DEFEAT MALARIA

DEFEAT MALARIA ACTIV ITY

QUARTERLY PERFORMANCE REPORT

FISCAL YEAR 2020 QUARTER 3 (APRIL 1, 2020 TO JUNE 30, 2020) 2020 QUARTERLY PERFORMANCE REPORT

Submission Date: July 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., Bahan Township 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 contrib- uting to the long-term national goal of eliminating ma- laria in Myanmar. Defeat Malaria has four core objec- tives, including:

 Objective 1: Achieve and maintain universal cover- age of at-risk populations with proven vector control and case management interventions, while pro- moting the testing of new tools and approaches.

 Objective 2: Strengthen the malaria surveillance sys- tem to comprehensively monitor progress and in- form the deployment and targeting of appropriate responses and strategies.

 Objective 3: Enhance technical and operational ca- pacity of the NMCP and other health service provid- ers at all levels of service provision.

 Objective 4: Promote the involvement of communi- ties, private healthcare providers, private companies and state-owned enterprises in malaria control and elimination initiatives. DEFEAT MALARIA FY 2020 QUARTER 3 KEY ACHIEVEMENTS

Testing & Case Finding 58,556 people were tested for malaria Health Communication 43,538 people, including 7,794 of whom migrants, were reached through 1,067 were positive cases interpersonal communication

Test Positivity Rate: 1.82%

Treatment Completion Preventive Commodities

549 individuals were Distributed 81,231 LLINs enrolled in DOT treatment; to villages, worksites, 99.5% of enrolled cases women attending completed DOT treatment ante-natal care clinics. EHO, forest goers, and Others in need Diagnostic and Treatment Commodities Capacity Building Distributed 83,350 RDTs 40 health workers and 7,751 ACTs received trainings to Defeat Malaria storage on malaria diagnostics sites to safeguard and case management continuous and on-time 40 health workers delivery of malaria health received training on Integrated Community care services Malaria Volunteers DEFEAT MALARIA QUARTERLY PERFORMANCE REPORT FY 2020 Q3

Table of Contents ACRONYMS AND ABBREVIATIONS ...... III EXECUTIVE SUMMARY ...... 1 INTRODUCTION ...... 3 FISCAL YEAR 2020 QUARTER 3: 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...... 12 OBJECTIVE 3: ENHANCE TECHNICAL AND OPERATIONAL CAPACITY OF THE NMCP AND OTHER HEALTH SERVICE PROVIDERS AT ALL LEVELS OF SERVICE PROVISION...... 15 OBJECTIVE 4: PROMOTE THE INVOLVEMENT OF COMMUNITIES, PRIVATE HEALTHCARE PROVIDERS, PRIVATE COMPANIES AND STATE- OWNED ENTERPRISES IN MALARIA CONTROL AND ELIMINATION INITIATIVES ...... 17 ANNEX 1: COVID-19 SITUATION IN MYANMAR (AS OF 30TH JUNE 2020)...... 21 ANNEX 2: INTERIM GUIDELINE FOR ICMVS DURING COVID-19 PANDEMIC ...... 24 ANNEX 3: COMMUNICATION WITH ICMVS AND COMMUNITY DURING COVID-19 ...... 26 ANNEX 4: ADMINISTRATIVE MANAGEMENT DURING COVID-19 PANDEMIC ...... 30 ANNEX 5: SITUATION OF RAKHINE STATE (AS OF 30TH JUNE 2020) ...... 33 ANNEX 6: PERFORMANCE ON PILOT MALARIA ELIMINATION ACTIVITIES (APR.-JUN. 2020) ...... 34 ANNEX 7: CASE FINDING AND MANAGEMENT OF ALL TOWNSHIPS BY DIFFERENT APPROACHES (APR.-JUN. 2020) ...... 37 ANNEX 8: ACTIVE CASE DETECTION BY MOBILE TEAM (APR.-JUN. 2020) ...... 38 ANNEX 9: VMWS/PPS MEETINGS (APR.-JUN. 2020) ...... 39 ANNEX 10: SUPERVISION AND MONITORING (APR.-JUN. 2020) ...... 40 ANNEX 11: REPORTING STATUS OF VMWS AND PPS (APR.-JUN. 2020) ...... 41 ANNEX 12: CLINICAL AUDIT (APR.-JUN. 2020) ...... 42 ANNEX 13: STOCK OUT MONITORING AT MONITORING VISITS (APR.-JUN. 2020) ...... 43 ANNEX 14: STOCK OUT MONITORING AT MONTHLY MEETING (APR.-JUN. 2020) ...... 44 ANNEX 15.A: HEALTH WORKERS TRAINED IN MALARIA DIAGNOSTICS (APR.-JUN. 2020) ...... 45 ANNEX 15.B: HEALTH WORKERS TRAINED IN MALARIA CASE MANAGEMENT (APR.-JUN. 2020) ...... 45 ANNEX 15.C: CAPACITY BUILDING ON INTEGRATED COMMUNITY MALARIA VOLUNTEER (APR.-JUN. 2020) ...... 45 ANNEX 16: BEHAVIOR CHANGE COMMUNICATION (APR.-JUN. 2020) ...... 46 ANNEX 17: PERFORMANCE INDICATORS (APR-JUN 2020) ...... 47 ANNEX 18: DEFEAT MALARIA ACTIVITIES DURING COVID-19 (APR.-JUN. 2020) ...... 52 ANNEX 19: COST SHARE ...... 53

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FIGURES: FIGURE 1: GEOGRAPHIC SPREAD OF DEFEAT MALARIA ACTIVITIES IN MYANMAR AS OF JUNE 2020 ...... 3 FIGURE 2: RDT TESTED, RDT DISTRIBUTED AND STATUS OF NO RDT STOCK OUT (APRIL - JUNE 2020) ...... 5 FIGURE 3: MALARIA CASES DETECTED, ACT DISTRIBUTED AND STATUS OF NO ACT STOCK OUT (APRIL - JUNE 2020) ...... 5 FIGURE 4: MALARIA TESTING AND POSITIVE CASES FOUND BY PROVIDERS (APRIL - JUNE 2020) ...... 10 FIGURE 5: REPORTING STATUS OF VMW/PP BY STATE AND REGION ...... 14 FIGURE 6: RDQA COVERAGE FOR 36 TOWNSHIPS OF DEFEAT MALARIA IMPLEMENTING AREAS (APRIL-JUNE 2020) ...... 14 FIGURE 7: STATUS OF RDQA CONDUCTED BY DQO/M&E (APRIL - JUNE 2020) ...... 15

TABLES: TABLE 1: PROJECT AREA COVERAGE AS OF JUNE 2020 ...... 3 TABLE 2: TYPES OF IEC MATERIALS PRODUCED ...... 6 TABLE 3. LONG LASTING INSECTICIDE NET (LLIN) DISTRIBUTION AT VILLAGES (APR.-JUN. 2020) ...... 7 TABLE 4. LLIN DISTRIBUTION AT WORKSITES (APR.-JUN. 2020) ...... 8 TABLE 5. LLIN COVERAGE AND UTILIZATION BY STATE/REGION (APR-JUN 2020) APPLYING ODK-BASED METHOD ...... 8 TABLE 6: WASTE DISPOSAL OF LLIN BAGS IN NORTHERN RAKHINE ...... 9 TABLE 7: MALARIA TESTING BY DEFEAT MALARIA COVERED STATE/REGION (APRIL - JUNE 2020) ...... 10 TABLE 8: INVOLVEMENT OF PPS, GPS AND NFPP IN 3 ELIMINATION TOWNSHIPS (APR.-JUN. 2020) ...... 20

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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 BCC Behavior Change Communication BPHWT Back-Pack Health Worker Team CBO Community based organization cRDT Conventional rapid diagnostic test CSG Community Support Group COVID-19 Coronavirus disease 2019 DOT Directly Observed Treatment DQO Data Quality Officer EHO Ethnic Health Organization ELISA Enzyme-Linked Immunosorbent Assay FCDO Field Capacity Development Officers FETP Field Epidemiology Training Project GP General Practitioners HH Households HRP2 Histidine Rich Protein 2 hsRDT Highly-sensitive rapid diagnostic test ICMV Integrated Community Malaria Volunteers IEC Information, Education and Communication IPC Interpersonal communication Jhpiego Johns Hopkins Program for International Education in Gynecology and Obstetrics LLIN Long-lasting insecticidal nets M&E Monitoring and Evaluation MHAA Myanmar Health Assistant Association MMP Mobile and migrant populations MMW Mobile Malaria Worker MNMA Myanmar Nurse and Midwife Association MoHS Ministry of Health and Sports NFPP Non-formal private provider NMCP National Malaria Control Program NSP National Strategic Plan NTG National Malaria Treatment Guidelines PCR Polymerase Chain Reaction P.f Plasmodium falciparum PMI President’s Malaria Initiative

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PP Private providers P.v Plasmodium vivax RDQA Routine Data Quality Assessments RDT Rapid diagnostic tests RHC Rural Health Centers SBCC Socio-behavior change communication SMT Senior Management Team TPR Test positivity rate URC University Research Co., LLC USAID United States Agency for International Development usPCR Ultra-sensitive Polymerase Chain Reaction VBDC Vector Borne Disease Control VMW Village Malaria Worker WHO World Health Organization

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Executive Summary Myanmar’s National Malaria Control Program (NMCP) presented the 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) and 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 Ministry of Health and Sports (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 briefs, 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 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 initiatedelimination activities in three pilot townships, and the achievements and experiences gained have been documented for reporting to MCP. N These findings and experiences further support extending Defeat Malaria’s technical and operational support to increase the number of elimination areas. In this quarter, Defeat Malaria monitored the COVID-19 situation on a daily basis and continued the strategic and administrative activities according to the level of COVID-19 transmission, the announcements of Central Committee for Prevention, Control and Treatment of COVID-19, the orders of Coronavirus Disease 2019 (COVID-19) Control and Emergency Response Committee, the guidance of Ministry of Health and Sports, the restrictions imposed by local authorities, and sensitivity of the communities. Communication channels were activated in various ways to reach Integrated Community Malaria Volunteers (ICMVs) and communities. As of 30th June 2020, Myanmar has identified 299 positive cases, 76,315 have been tested, and there has been 6 COVID-19 related deaths (Annex 1, 2, 3, and 4).

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Project Year 4 Quarter 3 Key Highlights (April 2020 - June 2020) • As of June 2020, overall coverage of Defeat Malaria is around 1,568,025 people from 2,889 villages among 36 townships of Rakhine, Kayin, Tanintharyi and Sagaing States/Regions. • Defeat Malaria activities were continued according to the business contingency and continuity plan during COVID-19, and community-based malaria intervention activities were thoroughly maintained except mass campaigns and large group activities. o Reporting status of ICMVs was maintained at 97.3% o Rapid diagnostic tests (RDT) testing during the same quarter of previous year was 66,346 tests and that of FY 2020 Q3 was 58,556 tests and found as 11.7% lesser. o Proactive case detection for prevention of potential outbreak was limited due to restriction of movement of township team under high community sensitivity on outsiders. o More beneficiaries were reached through inter-personal communication during FY 2020 Q3 (22,269 in Q2 versus 43,538 in Q3) compensating less beneficiaries reached through group health talks (13,368 in Q2 versus 352 in Q3). o Long-lasting insecticidal nets (LLIN) distribution for top-up at the villages and worksites, and pregnant women through antenatal care facilities were well maintained, but LLIN distribution in mass campaign activities were markedly reduced due the need to apply social distancing approach, door to door distribution, and in small group less than 5 people. o Some villages in the townships of Tanintharyi Region experienced unusually high occurrences of malaria cases which were noted in early phases, but immediate responses could not be undertaken by township team due to restriction of travel. These situations were reported to the Township Health Department and ICMVs were encouraged to test all fever cases and inform the community for strengthening of malaria prevention, early diagnosis and treatment during seasonal rise of malaria. o No stock-out of RDT and artemisinin-based combination therapy (ACT) were found as ICMVs were adequately provided for 2 to 3 months of their consumption beforehand following proactive risk mitigation measures • ICMVs’ guideline on tailoring malaria intervention in the context of COVID-19 has been developed in May 2020 and communicated with Defeat Malaria township teams by virtual meetings for further explanation to ICMVs about the importance of sustaining malaria control and elimination. • Defeat Malaria township teams were encouraged to communicate with ICMVs and communities for providing malaria awareness by contrasting COVID-19 messages to meet dual health needs as the component of multiple health needs of the communities. • Regarding personal protection and safety of frontline health workers, 9,500 surgical masks, 5,000 reusable cloth masks, 2,500 face-shield, and hand sanitizer in bottles of various sizes were procured for distributing to ICMVs and Defeat Malaria staffs in accord with the information from the office of acquisition and assistance in the bureau for the management of the USAID. • Malaria elimination activities undertaken during 2019 in the three pilot townships have been reviewed and additional improvement measures were strategized for enhancing malaria elimination activities. Community involvement in malaria elimination has been designed by incorporating updated socio-behaviour change communication strategies. • Backpack Health Worker Team (BPHWT) met with URC Defeat Malaria at Yangon office and discussed collaborative malaria intervention activities. Defeat Malaria provided 46,400 LLINs for utilization in high malaria transmission areas, 21,000 RDTs for diagnosis of suspected malaria cases, 1,435 strips of ACT drugs, 21,000 Primaquine tablets, 8,200 150 mg Chloroquine tablets, 8,200 250 mg Chloroquine tablets for treatment, and 350 job aids for the treatment guidance.

