Funding Request Tailored to Material Change Mr Tobgyel Dy. CPO, VDCP New Application, Tailored Review

New Application, Tailored Review Background why Tailored Review Transitioning from donor support gradually Focused on future sustainability BHTF(Agreement of (15%) of allocated fund 1:1 bases contribution from government Not much programme shift of polices and strategies except few activities changes based on: -NSP 2015-2020 - External Review recommendations - KAP/MIS survey findings New Application, Tailored Review

Epidemiological updates New Application, Tailored Review

33rd CCM Meeting 26th -27th May, 2016 ( Malaria)

New Application, Tailored Review

Bhutan is progressing well towards the stated goal of the NMSP 2015-2020 to interrupt indigenous transmission by 2018. Years Districts 2009 2010 2011 2012 2013 2014 2015 2016 Bumthang   Chuka 1Pv  1Pv Dagana 1Pf Gasa Haa Lhuntse Monggar 2Pf Paro Pemagatshel 1Pf/4Pv Punakha Samdrupjongkhar 4Pf/2Pv  6Pf/1P v  2Pf/1P v  1Pf Samtse Sarpang  6Pf/6 Pv  5Pf/7P v 11Pf/ 20Pv   15Pv/ 1 Mixed Tashiyangtse Thimphu Tashigang Trongsa Tsirang 3Pv Wangdue 1Pf/7Pv Zhemgang 2Pf/1Pv TOTAL 559Pf/ 413Pv 175Pf/ 261Pv 102Pf/ 92Pv 35Pf/ 47Pv 6Pf/ 9Pv 11Pf/ 8Pv 13Pf/ 21Pv 1Pf/16Pv / 1 Mixed Elimination Phase Prevention of Re-establishment Phase Non-Receptive Areas

PROGRESS TOWARDS MALARIA ELIMINATION (External review Comments) Indigenous transmission has been interrupted in all Districts with seasonal pattern of transmission and in most border Districts with perennial transmission, where only imported cases are presently reported; However, active foci with ongoing transmission remain in two border districts (Sarpang & Samdrupjongkhar) most probably due to continuous importation of malaria from neighboring India, particularly of Assam which is still endemic; Noting that most of locally acquired cases are single, sporadic and not epidemiologically connected to each other in space and time, one can assume that these cases have an introduced nature (first-generation local transmission due to importation).

Way forward WHO classification API<1/1000 population at risk 0 locally acquired cases SPR <5% in fever cases WHO certification 3 years ------------ Control Pre elimination Elimination Prevention of reintroduction 2nd Programme reorientation 1st Programme reorientation BHUTAN is at this level (from 2011-2013) BHUTAN was at this level (from 2005-2010) 31st CCM, Ministry of Health, 10th Oct. 2014

Bhutan National Strategic Plan 2015-2020 Vision Bhutan free of indigenous malaria Mission Achieving malaria elimination through use of evidence based preventive, control and treatment methods, community empowerment, strengthened surveillance systems and institutional establishment for sustained elimination and prevent reintroduction of transmission Goal To achieve zero indigenous malaria in Bhutan by 2018 and obtain WHO malaria free certification by 2020

33rd CCM Meeting 26th -27th May, 2016 ( Malaria) Goal and Objectives Goal: To achieve zero indigenous malaria in Bhutan by 2018 and obtain WHO-malaria free certification by 2020. Outcome Objectives: Active Foci of malaria eliminated by 2018 Resurgence of malaria prevented from 2018 onwards Achieve Zero malaria death and sustained Health system and community system strengthened to sustain malaria elimination 33rd CCM Meeting 26th -27th May, 2016 ( Malaria)

Key areas proposed for Note Governance Bhutan Malaria Elimination Commission (BMEC) Members (Chaired by Lyonpo) TOR Bhutan Malaria Elimination Technical Advisory Group (BMETAG) Focused Prevention and control Geographical reconnaissance via mapping Gewog-wise Stratification of malaria risk areas and populations Targeted interventions Enhanced case & vector surveillance All case follow-up and investigation Active & reactive case detections Web-based Bhutan Malaria and Febrile Information System (BMFIS) SMS case alert and notification Intensified monitoring and supervision Quality assured laboratory diagnosis & treatment Establishment of EQA at PHL for malaria diagnosis Obtaining certification and accreditation PCR confirmation & genotyping of malaria cases Institute malaria diagnosis QA in all health facilities New Application, Tailored Review

Financial Gap Analysis (Malaria) 2018 -2019 2019-20 2020-21 Total     Financial Gap Analysis (Malaria) 2018 -2019 2019-20 2020-21 Total A Total funding needs( US $) as per NSP 2,831,794.44 2,242,599.24 2,243,123.44 7,317,517.12 B National funding 2,119,285.81 1,114,625.81 1,427,235.81 4,661,147.43 C External Source (GOI /WHO/APMEN 189,242.75 175,967.75 196,031.75 561,242.25 D Total planned resources (B+C)= 2,308,528.56 1,290,593.56 1,623,267.56 5,222,389.68 E Proposed for GFATM 497,070.25 753,246.22 410,051.21 1,660,367.68 G Still gap A - (D+E)= 26,195.63 198,759.46 209,804.67 434,759.76 New Application, Tailored Review

