Completion Report Project Number: 48446-001 Technical Assistance Number: 8959 June 2019 Malaria and Communicable Diseases Control in the Greater Mekong Subregion This document is being disclosed to the public in accordance with ADB’s Access to Information Policy. In preparing any country program or strategy, financing any project, or by making any designation of or reference to a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area. TA Number, Country, and Name: Amount Approved: US$ 4,500,000 TA 8959-REG: Malaria and Communicable Diseases Control in the Greater Revised Amount: Not Applicable Mekong Subregion Executing Agency: Source of Funding: Regional Malaria and Other Amount Undisbursed: Amount Utilized: Asian Development Bank Communicable Disease Threats Trust Fund $327,879.04 $4,172,120.96 TA Approval Date: TA Signing Date: Fielding of First Consultants: TA Completion Date 23 September 2015 30 October 2015 Original: 30 June 2017 Actual: 25 June 2018 Account Closing Date Original: Actual: 30 June 2017 19 December 2018 Description. The spread of multiresistant-drug malaria is jeopardizing the remarkable progress made in malaria control in the Greater Mekong Subregion (GMS) since 2000. The Asian Development Bank (ADB) designed the TA at the request of the governments of Cambodia, Lao People’s Democratic Republic (Lao PDR), and Myanmar (CLM), to address the following binding constraints for malaria elimination in the region: (i) inadequate malaria and communicable disease control strategy in Myanmar where malaria incidence is highest and malaria care in the region is least-developed; (ii) lack of services addressing specific needs of the migrant and mobile population (MMP), a key risk group for malaria given their exposure to disease vectors and inaccessibility to the health system; and (iii) insufficient coordination for malaria control in the region. Expected Impact, Outcome, and Outputs. The impact of the TA was to eliminate malaria across Cambodia by 2025, and Lao PDR and Myanmar by 2030, as stated in the countries’ national malaria elimination strategies. The outcome of the TA was national malaria and communicable diseases control (CDC) programs strengthened and better coordinated in CLM. The outputs were (i) Myanmar malaria surveillance and diagnostic systems improved, (ii) MMP’s specific needs for malaria prevention and treatment addressed, and (iii) regional coordination on malaria and CDC among GMS countries strengthened. The TA is rated relevant. The TA is aligned with GMS countries’ respective plans for malaria elimination, which in turn was based on the agreement at the Ninth East Asia Summit in 2014 towards the goal of an Asia and the Pacific region free of malaria by 2030. The TA is also aligned with ADB’s Operational Plan for Health 2015–2020, Regional Cooperation and Integration Strategy, and Strategy 2020 midterm review (2014) which recommended expanding health sector operations. At completion, the TA continued to align with country plans and government strategies, and ADB’s Strategy 2030, particularly in fostering regional cooperation and integration. The TA was designed in dialogues with major development institutions, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) under World Health Organization (WHO) technical leadership. The TA design was well articulated, particularly on malaria elimination which is high on the government agenda. The TA targeted the most at-risk groups and helped the countries to address the following critical constraints under their respective malaria elimination programs (i) undeveloped disease surveillance systems; (ii) inadequate quality assurance systems for malaria diagnosis in laboratories; and (iii) weak public health systems unable to serve large populations. The risk of shifting governments’ focus from malaria and CDC towards other issues was mitigated through a continuous dialogue with the countries, and coordination with international non-governmental organizations (NGO), GFATM, and WHO leadership. The TA deliverables were well received by the countries and incorporated in their national policies. The TA aligns with current ADB interventions (see overall assessment and major lessons). The TA developed innovative activities, such as use of information technology based on mobile phone in malaria surveillance, quality assurance system for malaria diagnostic, and private sector involvement in malaria control and prevention. These innovations have good demonstration value for CLM governments and future ADB engagement. Delivery of Inputs and Conduct of Activities. Under Output 1, the TA mobilized University Research Co. (URC), an international NGO. URC worked closely with the National Malaria Control Program (NMCP) and the National Health Laboratory (NHL). Originally, two NGO packages were planned, but a minor change in implementation arrangements to combine services under one package proved to be more efficient and significantly reduced recruitment processing times. The TA brought together NMCP and NHL and several development institutions such as WHO, Save the Children, and Japan International Cooperation Agency. The TA developed with NMCP, a mobile data management system (mDMS) which allows basic health services staff and village malaria workers to report malaria cases to the central level using mobile phone technology. It (i) provided guidelines for mDMS usage; (ii) trained 179 health staff (of which 116 female); (iii) provided IT hardware (servers and laptops) and 168 mobile phones to staff (102 to female staff); and (iv) piloted the mDMS in five townships in two states. The TA reviewed the laboratory quality assurance malaria diagnostic capacities and training of relevant health staff, and developed the National Guidelines on Microscopy and the Manual on Laboratory Quality Assurance. The TA distributed (i) 1,500 national guidelines to hospitals nationwide; and (ii) 500 manuals to Myanmar State/Region Vector Borne Disease Control staff. The TA (i) trained about 61 health staff (of which 45 female) in targeted hospitals; (ii) equipped 27 facilities in 10 targeted townships with laboratory diagnostic equipment and medical supplies; and (iii) conducted staff supervision in collaboration with NMCP and NHL. Output 2 activities were carried out by the International Organization on Migration (IOM) which supported MMP-focused interventions in selected districts in CLM. This output consisted of field-based activities in selected CLM districts to assess MMP malaria risks and develop pilot models to address MMP needs linked to worksites along forest areas. The TA conducted situation analysis of the malaria risks faced by MMPs in CLM, including in private sector enterprises. The TA provided information, education, and communications materials to address these. The TA trained 75 volunteers and peer educators (of 2 which 15 female) to improve access to malaria prevention and testing for MMP groups. The low percentage of women in the private enterprise (mining) explain the low proportion of female in trainings. The TA conducted worksite interventions in more than 60 sites where MMPs were at risk of malaria infection. A regional MMP workshop presented the implementation of the pilot models and their achievements. Under Output 3, the TA implemented cross-border information sharing procedures including malaria data and communicable diseases outbreaks in 27 CLM provinces. CLM national malaria programs designed and developed specific malaria-targeted action plans in border areas. CLM countries shared information and experiences on MMP interventions during regional meetings and issued recommendations for further activities targeting MMPs. The TA also conducted regional meetings to support regional health cooperation improvement of infection prevention and control in hospitals and in laboratory services in the GMS (including Thailand and the People’s Republic of China). TA activities were relevant to achieve TA outputs, and the governments were satisfied with inputs received from the TA. The Government of Myanmar endorsed guidelines and manuals prepared by the TA for nationwide use. At governments’ request, ADB allowed a one year, no-cost TA extension to allow more time for monitoring results, completing activities (including additional training and delivery of durable insecticide impregnated bed nets), and planning for eventual take-over of the TA under the countries’ respective national malaria programs. The minor changes in implementation arrangements described in previous paragraphs were processed not out of design deficiencies but to facilitate implementation of activities. The design and monitoring framework remained unchanged. TA savings were realized because existing national programs and GFATM financed the consumables for the implementation of pilot interventions under outputs 1 and 2. Studies were incorporated in the consulting firms’ contracts. The TA hired five individual national and international consultants for a total of 124 person months. This was more than the envisaged 78 person-months at design, as longer inputs were needed to advise governments on multiple and complex issues such as those related to the malaria program in Myanmar. The performance of all individual consultants, URC, and IOM for the duration of the TA is rated satisfactory. They all delivered their respective outputs and collaborated well with ADB, countries’