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• Community Support Group (CSG) guide has been endorsed by all Defeat Malaria partners and an agreement has been made to move forward for stepwise community empowerment processes. Introduction Defeat Malaria coverage as of June 2020 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. Malaria is becoming an increasingly focal disease and 12 townships in five States/Regions accounted for 64% of Myanmar’s malaria burden (NSP, 2021-2025). Rakhine State has deep forested mountain ranges. Kayin State has Dawna Mountain Range extends southward, merging with the northern part of Tanintharyi Hill. Deeply forested areas provide favourable conditions for mosquitoes’ receptivity and contribute to a high malaria prevalence. In addition, the difficult terrain is a significant barrier to access health services in these remote areas. Table 1 provides a summary of villages and populations covered by Defeat Malaria. By the end of June 2020, the Defeat Malaria project is sustaining the implementation of activities in 36 townships. Defeat Malaria continuously engages with the national program and other implementing partners to ensure universal coverage of malaria prevention, case detection and management services in Myanmar by inclusiveness of hard-to-reach populations residing in high risk malaria areas. Figure 1: Geographic spread of Defeat Malaria activities Malaria services reached beneficiaries through a in Myanmar as of June 2020 network of 2,146 Village Malaria Workers (VMWs) and Private Providers (PPs), township mobile teams, and 21 Mobile Malaria Workers at 2,889 villages and worksites. Currently, Defeat Malaria’s overall population coverage is around 1,568,025 beneficiaries. Table 1: Project area coverage as of June 2020 State & Region No. of Total Total Covered Total Total Covered % of VMW/PP Covered Villages/ Population Population Population /MMW Townships Worksites Covered Tanintharyi 503 10 589 1,408,401 328,507 23.32% Northern Rakhine 743 10 728 1,298,458 444,529 34.24% Southern Rakhine 517 7 1,015 803,656 462,707 57.58% Kayin 215 4 235 1,008,001 133,873 13.28% Sagaing 189 5 322 747,114 198,409 26.56% Total 2,167 36 2,889 5,265,630 1,568,025 29.78%

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FY2020 Quarter 3 Summary of Key Achievements ✓ Training activities - Integrated Community Malaria Volunteer trainings were conducted for 37 VMWs (30 males and 7 females) and 3 PPs (3 males) in Rakhine State. Defeat Malaria targets ethnic minorities and also minorities among ethnic people. Thirty VMWs/PPs from Bengali communities (75% of total trained in this quarter) were trained to become ICMVs to serve their communities. ✓ 58,556 people were tested for malaria through VMWs, private providers and mobile outreach teams. ✓ 1,067 positive cases were detected and 1,050 out of 1,058 treated cases (99.2%) were in line with National Treatment Guidelines. The other 9 cases were referred to health facilities for further appropriate treatment at township health facilities. ✓ Under the Directly Observed Treatment (DOT) strategy, 549 out 1,067 positive cases (51.5%) were enrolled for DOT and 546 among enrollments (99.5%) completed the treatment courses. In this quarter, 478 out of 946 P.v cases enrolled and 475 out of 478 enrolled P.v cases (99.4%) completed 14 days DOT course, 1 out of 3 mixed infected cases enrolled and completed 14 days DOT course, and 70 out of 118 P.f cases enrolled and completed 3 days DOT course. ✓ Interpersonal communication – Defeat Malaria reached 43,538 people (21,710 males and 21,828 females) through interpersonal communication (IPC) including 7,794 migrants. In this quarter, 43 group health talks were conducted reaching 352 people (171 males and 181 females) including 55 migrants in targeted areas. ✓ A total of 81,231 LLINs were distributed in which 31,145 LLINs were provided in 196 villages and 23 worksites, 1,672 LLINs were provided to pregnant women attending antenatal clinics, 650 LLINs were provided to forest goers as a component of forest goers kit under operational research activities, and 46,400 LLINs were provided to Back-Pack Health Worker Team (BPHWT) with regular engagement activity of Ethnic Health Organization (EHO), 1,300 LLINs were donated to COVID-19 quarantine centers of 2 townships, and 64 LLINs were supported to positive patients during case investigation and management for preventing onward malaria transmission.

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Fiscal Year 2020 Quarter 3: 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 supply of malaria commodities for targeted communities, VMWs are provided at least 25 RDTs and 3 ACT strips. However, with the increasing threat and spread of COVID-19, VMWs/PPs were provided with malaria commodities for twoto three months of their consumption to minimize the risk of stock-out if restriction of movement and lock-down situations become activated. In this quarter, 83,350 rapid diagnostic tests (RDTs) and 7,751 first line antimalarials (ACTs) were distributed to established commodity storage sites of Defeat Malaria from the central warehouse of Yangon (see Figures 2 & 3). From those township level storage sites, 6,574 RDTs and 4,781 ACTs were provided to respective VMWs/PPs. As compared to distribution in last quarter, number of commodities distributed have increased. Figure 2: RDT tested, RDT distributed and status of no RDT stock out (April - June 2020) 60,000 120% 100% 100% 100% 49,675 50,000 100%

40,000 33,675 80% 30,000 26,535 60% 17,394 20,000 14,627 40%

10,000 20%

- 0% Apr-20 May-20 Jun-20

RDT tested RDT distributed No stock out of RDT

Figure 3: Malaria cases detected, ACT distributed and status of no ACT stock out (April - June 2020) 6,000 120% 100% 100% 5,555 100% 5,000 100%

4,000 80%

3,000 60% 2,196 2,000 40%

1,000 650 20% 200 217 - 0% Apr-20 May-20 Jun-20

Positive cases ACT distributed No stock of ACT

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RDTs and ACTs were replenished at VMWs/PPs meetings, monitoring visits and on-site report collection at the villages to prevent stock-outs. During FY2020 Q3, stock-out monitoring was conducted a total of 5,334 times in which 2,813 times at the VMWs/PPs meetings and 2,221 times at the supervision visits and on-site data collection. In this reporting period, RDT as well as ACT stock-out was not encountered. ❖ Optimize coverage and promote use of proven vector control interventions Strengthening Socio-Behavior Change Communication (SBCC) Table 2: Types of IEC materials produced # Materials Number Target Distribution Objective Key messages produced audience sites 1 VMW sport 2,200 ICMVs VMW To promote Defeat “Village Malaria shirts, units training and Malaria and USAID Worker” text with jackets meetings branding PMI/USAID and Defeat Malaria logos 2 Cap 2,500 ICMVs and Defeat To raise the Defeat Malaria logo units project staffs Malaria staff visibility of and VMW PMI/USAID & meetings Defeat Malaria 3 Malaria Case 500 units Defeat Defeat Tool for Incubation period, Classification Malaria staffs Malaria surveillance; used Timelines of malaria Calculator and NMCP project areas for case transmission classifications 4 Pamphlets 1,500 Forest goers Forest goers’ Promote To sleep under LLIN at (Forest units survey awareness to night, use of mosquito Goer) forest goers for repellents, Blood test malaria prevention at the earliest for the onset of fever Based on the findings and recommendations of SBCC assessment, Information, education and communication (IEC) materials will be revised and redesigned for promoting community behaviour impact. Interpersonal Communication and group health talks From April to June 2020, a total of 43,538 people (50.1% female), including 7,794 migrants, were reached through interpersonal communication (IPC) activities. The beneficiaries received key malaria messages on sleeping under LLINs at night, early access to RDTs for any suspects of malaria, and importance of taking treatment completely to ensure cure and prevent drug resistant malaria. In this quarter, due to limitation of gathering people and travel restriction, only 43 group health talk sessions were conducted at the villages and work sites reaching 352 people (51.4% female), and 55 of them were migrants. All IPC activities and Health awareness session at the village of group health talks were conducted by applying social Buthidaung township of Rakhine State distancing at least 6 feet apart between individuals. Distribution of printed materials During FY 2020 Q3, 13,361 malaria pamphlets were distributed to targeted populations in project areas and only 3 malaria posters were equipped at ICMVs’ posts to promote communities’ knowledge on

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malaria control and elimination. Through collaboration between USAID partners and organizing efforts of USAID Burma, Defeat Malaria provided COVID-19 awareness information to the communities through 2,146 ICMVs for the distribution of 25,000 cough etiquette flyers, 30,000 COVID-19 generic flyers, and 9,000 vinyl posters by collaboration with communication section of UNICEF to get COVID-19 IECs. Printed digital media and Defeat Malaria on Social Media To disseminate project achievements and advocate for malaria elimination, online communication is used to reach various audiences. The Facebook page, “Defeat Malaria Myanmar,” had been updated with relevant information and the successes reaching 36,124 people in this quarter. In addition to the information of Defeat Malaria activities, a COVID-19 prevention awareness video from USAID, donation of URC staffs for prevention of COVID-19, World Malaria Day events, and activities of VMWs/PPS during COVID-19 pandemic were disseminated through the Facebook page. Long-lasting insecticide net (LLIN) distribution LLIN is a key vector control intervention and LLIN distribution is prioritized for high malaria transmission areas and for the high-risk groups such as migrants and pregnant women. Defeat Malaria applies various approaches for LLIN distribution including mass LLIN distribution at Hnam Kham village of Rathedaung and Htee Kaw Htaw in Myawaddy distribution once for a three- year period by collaborating with NMCP, and top up distribution at the villages in gaps after LLIN monitoring and distribution for the influx of inbound migrants. The objectives are to achieve and maintain high level of vector control coverage and LLIN utilization for malaria prevention. Additional distribution in this quarter included distribution of 650 LLINs to forest goers participants involved in operational research, provision of 46,400 LLINs to BPHWT (an ethnic health organization), donating 1,300 LLINs to COVID-19 Facility Quarantine Centers for the protection of quarantined migrants, and supporting 64 LLINs to malaria positive cases during case investigation and management activities. Distribution of LLINs at the villages In this reporting period, 29,392 LLINs were distributed in 196 villages through mass and top up distribution. This provided for the protection of 47,299 people from 15,167 households. Both household and population coverage were targeted for 100% coverage. Average population per LLIN is 1.61. Table 3 shows mass LLIN distribution/top up at the villages of four states/regions. Table 3. Long lasting insecticide net (LLIN) distribution at villages (Apr.-Jun. 2020) Indicator Mass Distribution Top Up Grand Total # of Villages 83 113 196 # and % of HHs covered 6,779 (100%) 8,388 (100%) 15,167 (100%) # and % of Population covered 33,395 (100%) 13,904 (100%) 47,299 (100%) Total LLINs distributed 18,461 10,931 29,392 Net Ownership (Persons/LLIN) 1.81 1.27 1.61

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LLIN distribution to migrants and mobile populations in collaboration with employers Defeat Malaria targets mobile and migrant populations (MMP) for malaria service provision and LLINs distribution at work sites for malaria prevention in collaboration with worksites’ employers and supervisors. A total of 1,753 LLINs were distributed in 23 work sites to cover 2,958 MMPs. All households and populations were covered by LLINs in these worksites, resulting in 100% coverage and average population per LLINwas 1.69. Table 4. LLIN distribution at worksites (Apr.-Jun. 2020) Indicators Mass distribution Top up Grand total

# of worksites 6 17 23 # and % of HHs covered 291 (100%) 312 (100%) 603 (100%) # and % of Population covered 1,619 (100%) 1,339 (100%) 2,958 (100%) Total LLINs distributed 925 828 1,753 Net Ownership (Persons/LLIN) 1.75 1.62 1.69

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 6 townships of Rakhine State. In this quarter, LLINs were distributed to 1,672 pregnant women who came to utilize antenatal care at 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.). Monitoring on LLIN coverage and utilization LLIN monitoring was conducted by using mobile tablets through Open Data Kit (ODK) application by township staffs but paper- based monitoring was continued by VMWs/PPs in some areas with conflict affected and security concerns. LLIN monitoring by township team was limited by COVID-19 threat and LLIN monitoring was conducted only at 53 villages in this quarter. LLIN coverage was found adequate in 41 out of 53 villages monitored (77.4%) and provided top-up of LLINs at the villages in gaps. LLIN monitoring at the Kyet Sar Chaung village Regarding LLIN utilization, 40 out of 53 villages monitored (75.5%) of Thandwe had the acceptable level of utilization (85% of people slept under LLIN in the previous night) and social behavior change communication for LLIN utilization were conducted with those who did not use LLINs. Table 5. LLIN Coverage and Utilization by State/Region (Apr-Jun 2020) applying ODK-based method State/Region # Villages LLIN Coverage LLIN Utilization monitored # (%) villages with # villages with # (%) villages with # villages with acceptable LLIN unacceptable LLIN acceptable LLIN unacceptable LLIN coverage coverage utilization utilization Tanintharyi 5 4 (80%) 1 4 (80%) 1 Rakhine (South) 14 11 (79%) 3 9 (64%) 5 Rakhine (North) 23 22 (96%) 1 22 (96%) 1 Kayin 8 4 (50%) 4 5 (63%) 3 Sagaing 3 0 (0%) 3 0 (0%) 3 Grand Total 53 41 (77%) 12 40 (75%) 13

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According to the findings, Defeat Malaria teams took the actions for topping up the LLIN gaps by distributing 1,046 LLINs and conducting 99 health awareness sessions to promote the utilization of LLINs. A total 613 people were reached in which 66.9% of them were females. Disposal of Medical Waste and LLIN Bags Emptied plastic bags of LLINs were disposed in accordance with the Environmental Mitigation and Monitoring Plan guidelines. It is communicated to communities to not use LLIN bags for any other purpose to avoid the risk of pesticide side effects. They are also instructed 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 the appropriate places at their villages, it is instructed to send the bags to the township office and then to Yangon for further incineration at Yangon Waste to Energy Plant. Table 6 shows an example of LLIN bags disposed at Northern Rakhine State as seen below: Table 6: Waste Disposal of LLIN Bags in Northern Rakhine Waste Disposal Report (LLIN bags after mass distribution)

# of villages # of LLIN bags # of LLIN bags # of LLIN bags # of LLINs distributed for disposed by stored at disposed by distributed Sr No. Organization Township Mass LLINs burial township incineration Apr-Jun 2020 1 URC Kyauktaw 0 0 0 0 0 2 URC Minbya 1 66 66 0 0 3 URC Mrauk-U 5 373 348 25 0 4 URC Myebon 4 789 789 0 0 5 URC Pauktaw 0 0 0 0 0 6 URC Ponnagyun 0 0 0 0 0 7 URC Sittwe 0 0 0 0 0 Northern Rakhine Total 10 1228 1203 25 0 ❖ 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 To provide quality malaria health care services to targeted communities and for refreshment training on malaria diagnosis and case management, ICMV trainings were conducted at the townships of Rakhine State by collaboration with township Vector Borne Disease Control (VBDC). The training agenda included not only malaria but also other communicable diseases like tuberculosis, dengue, lymphatic filariasis, STD/HIV, and Leprosy. In this quarter, 37 VMWs (30 males, 7 females) and 3 PPs (all male) attended a 3 day course on malaria laboratory diagnostics and case management, and a 2 day course on other communicable diseases. Out of 40 VMWs/PPs trained, 30 of them were Bengali people who were trained to serve for their communities. VMWs/PPs’ supervision In this reporting period, Defeat Malaria conducted 513 supervision visits to VMWs and PPs through the use of mobile tablets. The performance of VMWs/PPs were closely supervised by continuous on-job VMW Supervision at Thea Khaing Chang in VMW supervision at the village of Hpa- trainings. It is intended to ensure Gwa An

