SEA -MAL-219 Distribution: General
Roll Back Malaria: Technical Support Networks in South-East Asia Report of the Informal Consultative Meeting Chiang Mai, Thailand, 13–17 March 2000
WHO Project : ICP CPC 400 XA 00
World Health Organization Regional Office for South-East Asia New Delhi May 2001
© World Health Organization 2001 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents responsibility of those authors . by named authors are solely the
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Contents Page Executive Summary................................................................................................v 1. 2. 3. 4. INTRODUCTION........................................................................................... 1 OBJECTIVES................................................................................................... 1 PROCEEDINGS.............................................................................................. 2 INSTITUTIONAL ARRANGEMENT ................................................................. 3 4.1 Regional Network.................................................................................... 3 4.2 National Chapters ................................................................................... 3 STRATEGIC DEVELOPMENT.......................................................................... 3 5.1 Technical Support Network on Transmission Risk Reduction (TSN-TRR)............................................................................................... 3 5.2 Technical Support Networks on Surveillance, Information Management and Epidemic Preparedness and Response (TSN-SIE)................................................................................................. 8 5.3 Technical Support Network on Drug Resistance and Policies (TSN-DRP) ............................................................................................ 11 RBM NETWORK AND TDR TASK FORCE ON DRUG RESISTANCE AND POLICY - JOINT MEETING .............................................. 13 CONCLUSIONS AND RECOMMENDATIONS............................................. 14 Annexes 1. 2. List of Participants......................................................................................... 15 Standard Case Definitions and Core Epidemiological and Operational Indicators as recommended by the Meeting for the Mekong Co untries............................................................................. 24 Workplan 2000 – 2003 TSN on Transmission Risk Reduction ....................... 29
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6. 7.
3.
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Executive Summary Technical Support Networks (TSNs) were set up in the WHO South-East Asia Region with national chapters in respective Member Countries. TSNs comprise the following networks: (i) Transmission Risk Reduction (TRR), (ii) Surveillance, Information Management and Epidemic Preparedness and Response (SIE), and (iii) Drug Resistance and Policy (DRP). These networks will serve as technical resource to support Roll Back Malaria in South -East Asia. The secretariat of the TSNs is initially based in WHO/SEARO and will rotate within Member Countries. The national chapter of each network (TRR, SIE, DRP) will have two focal persons, one from the malaria control programme and another one from a research or technical institution who will be responsible for its coordination and functioning. There will be an overall national coordinator nominated by the government. The work plan of each TSN for 2000-2003 reflects the identified priorities to be addressed by each TSN.
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1.
INTRODUCTION Roll Back Malaria (RBM) was initiated by the Director-General of WHO in May 1998 aiming at reducing malaria burden by 50% by the year 2010. WHO RBM Cabinet Project was established on 23 July 1998 to support this initiative. RBM was launched on 31 October 1998 by WHO, UNICEF, UNDP and WB as the founding partners, and supported by member countries, bilateral agencies, NGOs and other sectors ‘of society. Since then, several advocacy and consensus meetings have been conducted in the SEA Region. It was recognized that RBM in this Region should draw its strength through networking of the existing technical resources at national and regional levels to address priority issues related to Transmission Risk Reduction(TRR), Surveillance, Information Management, Epidemic Preparedness and Response (SIE), and Drug Resistance and Policy (DRP). In an informal consultative meeting held from 13-17 March 2000 in Chiang Mai, Thailand, the technical support networks were organized to address the above technical areas.
2.
OBJECTIVES (1) To discuss the role and develop terms of reference of the technical support networks on TRR, SIE and DRP; (2) To identify institutions, core groups and individuals from the SEA Region, and specific areas that require strengthening; (3) To identify programme needs on TRR, SIE and DRP; (4) To develop working mechanisms within and outside the resource network, and (5) To develop a regional work plan for each TSN for 2000-2001 and 2002 -2003.
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3.
