Learning Unit 7 Health systems and inter-sectoral and cross-border collaboration 14 Feb 2014 Dr. Leonard I. Ortega Regional Adviser, Malaria WHO-SEARO

Introduction “Malaria eradication – similar to military operations” “Malaria elimination is war!” “We have the responsibility but we do not have the authority” “Health system” “Systems thinking”

Learning Objectives By the end of this Unit, the Participant should be able to: Explain how the different components of the health systems relate to effective malaria control and elimination Give examples of common weaknesses in health systems that constrain malaria elimination and identify ways to overcome those weaknesses Describe measures for re-orienting the health system towards the needs of malaria elimination Determine the roles of different actors including the private sector, the community, different sectors and inter-country collaboration Identify suitable topics for operational research related to elimination

What is health system?

Health system: definition and building blocks

Health System (1) (1) Governance: ensuring strategic policy frameworks combined with effective oversight, coalition building, accountability, regulations, incentives and attention to system design; (2) Health workforce: responsive, fair and efficient given available resources and circumstances, and available in sufficient numbers;

Health System (2) (3) Health financing: raising adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them; (4) Medical technologies: including medical products, vaccines and other technologies of assured quality, safety, efficacy and cost- effectiveness, and their scientifically sound and cost-effective use;

Health System (3) (5) Health information: ensuring the production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status; (6) Service delivery: including effective, safe, and quality personal and non-personal health interventions that are provided to those in need, when and where needed (including infrastructure), with a minimal waste of resources.

Health system needs for malaria elimination

Analyzing and improving quality of service delivery

The private health care sector What are the roles of private health care sector? Some examples… Four approaches of malaria elimination: 1.Early detection of all cases 2.Prevention of onward transmission from cases 3.Management of foci 4.Management of importation of malaria parasites

Inter-sectoral collaboration Malaria is not just a health problem; it is a socio- economic development issue Collaboration with other sectors is important; some examples: – Business/corporate sector (in Bhutan; the Philippines; Malaysia) – The military (in Sri Lanka; Thailand) – Civil societies/FBO/NGOs (in the Philippines; Sri Lanka; Thailand, Solomon Islands) – Other government sectors (in Bhutan; the Philippines, Thailand)

Inter-country collaboration Multi-country – ASEAN – Asia Pacific Malaria Leaders Alliance (APLMA) – Greater Mekong Sub-region – BBINMS (Bangladesh, Bhutan, India, Myanmar, Nepal, Sri Lanka) – South Pacific Community – Mekong Basin Disease Surveillance – Lower Mekong Malaria Initiative (Cambodia, Myanmar, Thailand) – ACTMalaria – Asia Pacific Malaria Elimination Network Bilateral – Myanmar-Thailand – India-Nepal – India-Bhutan

BBINMS Agreed Key Areas for Collaboration (August 2012) 1.Disease surveillance 2.Entomological surveillance, including insecticide resistance 3.Capacity development 4.Sharing of information 5.Joint cross border meeting, planning and development of common materials 6.Operational research to address forest-related malaria and malaria related to population movement 7.Monitoring therapeutic efficacy and quality of anti- malarial drugs.

The road towards malaria elimination is long and difficult… … but together we can make it! Thank you!

Group Exercise Please see Guide for Participants, pages Group 1 (Bhutan, Malaysia, Vietnam): Exercise 7.1 Facilitator: Leonard Group 2 (Sri Lanka, Philippines, Nepal, Vanuatu): Exercise 7.2: Facilitators: Cecil, Rabi Group 3 (China, Thailand, ROK, Solomon) Exercise 7.4; Lasse and Jean One hour group work; one hour presentations and discussions