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patients’ safety, and for better scheduling and prioritization to immediate needs of repeated supervision. On-site supervision activities faced challenged during the COVID-19 threat, and as a result tele-supervision mechanism were developed as a risk mitigation measure. Field restriction of movement due to conflict by the township teams in Northern Rakhine State applied on-job supervision to some selected VMWs/PPs during the monthly meetings. 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 treatment provided by VMWs/PPs to the beneficiaries. The treatment provided for positive cases were checked whether all cases received the treatment according to National Treatment Guidelines. In this quarter, 1,050 out of 1,058 treated cases (99.2%) received correct antimalarial treatment according to the NTG, and 9 cases were referred to health facilities for further appropriate treatment. Most of the referred patients in pregnancy and infancy refused to go to health centers due to the COVID-19 threat. At that time, VMWs/PPs informed the township team to provide the treatment under close supervision, and the treatment to these patients were documented as deviations from the NTG. Case detection and treatment Figure 4: Malaria testing and positive cases found by providers (April - June 2020) During this reporting period, 58,556 50,000 2.2% 2.1% 2.5% people were tested by various 40,000 2.0% approaches including passive case 43,503 30,000 1.5% detection of VMWs, proactive case 1.0% detection of mobile teams, and 20,000 1.0% 6,860 engagement with the private sector. 10,000 4,787 3,406 0.5% 944 0.1% A total of 1,067 positive cases were 46 71 6 - 0.0% identified (118 P. falciparum, 946 P. Mobile VMWs PP Others vivax and 3 mixed). The overall Test Total Tested Total Positive TPR% Positivity Rate (TPR) was 1.82% (see Table 7). More specifically, mobile teams tested 4,787 people in project and non-project villages, VMWs tested 43,503 people, private providers tested 3,406 people, and all other providers tested 6,860 people (see Figure 4). In non-project villages, 25 positive cases (8 P. falciparum and 17 P. vivax) were found among 4,076 tested and in project villages 20 P. vivax cases were found among 711 tested. Although there were limitations for conducting active case detection (ACD) during COVID-19 threat, Defeat Malaria prioritized the areas and conducted ACD at 25 project targeted areas which have neither health facilities nor volunteer services, were seasonal and dispersed small settlements, high threat of malaria outbreak, and persistently high residual malaria transmission. ACD was also conducted at other 42 villages in need of malaria service by collaboration with respective township health departments. Table 7: Malaria testing by Defeat Malaria covered state/region (April - June 2020) State/Region Tested Total Positive P.f P.v Mix TPR% Tanintharyi Region 12,448 813 28 783 2 6.53% S. Rakhine State 13,615 32 26 6 0 0.24% N. Rakhine State 24,118 167 54 112 1 0.69% Kayin 3477 42 1 41 0 1.21% Sagaing 4,898 13 9 4 0 0.27% Total 58,556 1,067 118 946 3 1.82%

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Directly Observed Treatment (DOT) and patients’ compliance to DOT To prevent the spread of artemisinin-resistant malaria, Defeat Malaria applies DOT strategy to ensure full adherence to the antimalarial treatment achieving radical cure and to prevent onward transmission in malaria elimination. In this reporting period, 51.5% of the positive cases found (549 out of 1,067) were enrolled for DOT and 546 out of 549 patients (99.5%) enrolled in DOT completed their treatment. 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 treatment. As there have been frequent findings of errors in CareStart RDT testing, the proficiency of CareStart RDT is continuously monitored by collaboration with parasitology section of Department of Medical Research. In this quarter, 4 boxes of CareStart malaria RDT were collected per township from 12 out of 36 townships where Defeat Malaria activities are being implemented. The samples were taken from 7 townships of Rakhine (Minbya, Mrauk-U, Maungdaw, Ann, Toungup, Gwa, and Ramree), Pale township of Sagaing, Myawaddy township of Kayin and 3 townships of Tanintharyi (Bokpyin, Kyunsu, and Myeik) and sent to Department of Medical Research. ❖ 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 Malaria implementing partners mapping activitiesin Kayin and Rakhine States were not conducted due to COVID-19. Reaching out to forested worksites through the recruitment of Mobile Malaria Workers (MMWs) MMWs were mobilized from migrant workers to serve for their people at their remote forested worksites for provision of malaria prevention, diagnosis, and case management services. Additional interventions were suggested by the previous assessments done in FY 2019 to cover remote worksites with persistently high residual malaria transmission areas. By networking with nearby VMWs for reporting and replenishment of malaria commodities, 13 MMWs in Tanintharyi Region and 8 MMWs in Southern Rakhine State were contributing malaria diagnosis and case management activities.As a result, 82 positive cases were detected and appropriately treated according to NTG by testing 609 forest goers (TPR – 13.5%). ❖ 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) An evaluative study on the performance of highly sensitive RDT (hsRDT) confirmed by ultra-sensitive Polymerase Chain Reaction (usPCR) in reactive case detection of malaria was conducted from September 2017 to June 2019. Defeat Malaria further investigated the false positive samples (usPCR-/hsRDT+), for the presence of Histidine Rich Protein 2 (HRP2) to assess whether hsRDT+ results were truly positive. It was found that HRP2 concentrations were highest in the usPCR+/hsRDT+ group, followed by the usPCR- /hsRDT+ group. Using a sensitive HRP2 Enzyme-Linked Immunosorbent Assay (ELISA), we found only 3/21 samples of interest were HRP2-positive. Thus, 18/21 contact cases who tested positive by hsRDT may not have had detectable HRP2 levels at the time of sample collection and therefore had false-positive hsRDT results. It was concluded that hsRDT itself is more sensitive than conventional rapid diagnostic test (cRDT) but the false positive rate of hsRDT in this study is too high touse as the point of care tests in populations with low malaria burden. By the end of June 2020, the operational research activities collaborating with

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Duke University, Global Health Institute, has been successfully accomplished. The additional analysis on hsRDT (+) and usPCR (-) cases by ELISA report has been submitted to PMI and NMCP. Operational research on reducing malaria incidence in villages resided by forest-goers Field research activities for operational researchon “Impact of mosquito topical repellents and extended standard interventions on malaria control and elimination in Myanmar,” faced unforeseeable challenges such as the advent of COVID-19 and security concerns of armed conflict between Myanmar Army and Arakan Army in Rakhine State. Some research activities were implemented later than anticipated and some modifications have been made to study sites. Due to COVID-19, forest goer kit distribution was postponed from April 1, 2020 to May 10, 2020. During this time, weekly monitoring data was gathered using phone communications with VMWs. Field implementation has resumed since May 11, 2020 and social distancing was applied in all field activities. Although Kawthoung township was initiallytargeted for the study, baseline situation assessment revealed that there were no more malaria cases in the selected sites during 2019. Thus, it was decided to replaced Kawthoung township (ineligibility due to no malaria cases) and Ann township (reduction in number of study sites due to armed conflict)with Dawei and Thayetchaung townships. Amendments were submitted to the Institutional Review Board at the University of Public Health, Yangon. In this quarter, a total of 1,791 forest goers have been screened and 1676 were identified as eligible participants. Among them, 1622 forest goers gave consent to be involve in the study and 52 of them have refused. Study enrollment was completed in Palaw, Bokpyin and Tanintharyi townships. To date, 197 RDT tests have been conducted and 5 malaria positive cases have been identified among study participants, along with a total of 280 repellents that have been replenished. Using forest goers monitoring tool, study participants who have not received RDT testing and replenished topical repellents will be identified and encouraged to do so after Provision of malaria prevention kit to forest goer their forest visits. Objective 2: Strengthen the malaria surveillance system to comprehensively monitor progress and inform the deployment and targeting of appropriate responses and strategies. ❖ Strengthen the malaria surveillance system in line with malaria elimination, improve data management capacity at all levels of the health system, from village to central level, and support appropriate information technology to facilitate data collection, reporting, and use in both public and private sectors Advocacy meetings The plan to conduct malaria elimination launching at Kayin State and capacity building to the basic health staffs, hospital staffs and partners for malaria elimination trainings were pending under the threat of COVID-19 pandemic. However, it was successfully advocated to Kayin State Health Department for the application of updated guidelines on 14 days treatment of Primaquine for P. vivax. Routine surveillance activities In FY 2020 Q3, routine surveillance activities were continued with the support of the central technical team in Yangon. Unusually high occurrences of malaria areas and prevention of potential malaria outbreak

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areas were tracked continuously. VMWs/PPs have been instructed for immediate notification and reporting of high malaria occurrences to township team by phone. Township teams submits these unusual events to the Monitoring and Evaluation (M&E) Surveillance Officer through mail by using standard reporting forms. But there has been challenges that emerged with conducting immediate field investigation and appropriate responses of Defeat Malaria teams and VBDC staffs under COVID-19 threat. These areas have been marked beforehand for proactive case detection and performing prevention of potential outbreak, but township teams have instructed ICMVs to communicate through phone to conduct reactive case detection to the peers, family members and neighbors for weekly fever surveillance and reporting. Vigilance on increased occurrences of malaria cases during Apr-Jun 2020 In FY 2020 Q3, 1,067 positive cases were identified only in 28 out of 36 project townships. Further analysis revealed unusually high occurrence of malaria cases in some villages in the townships of Tanintharyi Region. Malaria cases detected fraction of Palaw and Thayetchaung was 49% of all malaria cases detected by Defeat Malaria and increased to 65% with the addition of Dawei and Bokpyin townships. In this quarter, case investigation was conducted for 210 cases in which 24 cases were contacted for investigation at Case investigation by Defeat Malaria with BHS their villages by the township teams, but the remaining 186 cases were investigated according to the simplified approach through the support of VMWs. Among 210 cases investigated, the cases were classified as indigenous (94 cases), introduced (one case), imported (109 cases), relapse (5 cases), and induced (one case) respectively. M&E Surveillance Officer coordinated with the central technical team and provided suggestions to respective township staff for undertaking appropriate responses. • At villages targeted for performing key surveillance activities of malaria elimination From January to June 2020, 102 positive cases were identified in 42 villages of areas targeted for performing key surveillance activities of malaria elimination. Malaria cases were identified more than one calendar month in 10 out of 42 villages under vigilance. Unusually high occurrence of malaria cases were noted in a 10-miles plantation worksite of Bokpyin, 4 villages of Thayetchaung (A Lae Su, Kyauk Aing, Win Ka Hpaw, and Laung Min Ba), and 2 villages of Yebyu (Mi Kyaung Hlaung -Ywar How and Hpar Chaung). Among 102 positive cases, case investigation activities could be conducted for 28 cases and classified as indigenous (4 cases), imported (20 cases), introduced (1 case), relapsed (2 cases) and induced (1 case). • At villages targeted for performing simplified surveillance interventions From January to June 2020, 97 positive cases were identified at 46 villages which were targeted for performing simplified surveillance interventions. Among 97 positive cases, simplified case investigation activities could be conducted for 23 cases and classified as indigenous (8 cases), imported (14 cases), and one relapse. Unusually high occurrences of malaria cases were noted in 2 villages of Tanintharyi Township (Chaung La Mu and Kywe Htein Kone), Pin Pwar Aw Ywar Thit village of Kyunsu, and 2 villages of Yebyu (Sin Thay and Kyauk Ka Din). The key challenge to conduct this approach was impossible to access the network. • At villages targeted for performing burden reduction interventions From January to June 2020, 844 positive cases were identified in 104 villages targeted for burden reduction interventions. Occurrence of ≥5 cases within 6 months was noted in 41 villages. Out of which,

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10 villages revealed high caseloads in comparison with previous years. In this quarter, intensive burden reduction activities were suggested to respective ICMVs and communities by telecommunication. • At villages with no accessible areas (armed attacks with unsafe, insecurity and restricted areas) For non-accessible areas, ICMVs were encouraged to test all fever cases, notify the communities about the seasonal rise of malaria cases, to test as soon as possible for all fever patients, to sleep under LLINs at night and to keep young children under protection of LLIN beginning in the early evening. From January to June 2020, high occurrences of malaria cases were detected in 2 villages of Bokpyin township (Chaung Phyar Garden and Ka Taw Chaung Phyar). Within 2 calendar months, 24 positive cases were detected among 73 tested in Chaung Phyar Garden and 7 cases detected among 22 tested in Ka Taw Chaung Phyar. All cases were P. vivax, and the test positivity rates (TPR) were very high (33%) for Chaung Phyar Garden and 32% for Ka Taw Chaung Phyar. By coordination with liaison office of ethnic group and by collaboration with township VBDC, Bokpyin township team conducted reactive case detection, LLIN top-up distribution, repellant distribution, and suggested ICMVs for weekly fever surveillance. Reporting status of VMWs/PPs 99.7% 99.6% 2,500 98.1%98.2% 102.0% 96.7% 97.7% 100.0% 2,000 95.5% 98.0% 96.0% 1,500 94.0% 88.8% 89.7% 92.0% 1,000 90.0% 88.0% 500 86.0% 84.0% - 82.0% Southern Northern Tanintharyi Kayin Sagaing Rakhine Rakhine # of VMW/PP reports to be submitted 1,471 1,527 2,228 645 563 # of VMW/PP reported 1,405 1,476 2,188 643 550 # of VMW/PP reported timely 1,247 1,428 2,146 577 548 % of reporting 95.5% 96.7% 98.2% 99.7% 97.7% % of timely reporting 88.8% 96.7% 98.1% 89.7% 99.6%

Figure 5: Reporting status of VMW/PP by State and Region The VMWs/PPs’ reporting status was continuously monitored to track for the sustaining of community- based malaria interventions through ICMVs especially during COVID-19 threat. During the reporting period, 6,262 (97.3%) out of 6,434 reports expected to be submitted by VMW/PP were received, of which 5,946 (95%) reports were received in timely manner (seeabove figure). Reporting status was not affected due to COVID-19, but timely reporting was slightly lower than the previous quarters. Routine Data Quality Assessment (RDQA) Figure 6: RDQA Coverage for 36 townships of Defeat Malaria implementing areas (April-June 2020)

12 10 8 5 7 6 4 4 2 2 5 3 3 5 0 2 0 Southern Northern Tanintharyi Kayin Sagaing # of townships townships of # Rakhine Rakhine