PROCEEDINGS The meeting was commenced with a message from the Regional Director, WHO/SEARO read by the WHO Representative in Thailand followed by the inaugural address by the Deputy Director-General, Department of Communicable Disease Control, Ministry of Public Health, Thailand. The Director, Malaria Division, Bangkok, Thailand made the introductory remarks. Representatives from RBM/CDS/WHO and RBM partner s (USAID, Faculty of Tropical Medicine / Mahidol University/SEAMEO-TROPMED, JICA Philippines Office, and Tokyo Women’s University) delivered their remarks. The participants were from seven SEARO Member Countries (Bangladesh, India, Indonesia, Myanmar, Nepal, Sri Lanka and Thailand), and two WPRO Member Countries (Philippines and Papua New Guinea) as well as from partner agencies. See Annex 1 for list of participants. Dr. Krongthong Thimasarn (Thailand) was elected Chairperson of the meeting while the co -chairperson was Dr Myint Lwin (Myanmar). Dr. V P Sharma (India) and Dr. Enrique Tayag (Philippines) were the rapporteurs. Three groups corresponding to the three technical support networks met simultaneously with joint sessions during the first and last day. Each group selected their respective chairperson and rapporteurs. TDR’s Task Force on Research on Drug Resistance and Policy had its meeting during the same period at the same venue. They joined the plenary sessions and had joint sessions with the TSN on DRP. The terms of reference of each TSN were developed and finalized by the respective group. Basically, the TSNs will serve as technical resource not only to the national malaria control programmes and WHO/SEARO but also to RBM partners in the Region and in the Member Countries. The TSNs will function and address relevant technical issues according to their comparative strengths. Institutional arrangement to facilitate work was also discussed. The three groups had technical sessions wherein relevant topics were presented and discussed. Based on these discussions, major technical areas and some specific issues that each TSN will work on were identified. It was envisaged that the TSNs would have significant contributions in rolling back malaria by addressing the technical areas listed in their plan of work for 2000 - 2003.
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4. 4.1
INSTITUTIONAL ARRANGEMENT Regional Network The regional network comprises a core of experts in various disciplines relevant to TRR, SIE, and DRP from Member Countries of the WHO SEA Region. It will co-opt members from outside the Region as and when the need arises. The network has two focal persons each on TRR, SIE and DRP from each Member Country - one from the malaria control programme and another from a research institution or from other institution with technical expertise. Initially the network secretariat will be based in WHO-SEARO and function in collaboration with and within the framework of the RBM project in SEARO and HQ every two years, the secretariat will rotate within the Member Countries.
4.2
National Chapters Two core members identified from each country will serve as the focal points who will initiate and facilitate the establishment of national chapters of the TSNs in their respective countries. The Director (Natio nal Malaria Control Programme Manager) or a more senior official in the Ministry of Health will be the overall national coordinator. The national core group members would include representatives from various disciplines, key staff from the control programmes, professional associations, research institutes, medical colleges, private health care providers, pharmaceutical industries, consumer associations, etc. Where similar technical committees or groups already exist in the country, the national chapter should be built on these existing structures and not duplicate them. The members and partners of each TSN will develop the working mechanisms after the network is established.
5. 5.1
STRATEGIC DEVELOPMENT Technical Support Network on Transmission Risk Reduction (TSN-TRR) The group considered two modalities of transmission risk reduction- vectorbased and parasite-based. Within the framework of TRR network, the group agreed to focus only on vector-based transmission risk reduction.
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Within the RBM partnership, t echnical support to national malaria control programmes is an essential component. Technical support networks (TSN-TRR) provide the necessary mechanism. (1) Terms of Reference (a) To provide technical assistance to RBM partners in the Region in support of the development and establishment of integrated vector management programmes for routine control and the prevention of adverse impacts of development projects. (b) To assist in the establishment of an agenda of relevant research questions in this area, co ordinate multidisciplinary research efforts and ensure that research outcomes reach the appropriate authorities. (c) To review the status of the integrated vector management, compile information on experience in and outside the Regions on the promotion of integrated vector management and make this information available to the RBM partners. (d) To assess capacity-building needs in support of integrated vector management and develop capacity building programmes in response to these needs. (e) To assist Member Countries in the Regions in the process of developing policy review and adjustment, both in the health sector and in other development sectors, and to harmonize sectoral policies. (2) Scope and Focus TSN-TRR will address the following general issues: (a) Methods currently available for achieving a reduction in the transmission potential ranging from personal protection methods (e.g., insecticide-treated bednets and repellents) to vector control based on non-chemical and chemical methods; (b) Selective and integrated use of the available methods in the most effective and efficient manner, based on the best evidence at the local level;
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(c) Methods and procedures for strategic health risk assessment and health impact assessment; (d) Institutional strengthening for training on integrated public health measures against vector-borne diseases; (e) Optimal use of national, regional and global expertise and resources in transmission risk reduction, and (f) Coordination of transmission risk management efforts as a b asis for the sustainability of RBM achievements. (3) Actions for RBM Regional trends and strategic responses (a) Identify regional issues, define problems and assess needs to overcome these problems. (b) Inventory the existing expertise in the Region. (c) Document and exchange information and experience. (d) Interface with other regional technical networks (e.g. TSN-SIE and TSN-DRP) to provide fully integrated technical advice for RBM implementation in countries. Research & Development (a) At regular intervals, review and update a research agenda in transmission risk reduction. (b) Mediate the transfer of knowledge gained by research for application in control programmes. (c) Disseminate information on up-to-date technologies and methods by reviewing the latest developments in the field. Framework for a generic capacity-building strategy (a) Formulate regional policies and guidelines on transmission risk reduction for adoption by Member Countries.