Priority needs based on Gap Analyses Area of focus Vector Control Procurement of LLIN /Spray pumps for IRS/ Insecticide resistance monitoring & entomological surveillance Case Management Facility based treatment (DOTS) for all malaria cases/ Management of Severs malaria/epidemic preparedness/ Quality monitoring of drugs efficacy /IEC/BCC / Case investigation and follow up, Therapeutic efficacy studies in all positive cases. Health Information System and M&E Program performance monitoring through data analyses/reviews and survey. GIS mapping & expansion of web-based reporting to assist the risk population and prompt targeted interventions, mobile clinics in high risk areas Programme Management Institutional linkages/stake holders involvement and HR development/proper grant management & ensuring the supplies management of the programme related interventions Community System Strengthening Strengthening community stakeholders to build ownership through participatory approach (e.g formation and expansion of Community Action Group in the community/Involvement of VHWs on fever surveillance and management. Policy and Planning Formation of Malaria Elimination Commission and Technical Advisory Group/ monitoring on progress and providing guidance New Application, Tailored Review

New Application, Tailored Review New activities Establishment of national reference lab at RCDC External Quality Assessment (EQA) of microscopes and certification/accreditation Mobile clinics for high risk screening and PCR Provision of LLIN for closed border population across border through Bhutan India Friendship Association Independent Malaria Elimination Commission and Technical Advisory Taskforce will be established 15% fund contribution to the BHTF New Application, Tailored Review

New Application, Tailored Review

Budget Cost grouping By Cost Grouping Year 1 Year 2 Year 3 Total % 1.0 Human Resources 27656 27779 27903 83338 0.05 2.0 Travel related costs 249763 240827 213806 704396 0.42 3.0 External Professional services 39000 76662 26000 141662 0.08 4.0 Health Products - Pharmaceutical Products 1137 3411 0.002 5.0 Health Products - Non-Pharmaceuticals 55865 252963 37734 346563 0.12 6.0 Health Products - Equipment 75586 29387 55945 160918 0.09 7.0 Procurement and Supply-Chain Management costs 18726 74137 20845 113708 0.07 10.0 Communication Material and Publications 6454 29119 6683 42258 0.03 11.0 Programme Administration costs 22881 21232 19996 64110 0.032 497070 753246 410051 1660368 1

Engagement during proposal development Technical Working groups. Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) Royal Centre for Disease Control (RCDC) Drug Regulatory Authority (DRA) District level Discussion: DHO/ DMS Medical Superintendent /Medical Specialist Local leader and member Community Action group PDC/ Experts View – WHO/GF/APMEN New Application, Tailored Review

New Application, Tailored Review Grant Over view Principal Recipient – Ministry of Health Implementing partners - DRA - UMSB - RCDC Grant Amount – USD 1,660,367.68 Grant Period – July 2018 - June 2021 New Application, Tailored Review

New Application, Tailored Review Thank you New Application, Tailored Review

New Application, Tailored Review Impact Indicators Impact Indicators Baseline Year 2018 2019 2020 Malaria I-1(M): Reported malaria cases (presumed and confirmed) 74 2016 Malaria I-3.1(M): Inpatient malaria deaths per year: rate per 100,000 persons per year Malaria I-9(M): Number of active foci of malaria 7 blocks Malaria I-10(M): Annual parasite incidence: Confirmed malaria cases (microscopy or RDT): rate per 1000 persons per year (Elimination settings) 0.06 0.05 New Application, Tailored Review

New Application, Tailored Review Outcome Indicators Outcome Indicators Baseline 2018 2019 2020 Malaria O-7(M): Percentage of existing ITNs used the previous night 99.2% 2016 - 99.5% Malaria O-9(M): Annual blood examination rate: per 100 population per year (Elimination settings) 12% 15% New Application, Tailored Review

Coverage for Impact Indicators Impact Coverage Classification Age /species Numbers Year Malaria I-1(M): Reported malaria cases (presumed and confirmed) Age U5 2 2016 5+ 74 Malaria case definition Confirmed Presumptive Species P. Vivax 54 P. Falciparum 20 Other species New Application, Tailored Review

New Application, Tailored Review Coverage Indicators Coverage Indicators Malaria I-10(M): Annual parasite incidence: Confirmed malaria cases (microscopy or RDT): rate per 1000 persons per year (Elimination settings) Imported 0.18 2016 Induced Local-indigenous 0.04 Local-introduced 0.009 New Application, Tailored Review