Target RDQA for conducted 10 7 10 4 5 Simplified RDQA 5 4 7 2 5 RDQA 5 3 3 2 0

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Due to the threat of COVID-19, central M&E team 6 5 developed a simplified RDQA tool for conducting 5 data quality assurance mechanism and circulated 4 3 3 the tool to the township teams for field 3 2 implementation. Township teams need to 2 conduct data verification processes by themselves 1 0 using simplified RDQA approach under the tele- 0 Tanintharyi Southern Northern Kayin Sagaing supervision of respective Data Quality Officer Rakhine Rakhine (DQO) or M&E Officer. If DQO or M&E Officer are not able to visit to the townships and simplified Excellent Adequate Poor RDQA is applied, but it will not replace the formal Figure 6: Status of RDQA conducted by DQO/M&E (April - RDQA if the situation is feasible to conduct RDQA June 2020) quarterly for all townships. During this period, 13 RDQAs were conducted by DQOs and 23 simplified RDQAs were conducted by township teams covering all 36 townships of Defeat Malaria implementing areas. Simplified RDQA verifies the reported figures against source documents for thereport availability, timeliness, and completeness.Overall, the simplified RDQAs atthe township level revealed that there was good data quality without minor or major data quality issues on the verified key performance indicators. Simplified RDQA creates self-awarenss of respective township teams for their data quality and DQOs/M&E Officers’ challenges for reaching all wnshipsto in this quarter during COVID-19 could be minimized. The 13 townships with RDQAs conducted by DQOs/M&E Officers showed that there was acceptable level status on M&E system and data quality. As the common findings in data verification, missing signatures of health staffs at the Rural Health Center level in source documents of LLINs distribution in villages and discrepancies in patient addresses were also verified. Pilot Malaria Elimination Activities Performance on pilot malaria elimination activities conducted in this quarter is described in Annex 6. ❖ 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. Residual malaria transmission assessment including entomological survey were not conducted in this quarter according to the NMCP guidance upon tailoring of malaria interventions during COVID-19. 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 Defeat Malaria Jhpiego together with the central technical and M&E teams reviewed and updated the training manuals for ICMV and for the General Trainers during COVID-19. A virtual training approach was developed by applying google form questionnaires to continue capacity building activities. Zoom application was introduced to organize virtual competency-based trainings and meetings to update the knowledge, strengthen skills and internalization. General Trainers Training was conducted for 11 Defeat Malaria staffs working at 9 townships of Sagaing and Tanintharyi Regions. The objectives were to

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provide multiple trainings to ICMVs in their townships. The training agenda included malaria prevention and case management, malaria elimination, and technical skills related to Dengue, Lymphatic Filariasis, Leprosy, Tuberculosis and HIV/AIDS. Despite the use of a virtual method to organize the training, all the trainees could be assessed for their facilitation skills by means of checklists. The trainees had to practice RDT testing by following the standard operation procedures and master mentors were coached by using the checklist. As a result, all the participants showed improvement at posttest Practicing malaria diagnostics by trainees from Pale Township compared to pretest in all training areas: basic malaria technical skill, training skill and community-based interventions. To ensure the facilitation skill of the trainers, Defeat Malaria Jhpiego supervised 6 Master Mentors during their general trainers’ trainings conducted from April to June 2020. Only two out of thirteen skills could not be supervised by virtual approach (namely eye contact and movement around the room). To assess the capacity of ICMVs trained by NMCP and Defeat Malaria, the first part ofthe assessment was conducted to 197 ICMVs in this quarter. However, only the first part could be assessed remotely by trained interviewers using telecommunication, and the remaining second module of face to face interviews is planned to be completed in the coming quarters. The analysis of findings and recommendations will be reported to NMCP for further necessary actions. During this reporting period, a total of five ICMVs (Toungup-1, Gwa-1, and Thayetchaung-3) were supervised jointly for coaching and mentoring by Township Malaria Inspectors and Field Capacity Development Officers (FCDOs). Furthermore, FCDOs of Jhpiego, together with State/Region and Township VBDC staff, supervised total 36 ICMVs to assess their knowledge level and technical skill such as RDT testing, data management and stock management skills. ❖ Strengthening surveillance system by supporting NMCP on tools, equipment, telecommunication cost, capacity building and HR development Although Defeat Malaria supported MoHS for conducting Field Epidemiology Training Project (FETP) and coordination and launching meeting, the training activities have been pending in this quarter dueto COVID-19. Eighteen medical doctors who have already accomplished FETP are now being mobilized in the field epidemiological surveillance activities for providing appropriate responses to the current prevailing COVID-19 pandemic. They have been working in collaboration under the guidance of Central Epidemiological Unit and respective State/Region Public Health Departments. In this quarter, Defeat Malaria provided 6 laptops and 2 printer machines to Sagaing VBDC Regional Officer for database strengthening by linking with web-based surveillance system to be used at the regional level and in 5 townships for Sagaing Region, and 2 laptops ICMV trained and supported by Defeat Malaria involved in to Rakhine VBCD where Defeat Malaria is COVID-19 awareness session

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collaborating malaria control and elimination activities. Sagaing Region Health Department has also expressed their desire for support with elimination activities to be implemented in Pale township by Defeat Malaria. Capacity building to basic health staffs, VBDC staffs and hospital staffs for operationalization of malaria elimination activities were discussed. efeatD Malaria shared the experiences of pilot malaria elimination activities and discussed collaborative activities. 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 In this quarter, the Senior Management Team (SMT) members reorganized by 11 primary members and 10 secondary members. The chairman of SMT, Dr. May Aung Lin, introduced the team and addressed the updates of Defeat Malaria. He appreciated all the contributions of Defeat Malaria partners for the effective and efficient implementation up to Year 4. As Defeat Malaria activities will end on 14th August 2021, it will be important to emphasize SMT meeting is conducted at Defeat Malaria Yangon office sustainability of Defeat Malaria activities and osecl -out activities to be included in Year 5 workplan activities. Community Support Group (CSG) formation and implementation guide was endorsed and all SMT members agreed to apply CSG guide for further CSG funding processes. But the SMT suggested to develop CSG proposal review merit and due diligence checklist. Human Resource issues were also discussed, including high turnover of staff in Rakhine State (brought up by MNMA) and suggestion of prioritizing the recruitment of native staffs. ARC discussed the recruitment of Community Facilitators for full-time employment versus consultancy, which was agreed by all SMT members. Defeat Malaria activities were reviewed during COVID-19 and community-based malaria interventions were found to be sustained. It was discussed about the COVID-19 situation and the importance of communication channels to be activated at all level. Jhpiego shared the experiences of continuation of training activities through virtual approach for pursuing the planned activities. URC shared the information about the development of ICMV interim guideline during COVID-19 pandemic to be utilized by all Defeat Malaria field staffs and ICMVs. Engagement with EHO For universal coverage of malaria service provision, regular engagement with and support to EHO is the key to undertake malaria control and elimination activities, especially along Thai-Myanmar border. Malaria prevention through LLIN utilization among hard-to-reach ethnic minorities, provision of malaria

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commodities to EHO for early diagnosis and standard treatment of malaria are essential for narrowing the epidemiological landscape. Logistic support, capacity building and participatory discussion between Defeat Malaria and EHO are important aspects of collaboration for reaching malaria elimination goals. Defeat Malaria met with Deputy Director and Logistic Manager of BPHWT at Yangon on 8th June 2020. Durining this meeting, Defeat Malaria presented about malaria control and elimination activities bring implementing at 36 townships of Myanmar. BPHWT also explained about 100 BPHW posts, each post is composed of 3-5 members covering about 2,000 people. The BPHW posts are spread out at about 34 townships, mostly in Kayin State (>50 posts), Taninathryi (7 posts), and other states th Defeat Malaria URC hosted BPHWT at Yangon office on 8 June 2020 and regions. Malaria transmission and decreasing trend of malaria over the past years were noted, along with heterogeneity of malaria transmission among forest dwellers and forest goers. Malaria is seasonal and usually high in the rainy season. Defeat Malaria discussed about high malaria burden townships of Hpar- pun and Kyainseikkyi where ethnic health organizations are mainly implementing malaria control activities. Due to restriction of movement, the capacity building to BPHWT about community-based malaria interventions by Defeat Malaria will be scheduled in the appropriate time in the next quarter of 2020. The gaps of Ethnic Health Organizationswer e discussed in how to integrate them into the Year 5 Workplan for continuous support. Defeat Malaria also provided BPHWT with 46,400 LLINs for utilization in high malaria transmission areas, 21,000 RDTs (Care Start Malaria P.f/P.v) for the diagnosis of suspected malaria cases, 1,435 strips of ACT drugs, 21,000 Primaquine tablets, 8,200 150 mg Chloroquine tablets, 8,200 250 mg Chloroquine tablets, and 350 Job aids for malaria treatment guidance. COVID-19 information was shared and some COVID-19 posters of generic, handwashing steps, and cough etiquette were provided to BPHWT. Community Engagement Activities As of June 2020, preliminary assessments were conducted at 69 villages and 35 CSG have been formed in 3 townships of Tanintharyi Region (Dawei, Bokpyin, and Launglon), 4 townships of Kayin State (Myawaddy,

CSG Forming at War Taw village in Dawei CSG Forming at Ta Ya Ba in Toungupo

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CSG Forming at Kyauk Maung Hna Ma in Toungup CSG activity at Kyauk Maung Hna Ma village in Toungup Hpa-An, Hlaingbwe, and Kawkareik), and 1 township of Southern Rakhine State (Toungup). During this period, field teams conducted 4 preliminary assessments and 4 CSG forming meetings at Dawei and Launglon townships of Tanintharyi Region and Toungup of Southern Rakhine State. ❖ 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 Social and Behaviour Change Communication (SBCC) assessment Defeat Malaria conducted qualitative assessment nested on quantitative finings to identify SBCC gaps and for the improvement of SBCC strategies for community behavior impact. Quantitative assessment was a cross-sectional descriptive study using multistage cluster sampling and conducted between June 2019 and February 2020. Study populations were from endemic areas of Defeat Malaria covering 30 villages among Kayin, Southern Rakhine State and Tanintharyi Region. Due to political insecurity and transportation challenges, Northern Rakhine State was not included in this study. Since March 2020, qualitative assessment was started by outsourcing to freelance consultant team to complement the findings of quantitative assessment and for in-depth understanding on community perception and practices and behaviors toward malaria control and elimination (accomplished in June 2020). Health belief model was applied and 8 Focus Group Discussion, 4 one to one interviews and 16 Key Informant Interview (KII) were done in 6 villages from Tanintharyi, Kayin and Rakhine State with deviant sampling method using the criteria of “low knowledge, minimal practice of LLIN use, and treatment seeking more than 24 hours” related to malaria prevention, care and treatments based on quantitative findings. Recommendationswere : 1) SBCC approach should be modified and tailored to meet the particular needs of specific marginalized groups; 2) capacity of project staff and volunteers needs to be strengthened for community participatory approach applying Participatory Learning and Action methods; 3) malaria prevention messages should be reiterated to be more graphic, less text and audience attention oriented; 4) specific support should be provided to key population, mobile and migrant workers (e.g., forest goer kit with malaria prevention key messages); 5) malaria education program should be targeted to change men behaviors since men are at a high risk due to working situations, inconsistence use of LLINs with various reasons; and 6) the appreciation of community for the regular health talks and health education sessions provided by health staff during mass and continuous LLIN distribution. Based on the findings and recommendations of SBCC assessment, Defeat Malaria will develop an updated SBCC guide in designing community participation for empowerment. Capacity building trainings will be provided to field operation staffs for their contribution towards community empowerment and impact.

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❖ 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 practitionersGP ( ) and non-formal private providers (NFPP) The role and involvement of General Practitioners, drug stores and NFPPs are important in the malaria elimination activities. Due to COVID-19 GP clinics have been closed since April 2020. Some GP doctors were government staff and the clinics were closed upon their transfer. Some clinics were reopened only after May 2020. From 3 pilot malaria elimination townships, 11 General Practitioners tested 68 suspected malaria cases, but no positive result was seen in this quarter. Regarding trained private providers in elimination townships, a total of 22 private providers tested 297 suspected malaria cases and detected 1 P.f and 1 P.v cases. In this quarter, 6 out of 16 NFPPs referred 7 suspected for malaria cases to nearest health facilities and VMWs for malaria diagnosis and management. All suspected cases accessed to VMWs and received necessary services for malaria. Defeat Malaria also engages with 30 drug stores for Joint visit to GP by NMCP and Community appropriate referral to nearest health services. Facilitator of Defeat Malaria in Toungup Table 8: Involvement of PPs, GPs and NFPP in 3 Elimination Townships (Apr.-Jun. 2020) Types of No. Functioning Functioning Status by FY2020 Q3 (Apr-Jun 2020) private Townships providers Toungup Ramree Manaung Refer Tested Positives Pf Pv Mix TPR% Trained PPs 24 22 20 2 0 297 2 1 1 0 0.67% GPs 25 11 6 3 2 68 0 0 0 0 0% NFPP 16 8 8 0 0 7 Engagement with private companies In this reporting period, Defeat Malaria continuously engages with 53 companies in 10 townships of Tanintharyi, Rakhine and Kayin. Due to COVID-19, field teams could not conduct mobile visit and health awareness sessions as planned. Some of the companies have left upon completion of their work. Currently, 105 VMWs/PPs from 53 private companies have tested 1,976 people for malaria (1,150 males and 826 females), and treated 26 malaria cases (15 males, 11 females). All malaria cases were P. vivax and detected in the areas of Tanintharyi Region. Regarding malaria prevention, 355 LLINs were distributed and only 4 health awareness sessions could be conducted.

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Annex 1: COVID-19 Situation in Myanmar (As of 30th June 2020)

The first case of COVID-19 was detected on 23rd March 2020. There were 6,674 facility quarantine centers where cumulative number of 27,725 people were quarantined up to the end of June 2020. All COVID-19 positive cases were isolated at State/Region hospitals. Similarly, 5,950 persons under investigation were also admitted at State/Region designated hospitals.