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(b) Develop capacity to monitor and evaluate the impact of interventions directed at transmission risk reduction. (c) Link scientists and institutions with expertise to counterparts in disease control operations at district and national levels. (d) Afford training opportunities to a younger generation of health professionals and scientists within ongoing implementation activities of RBM. Assistance to Member Countries (a) Identify issues, define problems and assess needs to overcome these problems at the national level; (b) Assist in the planning and implementation of selective transmission risk reduction methods as an integral part of the health system; (c) Facilitate the establishment of national level networks to support district level RBM activities; (d) Utilize national centres of excellence as collaborating centres and network national experts as a regional resource for the effective implementation of RBM; (e) Assist in setting standards to ensure products/materials used in TRR, and quality assurance of
(f) Assist in reorienting the role of entomological services and support services for TRR, including advocacy for partnerships. (4) Regional Issues The group identified the following general issues across the Region. (a) The role of entomological services needs to be redefined for the Region to address RBM. (b) Clearly defined partnership mechanisms should be established in the Region to ensure sustainable support for RBM. (c) Lack of coordination between countries in insecticide policy towards the control of border malaria is a common problem.
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(d) Comprehensive approach should be adapted towards integrated vector- borne disease control. (e) Knowledge transfer on sociocultural aspects in vector control operationalization needed. (5) Priorities to be addressed by the TSN-TRR (a) Mosquito nets: In order to promote treated mosquito nets in the communities the following areas required emphasis and focused work. (i) Inventory the information on ITN operationalization (standardize parameters, identify knowledge gaps); (ii) formulate evidence-based guidelines for programme implementation (decision making criteria for ITN purchase, logistics for focused delivery and maintenance); (iii) set a research agenda and strategy for resource mobilization to implement it; and (iv) social marketing of ITN and private sector involvement. (b) Insecticides : It was realized that insecticides would continue to play an important role in malaria control. TSN would focus on institutional strengthening to develop training capacity for integrated public health measures against vector-borne diseases. Therefore, there is a need to: review the knowledge base and decision making procedures for judicious use of pesticides; advise on the modalities for the operationalization of selective/integrated approaches with optimal complimentarity of chemical an d non -chemical transmission risk reduction interventions; and inventory regional insecticide resistance and provide guidance on resistance management strategies. (c) Targeting Training : Manpower training in medical entomology in the malaria endemic countries should receive priority, with emphasis on identification of training needs and resources at different levels and development of curricula, training modules and advocacy, and IEC materials to address the acute shortage there. (d) Research : (a) Studies on cytotaxonomy and vector biology (special problems related to An. dirus, An. minimus and An. fluviatilis ) should be directed to: (i) complete a regional picture (including islands) of sibling species; (ii) develop a strategic approach to filling knowledge gaps; (iii) coordinate, stimulate and document at least 5 case studies on ecosystem- based TRR approaches that can serve as regional Page 7
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prototype; and (iv) develop mapping and possible TRR interventions in dirus-fluviatilis-minimus settings, and (b) Research agenda on TRR interventions through intersectoral action. (e) Monitoring and evaluation : TSN-TRR should support malaria control programmes reviewing the regional situation using TRR indicators, and assess the potential to upgrade information system (both health sector/outside the health sector) for decision-making based on the Geographical Information System (GIS). (f) International Borders: Malaria control at the international borders should be organized by providing technical support and assistance in the synchronization of field operations in the border areas, and malaria control programmes should review and promote experiencesharing of existing mechanisms and partnerships for cross border collaboration in TRR operations, TRR & SIE coordination using GIS technology. (g) Health Impact Assessment/Health Risk Management: National activities (assessment workshops) to review, adjust and harmonize development policy frameworks to promote HIA/HRM and adapt existing generic HIA guidelines for specific use at the country level should be coordinated; and a research agenda on TRR interventions through intersectoral action set. In addressing these issues, the TRR would consider: RBM's pathfinder role in health sector-wide development; on-going processes and decentralization and structural adjustment, and a strengthened role of the health sector in the works of other public and private sectors.
