coverage. The use of repellents during forest works at night and active case detection at pre and post monsoon season are suggested as additional measures. • For Yae Pu village, regular topping-up and promotion of LLINs utilization, strengthening of early case detection and treatment will help to maintain low malaria transmission. Possibility of outbreak conditions should be tracked by the local VMW and township team. Further epidemiological profiling should be conducted.

Type of housing at Yae Byat of Types of housing at Yae Pu village of Thayetchaung township, Thayetchaung Tanintharyi region

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Annex 3: Quarterly Report on Pilot Malaria Elimination Activities Toungup| Ramree| Munaung Malaria Elimination Coordination Committee (MECC) Quarterly Meetings MECC quarterly meeting was conducted on October 25th, 2019 at Township Administrative Office of Ramree Township. It was attended by 23 participants (12 MECC members and other 11 participants from RHC and Defeat Malaria). Meeting was chaired by Township Administrative Officer and Township Medical Officer vedser as Secretariat. Defeat Malaria presented updated malaria elimination activities, achievements, challenges and plan for the upcoming quarter. It was discussed about finding and inclusion of new uncovered village by recruitment of VMW, interdepartmental coordination between Township Health Department and other related departments (General Administrative, Fishery, Forestry, Traditional Medicine, Police) for mobility monitoring. Police Department is coordinated for regular screening of staff upon the arrival from malaria endemic areas. The representative of General Practitioners presented quarterly progress report of private healthcare providers. It was also conducted on October 30th, 2019 at Township Administrative Office of Munaung Township. It was attended by 29 participants (11 MECC members and other 18 participants from RHCs and Defeat Malaria). It was discussed that Munaung Township was free from no locally contracted malaria case for nearly two years, and so it would need to emphasize on the quality of surveillance activities and the mobility monitoring to reduce the importation risks of malaria parasite to Munaung island. Semiannual coordination meeting with Non formal Private Provider (NFPP) Semi-annual coordination meeting with NFPP was conducted on November 6th, 2019 in Toungup Township. PPM Coordinator joined the meeting and 16 out of 18 invited NFPPs attended the meeting. NFPPs are intended to be involved in malaria elimination activities by referring suspected malaria cases to nearest BHS/VMWs in a timely manner and submission of monthly referral list for activity tracking. It was suggested to conduct regular quarterly coordination meetings onwards. Monthly township level collaborative meetings between VBDC and Defeat Malaria Monthly township level collaborative meetings between VBDC and Defeat Malaria were conducted for the following objectives: 1. To tackle operational challenges and provide appropriate solutions 2. To monitor the reporting performance of all reporting units for appropriate responses (especially notice letter for non-reported villages) 3. To promote data quality of reports by joint verifications between VBDC and Defeat Malaria 4. To schedule and plan the visits to mobile migrants’ worksites ICMV trainings to Defeat Malaria VMWs in malaria elimination areas Defeat Malaria VMWs/PPs from pilot malaria elimination townships were trained in harmonization with NMCP guidelines. A total of 5 days of ICMV trainings were conducted at Toungup and Ramree townships but not to Muanung as only BHS are available without VMWs for routine surveillance activities. Table A: Summary of ICMV trainings

Sr Township Date Participants of ICMV training Male Female Total

1 Toungup 04-08/Nov/2019 Defeat Malaria VMWs 43 38 81

2 Ramree 25-29/Nov/2019 Defeat Malaria VMWs 48 25 73

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Reduction of mportationi risks of malaria parasites Vulnerability monitoring plays an important role in low malaria transmission settings with the objective of prevention of reintroduction of malaria. To meet the objective, township VBDC and Defeat Malaria conducted proactive cases detection and preventive interventions among seasonal mobile migrant worksites in collaboration with related departments. During this quarter, 6 brick production worksites in Toungup, 4 fishing and construction worksites in Ramree, and 2 migrant fishing worksites in Munaung could be explored. Receptivity, vulnerability, quality of health care and behaviors of the migrant workers were analyzed for taking appropriate actions. Seasonal worksites usually start from October to November and April to May. Table B: Summary of proactive case detection activities inthe pilot malaria elimination townships Sr Township Name of worksite Date Population Tested Positive # of LLINs distributed 1 AAA Brick Kiln 26-Nov-19 31 27 0 10 2 OK Brick Kiln 27-Nov-19 45 26 0 14 3 Toungup 555 Brick Kiln 03-Dec-19 30 17 0 0 4 MT Brick Kiln 03-Dec-19 26 13 0 0 5 TK Brick Kiln 03-Dec-19 22 22 0 0 6 TW Brick Kiln 03-Dec-19 27 22 0 0 7 San Tin Maw Peik Seik 03-Nov-19 810 228 0 153 8 Hlaing Khaung 15-Nov-19 12 10 0 11 9 Ramree Shwe Pyi Taw Peik Seik 18-Nov-19 411 159 0 150 10 Yan Thit Gyi Ah Wa 03-Dec-19 13 13 0 5 11 Munaung Ye Kyun Peik Seik 20-Dec-19 146 146 0 0 12 Ka Ei Peik Seik 27-Dec-19 80 80 0 0 Table C: Summary of Surveillance Report (Oct-Dec 2019)

surveillance report – Case detection, notification, investigation, and classification in 3Townships (Oct19 - Dec19) Pf

Township Pv

cases

Mixed

Tested

Positive

Number of Number

Relapsecase case Induced

Imported case Imported

Introduced case Introduced Indigenouscase

Indigenouscase)

investigatedCases

Number of notifiedof Number Recrudescencecase Cryptic case (Isolatedcase Cryptic Toungup 5,544 28 25 3 - 28 27 24 0 3 0 0 0 0

Ramree 4,258 4 0 4 0 4 4 0 2 2 0 0 0 0

Munaung 2,407 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 12,209 32 25 7 0 32 31 24 2 5 0 0 0 0

In Toungup, 28 positive cases were detected in this quarter and only 27 cases were reviewed by case investigation. One patient from Pe Yar Thu village, Ann township was lost to follow-up due to mobility. Among 24 imported cases, 22 cases were contracted within the township and 2 cases got infections from outside Toungup (source of infection: forested areas of Ann Township). Four positive cases that were identified during December 2019 in Toungup were not included due to late reporting from respective

