Regional initiative to sustain country achievement SEAR Krongthong Thimasarn Regional Adviser, Malaria World Health Organization Regional Office for South- East Asia, New Delhi

Malaria trends in the SEA Region are disturbing…… Huge size of population at risk (252m of Pf, 1347m of Pv) Highly unstable, dynamic and great diversity of malaria epidemiology –Affected by socio-ecological changes P. falciparum increasing: –now about 50% of all cases Drug resistance to P. falciparum spreading Emergence of ACT tolerant strain Pf in Mekong region Outbreaks frequent and widespread Trends of P falciparum proportion in SEA Region,

Malaria trends in the SEA Region are disturbing……(cont) Underreporting of cases/deaths Treatment by private sector (~80%) Irrational use of drugs 4 high burden countries –India –Indonesia –Bangladesh –Myanmar

Malaria Endemicity in SEA Region, 2007

Country categorization in Asia- Pacific Source: World Malaria Report Geneva, World Health Organization, 2008.

Classification of SEAR countries according to its broad status of malaria control GMAP High disease burden countries: to scale-up key interventions (Bangladesh*, India,* Indonesia*, Myanmar and Timor Leste) –The present coverage of ITN/LLIN, ACT is low Moderate burden countries: to sustain achievement (Bhutan, Nepal and Thailand) Low transmission: aim for malaria elimination (DPR Korea and Sri Lanka) Malaria –free: Maldives * India, Indonesia, Bangladesh are 3 of 5 countries in the world having largest population

The Revised Malaria Control Strategy for SEAR endorsed by 60 th Regional Committee Broad strategies Reform approaches to programme planning and management Revamp surveillance and strengthen monitoring and evaluation Scale up coverage and proper use of ITN/LLIN Target interventions to risk groups Scale up control of P.vivax malaria

The Revised Malaria Control Strategy for SEAR Guiding principles Emphasis on ecological, environmental and behavioral determinants Revamping surveillance and strengthening monitoring & evaluation Improving programme planning and management Multi-sectoral involvement

Approaches to sustain achievements 1) to scale-up/maintain high coverage of key interventions 2) to strengthen capacity of national malaria control programmes at country and district levels 3) to maintain high level political commitment and donor contribution 4) to maintain awareness of community 5) to prevent outbreaks through strengthening surveillance (Integrated disease surveillance)

Approaches to sustain achievements (cont) To scale-up / maintain high coverage of key interventions based on area stratification and identification of pop at risk Diagnosis and treatment (RDT & ACT) –To strengthen public-private partnership –Strengthen capacity of non-health and private sectors in deploying RDT and ACT –Promote production of RDT & establish QC system –Subsidized prized RDT ACT for private sector To implement integrated vector management (IVM) through multisectoral approach ITN/LLIN – at least 80% coverage (target of 60% in 2010) –To give free or highly subsidized ITN/LLIN (need support from donors) IRS in high risk areas & epidemics

Approaches to sustain achievements (cont) To strengthen capacity of national malaria control programmes at country and district levels Support regional/national training to building cadres of malaria staff to replace malaria veterans Develop training curriculum, guidelines and work with medical colleges Promote multisectoral approach and building up partnership with non-health sectors

Approaches to sustain achievements (cont) To maintain high level political commitment and donor contribution Advocate malaria in all forums To maintain awareness of community Promote malaria campaign Identify potential groups in community IEC - BCC To prevent outbreaks through strengthening Surveillance (Integrated disease surveillance) Health system strengthening To integrate malaria with healthy public policies

Way forward Slow decline of malaria morbidity and mortality reported from countries ( ) Sharp increase in coverage of interventions over the past 2-3 years –ITN/LLIN coverage increased from 3 to 14% (still too low) –IRS coverage increased from 22 to 35% (large size of and hard-to-reach Pop at risk are main obstacles) All SEAR countries with Pf adopted ACT and are up- scaling coverage WHO at all levels committed to provide technical support to Member states in order to reach targets and maintain acheivements