5.2
Technical Support Networks on Surveillance, Information Management and Epidemic Preparedness and Response (TSN-SIE) The group identified the need for TSN-SIE to: develop a reliable and rapid information management system; standardize the core indicators for monitoring and surveillance; assist countries to develop early warning systems and to mobilize resources for epidemic preparedness and control.
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(1) Terms of Reference (a) To formulate policies, strategies and guidelines on surveillance, information management, and epidemic preparedness and response; (b) To identify common core indicators for monitoring and evaluation of the implementation of RBM in Member Countries and the Region. To strengthen the regional, national and sub-national capacity for RBM related to SIE by promoting the better use of collaborating centres / centres of excellence through networking; creating training opportunities for health professionals and scientists, and improving links between institutions/scientists and the control programme; (c) To establish appropriate channels of communication among Member Countries and stakeholders; (d) To identify priorities and promote research related to SIE and ensure transformation of research findings into policies and practices, and (e) To maintain interface with other regional networks. (2) Scope and focus The SIE group agreed on five major technical areas and so me specific issues that will be addressed by the SIE network. The number one priority activity is to validate the core indicators that were recommended during the WHO Bi regional Meeting in Kunming, China in 1999 for monitoring and evaluation of RBM implementation. (a) Surveillance system • Identifying and validating core indicators; • Improving reporting of deaths, and • Involving the private sector/other systems of health care (b) Information management system • Timeliness of reporting and feedback; • Introducing information technology, and • Information-based decision-making.
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(c) Epidemic preparedness and response • Early warning and detection systems; • Emergency drugs and insecticides; • Rapid response teams (RRT); • Collaboration with other sectors for prevention of epidemics and rapid response, and • Investigation and analysis of epidemics. (d) Information exchange and networking • Define priority information for sharing, and • Level of networking. (e) Operational research • Validation of core indicators; • Evaluation of use of information technology; • Establishment of early warning and detection systems; • Community based surveillance (lay reporting), and • Identify weaknesses (including delays) of the existing surveillance system. (3) Actions for RBM (a) Selection of indicators to be validated in RBM districts and to be used in SEA Region based on those agreed upon during the SEA/WPR Biregional Meeting on Malaria Control, Kunming, Yunnan Province, China in 3-5 November 1999. See Annex 2 for standard case definitions and core epidemiological and operational indicators adopted and recommended for the countries in the Mekong area which are to be validated in other SEA countries. (b) Efficient information management system focusing on informationbased decision-making and introduction of new technology such as "Health Mapper" at district levels. (c) Epidemic preparedness and response focusing on the progressive setting up of early warning and early detection systems, as well as rapid response teams at district level. Page 10
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(d) Improving the exchange of agreed information between SEA countries. (e) Field researches focusing on the selection of community-based monitoring indicators and the development of a methodological guideline for surveillance and monitoring of RBM interventions at the periphery. The networks on SIE and TRR should be linked up to address interrelated technical issues, for example in early warning system and forecasting of epidemics, with the application of geographical information system (GIS). Since the use of GIS in malaria control is still under development, the two networks should work together.
5.3
Technical Support Network on Drug Resistance and Policies (TSN-DRP) The DRP group highlighted the need for drug resistance monitoring, standardized protocols, pre-packaging of drug combination, early diagnosis using dip-stick, pediatric formulation (drug combination), quality assurance, and sharing information on "fake drugs". (1) Terms of Reference (a) To formulate the regional anti-malarial drug policies and guidelines on drug resistance and policy for adaptation by the Member Countries. (b) To facilitate the planning and implementation of anti-malarial drug policy and drug resistance monitoring as an integral part of RBM initiative within the context of national health development through a national level DRP networking, and provision of technical expertise. (c) To assist the nationals programme in the development of evidencebased drug policy and facilitate or conduct research in support of policy-making. (d) To assist the national programme in the development of a strategic plan in the area of capacity-building and operational research through optimal utilization of the network of national and regional expertise in DRP.
