Regional  Artemisinin Initiative (RAI)

Dr Faisal MansoorHead of the Programme Unit UNOPS Myanmar, PR GFATM

MMV meeting Siem Reap25 Feb. 2015

RAI - overview• Artemisinin Resistance is a Regional and Global threat that requires

regional coordination and harmonization.• In response to the above, in March 2013 the Global Fund Board

allocated $100m to address this threat in the Greater Sub-Mekong region.

• Based on disease burden and financial gap analysis, the funds are allocated as follows:

Myanmar 40MCambodia 15MVietnam 15M

Thailand 10MLaos 5MICC 15M

RAI Geographical Coverage

Cambodia7%

Lao People's

Democratic Republic

8%

Myanmar79%

Thailand5%

Viet Nam1%

Yunnan0%

API= 7.88

API= 7.09

API= 2.74

API= 0.22

API= 0.51

Burden of malaria in the GMS region

RAI - overview• The Regional Artemisinin Resistance Initiative, or RAI, is the

result of a collaborative effort between multiple partners and the Ministries of Health of the five countries, which worked together with great commitment and a strong cross-border spirit. The initiative aims to achieve elimination of P. falciparum malaria.

• The stakes of the initiative go far beyond the Greater Mekong Sub-region. If resistance were to reach India or sub-Saharan Africa, where most malaria cases occur, the public health consequences could be disastrous (There are already hints of resistance on the western border of Myanmar)

• The RAI has joined forces with all key partners. A high level Regional Steering Committee that oversee the RAI has all the key stakeholders (national, regional and international) to ensure the initiative builds on efforts currently underway.China will provide technical support to RAI by sharing experience and best practices

Implementation arrangement

RAI-Guiding principles

“containment of AR malaria can only be assured if the transmission of malaria stops and falciparum malaria is eliminated from the region”

“5-M approach”1. Migrant and Mobile Populations2. Monotherapy3. Monitoring and surveillance4. Malaria Posts5. Malaria Parasite

At Risk populations in Tier 1 & 2

Indicator Country 2014 2015 2016

Static Pop

Cambodia 9,096,163 9,236,244 9,378,482Lao, PDR 563,607 9,238,259 9,380,498Myanmar 5,030,681 8,645,976 11,153,308Thailand 1,916,104 1,654,105 1,699,381Vietnam 7,543,454 10,300,081 12,852,689

Total 24,150,008 39,074,664 44,464,359

Mobile / Migrant Pop ( estimates)

Cambodia 433,151 439,821 446,594 Lao, PDR 23,420 25,620 25,620 Myanmar 150,920 152,867 154,839 Thailand 156,930 156,930 156,930 Vietnam 115,595 40,000 40,000

Total 880,016 815,238 823,984

LLINs Coverages

Country Year 1 (2014) Year 2 (2015) Year 3 (2016)

Cambodia 61% 74% 71%

Lao, PDR 90% 55% 88%

Myanmar 57% 100% 100%

Thailand 87% 96% 77%

Vietnam 10% 60% 60%

2015 And 2016 are projected % based on current LLIN distribution data

Budget Distribution at Modular level in Concept Note

Module Cambodia % Laos % Myanmar % Thailand % Vietnam%

VC

CM

M&E

PM

46

26 25 54

55 38 80 23

7 3 10 211

48 26 5 20

7 5

8

Budget Distribution at Modular level after Grant making

Module Cambodia % Laos % Myanmar % Thailand % Vietnam%

VC

CM

M&E

PM

47 15 26 26 51

34 28 35 21 27

6 9 8 12 7

12 47 31 41 15

Budget Distribution at Modular level after Reprogramming

Module Cambodia % Laos % Myanmar % Thailand % Vietnam%

VC

CM

M&E

PM

1618 21 24

50 41 36 26 44

5 7 12 13

22 36 38 27

16

36

12

Key Milestones RAI- Up to June 2014

• Despite delayed startup, all countries reported achievements oncase management indicators as these activities are co-financedfrom country GF grant and government and other sources;

• Achievements against new RAI indicators is very low mostly asa delay in starting implementation. Thailand and Myanmarshowed good progress;

• As a result the overall budget absorption including commitmentsfor all countries is less than 25% of the P1 Budget.

All Countries Achievements vs. Targets (Jan- Jun 2014)

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

CAMBODIA LAOS MYANMAR THAILAND VIETNAM

-

96,500 167,081

531,244

300,000

97,824 50,481

100,671

801,251

-

Targeted # Actual Reached

Suspected Malaria Cases received Parasitological tests

All Countries Achievements vs. Targets (Jan- Jun 2014)

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

CAMBODIA LAOS MYANMAR THAILAND VIETNAM

14,469 17,136

41,754

11,638 11,780 14,834

10,136 8,678

10,604

-

Targeted # Actual Reached

Confirmed Malaria Cases received treatment

RAIICC

(3M’s)(Village level)

RAIICC

(3M’s)(Village level)

RAI country

component(TSPs Level)

RAI country

component(TSPs Level)

National Malaria Control

Program(National Level)

National Malaria Control

Program(National Level)

MALARIAELIMINATION

Complementarity& Inter-linkages: ICC, RAI and MCP

Map, Mop and Monitor

INTER COUNTRY COMPONENT - Implementation Update

• Grant Agreements for Year 1 (July 2014-June 2015) signed withall three selected ICC SRs (SMRU, MAM, CPI);

• First funds disbursement remitted to all ICC SRs;• Processes for procurement of ACT, DHA+PPQ and RDT are

completed.• Protocol for TME got Ethical Approval in November 14• CPI – sent a DMR scientist to University of Maryland to get

trained in qPCR and sample collection;• MAM - completed Villages identification selections and training

of new VHVs completed. Also, conducted advocacy with ethnicpartners and community engagement for the implementation ofqPCR;

• SMRU – started dynamic mapping.

Next plans• Current grants are extended to 31 March 2015 based on current

workplans/budgets to avoid interruption of implementation.

• PR conducted the in–country workshops to develop detailedwork plans / budgets for April 2015 – Dec 2016

• Grant negotiations with GF in March 2015, contracts betweenUNOPS and countries issued by 30 March, and implementationcontinues 1 April 2015;

• Selection of new SRs under Phase 2 of ICC is underway. Thiswill target other border areas. Implementation of new ICC canonly start in July 15.

Summary of programmatic changes 2015-16

• Expansion in the targeted geographical areas and, thus,increase in numbers of the targeted populations exceptfor Thailand.

• Myanmar has not officially updated the tiers map but RAIactivities is planned to be expanded to its westernborders.

• All countries increased their targets for impact andsome key output indicators. For Impact indicator mostcountries aimed for remarkably lower Malaria Morbidityrates e.g. Laos is aiming for 70% reduction by 2016 from2012 baseline. All countries increased their testingtargets

Thankyou