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providers. Currently, it is ongoing for late report tracking and foci-classification of the areas will be updated after complete tracking of all reports in next quarter. Table D: Provider based surveillance report (Oct – Dec 2019) Provider Based Surveillance Report (Oct19 - Dec19) Toungup Ramree Munaung Total Tested Positive Tested Positive Tested Positive Tested Positive

Basic Health Staff 2166 6 1447 0 2094 0 5,707 6

Hospital 134 12 24 0 27 0 185 12

General Practitioner 108 1 7 0 20 0 135 1

Private Provider (Informal) 460 2 41 0 0 0 501 2

Village Malaria Worker 1978 6 2007 2 0 0 3,985 8

Defense Medical Services 10 0 0 0 14 0 24 0

Mobile (Response Team) 688 1 732 2 252 0 1,672 3 Total 5544 28 4258 4 2407 0 12,209 32

*Remark: No Defense Medical Services in Ramree Township Table E: Reporting status of Surveillance Units in 3 Townships (Oct-Dec2019) Townships # of reporting # of units reported (excluding # of units left for report units zero tested units) or with zero tested Toungup 240 230 10 Ramree 228 216 12 Munaung 139 138 1 Total 607 584 23

*Remark: Reporting units submitting zero tested are counted as not reported. There is ongoing late report tracking. Table F: Performance indicators Basel FY2020 Indicators (Pilot Elimination Townships) Frequency ine Achievement Target IP 3: Percent of indigenous cases among cases investigated Quarterly 9% 16% 60%

5 Number of cases classified as indigenous Number of cases investigated 31 OC 2.3 % of positive cases notified within 24 hours Quarterly N/A 88 % 80%

Number of positive cases notified within 24 hours 28

Number of positive cases notified 32 OC 2.4 Foci investigation rate Quarterly N/A N/A 70% Number of foci investigated 10 Number of cases investigated 31 OC 2.5 Active focus response rate Quarterly N/A 100% 80% Number of confirmed active foci investigated in which an 4 appropriate response was initiated within 7 days Number of confirmed active foci 4

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Activities Photos on pilot malaria eliminationactivities

NFPP coordination meeting at Toungup MECC quarterly meeting at Ramree

NFPP coordination meeting @ Toungup MECC quarterly meeting @ Ramree

MECC quarterly meeting at Munaung Health awareness session provided by Malaria Inspector at TK brick kiln worksite of Toungup

MECC quarterly meeting @ Munaung Health awareness session provided by Malaria Inspector @ TK brick kiln worksite of Toungup

Health awareness session conducted at San Tin Maw Peik Proactive case detection conducted at Ye Kyin Peik Seik, Seik, Ramree Munaung

Health awareness session conducted @ San Tin Maw Peik Seik, Proactive case detection conducted @ Ye Kyin Peik Seik, Ramree Munaung

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Annexes 4.A PMI-USAID advocate to HE Minister of MoHS about PMI supports for malaria elimination

Annexes 4.B Defeat Malaria advocated to Permanent Secretary of MoHS about pilot malaria elimination activities

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Annexes 4.C USAID/PMI Booth displayed at National Level Malaria Elimination Launching

Dr. Nu Nu Khin (PMI) advocate to HE Minister of MoHS about PMI supports for malaria elimination

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Annex 5: Knowledge Translation about Cost Analysis and Projection

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Annex 6: Malaria Case Classification Calculator

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Annex 7: Socio-behavior change communication

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Annex 8: Factors associated with adherence to primaquine 8-week regimen among P. vivaxi cases

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Annexes 9: Community engagement activities (Oct 2019 – Dec 2019) SN Community Engagement Activities Achievement 1 Number of villages where community has been engaged for 15 community support group development (quarterly) 2 Number of community participatory sessions conducted (quarterly) 16

3 Number of people involved in the community engagement 548 meetings and participatory sessions 4 Number of community support groups established (cumulative) 9

Community participatory sessions at Htee Par Do Khee, Hpa-An

Preliminarily assessment meetings at Ta Community participatory sessions at Wel Ba Ya village, Toungup Pyan Chaung Wa, Hpa-An Preliminarily assessment meetings at Ta Ba Ya village, Toungup

On-job training to VMW at Shwe Taung Tan Palm Health awareness session conducted at “N” zone Oil Plantation Company worksite of Yuzana company

Health awareness session conducted at “N” zone worksite of Yuzana company

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Annex 10: Case Finding and Management of all Townships by Different Approaches (Oct -Dec 2019) No Township Tested Total Positive Pf Pv Mixed TPR% 1 Bokpyin (ARC) 1,048 4 - 4 - 0.38% 2 Dawei (URC) 1,081 56 2 53 1 5.18% 3 Kawthoung (ARC) 1,813 2 1 1 - 0.11% 4 Kyunsu (URC) 2,435 46 - 46 - 1.89% 5 Launglon (URC) 993 - - - - 0.00% 6 Myeik (URC) 815 1 - 1 - 0.12% 7 Palaw (URC) 1,671 71 7 63 1 4.25% 8 Tanintharyi (ARC) 1,136 25 9 16 - 2.20% 9 Thayetchaung (URC) 868 24 - 24 - 2.76% 10 Yebyu (URC) 1,544 9 - 9 - 0.58% Tanintharyi Total 13,404 238 19 217 2 1.78% 11 Ann (URC) 2,760 52 46 5 1 1.88% 12 Gwa (MNMA) 884 1 - 1 - 0.11% 13 Kyuakpyu (URC) 709 - - - - 0.00% 14 Munaung (URC) 2,633 - - - - 0.00% 15 Ramree (URC) 4,520 4 - 4 - 0.09% 16 Thandwe (MNMA) 1,500 2 2 - - 0.13% 17 Toungup (URC) 5,767 24 22 2 - 0.42% Southern Rakhine Total 18,773 83 70 12 1 0.44% 18 Buthidaung (MHAA) 6,376 48 15 27 6 0.75% 19 Kyauktaw (URC) 4,230 58 33 24 1 1.37% 20 Maungdaw (MHAA) 833 - - - - 0.00% 21 Minbya (URC) 1,488 140 104 36 - 9.41% 22 Mrauk-U (URC) 2,051 15 10 5 - 23 Myebon (URC) 1,372 1 1 - - 0.07% 24 Pauktaw (URC) 1,149 1 - 1 - 0.09% 25 Ponnagyun (URC) 2,637 16 4 12 - 0.61% 26 Rathedaung (MHAA) 1,096 2 - 2 - 0.18% 27 Sittwe (URC) 1,577 2 - 2 - 0.13% Northern Rakhine Total 22,809 283 167 109 7 1.24% 28 Hlaingbwe (ARC) 1,077 7 1 6 - 0.65% 29 Hpa-an (ARC) 1,203 7 - 7 - 0.58% 30 Kawkareik (ARC) 885 4 1 3 - 0.45% 31 Myawaddy (ARC) 956 42 - 42 - 4.39% Kayin Total 4,121 60 2 58 - 1.46% 32 Banmauk (URC) 1,014 2 - 2 - 0.20% 33 Homalin (URC) 1,219 1 1 - - 0.08% 34 Indaw (URC) 1,422 13 3 10 - 0.91% 35 Pale (URC) 661 1 - 1 - 0.15% 36 Pinlebu (URC) 1,385 5 4 1 - 0.36% Sagaing Total 5,701 22 8 14 - 0.39% Defeat Malaria Grand Total 64,808 686 266 410 10 1.06%