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(2) Scope and Focus The issues identified by DRP were grouped into four major areas as listed below. Some are not technical per se, such as the procurement and distribution system of anti-malarial drugs. However, the group felt that this area has very significant bearing on rolling back malaria, and the TSN-DRP would be able to provide some assistance in improving it. (a) Data banking and information exchange • Drug policies and drug regimens; • Drug resistance data; • Directory of national experts relevant to DRP; • Activities of the network, and • Standardization of the format for reporting and exchange of information. (b) Capacity-building • Support for infrastructure development for monitoring drug resistance; • Training on development of anti-malarial drug policy; • Anti-malarial drug quality assurance, and • Institutional strengthening in drug monitoring and sharing information on "fake drugs". (c) Procurement and distribution system for anti-malarial drugs • Review of existing systems; • Explore the feasibility of pooled procurement, and • Social marketing of anti-malarial drugs. (d) Priority Operational Research Issues • Large scale trials on the impact of drug combinations on transmission potential and on delaying emergence of resistance: probable combinations artesunate and schizonticides (Sulfadoxine or Sulfalene Pyrimethamine / Chloroquine / Mefloquine);
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• Research on the impact of early diagnosis and effective treatment with existing anti-malarial drugs regimens; • Pediatric formulation with drug combination; • Operational use of more sensitive tools for monitoring of P. falciparum drug resistance, and • Initiation of P. vivax drug -resistant studies. (3) Actions for RBM (a) Anti-malarial supply management should ideally be a part of the national essential drugs supply system. (b) The regional network on drug resistance and policies should address the issue of anti-malarial quality in South-East Asia. (c) As drug quality and supply are critical for RBM, country and drug supply managers should, from time to time, participate in national and international fora. (d) Studies are required on access to anti-malarial drugs for the poor in South- East Asia, as malaria control managers largely overlook this subject.
6.
RBM NETWORK AND TDR TASK FORCE ON DRUG RESISTANCE AND POLIC Y - JOINT MEETING A TDR Task Force meeting on Drug Resistance and Policy was held on the same dates to facilitate interaction with the Technical Support Network (TSN). In a joint meeting the TDR Task Force addressed many issues raised by the countries of the SEA Region, and in general advised that: • Any new anti-malarial should be deployed in combination; • Combining sulfadoxine-pyrimethamine and chloroquine will, in principle, delay the development of resistance, as their mechanisms of action are different, and • Studies now underway will clarify many of the outstanding issues and provide the evidence required by countries for decision-making.
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7.
CONCLUSIONS AND R ECOMMENDATIONS (1) Three technical support networks (TSNs) are established in the WHO South-East Asia Region: (i) Transmission Risk Reduction (TRR); (ii) Surveillance, Information Management and Epidemic Preparedness and Response (SIE), and (iii) Drug Resistance and Policy (DRP). The network will basically serve as technical resource to rolling back malaria in the South East Asia Region. Each TSN has terms of reference and identified priority technical areas on which future activities will be based. The work plan of each TSN for 2000-2003 was developed See Annex 3. The work plan needs to be translated into a country plan with more specific details for implementation. At the regional level the TSNs shall have a secretariat to coordinate the activities, which will be initially based in WHO/SEARO and would rotate within Member Countries every two years thereafter. Two focal persons, one each from the Ministry of Health and from another institution, have been identified, who are responsible for initiation and facilitation of the establishment of national TSNs. The Malaria Control Programme (MCP) Manager or a superior officer shall be the overall coordinator of the national TSNs. The TSNs are encouraged to establish linkage with partners within the framework of RBM to mobilize resources to support its activities. Mechanisms for partnership and linkages with other organization such as UNICEF and Special Programme for Research and Training in Tropical Diseases (TDR) will be evolved. Crosscutting issues between networks such as advocacy, social mobilization, and information, education and communication (IEC) shall be discussed in a common forum. Seed money and technical support shall be available from WHO Roll Back Malaria Cabinet Project and its partners. Each network from Member Countries is encouraged to find other funding sources to support related activities.
