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

2. 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
- External Review recommendations
- KAP/MIS survey findings
New Application, Tailored Review

3. Epidemiological updates
New Application, Tailored Review

4. 33rd CCM Meeting 26th -27th May, 2016 ( Malaria)

5. New Application, Tailored Review

6. Bhutan is progressing well towards the stated goal of the NMSP 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/ 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 / Mixed
Elimination Phase
Prevention of Re-establishment Phase
Non-Receptive Areas

7. 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).

8. 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 )
BHUTAN was at this level
(from )
31st CCM, Ministry of Health, 10th Oct. 2014

9. Bhutan National Strategic Plan
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

10. 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)

11. 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

12. Financial Gap Analysis (Malaria) 2018 -2019 2019-20 2020-21 Total
  Financial Gap Analysis (Malaria)
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

13. 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

14. 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

15. New Application, Tailored Review

16. 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 1

17. 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

18. 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 June 2021
New Application, Tailored Review

19. New Application, Tailored Review
Thank you
New Application, Tailored Review

20. 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

21. 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

22. 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

23. 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