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Annex 11: Active case detection by mobile team (Oct-Dec 2019) No Township Tested Total Positive Pf Pv Mixed TPR% 1 Bokpyin 5 - - - - 0.00% 2 Dawei 111 - - - - 0.00% 3 Kawthoung 64 - - - - 0.00% 4 Kyunsu 553 2 - 2 - 0.36% 5 Launglon 54 - - - - 0.00% 6 Myeik 142 - - - - 0.00% 7 Palaw 354 1 - 1 - 0.28% 8 Tanintharyi 86 - - - - 0.00% 9 Thayetchaung 15 - - - - 0.00% 10 Yebyu ------Tanintharyi Total 1,384 3 0 3 0 0.22% 11 Ann 253 6 6 - - 2.37% 12 Gwa 106 - - - - 0.00% 13 Kyaukpyu ------14 Munaung ------15 Ramree 732 2 - 2 - 0.27% 16 Thandwe 207 - - - - - 17 Toungup 539 1 1 - - 0.19% Rakhine (South) Total 1,837 9 7 2 0 0.49% 18 Buthidaung ------19 Kyauktaw 229 - - - - 0.00% 20 Maungdaw ------21 Minbya ------22 Mrauk-U ------23 Myebon ------24 Pauktaw 22 - - - - 0.00% 25 Ponnagyun 181 - - - - 0.00% 26 Rathedaung ------27 Sittwe 122 - - - - 0.00% Rakhine (North) Total 554 0 0 0 0 0.00% 28 Hlaingbwe 26 - - - - 0.00% 29 Hpa-an ------30 Kawkareik 150 - - - - 0.00% 31 Myawaddy 231 2 - 2 - 0.87% Kayin Total 407 2 0 2 0 0.49% 32 Banmauk ------33 Homalin ------34 Indaw 174 1 1 - - 0.57% 35 Pale ------36 Pinlebu 57 - - - - 0 Sagaing Total 231 1 1 0 0 0.43% Grand Total 4,413 15 8 7 0 0.34%

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Annex 12: VMWs/PPs Meetings (Oct-Dec 2019) VMW / PP Posts % of VMWs/PPs Sr Township have to attend Male Female Total attended the No. the meeting meeting 1 Bokpyin 173 28 137 165 95.4% 2 Dawei 63 14 44 58 92.1% 3 Kawthoung 175 95 62 157 89.7% 4 Kyunsu 189 47 137 184 97.4% 5 Launglon 99 11 77 88 88.9% 6 Myeik 94 9 82 91 96.8% 7 Palaw 157 37 104 141 89.8% 8 Tanintharyi 171 40 122 162 94.7% 9 Thayetchaung 90 15 73 88 97.8% 10 Yebyu 199 44 140 184 92.5% Tanintharyi Total 1,410 340 978 1318 93.5% 11 Ann 333 210 87 297 89.2% 12 Gwa 195 81 114 195 100.0% 13 Kyaukpyu 150 107 38 145 96.7% 14 Munaung - - - - - 15 Ramree 231 143 70 213 92.2% 16 Thandwe 351 117 234 351 100.0% 17 Toungup 269 131 122 253 94.1% Southern Rakhine Total 1,529 789 665 1454 95.1% 18 Buthidaung 424 392 27 419 98.8% 19 Kyauktaw 303 137 165 302 99.7% 20 Maungdaw 65 56 1 57 87.7% 21 Minbya 216 114 98 212 98.1% 22 Mrauk-U 231 165 66 231 100.0% 23 Myebon 237 102 109 211 89.0% 24 Pauktaw 126 72 54 126 100.0% 25 Ponnagyun 219 111 108 219 100.0% 26 Rathedaung 195 73 94 167 85.6% 27 Sittwe 123 30 93 123 100.0% Northern Rakhine Total 2,139 1252 815 2067 96.6% 28 Hlaingbwe 156 27 129 156 100.0% 29 Hpa-an 258 58 191 249 96.5% 31 Kawkareik 147 63 83 146 99.3% 33 Myawaddy 70 20 50 70 100.0% Kayin Total 631 168 453 621 98.4% 34 Banmauk 90 16 72 88 97.8% 35 Homalin 81 44 31 75 92.6% 36 Indaw 101 17 80 97 96.0% 37 Pale 93 27 55 82 88.2% 38 Pinlebu 133 53 64 117 88.0% Sagaing Total 498 157 302 459 92.2% Grand Total 6,207 2706 3213 5919 95.4%