(2)
(3)
(4)
(5)
(6)
(7)
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Annex 1 LIST OF PARTICIPANTS Bangladesh Dr A. Mannan Bangali Deputy Programme Manager Malaria and Vector Borne Disease Control Directorate-General of Health Services Mohakhali Dhaka 1212 Tel: (00-880-2) 606326 Fax: (00-880-2) 988-6415 E-Mail: vbdc@bdonline.com Dr Md. Jalil Mondal Deputy Programme Manager (DPM) Disease Surveillance Esp Directorate-General of Health Services Mohakhali Dhaka 1212 Tel: (00-880-2) 600259 (Off.) Fax: (0088-02) 988 6915 E-Mail: vbdc@bdonline.com Dr Md. Mushfiqur Rahman Evaluator Malaria and Parasitic Diseases Control Directorate-General of Health Services Mohakhali Dhaka 1212 Tel: 0088-02-606326 605516 Fax: 0088-02-988 6915 E-Mail: vbdc@bdonline.com Cambodia Dr Jan Rozendaal Malaria Expert P.O. Box 91 Phnom Penh Cambodia Fax: 855 23 214-310 E-Mail: jrozendaal@bigpond.com.kh China Prof. Li Guo Qiao Sanya Institute of Tropical Medicine Guangzhou University of Tropical Medicine 12 Airport Road Guanphon People’s Republic of China Tel: 86 20 863-7356 Prof. Wang Xin-Hua Sanya Institute of Tropical Medicine Guangzhou University of Tropical Medicine 12 Airport Road Guanphon People’s Republic of China Tel: 86 20 863-7356 E-Mail: gzzywxh@public.guangzhou.gd.com India Mr N.L. Kalra A-38 Swasthya Vihar Vikas Marg Delhi – 110 092 Tel: 91-11-220 9210 (Residence) E-Mail: C/O Aruna@Ndf.Vsnl.Net.In and arunasrivastava@hotmail.com Dr J.R. Sharma Head & Project Director Regional Remote Sensing Service Centre Department of Space Government of India Cazri Campus Jodhpur - 342 003 Tel: 91-291-740004 / 744647 Fax: 91-291-741516 E-Mail: rrsscj@vsml.com jrsharma@hotmail.com
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Report of the Informal Consultative Meeting Dr V.P. Sharma Cii/55 Satya Marg Chanakyapuri New Delhi-110 021 Tel: 91-11-6885195 / 4674587 Fax: 91-11-2215086 E-Mail: v_p_sharma@hotmail.com sharmavp@whosea.org Dr G.P. Singh Joint Director In-Charge of Epidemiology National Anti-Malaria Programme 22 Shamnath Marg Delhi – 110 054 Tel: 3918576 (Off.) 6123526 (Res.) E-Mail: gajinder@bol.net.in gagandhillon@hotmail.com Dr S. Sarala K. Subbarao Director Malaria Research Centre 22 Shamnath Marg Delhi – 110 054 Tel: 91-11-3981690 / 3981905 Fax: 91-11-2946150 / 7234234 E-Mail: sks@ndt.vsnl.net.in Indonesia Dr Ferdinand J. Laihad Chief Sub-Directorate of Malaria CDC & EH Ministry of Health Jakarta Tel: 62-21-424 7608 Ext. 150 Fax: 62-21-424 7573 E-Mail: laihad@centrin.net.id Dr Muhammad Nadhirin Head of Data Analyzing Sub-Directorate of Epidemiological Surveillance Directorate of Epidemiology & Immunization Directorate-General of CDC & EH Ministry of Health Jakarta Tel: 62-21-426 5974 (Office) 864 3810 (Home) Fax: 62-21-426 6919 E-Mail: nestppm@cbn.net.id Dr Sustriayu Nalim Vector Control Specialist Vector and Reservoir Control Research Unit Salatiga Semarang. Tel: 62-29827096 Fax: 62-29822604 Dr Soejono H. Skm. Chief Provincial Health Office In Central Java Jl Madukoro Blok Aa-Bb No.8 Samarang. Tel: 62-24 613633 Fax: 62-24 613330 Dr Emiliana Tjitra Researcher Communicable Diseases Research Centre National Institute of Health Research and Development Ministry of Health Jakarta Tel: 62-21-425 9860 Fax: 62-21-424 5386 E-Mail: email@jakarta.wasantara.net.id Laos Dr Valery Gilbos Consultant Health-Anthropology Vila Zarafa Vat Ban Khoy Sangkhalohk Luang Prabang. Tel: 856-71-212750 Fax: 856-71-212750 E-Mail: valery@gilbos.com Myanmar Dr Khin Aung Cho State Health Director Shan State Taunggyi Dr Maung Maung Senior Medical Officer Disease Control Division Department of Health Yangon