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Although 70% of cases were detected in Yangon, there were no local transmission cases within Yangon since 17th May 2020 until 30th June 2020. All travelers from other countries or other States/Regions were quarantined at facility quarantine centers at respective townships for 21 days. WHO classified the level of occurrence of COVID-19 in Myanmar as clusters of cases on 10th April 2020 and the situation was well controlled until 30th June 2020. COVID-19 tests were applied to persons under investigation (those with COVID-19 symptoms), close contacts of COVID-19 cases, and travelers from local spread of COVID-19 areas in term of high-risk screening approach. COVID-19 related indicators of Myanmar for a population of 54.43 million (as of 30th June 2020): • Cases per 1 million population – 6 • Deaths per 1 million population – 0.1 • Tests per 1 million population – 1,402 Key responses and the timelines started to be effective: • Started community-based facilities quarantine (22nd March 2020) • 14 days quarantine for incoming travelers from other countries (24th March 2020) • Entry ban for all countries (31st March 2020) but there were managed entries from Thailand and neighbor countries through border gates and relief flights • Extended the period of quarantine at designated facilities (including incoming travelers from other countries or other States/Regions of Myanmar) from 14 days to 21 days (11th April 2020) • Lock down and stay home restriction at 7 townships of Yangon (18th April 2020)

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• Lock down restriction eased at 5 townships on 14th May, 4 townships on 28th May and one remaining township of Yangon on 27th of June 2020 • Extension of restriction (stay home for general population, social distancing or use of mask, avoid social gathering, etc.) till 30th June 2020 (12th June 2020) • Extension of restriction till 15th July 2020 (27th June 2020) • Extended the ban on international commercial flights up to 31st July 2020 (28th Jun 2020) References 1. https://mohs.gov.mm/page/9575 CEU-DOPH-MOHS Myanmar (2020). Coronavirus Disease 2019 (COVID-19). Central Epidemiological Unit. Department of Public Health. Ministry of Health and Sports, Myanmar. 2. https://mohs.gov.mm/page/9575 CEU-DOPH-MOHS Myanmar (2020). COVID-19: Situation Report 86 (30 June 2020)

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Annex 2: Interim Guideline for ICMVs during COVID-19 Pandemic National Malaria Control Programme (NMCP) developed and shared the guidance on “Tailoring Malaria Intervention in the context of COVID-19 in Myanmar” at the Technical Strategic Group (TSG) meeting conducted on 8th May 2020. Defeat Malaria developed ICMV interim guideline during COVID-19 pandemic in the local language and shared with the township teams including all Defeat Malaria partners by interactive virtual discussion meetings for further convincing to all ICMVs to continue and sustain community-based malaria intervention activities. The guideline was intended for the safety of frontline health workers, called ICMVs, in performing community-based malaria interventions and it is to be followed by all ICMVs supported by Defeat Malaria. • The introduction describes the do and don’ts measures for prevention of COVD- 19 infection among all ICMVs and explains the importance of continuation and sustaining of community-based malaria interventions (Pg. 1). • Regarding malaria diagnosis through RDT testing, active case detection activities Cover page of ICMV Interim Guideline during COVID-19 are to be followed under the guidance of respective township health department (Pg. 2). • Key symptoms of malaria were contrasted with those of COVID-19 and recommended immediate notification to nearest health facilities if any COVID-19 suspected patients were found (Pgs. 3-6). • Blood testing by applying social distancing, taking infection prevention and control measures through use of mask, use of face-shield, handwashing, and use of hand-sanitizers. • Regarding health awareness sessions, avoid gathering of more than 5 audiences and it is encouraged to apply loudspeakers if local leader is assigned to ICMVs (Pg. 7). • Key messages related with COVID-19 to share with the communities include: o key symptoms (Pg. 7) o mode of transmission (Pg. 8) o 10 key messages for prevention (Pg. 9) o use of masks (Pg. 10) o handwashing steps (Pg. 11) o general preventive measures (Pg. 12) o avoid crowds and applying social distancing measures. (Pgs. 7-14) • Regarding LLIN distribution, it should be arranged to distribute LLINS by a group of no more than 3 people for door to door distribution by using masks, after handwashing or using hand sanitizer and applying social distancing (Pg. 15).

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Symptoms of COVID-19 (Pg.7) IEC material on hand-washing steps (Pg.11)

IEC material about COVID-19 preventive messages IEC material on the importance of social distancing (Pg.12) (Pg.14)

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Annex 3: Communication with ICMVs and Community During COVID-19 Why community involvement is important in malaria control and elimination during COVID-19? 1. Community involvement in malaria control and elimination is more important during COVID-19 pandemic due to travel restriction and movement control as there are some challenges for the outreach service provision of Township Health Department and Implementing Partners. 2. Myanmar achieved the reduction of malaria cases and deaths by 90% and 97% respectively between 2012 and 2019. 3. Moving towards malaria elimination goal should not be derailed as a lot of investment has been made and the continuation of commitment is the key for pursuing elimination milestones. 4. Continuous empowering the community and strengthening of local capacity is sustainable. 5. Expressed needs of the community for worrying about the threat of COVID-19 should be appropriately tackled in a collaborative way and we should try to support meetings with the health needs of the community for continuation of reducing morbidity and mortality of common prevailing health problems including malaria. 6. Advocacy is critical as commonly prevailing health problems including malaria are as important as COVID-19 infection. 7. It is important for community involvement in malaria control and elimination especially for: a. high malaria occurrence areas (more than 5 cases within a village in a month); b. persistently high residual malaria transmission areas; c. potential malaria outbreak areas (Unusual high occurrence of malaria in the previous year) needing proactive actions before malaria season; and d. active foci areas (especially in malaria elimination townships). Principle of communication 1. Telecommunication in group calls involving village leader(s), ICMV, township staff(s), community facilitator, and community moderator (PPM Coordinator or Township Coordinator) 2. Telecommunication should be scheduled at least 2 or 3 days in advance 3. The communication should not take more than 30 minutes. If there is needs to discuss more issues, please make another appointment for continued communication at a separate time. 4. The communication must be clear, factual, simple, transparent, and realistic. Communication about malaria and COVID-19 infection • Malaria is one of the common communicable diseases of Myanmar and COVID-19 is the newly emerging disease of the world started from Wuhan City of China. • Globally, over 300-600 million people suffered from malaria each year and over 1.9million people suffered from COVID-19 infection within 4 months up to the end of April 2020. • Over 1 million people died from malaria each year and over 230,000 people died from COVID-19 infection within 4 months up to the end of April 2020. • Essential malaria services should be continued for sustaining the gains along with using appropriate protective measure to the frontline healthworkers (ICMVs) and Defeat Malaria staffs for: • Testing of suspected cases of malaria by RDTs • Effective treatment following national malaria treatment guideline (NTG) • Prevention of malaria among pregnant women • Referral of severe malaria cases • Continue LLIN distribution to vulnerable population including forest goers, pregnant women, new settlements, and mobile migrant populations

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• To continue reporting, case investigation and foci investigation by applying appropriate protective measures and social distancing approaches. Data analysis and sharing is to be continued through virtual or phone communications • To take immediate actions for increased in number of cases and any occurrence of death; and • Supervision by virtual or telecommunications were encouraged for motivational support to and promoting the performance of ICMVs. Communication about similarities and differences between malaria and COVID-19 • Similarities and differences between malaria and COVID should be communicated as malaria is curable (by taking Artemisinin-based combination therapy or Chloroquine with Primaquine treatments) and preventable (by LLINs and repellents), and COVID-19 is preventable (by mask, social distancing, handwashing, etc.) while vaccine and drugs are under trial. Description Malaria COVID-19 Chain of disease transmission - Both are communicable diseases Agent Malaria Parasites - Plasmodium Severe acute respiratory syndrome - species (P.f, P.v, P.o, P.m) Coronavirus 2 (SARS-CoV-2) Reservoir Human or Mosquito Human, Bat, Civet, and other animals (Symptomatic or asymptomatic) (Symptomatic and asymptomatic) Mode of exit At the site of mosquito bite Coughing, Sneezing, (Talking) Mode of • By the bite of infected • Direct respiratory droplet (5-10 μm in Transmission female anopheline size within 3 feet at the time of mosquitoes coughing and sneezing) • Person to mosquito to • Indirect airborne (droplet nuclei having person particle size < 5 μm) • Contact with contaminated objects • Person to person Mode of entry At the bite of site through skin • Through nose by inhalation, and through eye and mouth by touching Environment - High receptive areas • Dormitory (numerous mosquito larva • Air-conditioned rooms breeding sites, forested areas, • Airplane and forest fringe), • Social gathering places - High vulnerability areas (population mobility) Susceptible - Any age and sex • Any age host - Forest goers and nighttime • Both sex but men are more suspectable workers, thus more in men • Within 14 days travel from local - Pregnant women and children transmission areas are more vulnerable • Having cardiovascular diseases, - Those who do not sleep under diabetes mellites, respiratory diseases, LLINs cancer Incubation P.f – 9 to 14 days • 2 to 14 days (95% Confidence Interval) period P.v – 12-17 days • 0-21 days (98% Confidence Interval) Gametocyte P.f – 7 – 15 days • Not relevant formation P.v – 1 – 7 days History

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Travel history During last 9-14 days for P.f and During last 2 weeks 12-17 days for P.v ✓ Abroad ✓ Endemic areas ✓ Local transmission (Yangon) ✓ Hot spots ✓ Forest worksites Common symptoms Chills & rigor + + Muscle pain + + Headache + + Diarrhea (+/-) (+/-) Cough (+/-) + Sore throat - + New loss of - + taste or smell Nausea, + + vomiting Anemia & + - Jaundice Severe Renal failure, mental confusion, Fast or difficult breathing, pneumonia, complications coma ARDS Diagnosis, Key Interventions and Outcomes Diagnosis • Diagnosed by malaria RDT at • RT PCR (Reverse transcription the point of care by taking polymerase chain reaction) Or Nucleic blood (finger prick) acid amplification test • Microscopy test • IgM/IgG RDT (Antibody test) Key • Slept under LLINs • Prevention by social distancing, use of interventions • Early diagnosis by RDT mask and handwashing • Treatment by ACT, CQ, PQ • No vaccine yet (NTG) • No curative treatment yet Notification • It is notified by health care • It is notified by any persons who persons in malaria elimination identified COVID-19 suspects in all areas townships Quarantine • Not applied Quarantine is applied 21 days to • close of contacts of COVID-19 identified cases • travelers from local transmission areas (within or outside countries) • Person under investigation for COVID- 19 suspected cases Isolation Malaria cases should be • COVID-19 cases are isolated from stayed/slept under LLIN to avoid others at home or hospital until any mosquitoes’ bites for the recovery for 14 to 21 days to prevent first 4 days of treatment to further local spread in the defined prevent of onward transmission community. Contact Done at the time of reactive case Close contacts of COVID-19 identified cases tracing detection in elimination areas

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Mortality rate Mortality will be very high for P.f 3-4 % of infected cases infection if untreated Monitoring on communication of township team with ICMVs and Community Defeat Malaria central program and M&E team reached out to all focal staffs of townships, states/regions, and partners (ARC, MHAA, and MNMA) for convincing the importance of effective communication with communities by virtual meetings. Then weekly tracking tool for monitoring of sustaining Defeat Malaria activities was applied and activated in the month of May 2020. Community-based interventions of ICMVS were noted as well functioning, and routine reporting mechanism has been resumed and weekly tracking of Defeat Malaria activities was discontinued ni June 2020.

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Annex 4: Administrative management during COVID-19 Pandemic Administrative events and management timeline WHO declared COVID-19 as pandemic on 11th March 2020 and the first case of COVID-19 in Myanmar was detected on 23rd March 2020. WHO classified the level of COVID-19 in Myanmar as cluster of cases on 10th April 2020 and the situation was not advanced until 30th June 2020. Defeat Malaria has drawn up the following contingency and continuity plans in March 2020: 1. Business contingency and continuity plan of Defeat Malaria during COVID-19 pandemic 2. Risk mitigation plan of ICMVs in the community and 3. 60 days Defeat Malaria workplan activities for April-May 2020 Defeat Malaria activities were continued according to the level of COVID-19 transmission, the announcements of Central Committee for Prevention, Control and Treatment of COVID-19, the orders of Coronavirus Disease 2019 (COVID-19) Control and Emergency Response Committee, the guidance of Ministry of Health and Sports, the restrictions imposed by local authorities, and sensitivity of the communities. Warden trees have been drawn-up and activated since 24th March 2020. All 304 Defeat Malaria staffs including partners were communicated by phone daily to notify immediately for any occurrences of COVID-19 suspects and infections among the staffs. COVID-19 updates and announcements of the Ministry of Health and Sports were shared daily by email. BCC Officer and Sub-Grant Officer were assigned as the hubs for warden communication. Timeline Administrative Events and Activities Apr. 01 – 09 • Routine office and field activities were undertaken. • The operation plans targeted for sustaining of community-based malaria interventions through ICMVs in all situations. • Field operation emphasized to be no stock-out of malaria commodities at ICMVs and township teams provided adequate stocks for 2 to 3 months of consumption based on malaria situation of the areas and possible influx of mobile migrant population especially during long holidays of Myanmar New Year and the advent of COVID-19 threat. Apr. 10-20 • Holidays of Myanmar New Year • Lock-down in 7 townships of Yangon including Defeat Malaria Office and stay home orders announced on 18th April 2020 Apr 21-30 • Lock-down in 7 townships of Yangon including Defeat Malaria Office and stay home orders. • Key positioned staffs of Defeat Malaria meet daily for vigilance of COVID-19 situations in all implementing areas, continuation of Defeat Malaria activities and continuous communication with respective township teams and partners. • Work from home for FY 2020 quarter 2 report verification and report preparation. • Submitted quarterly report on 30th April 2020 to PMI • After long holidays of Myanmar New Year, 35 staffs (11.5% of all 304 staffs) going back to duty stationed townships across States/Regions were being quarantined at the facilities and home for 21 days.