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Annex 13: Supervision and Monitoring (Oct-Dec 2019) # of visits to # of visits to Total # of supervision visits to Sr No. Township VMWs PPs VMWs and PPs 1 Bokpyin 32 1 33 2 Dawei 27 1 28 3 Kawthoung 36 6 42 4 Kyunsu 36 7 43 5 Launglon 22 0 22 6 Myeik 12 5 17 7 Palaw 25 3 28 8 Tanintharyi 33 0 33 9 Thayetchaung 21 5 26 10 Yebyu 33 0 33 Tanintharyi Total 277 28 305 11 Ann 34 12 46 12 Gwa 33 0 33 13 Kyaukpyu 38 3 41 14 Munaung 0 0 0 15 Ramree 31 0 31 16 Thandwe 60 0 60 17 Toungup 26 6 32 Southern Rakhine Total 222 21 243 18 Buthidaung 0 0 0 19 Kyauktaw 7 0 7 20 Maungdaw 0 0 0 21 Minbya 4 0 4 22 Mrauk-U 5 0 5 23 Myebon 14 2 16 24 Pauktaw 12 3 15 25 Ponnagyun 3 0 3 26 Rathedaung 0 0 0 27 Sittwe 19 0 19 Northern Rakhine Total 64 5 69 28 Hlaingbwe 36 0 36 29 Hpa-an 57 1 58 30 Kawkareik 25 0 25 31 Myawaddy 17 0 17 Kayin Total 135 1 136 32 Banmauk 14 0 14 33 Homalin 14 0 14 34 Indaw 17 0 17 35 Pale 0 0 0 36 Pinlebu 21 0 21 Sagaing Total 66 0 66 Grand Total 764 55 819

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Annex 14: Reporting Status of VMWs and PPs (Oct-Dec 2019) Cumulative # # of # of VMW/PP of VMW/PP VMW/PP % of % of timely No State/Region Township reported (On reports to be reported reporting reporting time + Late) submitted timely 1 Tanintharyi Bokpyin 180 175 171 97.2% 97.7% 2 Tanintharyi Dawei 96 96 94 100.0% 97.9% 3 Tanintharyi Kawthoung 189 180 180 95.2% 100.0% 4 Tanintharyi Kyunsu 189 189 188 100.0% 99.5% 5 Tanintharyi Launglon 99 99 95 100.0% 96.0% 6 Tanintharyi Myeik 96 94 94 97.9% 100.0% 7 Tanintharyi Palaw 160 153 153 95.6% 100.0% 8 Tanintharyi Tanintharyi 183 169 164 92.3% 97.0% 9 Tanintharyi Thayetchaung 90 90 88 100.0% 97.8% 10 Tanintharyi Yebyu 207 197 190 95.2% 96.4% Tanintharyi Total 1,489 1,442 1,417 96.8% 98.3% 11 Rakhine (South) Ann 333 333 333 100.0% 100.0% 12 Rakhine (South) Gwa 195 195 195 100.0% 100.0% 13 Rakhine (South) Kyaukpyu 150 150 150 100.0% 100.0% 14 Rakhine (South) Munaung - - - - - 15 Rakhine (South) Ramree 231 231 231 100.0% 100.0% 16 Rakhine (South) Thandwe 351 351 351 100.0% 100.0% 17 Rakhine (South) Toungup 269 265 265 98.5% 100.0% Southern Rakhine Total 1,529 1,525 1,525 99.7% 100.0% 18 Rakhine (North) Buthidaung 428 419 419 97.9% 100.0% 19 Rakhine (North) Kyauktaw 372 372 371 100.0% 99.7% 20 Rakhine (North) Maungdaw 65 61 57 93.8% 93.4% 21 Rakhine (North) Minbya 222 215 214 96.8% 99.5% 22 Rakhine (North) Mrauk-U 234 231 231 98.7% 100.0% 23 Rakhine (North) Myebon 237 217 212 91.6% 97.7% 24 Rakhine (North) Pauktaw 126 126 126 100.0% 100.0% 25 Rakhine (North) Ponnagyun 228 228 228 100.0% 100.0% 26 Rakhine (North) Rathedaung 195 176 167 90.3% 94.9% 27 Rakhine (North) Sittwe 123 123 123 100.0% 100.0% Northern Rakhine Total 2,230 2,168 2,148 97.2% 99.1% 28 Kayin Hlaingbwe 156 156 156 100.0% 100.0% 29 Kayin Hpa-an 270 268 268 99.3% 100.0% 30 Kayin Kawkareik 147 147 147 100.0% 100.0% 31 Kayin Myawaddy 70 70 70 100.0% 100.0% Kayin Total 643 641 641 99.7% 100.0% 32 Sagaing Banmauk 90 89 89 98.9% 100.0% 33 Sagaing Homalin 81 74 74 91.4% 100.0% 34 Sagaing Indaw 101 97 97 96.0% 100.0% 35 Sagaing Pale 93 89 89 95.7% 100.0% 36 Sagaing Pinlebu 133 133 130 100.0% 97.7% Sagaing Total 498 482 479 96.8% 99.4% Grand Total 6,389 6,258 6,210 97.9% 99.2%

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Annex 15: Clinical Audit (Oct-Dec 2019) Total % of treated % of Positive Total Total positive Total cases patients who Sr. Positive Positive cases Township referred among was treated No. cases cases treated cases positive according to found treated according to cases NTG NTG 1 Bokpyin 4 3 3 1 75.0% 100.0% 2 Dawei 56 56 55 0 100.0% 98.2% 3 Kawthoung 2 2 2 0 100.0% 100.0% 4 Kyunsu 46 44 44 2 95.7% 100.0% 5 Launglon 0 0 0 0 0 0 6 Myeik 1 1 1 0 100.0% 100.0% 7 Palaw 71 71 69 0 100.0% 97.2% 8 Tanintharyi 25 24 24 1 96.0% 100.0% 9 Thayetchaung 24 23 23 1 95.8% 100.0% 10 Yebyu 9 9 9 0 100.0% 100.0% Tanintharyi Total 238 233 230 5 97.9% 98.7% 11 Ann 52 50 50 2 96.2% 100.0% 12 Gwa 1 1 1 0 100.0% 100.0% 13 Kyaukpyu 0 0 0 0 0.0% 0.0% 14 Munaung 0 0 0 0 0.0% 0.0% 15 Ramree 4 4 4 0 100.0% 100.0% 16 Thandwe 2 2 2 0 100.0% 100.0% 17 Toungup 24 24 23 0 100.0% 95.8% S. Rakhine Total 83 81 80 2 97.6% 98.8% 18 Buthidaung 48 48 48 0 100.0% 100.0% 19 Kyauktaw 58 57 57 1 98.3% 100.0% 20 Maungdaw 0 0 0 0 0.0% 0.0% 21 Minbya 140 140 140 0 100.0% 100.0% 22 Mrauk-U 15 15 15 0 100.0% 100.0% 23 Myebon 1 1 1 0 100.0% 100.0% 24 Pauktaw 1 1 1 0 100.0% 100.0% 25 Ponnagyun 16 16 16 0 100.0% 100.0% 26 Rathedaung 2 2 2 0 100.0% 100.0% 27 Sittwe 2 2 2 0 100.0% 100.0% N. Rakhine Total 283 282 282 1 99.6% 100.0% 28 Hlaingbwe 7 7 7 0 100.0% 100.0% 29 Hpa-an 7 7 7 0 100.0% 100.0% 30 Kawkareik 4 4 4 0 100.0% 100.0% 31 Myawaddy 42 42 42 0 100.0% 100.0% Kayin Total 60 60 60 0 100.0% 100.0% 32 Banmauk 2 2 2 0 100.0% 100.0% 33 Homalin 1 1 1 0 100.0% 100.0% 34 Indaw 13 12 12 1 92.3% 100.0% 35 Pale 1 1 1 0 100.0% 100.0% 36 Pinlebu 5 5 5 0 100.0% 100.0% Sagaing Total 22 21 21 1 95.5% 100.0% Grand Total 686 677 673 9 98.7% 99.4%