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Roll Back Malaria: Technical Support Networks in South-East Asia Dr Maung Maung Thein Team Leader Vector Borne Disease Control Bago Division Dr Myint Lwin Director General Department of Medical Research Upper Myanmar Mondalay Tel: 095-01-39382 549351 Dr Saw Lwin Program Manager Vector Borne Disease Control Unit Department of Health Yangon Tel: 095-01-663730 / 640749 Dr Saw Maung Senior Medical Officer Disease Control Division Department of Health Yangon Tel: 095-01-549191 Dr Thein Tun Director Health Department Mandalay Division Mandalay Tel: 952-33173 Fax: 951-210652 Dr Ye Htut Deputy Director (Research) Department of Medical Research (Lower Myanmar) Yangon Tel: 951-251508 Ext. 153 Fax: 951-251514 Nepal Dr Manas Kumar Banerjee Chief of Disease Control Division Epidemiology and Diseases Control Div. Department of Health Services Ministry of Health Kathmandu Tel: 255-796 Fax: 262-268 Dr Mahendra Bahadur Bista Director Epidemiology and Diseases Control Divi. Department of Health Services Ministry of Health Teku Kathmandu Tel: 255796 (Office) 470739 (Home) Fax: 262268 Papua New Guinea Dr Vella Bagita Technical Advisor National Malaria Control Programme Papua New Guinea Tel: (675) 301-3737 / 301-3736 Fax: (675) 301-3769 E-Mail: vbagita@health.gov.pg Dr Francis Hombhanje Faculty of Medicine University of Papua New Guinea P.O. Box 5623 Boroko. Tel: (675) 324-3811 / 324-3812 Fax: (675) 324-3827 E-Mail: hombanfr@upng.ac.pg Mr Julius Kundi Malaria Surveillance & Control Unit P.O. Box 778 Goroko Eastern Highlands Province Tel: 731-2215 Philippines Dr Ma. Dorina Bustos Medical Specialist Research Institute for Tropical Medicine Department of Health Alabang Metro Manila Muntinlupa City. Tel: (632) 809-7599 / 807-2628 32 36 37 Fax: (632) 842-2245 E-Mail: dbustos@ritm.gov.ph
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Report of the Informal Consultative Meeting Ms Norma Joson Entomology Adviser Malaria Control Service Department of Health Manila Tel: (632) 781-8943 (632) 743-8301 Fax: (632) 781-8943 Dr Cleo Fe Tabada Medical Officer IV Malaria Control Programme – Davao Doh Regional Health Office No.11 Davao City Tel: (6384) 217-3483 E-Mail: cleo.tabada@eudoramail.com Dr Enrique Tayag Head Infectious Diseases Centres for Disease Control And Prevention Department of Health Manila Tel: (632) 732-2493 Fax: (632) 741-7048 / 732-2493 E-Mail: e_tayag@doh.gov.ph South Africa Prof. Peter Ian Folb Department of Pharmacology University of Cape Town Medical School Health Sciences Faculty K45 Old Main Building Observatory (K/C) 7925 South Africa Tel: (27-21) 406 6286 Fax: (27-21) 448 1989 E-Mail: pfolb@uctgshi.uct.ac.za Sri Lanka Dr Felix P. Amersinghe International Water Management Institute No.127 Sunil Mawatha Pelawatte Battaramulla Tel: 94-1-867404 Fax: 94-1-866854 E-Mail: f.amerasinghe@cgiar.org Dr Punsiri Fernando Director Anti-Malaria Campaign Colombo 5 Tel: 94 581918 / 588408 Fax: 94 585360 Dr Latha Hapugoda Director Health Education & Publicity Bureau of Health Education Ministry of Health No.2 Kynsey Road Colombo 8 Tel: 94 1 692613 696142 Fax: 94 1 692613 Dr Pushpa R.J. Herath 18 Ayurvedha Road Pallekelle Kundasale Kandy Tel: 94 8 420 876 Fax: 94 8 420 876 E-Mail: pusherat@sltnet.lk Dr Willem Van Der Hoek International Water Management Institute No. 127 Sunil Mawatha Battaramulla Tel: 94-1-867404 Fax: 94-1-866854 E-Mail: w.van-der-hoek@cgiar.org Dr A.R. Wickremasinghe Department of Community Medicine And Family Medicine Faculty of Medical Sciences University of Sri Jayewardenepura Gangodawila Nugegoda, Colombo Tel: 94-1-598014 Fax: 94-1-598014 E-Mail: rajwicks@slt.lk Dr (Mrs) Amgm Yapabandara Regional Malaria Officer Matale Tel: 066 - 22295 / 30358 Fax: 066 - 22777 E-Mail: malmalal@sitnet.ik