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May 01-15 • Lock-down restriction eased in 5 townships was announced on 14th May 2020. • Developed ICMV interim guideline during COVID-19. • Established enabling environment for the workplace of all Defeat Malaria office according to the guiding announcement of Central Committee for Prevention, Control and Treatment of COVID-19 (thermal screening, use of hand sanitizer, use of masks, social distancing setting of workplace, regular cleaning and disinfecting, case notification and response). • Procurement of Personal Protective Equipment and infection prevention and control items for staffs and ICMVs (surgical mask, alcohol-based hand sanitizer). • Daily office attending of key positioned staffs and managing to all staffs through telecommunication, email, and virtual meetings. All sectoral directors were regularly communicated with work from home staffs for daily and weekly target settings and tracking. • During work from home, staffs were encouraged to register for attending WHO online course for infection prevention and control of COVID-19. • Non-local township staffs were returned to duty stations upon the opening of express bus and transport channels and being quarantined at designated community-based facility quarantine centers according to local rule of respective townships May 16-31 • Lock-down restriction eased in 4 more townships was announced on 28th May 2020. • Daily office attending of key positioned staffs and managing to all staffs through telecommunication, email, and virtual meetings. All sectoral directors were regularly communicated with work from home staffs for daily and weekly target settings and tracking. • 50% of staffs from each sector were scheduled to work at office and another 50% of staffs were worked at home alternatively according to the guidance of Central Committee for Prevention, Control and Treatment of COVID-19. • Defeat Malaria central teams communicated with all field teams and partners for convincing the importance of continuation of Defeat Malaria activities amidst of COVID-19 infection, explained about ICMV interim guideline by virtual meetings and updated clear and correct information about COVID-19. • Defeat Malaria communicated with UNICEF by the coordination of USAID, IEC materials about COVID-19 were requested. • Field operation teams communicated with ICMVS about the importance of continuation of Defeat Malaria activities amidst of COVID-19 infection, explained about ICMV interim guideline by phone and during stock supply and report collection • Procurement of Personal Protective Equipment and infection prevention and control items for staffs and ICMVs (Surgical mask, reusable cloth mask, face- shield, alcohol-based hand sanitizer). Jun 01-15 • Lock-down restriction eased in one more township was announced on 14th June 2020.

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• Daily office attending of key positioned staffs and managing to all staffs through telecommunication, email, and virtual meetings. All sectoral directors were regularly communicated with work from home staffs for daily and weekly target settings and tracking. • 50% of staffs from each sector were scheduled to work at office and another 50% of staffs were worked at home alternatively according to the guidance of Central Committee for Prevention, Control and Treatment of COVID-19. Jun 16 -30 • All Defeat Malaria staffs were resumed to office attending • Field operation activities has been implementing by applying social distancing, use of masks, and taking infection prevention and control measures

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Annex 5: Situation of Rakhine State (as of 30th June 2020)

There are 17 townships in Rakhine State which is situated in the western coast of Myanmar. It borders with Bangladesh in the north, Bay of Bengal in the west, Paletwa township of Chin State in the north-east, Magwe and Bago Regions in the east, and in contact with Ayeyarwaddy Region in the south. Paletwa of Chin State is one of the highest malaria morbidity townships in Myanmar. The conflicts between Myanmar Armed forces and Arakan Army continued through the reporting period. According to the map created by United Nations Office for the Coordination of Humanitarian Affair (UNOCHA) on 21st June 2020, there were around 70,000 internal displaced people (IDP) in 155 IDP sites within Rakhine State. Local security situations of Defeat Malaria implementing areas reported by ICMVs and Defeat Malaria teams of Rakhine State • # of townships affected by armed conflict -13 (except Thandwe, Gwa, Munaung, and Maungdaw) • # of villages affected directly by armed attacks – 376 out of 1,797 villages of project areas • # of villages displaced due to armed conflict – 36 villages • # of townships with internet shutdown – 7 townships namely Buthidaung, Rathedaung, Ponnagyun, Mrauk-U, Kyauktaw, Minbya and Myebon • # of townships with field movement restriction for township team – all 10 townships of Northern Rakhine State (need prior approval from Rakhine State Coordination Committee) • One non-formal private provider (NFPP) who has been engaged by Defeat Malaria for referral of malaria cases in Toungup was assassinated • In April 2020, WHO driver staff transporting COVID-19 swabs was killed in Minbya as vehicle attacked by unknown armed group Reference: UNOCHA. Myanmar (2020). Myanmar Armed Forces & Arakan Army Conflict-generated Displacement in Rakhine and Chin States (As of 21 June 2020). United Nations Office for the Coordination of Humanitarian Affairs.

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Annex 6: Performance on Pilot Malaria Elimination Activities (Apr.-Jun. 2020) Toungup| Ramree| Munaung 1) Meetings and trainings conducted during April – June 2020 Malaria Elimination Coordination Committee (MECC) meetings Quarterly MECC meetings were pending due to the restriction of gatherings at the advent of COVID-19 pandemic. Monthly township collaborative meetings Township level monthly collaborative meetings between township vector-borne disease control (VBDC) staffs and Defeat Malaria were conducted regularly and for the following objectives: 1. To tackle operational challenges for overcoming and deciding possible solutions; 2. To track and supervise non-reported villages; 3. Collaborative data verifications between VBDC and Defeat Malaria; and 4. Ensure to support mobile migrants’ worksites.

Table 1: Monthly township collaborative meetings Sr. Township Date of meeting Male Female Total 1 Munaung 29-Apr-20 4 0 4 2 Munaung 28-May-20 5 0 5 3 Toungup 5-Jun-20 7 1 8 4 Ramree 10-Jun-20 3 0 3 5 Munaung 23-Jun-20 4 0 4 6 Ramree 29-Jun-20 9 1 10 2) Reducing the risks of importation of malaria parasite from mobile migrant population Vulnerability monitoring plays a significant role in low malaria transmission settings with the aim of reducing the risks of importation of malaria parasites from mobile migrant populations. Defeat Malaria in collaboration with township health epartmentd conducted proactive cases detection, migrant monitoring, screening of malaria and provision of malaria prevention services at seasonal mobile migrant worksites. During this quarter, Ramree team explored malaria situations of two construction worksites. The team assessed receptivity, vulnerability, quality of health care services and behaviors of those migrant workers and took appropriate actions upon the findings of malaria services gaps. Table 2: Summary of proactive case detection and LLIN distribution at Ramree Township Sr. Name of worksite Date of Population RDT tested Positive # of LLINs assessment Results distributed 1 Kyat Tha Brick 2/6/2020 & 47 45 0 8 Production Worksite 17/6/2020 2 Hospital Construction 15/6/2020 18 13 0 6 Worksite 3) Malaria surveillance activities Due to restriction of movement to the fieldunder COVID-19 threat and order, thorough foci investigation activities could not be conducted, but continuous telecommunication with respective ICMV to perform

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further onward malaria transmission is conducted as much as possible. No malaria cases were detected in Ramree and Munaung townships.

Table 3: Summary of malaria case-based surveillance (Apr-Jun 2020)

ed Cases ed

Indigenouscase

f v

Township

. .

Tested Positive P P Mixed of notified # cases of investigat # of Imported # case of Introduced # case of # of Relapse # case of Recrudescence # case Inducedcase Crypticcase Toungup 3,112 5 2 3 0 5 5 3 0 2 0 0 0 0 Ramree 3,284 0 0 0 0 0 0 0 0 0 0 0 0 0 Munaung 1,903 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 8,299 5 2 3 0 5 5 3 0 2 0 0 0 0 In this reporting period, there were 5 malaria cases detected in Toungup township. All malaria cases were notified within 24 hours of detection and case investigation activities were conducted and classified as2 indigenous and 3 imported cases. The 2 indigenous cases were from Let Yar Taking and Upper Kyauk Ta Gar villages and those villages were classified as active foci. Among 3 imported cases, 2 cases were contracted from other villages within the same township and another case got infections from forested worksites near Pa De Kyaw village of adjacent Ann township. Table 4: Provider-based surveillance report (Apr– Jun 2020) Toungup Ramree Munaung Total Types of Providers Tested Positive Tested Positive Tested Positive Tested Positive Basic Health Staff 1,421 1 1,262 - 1,836 - 4,519 1 Hospital 50 - 13 - 20 - 83 - General Practitioner 11 - 48 - 9 - 68 - Non-Formal Private 244 2 36 - - - 280 2 Provider (NFPP) Village Malaria Worker 1,262 1 1,867 - - - 3,129 1 Defense Medical - - - - 37 - 37 - Service Mobile Teams 124 1 58 - 1 - 183 1 Total 3,112 5 3,284 - 1,903 - 8,299 5 Table 5: Reporting status of surveillance units in three townships (Apr-Jun 2020) Township Number of reporting units # of reporting units # of zero reporting or (Villages/Worksites)* reported non-reporting units Toungup 720 (240 villages * 3 months) 623 (87%) 97 (13%) Ramree 684 (228 villages * 3 months) 630 (92%) 54 (8%) Munaung 417 (139 villages * 3 months) 403 (97%) 14 (3%) Total 1,821 (607 villages * 3 months) (1,656 (91%) 165 (9%) Although Defeat Malaria practices monthly reporting of ICMVs at monthly meetings, NMCP conducts monthly reporting of ICMVs through basic health staffs and mets with ICMVs quarterly.

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Defeat Malaria township teams met with township VBDC to track zero-reported villages and late reported villages for scheduling of prioritized supervision. If the reports received from previously non-reporting units after follow-up supervision, late reports are incorporated in the later months. Monitoring on weekly regular ACD rounds One of the malaria surveillance activity apart from passive case detection of health facilities and ICMVs, weekly regular active case detection (ACD) rounds by Basic Health Staff (BHS) were applied for some villages with smaller population where deployment of ICMVs are difficult. Table 6: Weekly active case detection for strengthening of surveillance

Township # of villages # of villages # of villages # of villages targeted for reached for ACD reached for 4 reached for ACD round times of ACD weekly regular

present ACD round # of BHS #

ACD round ACD (% of total) # of villages # assigned for Apr May Jun Apr May Jun Apr May Jun Toungup 240 22 24 (10%) 17 20 22 12 10 18 6 4 6 Ramree 228 11 12 (5%) 11 12 12 10 10 12 7 9 2 Munaung 139 60 99 (71%) 94 99 99 92 85 97 86 77 88 • Munaung Township - 60 BHS are assigned to cover the 99 out of 139 villages • Toungup Township – 22 BHS are assigned to cover 24 out of 240 villages • Ramree Township – 11 BHS are assigned to cover 12 out of 228 villages

By collaboration with Township Medical Officer of Munaung, compliance check with beneficiaries for ensuring data quality was supported by Defeat Malaria to improve the quality of weekly regular ACD rounds. In this quarter, compliance check was conducted at 46 villages in which 156 out of 233 people tested for malaria were reached out for verification. Out of 156 beneficiaries reached, 124 people (79% of respondents) responded as they were tested in the specified period by respective BHS.

Case investigation by Team Assistant at Sa Dway Larva source finding at Let Yar Sa Taing village of village of Toungup Toungup

Health education session to construction workers LLIN monitoring at Kan Day village of Toungup in Ramree

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Annex 7: Case Finding and Management of all Townships by Different Approaches (Apr.-Jun. 2020) No Township Tested Total Positive P.f P.v Mixed TPR% 1 Bokpyin (ARC) 1,036 68 1 67 - 6.56% 2 Dawei (URC) 821 94 3 91 - 11.45% 3 Kawthoung (ARC) 1,514 1 - 1 - 0.07% 4 Kyunsu (URC) 1,512 22 - 22 - 1.46% 5 Launglon (URC) 725 2 - 2 - 0.28% 6 Myeik (URC) 702 6 - 6 - 0.85% 7 Palaw (URC) 1,904 319 23 294 2 16.75% 8 Tanintharyi (ARC) 1,060 73 - 73 - 6.89% 9 Thayetchaung (URC) 1,769 207 - 207 - 11.70% 10 Yebyu (URC) 1,405 21 1 20 - 1.49% Tanintharyi Total 12,448 813 28 783 2 6.53% 11 Ann (URC) 2,249 24 21 3 - 1.07% 12 Gwa (MNMA) 714 - - - - 0.00% 13 Kyuakpyu (URC) 512 - - - - 0.00% 14 Munaung (URC) 2,084 - - - - 0.00% 15 Ramree (URC) 3,571 - - - - 0.00% 16 Thandwe (MNMA) 1,134 - - - - 0.00% 17 Toungup (URC) 3,351 8 5 3 - 0.24% Southern Rakhine Total 13,615 32 26 6 - 0.24% 18 Buthidaung (MHAA) 6,183 41 6 34 1 0.66% 19 Kyauktaw (URC) 7,676 29 13 16 - 0.38% 20 Maungdaw (MHAA) 778 6 6 - - 0.77% 21 Minbya (URC) 1,334 59 26 33 - 4.42% 22 Mrauk-U (URC) 1,782 11 2 9 - 0.62% 23 Myebon (URC) 1,486 1 1 - - 0.07% 24 Pauktaw (URC) 952 1 - 1 - 0.11% 25 Ponnagyun (URC) 1,726 18 - 18 - 1.04% 26 Rathedaung (MHAA) 1,015 - - - - 0.00% 27 Sittwe (URC) 1,186 1 - 1 - 0.08% Northern Rakhine Total 24,118 167 54 112 1 0.69% 28 Hlaingbwe (ARC) 810 3 - 3 - 0.37% 29 Hpa-an (ARC) 1,189 6 - 6 - 0.50% 30 Kawkareik (ARC) 836 3 - 3 - 0.36% 31 Myawaddy (ARC) 642 30 1 29 - 4.67% Kayin Total 3,477 42 1 41 - 1.21% 32 Banmauk (URC) 1,013 7 4 3 - 0.69% 33 Homalin (URC) 1,303 - - - - 0.00% 34 Indaw (URC) 989 1 - 1 - 0.10% 35 Pale (URC) 634 - - - - 0.00% 36 Pinlebu (URC) 959 5 5 - - 0.52% Sagaing Total 4,898 13 9 4 - 0.27% Defeat Malaria Grand Total 58,556 1,067 118 946 3 1.82%

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Annex 8: Active case detection by mobile team (Apr.-Jun. 2020)