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Annex 16: Stock out monitoring at the time of monitoring visits (Oct-Dec 2019) Total # % of sites % of sites Total % of sites % of sites of experienced experienced # of experience experience No. Org. State/Region Township visits No RDT No ACT visits d No RDT d No ACT to stock out stock out to PP stock out stock out VMW 1 ARC Tanintharyi Bokpyin 35 100.0% 100.0% 3 100.0% 100.0% 2 URC Tanintharyi Dawei 54 100.0% 100.0% 1 100.0% 100.0% 3 ARC Tanintharyi Kawthoung 44 100.0% 100.0% 9 100.0% 100.0% 4 URC Tanintharyi Kyunsu 31 100.0% 100.0% 7 100.0% 100.0% 5 URC Tanintharyi Launglon 29 100.0% 100.0% - - - 6 URC Tanintharyi Myeik 12 100.0% 100.0% 5 100.0% 100.0% 7 URC Tanintharyi Palaw 33 100.0% 100.0% 5 100.0% 100.0% 8 ARC Tanintharyi Tanintharyi 33 100.0% 100.0% - - - 9 URC Tanintharyi Thayetchaung 21 100.0% 100.0% 5 100.0% 100.0% 10 URC Tanintharyi Yebyu 38 100.0% 100.0% - - - Tanintharyi Total 330 100.0% 100.0% 35 100.0% 100.0% 11 URC S. Rakhine Ann 34 100.0% 100.0% 12 100.0% 100.0% 12 MNMA S. Rakhine Gwa 33 100.0% 100.0% - - - 13 URC S. Rakhine Kyaukpyu 38 100.0% 100.0% 3 100.0% 100.0% 14 URC S. Rakhine Munaung 15 URC S. Rakhine Ramree 31 100.0% 100.0% - - - 16 MNMA S. Rakhine Thandwe 60 100.0% 100.0% - - - 17 URC S. Rakhine Toungup 26 100.0% 100.0% 5 80.0% 100.0% Southern Rakhine Total 222 100.0% 100.0% 20 95.0% 100.0% 18 MHAA N. Rakhine Buthidaung ------19 URC N. Rakhine Kyauktaw 76 100.0% 100.0% - - - 20 MHAA N. Rakhine Maungdaw ------21 URC N. Rakhine Minbya 4 100.0% 100.0% - - - 22 URC N. Rakhine Mrauk-U 5 100.0% 100.0% - - - 23 URC N. Rakhine Myebon 14 100.0% 100.0% 2 100.0% 100.0% 24 URC N. Rakhine Pauktaw 12 100.0% 100.0% 3 100.0% 100.0% 25 URC N. Rakhine Ponnagyun 3 100.0% 100.0% 9 100.0% 100.0% 26 MHAA N. Rakhine Rathedaung ------27 URC N. Rakhine Sittwe 19 100.0% 100.0% - - - Northern Rakhine Total 133 100.0% 100.0% 14 100.0% 100.0% 28 ARC Kayin Hlaingbwe 36 100.0% 100.0% - - - 29 ARC Kayin Hpa-an 57 100.0% 100.0% 1 100.0% 100.0% 30 ARC Kayin Kawkareik 25 100.0% 100.0% - - - 31 ARC Kayin Myawaddy 17 100.0% 100.0% - - - Kayin Total 135 100.0% 100.0% 1 100.0% 100.0% 32 URC Sagaing Banmauk 14 100.0% 100.0% - - - 33 URC Sagaing Homalin 16 100.0% 100.0% - - - 34 URC Sagaing Indaw 17 100.0% 100.0% - - - 35 URC Sagaing Pale ------36 URC Sagaing Pinlebu 21 100.0% 100.0% - - - Sagaing Total 68 100.0% 100.0% - Grand Total 888 100.0% 100.0% 70 98.6% 100.0%

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Annex 17: Stock out monitoring at monthly meeting (Oct-Dec 2019) Total # % of sites % of sites Total % of sites % of sites of experienced experienced # of experienced experienced No. Org. State/Region Township VMWs No RDT No ACT PPs No RDT No ACT met stock out stock out met stock out stock out 1 ARC Tanintharyi Bokpyin 154 100.0% 100.0% 11 100.0% 100.0% 2 URC Tanintharyi Dawei 52 100.0% 100.0% 6 100.0% 100.0% 3 ARC Tanintharyi Kawthoung 140 100.0% 100.0% 17 100.0% 100.0% 4 URC Tanintharyi Kyunsu 154 100.0% 100.0% 30 100.0% 100.0% 5 URC Tanintharyi Launglon 88 100.0% 100.0% - - - 6 URC Tanintharyi Myeik 73 100.0% 100.0% 18 100.0% 100.0% 7 URC Tanintharyi Palaw 114 100.0% 100.0% 27 100.0% 100.0% 8 ARC Tanintharyi Tanintharyi 162 100.0% 100.0% - - - 9 URC Tanintharyi Thayetchaung 70 100.0% 100.0% 18 100.0% 100.0% 10 URC Tanintharyi Yebyu 184 100.0% 100.0% - - - Tanintharyi Total 1,191 100.0% 100.0% 127 100.0% 100.0% 11 URC S. Rakhine Ann 224 100.0% 100.0% 73 100.0% 100.0% 12 MNMA S. Rakhine Gwa 195 100.0% 100.0% - - - 13 URC S. Rakhine Kyaukpyu 128 100.0% 100.0% 17 100.0% 100.0% 14 URC S. Rakhine Munaung 15 URC S. Rakhine Ramree 206 100.0% 100.0% 6 100.0% 100.0% 16 MNMA S. Rakhine Thandwe 351 100.0% 100.0% - - - 17 URC S. Rakhine Toungup 164 99.4% 99.4% 50 100.0% 100.0% Southern Rakhine Total 1,268 99.9% 99.9% 146 100.0% 100.0% 18 MHAA N. Rakhine Buthidaung 419 100.0% 100.0% - - - 19 URC N. Rakhine Kyauktaw 290 100.0% 100.0% 6 100.0% 100.0% 20 MHAA N. Rakhine Maungdaw 57 100.0% 100.0% - - - 21 URC N. Rakhine Minbya 212 100.0% 100.0% - - - 22 URC N. Rakhine Mrauk-U 198 100.0% 100.0% 33 100.0% 100.0% 23 URC N. Rakhine Myebon 198 100.0% 100.0% 13 100.0% 100.0% 24 URC N. Rakhine Pauktaw 99 100.0% 100.0% 27 100.0% 100.0% 25 URC N. Rakhine Ponnagyun 193 100.0% 100.0% 12 100.0% 100.0% 26 MHAA N. Rakhine Rathedaung 167 100.0% 100.0% - - - 27 URC N. Rakhine Sittwe 123 100.0% 100.0% - - - Northern Rakhine Total 1,956 100.0% 100.0% 91 100.0% 100.0% 28 ARC Kayin Hlaingbwe 156 100.0% 100.0% - - - 29 ARC Kayin Hpa-an 249 100.0% 100.0% - - - 30 ARC Kayin Kawkareik 140 100.0% 100.0% 6 100.0% 100.0% 31 ARC Kayin Myawaddy 67 100.0% 100.0% 3 100.0% 100.0% Kayin Total 612 100.0% 100.0% 9 100.0% 100.0% 32 URC Sagaing Banmauk 88 100.0% 100.0% - - - 33 URC Sagaing Homalin 75 100.0% 100.0% - - - 34 URC Sagaing Indaw 97 100.0% 100.0% - - - 35 URC Sagaing Pale 82 100.0% 100.0% - - - 36 URC Sagaing Pinlebu 117 100.0% 100.0% - - - Sagaing Total 459 100.0% 100.0% - Grand Total 5,486 100.0% 100.0% 373 100.0% 100.0%

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Annex 18: Capacity Building on Malaria Diagnosis (Oct-Dec 2019)

Sr Village Malaria Workers Private Providers Township Grand Total No. M F Sub-total M F Sub-total 1 Bokpyin ------2 Dawei ------3 Kawthoung ------4 Kyunsu 10 41 51 2 7 9 60 5 Launglon 3 21 24 - - - 24 6 Myeik 2 23 25 - 6 6 31 7 Palaw 9 31 40 3 7 10 50 8 Tanintharyi ------9 Thayetchaung 5 19 24 - 6 6 30 10 Yebyu ------Tanintharyi Total 29 135 164 5 26 31 195 11 Ann 51 27 78 22 4 26 104 12 Gwa ------13 Kyaukpyu ------14 Munaung ------15 Ramree 46 25 71 2 - 2 73 16 Thandwe ------17 Toungup 29 33 62 14 5 19 81 Southern Rakhine Total 126 85 211 38 9 47 258 18 Buthidaung 84 6 90 - - - 90 19 Kyauktaw 42 53 95 2 - 2 97 20 Maungdaw 22 - 22 - - - 22 21 Minbya 37 36 73 - - - 73 22 Mrauk-U 47 19 66 8 3 11 77 23 Myebon 26 34 60 4 - 4 64 24 Pauktaw ------25 Ponnagyun 35 34 69 4 - 4 73 26 Rathedaung 14 20 34 - - - 34 27 Sittwe 7 2 9 - - - 9 Northern Rakhine Total 314 204 518 18 3 21 539 28 Hlaingbwe ------29 Hpa-an ------30 Kawkareik ------31 Myawaddy 4 18 22 - - - 22 Kayin Total 4 18 22 - - - 22 32 Banmauk 5 24 29 - - - 29 33 Homalin 16 11 27 - - - 27 34 Indaw 7 28 35 - - - 35 35 Pale 12 29 41 - - - 41 36 Pinlebu 20 25 45 - - - 45 Sagaing Total 60 117 177 - - - 177 Grand Total 533 559 1,092 61 38 99 1,191

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Annex 19: Capacity Building on Case Management (Oct-Dec 2019)

Sr Village Malaria Workers Private Providers Township Grand Total No. M F Sub-total M F Sub-total 1 Bokpyin ------2 Dawei ------3 Kawthoung ------4 Kyunsu 10 41 51 2 7 9 60 5 Launglon 3 21 24 - - - 24 6 Myeik 2 23 25 - 6 6 31 7 Palaw 9 31 40 3 7 10 50 8 Tanintharyi ------9 Thayetchaung 5 19 24 - 6 6 30 10 Yebyu ------Tanintharyi Total 29 135 164 5 26 31 195 11 Ann 51 27 78 22 4 26 104 12 Gwa ------13 Kyaukpyu ------14 Munaung ------15 Ramree 46 25 71 2 - 2 73 16 Thandwe ------17 Toungup 29 33 62 14 5 19 81 Southern Rakhine 126 85 211 38 9 47 258 Total 18 Buthidaung 84 6 90 - - - 90 19 Kyauktaw 42 53 95 2 - 2 97 20 Maungdaw 22 - 22 - - - 22 21 Minbya 37 36 73 - - - 73 22 Mrauk-U 47 19 66 8 3 11 77 23 Myebon 26 34 60 4 - 4 64 24 Pauktaw ------25 Ponnagyun 35 34 69 4 - 4 73 26 Rathedaung 14 20 34 - - - 34 27 Sittwe 7 2 9 - - - 9 Northern Rakhine 314 204 518 18 3 21 539 Total 28 Hlaingbwe ------29 Hpa-an ------30 Kawkareik ------31 Myawaddy 4 18 22 - - - 22 Kayin Total 4 18 22 - - - 22 32 Banmauk 5 24 29 - - - 29 33 Homalin 16 11 27 - - - 27 34 Indaw 7 28 35 - - - 35 35 Pale 12 29 41 - - - 41 36 Pinlebu 20 25 45 - - - 45 Sagaing Total 60 117 177 - - - 177 Grand Total 533 559 1,092 61 38 99 1,191