No Township Tested Total Positive P.f P.v Mixed TPR% 1 Bokpyin 95 - 4 - 4 4.21% 2 Dawei 111 - - - - 0.00% 3 Kawthoung 144 - - - - 0.00% 4 Kyunsu 665 - 2 - 2 0.30% 5 Launglon 154 - - - - 0.00% 6 Myeik 827 1 1 - 2 0.24% 7 Palaw 740 1 8 - 9 1.22% 8 Tanintharyi 197 - 11 - 11 5.58% 9 Thayetchaung 143 - 18 - 18 12.59% 10 Yebyu ------Tanintharyi Total 3,076 2 44 0 46 1.50% 11 Ann 587 12 2 - 14 2.39% 12 Gwa 186 - - - - 0.00% 13 Kyaukpyu ------14 Munaung ------15 Ramree 1,039 - 2 - 2 0.19% 16 Thandwe 489 - - - - - 17 Toungup 809 1 - - 1 0.12% Rakhine (South) Total 3,110 13 4 0 17 0.55% 18 Buthidaung 30 - - - - 0.00% 19 Kyauktaw 4,250 2 1 - 3 0.07% 20 Maungdaw ------21 Minbya 70 - - - - 0.00% 22 Mrauk-U ------23 Myebon 21 - - - - 0.00% 24 Pauktaw 22 - - - - 0.00% 25 Ponnagyun 181 - - - - 0.00% 26 Rathedaung 55 - - - - 0.00% 27 Sittwe 122 - - - - 0.00% Rakhine (North) Total 4,751 2 1 0 3 0.06% 28 Hlaingbwe 84 - - - - 0.00% 29 Hpa-an 154 - - - - 0.00% 30 Kawkareik 346 - - - - 0.00% 31 Myawaddy 763 1 4 - 5 0.66% Kayin Total 1,347 1 4 0 5 0.37% 32 Banmauk 184 - 1 - 1 0.54% 33 Homalin ------34 Indaw 174 1 - - 1 0.005747 35 Pale ------36 Pinlebu 282 - - - - 0 Sagaing Total 640 1 1 0 2 0.31% Grand Total 12,924 19 54 0 73 0.56%

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Annex 9: VMWs/PPs Meetings (Apr.-Jun. 2020)

VMW/PP Posts % of VMWs/PPs No Township must attend the Male Female Total attended the meeting meeting 1 Bokpyin 120 24 93 117 97.5% 2 Dawei - - - - - 3 Kawthoung - - - - - 4 Kyunsu 90 22 68 90 100.0% 5 Launglon 32 3 27 30 93.8% 6 Myeik 32 2 30 32 100.0% 7 Palaw 104 16 43 59 56.7% 8 Tanintharyi 114 26 78 104 91.2% 9 Thayetchaung 30 5 18 23 76.7% 10 Yebyu 67 16 51 67 100.0% Tanintharyi Total 589 114 408 522 88.6% 11 Ann 213 139 52 191 89.7% 12 Gwa 195 75 120 195 100.0% 13 Kyaukpyu 50 37 11 48 96.0% 14 Munaung - - - - - 15 Ramree 154 101 49 150 97.4% 16 Thandwe 348 132 216 348 100.0% 17 Toungup 180 76 71 147 81.7% Southern Rakhine Total 1,140 560 519 1079 94.6% 18 Buthidaung 429 381 28 409 95.3% 19 Kyauktaw - - - - - 20 Maungdaw 72 49 3 52 72.2% 21 Minbya - - - - - 22 Mrauk-U - - - - - 23 Myebon - - - - - 24 Pauktaw - - - - - 25 Ponnagyun - - - - - 26 Rathedaung 189 68 105 173 91.5% 27 Sittwe - - - - - Northern Rakhine Total 690 498 136 634 91.9% 28 Hlaingbwe 104 17 86 103 99.0% 29 Hpa-an 86 19 67 86 100.0% 31 Kawkareik 98 39 58 97 99.0% 33 Myawaddy 48 13 35 48 100.0% Kayin Total 336 88 246 334 99.4% 34 Banmauk 114 27 87 114 100.0% 35 Homalin 86 54 27 81 94.2% 36 Indaw 105 18 87 105 100.0% 37 Pale 78 24 52 76 97.4% 38 Pinlebu 135 60 73 133 98.5% Sagaing Total 518 183 326 509 98.3% Grand Total 3,273 1,443 1,635 3,078 94.0%

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Annex 10: Supervision and Monitoring (Apr.-Jun. 2020) Total # of supervision visits to No Township # of visits to VMWs # of visits to PPs VMWs and PPs 1 Bokpyin 24 2 26 2 Dawei 0 0 0 3 Kawthoung 20 5 25 4 Kyunsu 0 0 0 5 Launglon 0 0 0 6 Myeik 0 0 0 7 Palaw 0 0 0 8 Tanintharyi 35 0 35 9 Thayetchaung 0 0 0 10 Yebyu 0 0 0 Tanintharyi Total 79 7 86 11 Ann 35 8 43 12 Gwa 38 0 38 13 Kyaukpyu 12 0 12 14 Munaung 0 0 0 15 Ramree 24 1 25 16 Thandwe 61 0 61 17 Toungup 13 6 19 Southern Rakhine Total 183 15 198 18 Buthidaung 0 0 0 19 Kyauktaw 12 1 13 20 Maungdaw 0 0 0 21 Minbya 9 0 9 22 Mrauk-U 10 2 12 23 Myebon 7 0 7 24 Pauktaw 5 3 8 25 Ponnagyun 6 0 6 26 Rathedaung 0 0 0 27 Sittwe 9 0 9 Northern Rakhine Total 58 6 64 28 Hlaingbwe 26 0 26 29 Hpa-an 43 0 43 30 Kawkareik 19 2 21 31 Myawaddy 10 0 10 Kayin Total 98 2 100 32 Banmauk 8 0 8 33 Homalin 10 0 10 34 Indaw 13 0 13 35 Pale 8 0 8 36 Pinlebu 26 0 26 Sagaing Total 65 0 65 Grand Total 483 30 513

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Annex 11: Reporting Status of VMWs and PPs (Apr.-Jun. 2020)

Cumulative # of # of VMW/PP # of VMW/PP % of timely No Township VMW/PP reports to reported (On % of reporting reported timely reporting be submitted time + Late) 1 Bokpyin 181 159 148 87.8% 93.1% 2 Dawei 96 96 85 100.0% 88.5% 3 Kawthoung 186 172 144 92.5% 83.7% 4 Kyunsu 189 189 178 100.0% 94.2% 5 Launglon 99 96 95 97.0% 99.0% 6 Myeik 96 96 95 100.0% 99.0% 7 Palaw 156 150 124 96.2% 82.7% 8 Tanintharyi 171 158 148 92.4% 93.7% 9 Thayetchaung 90 89 89 98.9% 100.0% 10 Yebyu 207 200 141 96.6% 70.5% Tanintharyi Total 1,471 1,405 1,247 95.5% 88.8% 11 Ann 333 303 275 91.0% 90.8% 12 Gwa 195 195 195 100.0% 100.0% 13 Kyaukpyu 150 148 148 98.7% 100.0% 14 Munaung - - - - - 15 Ramree 231 228 228 98.7% 100.0% 16 Thandwe 348 348 348 100.0% 100.0% 17 Toungup 270 254 234 94.1% 92.1% Southern Rakhine Total 1,527 1,476 1,428 96.7% 96.7% 18 Buthidaung 429 429 409 100.0% 95.3% 19 Kyauktaw 372 371 367 99.7% 98.9% 20 Maungdaw 70 65 62 92.9% 95.4% 21 Minbya 222 221 221 99.5% 100.0% 22 Mrauk-U 231 231 231 100.0% 100.0% 23 Myebon 237 225 222 94.9% 98.7% 24 Pauktaw 126 126 126 100.0% 100.0% 25 Ponnagyun 228 222 212 97.4% 95.5% 26 Rathedaung 190 175 173 92.1% 98.9% 27 Sittwe 123 123 123 100.0% 100.0% Northern Rakhine Total 2,228 2,188 2,146 98.2% 98.1 28 Hlaingbwe 156 155 146 99.4% 94.2% 29 Hpa-an 270 269 213 99.6% 79.2% 30 Kawkareik 147 147 146 100.0% 99.3% 31 Myawaddy 72 72 72 100.0% 100.0% Kayin Total 645 643 577 99.7% 89.7% 32 Banmauk 114 114 114 100.0% 100.0% 33 Homalin 86 83 83 96.5% 100.0% 34 Indaw 105 105 105 100.0% 100.0% 35 Pale 123 113 113 91.9% 100.0% 36 Pinlebu 135 135 133 100.0% 98.5% Sagaing Total 563 550 548 97.7% 99.6% Grand Total 6,434 6,262 5,946 97.3% 95.0%

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Annex 12: Clinical Audit (Apr.-Jun. 2020)

% of Positive Total Total positive % of treated Total Total patients who Positive cases treated cases among No Township Positive referred was treated cases according to positive cases found cases according to treated NTG cases NTG 1 Bokpyin 68 68 68 0 100.0% 100.0% 2 Dawei 94 92 91 2 97.9% 98.9% 3 Kawthoung 1 1 1 0 100.0% 100.0% 4 Kyunsu 22 22 22 0 100.0% 100.0% 5 Launglon 2 2 2 0 100.0% 100.0% 6 Myeik 6 6 6 0 100.0% 100.0% 7 Palaw 319 316 311 3 99.1% 98.4% 8 Tanintharyi 73 73 73 0 100.0% 100.0% 9 Thayetchaung 207 204 204 3 98.6% 100.0% 10 Yebyu 21 21 21 0 100.0% 100.0% Tanintharyi Total 813 805 799 8 99.0% 99.3% 11 Ann 24 24 22 0 100.0% 91.7% 12 Gwa 0 0 0 0 - - 13 Kyaukpyu 0 0 0 0 - - 14 Munaung 0 0 0 0 - - 15 Ramree 0 0 0 0 - - 16 Thandwe 0 0 0 0 - - 17 Toungup 8 8 8 0 100.0% 100.0% Southern Rakhine 32 32 30 0 100.0% 93.8% Total 18 Buthidaung 41 41 41 0 100.0% 100.0% 19 Kyauktaw 29 29 29 0 100.0% 100.0% 20 Maungdaw 6 6 6 0 100.0% 100.0% 21 Minbya 59 59 59 0 100.0% 100.0% 22 Mrauk-U 11 11 11 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 18 18 18 0 100.0% 100.0% 26 Rathedaung 0 0 0 0 - - 27 Sittwe 1 1 1 0 100.0% 100.0% Northern Rakhine 167 167 167 0 100.0% 100.0% Total 28 Hlaingbwe 3 3 3 0 100.0% 100.0% 29 Hpa-an 6 6 6 0 100.0% 100.0% 30 Kawkareik 3 3 3 0 100.0% 100.0% 31 Myawaddy 30 30 30 0 100.0% 100.0% Kayin Total 42 42 42 0 100.0% 100.0% 32 Banmauk 7 7 7 0 100.0% 100.0% 33 Homalin 0 0 0 0 - - 34 Indaw 1 1 1 0 100.0% 100.0% 35 Pale 0 0 0 0 - - 36 Pinlebu 5 4 4 1 80.0% 100.0% Sagaing Total 13 12 12 1 92.3% 100.0% Grand Total 1067 1058 1050 9 99.2% 99.2%

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Annex 13: Stock out monitoring at monitoring visits (Apr.-Jun. 2020)

Total # of % of sites which % of sites which % of sites which % of sites which Total # of No Township visited experienced No experienced No experienced No experienced No visited PP VMW RDT stock out ACT stock out RDT stock out ACT stock out 1 Bokpyin 45 100.0% 100.0% 5 100.0% 100.0% 2 Dawei 71 100.0% 100.0% 4 100.0% 100.0% 3 Kawthoung 126 100.0% 100.0% 18 100.0% 100.0% 4 Kyunsu 21 100.0% 100.0% 4 100.0% 100.0% 5 Launglon 34 100.0% 100.0% - - - 6 Myeik 26 100.0% 100.0% 6 100.0% 100.0% 7 Palaw 33 100.0% 100.0% 6 100.0% 100.0% 8 Tanintharyi 57 100.0% 100.0% - - - 9 Thayetchaung 26 100.0% 100.0% 11 100.0% 100.0% 10 Yebyu 25 100.0% 100.0% - - - Tanintharyi Total 464 100.0% 100.0% 54 100.0% 100.0% 11 Ann 35 100.0% 100.0% 8 100.0% 100.0% 12 Gwa 38 100.0% 100.0% - - - 13 Kyaukpyu 12 100.0% 100.0% - - - 14 Munaung 15 Ramree 24 100.0% 100.0% 1 100.0% 100.0% 16 Thandwe 61 100.0% 100.0% - - - 17 Toungup 13 100.0% 100.0% 6 100.0% 100.0% Southern Rakhine 183 100.0% 100.0% 15 100.0% 100.0% Total 18 Buthidaung ------19 Kyauktaw 361 100.0% 100.0% 6 100.0% 100.0% 20 Maungdaw ------21 Minbya 207 100.0% 100.0% - - - 22 Mrauk-U 198 100.0% 100.0% 33 100.0% 100.0% 23 Myebon 206 100.0% 100.0% 15 100.0% 100.0% 24 Pauktaw 99 100.0% 100.0% 27 100.0% 100.0% 25 Ponnagyun 159 100.0% 100.0% 15 100.0% 100.0% 26 Rathedaung ------27 Sittwe 123 100.0% 100.0% - - - Northern Rakhine 1,353 100.0% 100.0% 96 100.0% 100.0% Total 28 Hlaingbwe 26 100.0% 100.0% - - - 29 Hpa-an 92 100.0% 100.0% 7 100.0% 100.0% 30 Kawkareik 20 100.0% 100.0% 2 100.0% 100.0% 31 Myawaddy 10 100.0% 100.0% - - - Kayin Total 148 100.0% 100.0% 9 100.0% 100.0% 32 Banmauk 8 100.0% 100.0% - - - 33 Homalin 10 100.0% 100.0% - - - 34 Indaw 13 100.0% 100.0% - - - 35 Pale 16 100.0% 100.0% - - - 36 Pinlebu 26 100.0% 100.0% - - - Sagaing Total 73 100.0% 100.0% - - - Grand Total 2,221 100.0% 100.0% 174 100.0% 100.0%

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Annex 14: Stock out monitoring at monthly meeting (Apr.-Jun. 2020)