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Annex 20: Capacity Building on Integrated Community Malaria Volunteer (Oct-Dec 2019) Sr Township Village Malaria Workers Private Providers Grand Total No. M F Sub-total M F Sub-total 1 Bokpyin ------2 Dawei ------3 Kawthoung ------4 Kyunsu 10 38 48 2 7 9 57 5 Launglon 3 21 24 - - - 24 6 Myeik 2 22 24 - 6 6 30 7 Palaw 9 31 40 3 7 10 50 8 Tanintharyi ------9 Thayetchaung 5 19 24 - 6 6 30 10 Yebyu ------Tanintharyi Total 29 131 160 5 26 31 191 11 Ann 51 27 78 22 4 26 104 12 Gwa ------13 Kyaukpyu ------14 Munaung ------15 Ramree 46 25 71 2 - 2 73 16 Thandwe ------17 Toungup 29 33 62 14 5 19 81 Southern Rakhine Total 126 85 211 38 9 47 258 18 Buthidaung 84 6 90 - - - 90 19 Kyauktaw 42 53 95 2 - 2 97 20 Maungdaw 22 - 22 - - - 22 21 Minbya 37 36 73 - - - 73 22 Mrauk-U 47 19 66 8 3 11 77 23 Myebon 26 34 60 4 - 4 64 24 Pauktaw ------25 Ponnagyun 35 34 69 4 - 4 73 26 Rathedaung 14 20 34 - - - 34 27 Sittwe 7 2 9 - - - 9 Northern Rakhine Total 314 204 518 18 3 21 539 28 Hlaingbwe ------29 Hpa-an ------30 Kawkareik ------31 Myawaddy 4 18 22 - - - 22 Kayin Total 4 18 22 - - - 22 32 Banmauk 5 24 29 - - - 29 33 Homalin 16 11 27 - - - 27 34 Indaw 7 28 35 - - - 35 35 Pale 12 29 41 - - - 41 36 Pinlebu 20 25 45 - - - 45 Sagaing Total 60 117 177 - - - 177 Grand Total 533 555 1,088 61 38 99 1,187

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Annex 21: Behavior Change Communication (Oct-Dec 2019)

Individual IPC Group Health Talk

Township

No. #

Male Male Total

Total

Female Female

Sessions Sessions

included included

Migrants Migrants 1 Bokpyin 579 562 1,141 667 29 214 309 523 275 2 Dawei 425 383 808 173 - - - - - 3 Kawthoung 1,184 889 2,073 2,073 37 207 178 385 385 4 Kyunsu 663 787 1,450 105 - - - - - 5 Launglon 260 549 809 4 - - - - - 6 Myeik 268 406 674 46 - - - - - 7 Palaw 445 531 976 112 - - - - - 8 Tanintharyi 505 618 1,123 72 22 166 211 377 10 9 Thayetchaung 308 593 901 166 - - - - - 10 Yebyu 622 829 1,451 78 - - - - - Tanintharyi Total 5,259 6,147 11,406 3,496 88 587 698 1,285 670 11 Ann 1,274 1,097 2,371 1,318 - - - - - 12 Gwa 705 818 1,523 44 16 200 251 451 2 13 Kyaukpyu 425 582 1,007 96 - - - - - 14 Munaung ------15 Ramree 418 446 864 171 6 191 157 348 325 16 Thandwe 1,132 1,354 2,486 28 20 284 538 822 18 17 Toungup 723 630 1,353 363 - - - - - Southern Rakhine Total 4,677 4,927 9,604 2,020 42 675 946 1,621 345 18 Buthidaung 4,135 1,514 5,649 57 22 160 67 227 - 19 Kyauktaw 1,481 1,712 3,193 360 61 211 306 517 39 20 Maungdaw 378 296 674 7 - - - - - 21 Minbya 607 523 1,130 81 18 58 113 171 13 22 Mrauk-U 752 699 1,451 15 - - - - - 23 Myebon 404 489 893 42 - - - - - 24 Pauktaw 397 420 817 27 - - - - - 25 Ponnagyun 643 926 1,569 138 9 41 75 116 25 26 Rathedaung 452 637 1,089 2 - - - - - 27 Sittwe 473 677 1,150 23 9 43 63 106 - Northern Rakhine Total 9,722 7,893 17,615 752 119 513 624 1,137 77 28 Hlaingbwe 371 494 865 24 - - - - - 29 Hpa-an 494 703 1,197 163 - - - - - 30 Kawkareik 272 565 837 31 3 14 43 57 - 31 Myawaddy 391 552 943 192 - - - - - Kayin Total 1,528 2,314 3,842 410 3 14 43 57 - 32 Banmauk 450 665 1,115 142 6 27 90 117 7 33 Homalin 693 374 1,067 90 - - - - - 34 Indaw 299 473 772 29 5 38 71 109 - 35 Pale 288 339 627 102 13 58 96 154 23 36 Pinlebu 359 534 893 71 6 48 83 131 - Sagaing Total 2,089 2,385 4,474 434 30 171 340 511 30 Grand Total 23,275 23,666 46,941 7,112 282 1,960 2,651 4,611 1,122

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Annex 22: Performance Indicators (Oct-Dec 2019)

Frequency of Achievement Baseline Q1 Progress Target Remark Indicators reporting %

IP 1: Annual Parasite Incidence (API) in Defeat Annual 8 (CAP-M PY4) 2.5 Annual Indicator Malaria villages

Number of confirmed malaria cases 686 686

Mid-year population at risk of targeted areas - IP 2: Annual Blood Examination Rate Annual 6% in 2015 9% Annual Indicator Number of parasitological tests carried out in (National M&E 64,808 64,808 Defeat Malaria target areas plan) Mid-year population at risk in Defeat Malaria - targeted areas

IP 3: Percent of indigenous cases among cases Quarterly 9% (from National 16.1% 16.1% 40% 31 cases were investigated and investigated (in elimination areas) M&E plan) classified as 5 indigenous and 26 imported.

Number of cases classified as indigenous 5 5

Number of cases investigated 31 31 IP 4: Percent of active foci among foci Monthly N/A 40% The indicator is under revising at investigated (in elimination areas) National Strategic Plan by Malaria Number of active foci investigated Technical Strategic Group.

Number of foci investigated

IP 5: Proportion of villages with zero positive Annually 18.5% (CAP-M Annual Indicator cases in a fiscal year database) 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 target areas that Baseline and NA 85% To be measured by end line survey. own at least one ITN end line

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OC 1.2 Percentage of households in target Baseline and 47% in Rakhine NA 85% To be measured by end line survey. areas that own at least one insecticide- end line 60,2% in TNT treated net for every two persons 65.6% in Kayin from CAP-M OC 1.3 % of individuals in targeted areas who Baseline and TBD after baseline NA 85% To be measured by end line survey. slept under ITN the previous night. end line (disaggregate by type of net, pregnant women, age and gender)

OC 1.4 % of service delivery points which Quarterly Minimum 85% 100.0% 90% 111% report no stock outs of RDTs lasting more (from CAP-M) than one week during the past 3 months (disaggregate by type of SDP)

OC 1.5 % of service delivery points which Quarterly Minimum 85% 100.0% 90% 111% report no stock outs of first line antimalarial (from CAP-M) medicines (ACT) lasting more than one week during the past 3 months (disaggregate by type of SDP)

OC 1.6 % of patients found positive who Quarterly minimum 95% 99.4% 95% 105% received antimalarial treatment according to (from CAP-M) National Malaria Treatment Guidelines Number of patients found positive who received antimalaria treatment according to 673 NTG Number of patients found positive who

received antimalaria treatment 677 OC 1.7 % of Malaria Positive cases with Quarterly 25% (from CAP-M 73.2% 73.2% 65% 113% having completed the treatment under DOT FY15 report) Number of total positive cases with DOT

having complete DOT 502 Number of total positive cases OP 1.1 Number of insecticide treated net Activity 92,986 (From CAP- 686 9% purchased in any fiscal year with USG funds implemented M PY5) 34,259 34,259 385,000 that were distributed in this quarter (PMI months required indicator)

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OP 1.2 Number of artemisinin-based Quarterly NA 7% combination therapy (ACT) treatments 785 785 11,950 purchased in any fiscal year with USG funds that were distributed in this reported fiscal year (PMI required indicator) OP 1.3 Number of RDTs purchased in any Quarterly NA 19% fiscal year with USG funds that were 52,400 52,400 270,000 distributed (PMI required indicator) OP 1.4 Number of individuals reached with Quarterly 514,333 (from 39% malaria behavior change messages through CAP-M PY5) 46,941 46,941 120,000 interpersonal communication (individual talks) OP 1.5 Number of health workers trained in Quarterly 5,155 (from CAP- 54% VMW = 1,092 case management with ACTs with USG funds M) 1,194 1,194 2,200 PP = 99 (Disaggregated by male, female, and MMW = 3 profession) (PMI required indicator) OP 1.6 Number of health workers trained in Month of 5,443 (from CAP- 54% VMW = 1,092 malaria laboratory diagnostics (rapid training M) 1,194 1,194 2,200 PP = 99 diagnostic tests (RDTs) or microscopy) with MMW = 3 USG funds (Disaggregated by male, female, and profession) (PMI required indicator) OP 1.7 % of VMWs/PPs in Defeat Malaria Annually N/A 90% Annual Indicator 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 targeted areas report monthly data of malaria cases Monthly ≥ 80% 97.9% 97.9% 90% 109% (disaggregate by type of SDP) OC 2.2 % of service delivery points in targeted areas report monthly data of malaria cases Annually N/A 99.2% 99.2% 90% 110% on time (disaggregate by type of SDP) OC 2.3 % of positive cases notified within 24 Quarterly N/A 87.5% 87.5% 90% 97% hours in elimination targeted townships

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Number of positive cases notified within 24 28 28 hours in elimination targeted townships Number of positive cases notified in 32 32 elimination targeted townships OC 2.4 Foci investigation rate Quarterly N/A NA 80% 10 active foci in need of Number of foci investigated in elimination investigation could be done. 10 10 targeted townships Number of cases investigated in elimination 31 31 targeted townships. OC 2.5 Active focus response rate Quarterly N/A 100.00% 90% The indicator is under revising at National Strategic Plan by Malaria Technical Strategic Group.

OP 2.1 Number of townships that have been Quarterly and NA 31 0% Annual Indicator developed and updated VBS annually annually OP 2.2 Number entomological surveys Semiannual N/A 2 0 8 0% Fulfilled previous year planned 2 conducted in persistent transmission areas surveys which were pending due to budget constraint.

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 with Annually TBD NA 70% No more relevant. Quality Assurance/Quality Control (QAQC) system received quarterly internal assessments of the QA system in collaboration with NHL/NMCP OP 3.2 Number of trainings on malaria Quarterly NA 4 4 20 20% technical skill and training facilitation skill supported by Defeat Malaria OP 3.3 Number of trainers developed through Quarterly NA 48 48 213 23% Defeat Malaria OP 3.4 Number of people trained through on- Quarterly 35 35 200 18% site training supported by USG program (Defeat Malaria) OP 3.5 Percentage of trainers supervised Quarterly NA 0% 0% 50% 0% Trained at Q1 and they will be during trainings supervised in next quarter.

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OP 3.6 Percentage of master mentors Quarterly NA 100.00% 100.0% 80% retaining at least 80% of acquired skills and knowledge OP 3.7 Number of joint supervision visits to Quarterly NA 7 7 20 35% VMW for data quality 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 and Annual N/A 56 56 60 93% state-owned enterprises involve in malaria activities OP 4.2 Number of health education sessions Monthly N/A 52 52 350 15% conducted in the targeted areas with participation from collaborating companies and enterprises

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DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT FY2020 Q1

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 | International Global Health Maryland University of Baltimore (IGH -MUB)

Room 602, 6th Floor, Shwe Than Lwin Condominium New University Ave. Rd., Bahan Township Yangon, Myanmar

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