Total # of % of sites which % of sites which Total # % of sites which % of sites which No Township VMW experienced No experienced No of PP experienced No experienced No met RDT stock out ACT stock out met RDT stock out ACT stock out 1 Bokpyin 107 100.0% 100.0% 10 100.0% 100.0% 2 Dawei ------3 Kawthoung ------4 Kyunsu 74 100.0% 100.0% 16 100.0% 100.0% 5 Launglon 30 100.0% 100.0% - - - 6 Myeik 26 100.0% 100.0% 6 100.0% 100.0% 7 Palaw 46 100.0% 100.0% 13 100.0% 100.0% 8 Tanintharyi 104 100.0% 100.0% - - - 9 Thayetchaung 22 100.0% 100.0% 1 100.0% 100.0% 10 Yebyu 67 100.0% 100.0% - - - Tanintharyi Total 476 100.0% 100.0% 46 100.0% 100.0% 11 Ann 142 100.0% 100.0% 49 100.0% 100.0% 12 Gwa 195 100.0% 100.0% - - - 13 Kyaukpyu 43 100.0% 100.0% 5 100.0% 100.0% 14 Munaung 15 Ramree 71 100.0% 100.0% 2 100.0% 100.0% 16 Thandwe 348 100.0% 100.0% - - - 17 Toungup 67 100.0% 100.0% 18 100.0% 100.0% Southern Rakhine 866 100.0% 100.0% 74 100.0% 100.0% Total 18 Buthidaung 409 100.0% 100.0% - - - 19 Kyauktaw ------20 Maungdaw 52 100.0% 100.0% - - - 21 Minbya ------22 Mrauk-U ------23 Myebon ------24 Pauktaw ------25 Ponnagyun ------26 Rathedaung 173 100.0% 100.0% - - - 27 Sittwe ------Northern Rakhine 634 100.0% 100.0% - - - Total 28 Hlaingbwe 103 100.0% 100.0% - - - 29 Hpa-an 86 100.0% 100.0% - - - 30 Kawkareik 93 100.0% 100.0% 4 100.0% 100.0% 31 Myawaddy 46 100.0% 100.0% 2 100.0% 100.0% Kayin Total 328 100.0% 100.0% 6 100.0% 100.0% 32 Banmauk 114 100.0% 100.0% - - - 33 Homalin 81 100.0% 100.0% - - - 34 Indaw 105 100.0% 100.0% - - - 35 Pale 76 100.0% 100.0% - - - 36 Pinlebu 133 100.0% 100.0% - - - Sagaing Total 509 100.0% 100.0% - - - Grand Total 2,813 100.0% 100.0% 126 100.0% 100.0%

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Annex 15. A: Health Workers Trained in Malaria Diagnostics (Apr.-Jun. 2020)

Village Malaria Workers Private Providers Grand No Township Total M F Sub-total M F Sub-total 1 Thandwe 1 - 1 - - - 1 Southern Rakhine Total 1 - 1 - - - 1 2 Kyauktaw 28 5 33 - - - 33 3 Maungdaw 1 - 1 - - - 1 4 Ponnagyun - - - 3 - 3 3 5 Sittwe - 2 2 - - - 2 Northern Rakhine Total 29 7 36 3 - 3 39 Grand Total 30 7 37 3 - 3 40 Annex 15. B: Health Workers Trained in Malaria Case Management (Apr.- Jun. 2020)

Village Malaria Workers Private Providers Grand No Township Total M F Sub-total M F Sub-total 1 Thandwe 1 - 1 - - - 1 Southern Rakhine Total 1 - 1 - - - 1 2 Kyauktaw 28 5 33 - - - 33 3 Maungdaw 1 - 1 - - - 1 4 Ponnagyun - - - 3 - 3 3 5 Sittwe - 2 2 - - - 2 Northern Rakhine Total 29 7 36 3 - 3 39 Grand Total 30 7 37 3 - 3 40 Annex 15. C: Capacity Building on Integrated Community Malaria Volunteer (Apr.-Jun. 2020)

Village Malaria Workers Private Providers Grand No Township Total M F Sub-total M F Sub-total 1 Thandwe 1 - 1 - - - 1 Southern Rakhine Total 1 - 1 - - - 1 2 Kyauktaw 28 5 33 - - - 33 3 Maungdaw 1 - 1 - - - 1 4 Ponnagyun - - - 3 - 3 3 5 Sittwe - 2 2 - - - 2 Northern Rakhine Total 29 7 36 3 - 3 39 Grand Total 30 7 37 3 - 3 40

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Annex 16: Behavior Change Communication (Apr.-Jun. 2020)

Individual IPC Group Health Talk

No Township al

Tot

Male Total Male

Female Female

included included included

Migrants Migrants Sessions # Sessions 1 Bokpyin 497 419 916 682 3 21 16 37 37 2 Dawei 325 271 596 86 - - - - - 3 Kawthoung 835 604 1,439 1,357 - - - - - 4 Kyunsu 424 450 874 77 - - - - - 5 Launglon 146 315 461 26 - - - - - 6 Myeik 229 304 533 20 - - - - - 7 Palaw 555 555 1,110 140 - - - - - 8 Tanintharyi 425 360 785 130 - - - - - 9 Thayetchaung 647 769 1,416 423 - - - - - 10 Yebyu 425 601 1,026 39 - - - - - Tanintharyi Total 4,508 4,648 9,156 2,980 3 21 16 37 37 11 Ann 996 865 1,861 1,009 - - - - - 12 Gwa 644 724 1,368 11 27 59 77 136 - 13 Kyaukpyu 313 429 742 63 - - - - - 14 Munaung ------15 Ramree 319 315 634 101 1 6 1 7 7 16 Thandwe 921 1,203 2,124 7 4 8 12 20 - 17 Toungup 431 272 703 238 3 26 23 49 11 Southern Rakhine Total 3,624 3,808 7,432 1,429 35 99 113 212 18 18 Buthidaung 4,041 1,498 5,539 82 - - - - - 19 Kyauktaw 1,953 2,953 4,906 2,365 - - - - - 20 Maungdaw 406 252 658 40 - - - - - 21 Minbya 459 460 919 113 - - - - - 22 Mrauk-U 570 535 1,105 30 - - - - - 23 Myebon 461 570 1,031 87 - - - - - 24 Pauktaw 418 416 834 21 - - - - - 25 Ponnagyun 514 546 1,060 122 - - - - - 26 Rathedaung 359 500 859 15 - - - - - 27 Sittwe 336 534 870 28 - - - - - Northern Rakhine Total 9,517 8,264 17,781 2,903 - - - - - 28 Hlaingbwe 884 595 1,479 22 - - - - - 29 Hpa-an 421 589 1,010 49 - - - - - 30 Kawkareik 449 785 1,234 20 2 5 35 40 - 31 Myawaddy 501 713 1,214 124 - - - - - Kayin Total 2,255 2,682 4,937 215 2 5 35 40 - 32 Banmauk 387 675 1,062 78 - - - - - 33 Homalin 547 495 1,042 42 - - - - - 34 Indaw 329 602 931 29 3 46 17 63 - 35 Pale 239 262 501 74 - - - - - 36 Pinlebu 304 392 696 44 - - - - - Sagaing Total 1,806 2,426 4,232 267 3 46 17 63 - Grand Total 21,710 21,828 43,538 7,794 43 171 181 352 55

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Annex 17: Performance Indicators (Apr.-Jun. 2020)

Frequency FY 2020 Target and Achievement Indicators of Baseline Achievement Remark Q3 Progress Target reporting % IP 1: Annual Parasite Incidence (API) Annual 8 (CAP-M 4.0 Annual Indicator in Defeat Malaria villages PY4) Number of confirmed malaria cases 1,067 2,249 Mid-year population at risk of

targeted areas IP 2: Annual Blood Examination Annual 6% in 2015 8% #DIV/0! Annual Indicator Rate (National Number of parasitological tests M&E plan) 58,556 184,340 carried out in Defeat Malaria areas Mid-year population at risk in Defeat

Malaria targeted areas IP 3: Percent of indigenous cases Quarterly 9% (from 37.5% 20.0% 60% Cases investigated = 8 (3 among cases investigated National cases of Q2 and 5 cases of (elimination area) M&E plan) Q3 were investigated). Number of cases classified as Three out of 8 cases 3 9 investigated were indigenous indigenous cases. Number of cases investigated 8 45 IP 4: Percent of active foci among Monthly N/A NA NA 60% This indicator is to be foci investigated (elimination area) rolled out by NMCP later (Ref: Myanmar National Number of active foci investigated M & E Plan for malaria Number of foci investigated elimination 2021-2025) IP 5: Proportion of villages with zero Annually 18.5% Annual Indicator positive cases in a fiscal year (CAP-M) Number of villages with ≥10% ABER

reported zero positive case Total number of Defeat Malaria covered villages with ≥10% ABER in assessment year Objective 1: Achieve and maintain universal coverage of at-risk populations with proven vector control and case management interventions, while promoting the testing of new tools and approaches

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OC 1.1 % of households in target Baseline and NA 85% To be measured by areas that own at least one ITN end line end-line survey. OC 1.2 Percentage of households in Baseline and 47% in Rakhine NA 80% To be measured by target areas that own at least one end line 60,2% in TNT end-line survey. 65.6% in Kayin insecticide-treated net for every from CAP-M two persons OC 1.3 % of individuals in targeted Baseline and TBD after NA 80% To be measured by areas who slept under ITN the end line baseline end-line survey. previous night. (disaggregate by type of net, pregnant women, age and gender) OC 1.4 % of service delivery points Quarterly Minimum 100.0% 100.0% 90% 111% which report no stock outs of RDTs 85% (from lasting more than one week during CAP-M) the past 3 months (disaggregate by type of SDP) OC 1.5 % of service delivery points Quarterly Minimum 100.00% 100.0% 90% 111% which report no stock outs of first 85% (from line antimalarial medicines (ACT) CAP-M) lasting more than one week during the past 3 months (disaggregate by type of SDP) OC 1.6 % of patients found positive Quarterly minimum 99.2% 99.3% 95% 105% who received antimalarial 95% (from treatment according to National CAP-M) Malaria Treatment Guidelines Number of patients found positive who received antimalaria treatment 1,050 2,201 according to NTG Number of patients found positive 1,058 2,216 who received antimalaria treatment OC 1.7 % of Malaria Positive cases Quarterly 25% 49.6% 59.6% 60% 99% with having completed the (CAP-M treatment under DOT FY2015) Number of total positive cases with 529 1,341 DOT having complete DOT Number of total positive cases 1,067 2,249

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OP 1.1 Number of insecticide- Activity 92,986 Mass campaigns were treated net purchased in any fiscal implemented (From CAP- 81,231 217,346 385,000 56% replaced by small groups, year with USG funds that were months M PY5) door to door distributed in this quarter (PMI required indicator) OP 1.2 Number of artemisinin- based combination therapy (ACT) Quarterly NA 7,751 11,008 11,950 92% treatments 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 Quarterly NA 83,350 204,550 76% in any fiscal year with USG funds 270,000 that were distributed (PMI required indicator) OP 1.4 Number of individuals Quarterly 514,333 43,538 136,390 114% reached with malaria behavior (from CAP- 120,000 change messages through M PY5) interpersonal communication (individual talks) OP 1.5 Number of health workers Quarterly 5,155 VMW = 37 (Male-30, trained in case management with (from CAP- 40 2,039 2,200 93% Female-7) ACTs with USG funds M) PP = 3 (Male-3) (Disaggregated by male, female, and profession) (PMI required indicator) OP 1.6 Number of health workers Month of 5,443 (from VMW = 37 (Male-30, trained in malaria laboratory training CAP-M) 40 2,039 2,200 93% Female-7) diagnostics (rapid diagnostic tests PP = 3 (Male-3) (RDTs) or microscopy) with USG funds (Disaggregated by male, female, and profession) (PMI required indicator) OP 1.7 % of VMWs/PPs in Defeat Annually N/A 90% Annual Indicator Malaria target areas received at least two supervisory visits per year

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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 109% Monthly ≥ 80% 97.3% 97.8% 90% data of malaria cases (disaggregate by type of SDP) OC 2.2 % of service delivery points 109% in targeted areas report monthly Annually N/A 95.0% 97.8% 90.00% data of malaria cases on time (disaggregate by type of SDP) OC 2.3 % of positive cases notified Quarterly N/A 80% 103% within 24 hours (Elimination 75.0% 82.2% targeted townships) Number of positive cases notified 6 37 within 24 hours Number of positive cases notified 8 45 OC 2.4 Foci investigation rate Quarterly N/A 38% 31% 30% 104% According to updated (Elimination townships) National M & E Plan for malaria elimination, 30% Number of foci investigated 3 14 of foci are expected to be Number of cases investigated 8 45 investigated. OC 2.5 Active focus response rate Quarterly N/A 67% 88% 35% 250% According to updated (Elimination township) National M & E Plan for Number of confirmed active foci malaria elimination, 35% investigated in which an appropriate 2 7 of active foci are expected to be revised. response was initiated within 7 days Number of confirmed active foci 3 8 OP 2.1 Number of townships that Quarterly NA Annual Indicator have been developed and updated and annually VBS annually OP 2.2 Number entomological Semiannual N/A 0 2 8 25% Pending during COVID-19 surveys conducted in persistent according to NMCP's transmission areas guidance Objective 3: Enhance technical and operational capacity of the NMCP and other health service providers at all levels of service provision

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OP 3.1 % of targeted health services Annually TBD NA NA 70% No more relevant. with 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 Quarterly NA 1 5 20 25% Pending during COVID-19 malaria technical skill and training according to NMCP's facilitation skill supported by Defeat guidance Malaria OP 3.3 Number of trainers Quarterly NA 11 59 112 53% developed through Defeat Malaria OP 3.4 Number of people trained Quarterly 0 35 400 9% Pending during COVID-19 through on-site training supported by USG program (Defeat Malaria) OP 3.5 Percentage of trainers Quarterly NA 13% 44% 50% 88% supervised during trainings OP 3.6 Percentage of master Quarterly NA 0.00% 100.00% 80% 125% mentors retaining at least 80% of acquired skills and knowledge OP 3.7 Number of joint supervision Quarterly NA 5 20 20 100% visits to 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 Annual N/A 53 57 60 95% Four construction companies and state-owned companies were finished enterprises involve in malaria their work and moved to activities other areas. OP 4.2 Number of health education Monthly N/A 4 130 320 41% Health education sessions sessions conducted in the targeted were limited due to areas with participation from restriction of gathering in collaborating companies and COVID-19 pandemic enterprises

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Annex 18: Defeat Malaria Activities During COVID-19 (Apr.-Jun. 2020)

LLIN distribution by collaboration with basic health staff CSG Forming Meeting at Inn Wun village in Launglon Providing COVID-19 IEC to ICMVs in Kyauktaw in Myeik Township township township

Defeat Malaria activities are continuing by applying social distancing and personal protective measures following the COVID-19

guidance and announcements of the Ministry of Health and Sports.

ICMVs were encouraged to contribute all their efforts in community awareness raising on COVID-19 prevention and maintain their implementation of integrated community malaria intervention activities.

Coordination meeting at Rural Health Center in Mrauk-U LLIN distribution at Taw Gan village in Buthidaung ICMV training at Kyauktaw

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Annex 19: Cost Share

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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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