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Roll Back Malaria: Technical Support Networks in South-East Asia Thailand Dr Apinun Aramrattana Department of Family Medicine Faculty of Medicine Chiang Mai University Chiang Mai Tel: 66-53-945462 Fax: 66-53-217144 E-Mail: apinun@mail.med.cmu.ac.th Ms Elizabeth Ashley Faculty of Tropical Medicine Mahidol University Hospital for Tropical Medicine 420/6 Rajvithi Road Bangkok 10400. Tel: (66 2) 246 0832 Fax: (66 2) 246 7795 E-Mail: e.ashley@correspondence.co.uk Dr Virasakdi Chongsuvivatwong Epidemiologist/Gis Specialist Epidemiology Unit Faculty of Medicine Prince Songkhla University Songkhla Tel: 66 74 429754 Fax: 66 74 212900 E-Mail: cvirasak@ratree.psu.ac.th Dr Jirapat Kanlayanaphotporn Field Epidemiology Training Programme Epidemiology Division Ministry of Public Health Bangkok Tel: (02) 590-1734-5 Fax: (02) 591-8581 E-Mail: jirapat@health.moph.go.th Prof. Sornchai Looareesuwan Dean Faculty of Tropical Medicine Mahidol University Bangkok Tel: (66 2) 247-1688 Fax: (66 2) 245-7288 E-Mai l: tmslr@mahidol.ac.th. Dr F. Nosten Smru Mahidol University, Bangkok. Tel: +66 55 531 531 Fax: +66 55 544 442 E-Mail: ghokco@cscoms.com Dr Lorrin Pang Armed Forces Research Institute of Medical Sciences USA Army Medical Component APO Pacific 96546, Bangkok 10400. Tel: (66 2) 644 6125 / 644 7135 Fax: (66 2) 247 6030 E-Mail: pangl@mozart.inet.co.th Ms Wirichada Pongtavornpinyo Mahidol University Wellcome Unit Faculty of Tropical Medicine 420/6 Rajvithi Road, Bangkok 10400. Tel: (66 2) 246-0832 / (55 2) 644-4541 Fax: (66 2) 246-7795 E-Mail: fnnjw@diamond.mahidol.ac.th Dr Somsak Prajakwong Director Vector Borne Disease Office No.2 Chiang Mai 50200 Tel: (053) 894271 Fax: (053) 212389 E-Mail: malar@chmai.loxinfo.co.th Dr Pratap Singhasivanon Epidemiologist/Gis Specialist Faculty of Tropical Medicine 420/6 Rajvithi Road Mahidol University, Bangkok Tel: (662) 644 7483 246-0056 Ext. 682 Fax: (662) 644 4436 246-8340 E-Mail: tmpsh@mahidol.ac.th Dr Jeeraphat Sirichaisinthop Director Vector Borne Disease Control Office 1 Prabuddhabat Saraburi Tel: (66 36) 266162 Fax: (66 36) 267586 E-Mail: jrp@cdcnet.moph.go.th
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Report of the Informal Consultative Meeting Dr Sombat Tanprasertsuk Director Epidemiology Division Ministry of Public Health Bangkok Dr Suwit Thamapalo Medical Officer and Epidemiologist Office of Vector Borne Disease Control 4 428 Saiburi Road Muang District Songkhla 90000 Tel: (074) 311411 311578 E-Mail: suwich@hotmail.com Dr Krongthong Thimasarn Director Malaria Division Department of Communicable Disease Control Ministry of Public Health Nonthaburi 11000. Tel: (662) 591-8420 590-3121 590-3135 Fax: (662) 591-8422 E-Mail: krongtho@health.moph.go.th Prof. Nicholas White Mahidol University Faculty of Tropical Medicine Hospital for Tropical Diseases 420/6 Rajvithi Road Bangkok 10400. Tel: (66 2) 246-0832 Fax: (66 2) 246-7795 E-Mail: fnnjw@diamond.mahidol.ac.th USA Dr Malcolm Clark Management Sciences for Health (MSH) Drug Management Program Suite 710 1515 Wilson Boulevard Arlington VA 22003 Tel: 1 703 248 1603 Fax: 1 703 524 7898 E-Mail: malark@msh.org Dr Mary Ettling Malaria / Infectious Disease Advisor USAID Bureau for Africa 1325 G Steet NW #400 Washington DC 20005 Tel: 1 202 219-0486 Fax: 1 202 219-0507 E-Mail: mettling@afr-sd.org Dr Ramanan Laxminarayan Resources for the Future 1616 P St NW Washington Dc 20036 Tel: (202) 328 5085 Fax: (202) 939 3460 E-Mail: ramanan@rff.org Vietnam Dr Tran Tinh Hien Center for Tropical Diseases 190 Ben Ham Tu Q5 Ho Chi Minh City-Ville Quan 5 Viet Nam Vn-15000 Tel: 84 - 8 - 835 0475 / 835 3804 Fax: 84 - 8 - 835 3943 / 835 3904 E-Mail: tthien@hcm.vnn.vn Observers Ms Supawadee Konchom Technical Officer, Malaria Division CDC Department, Ministry of Public Health Nonthaburi 11000 Thailand Tel: (02) 590-3126-7 Fax: (02) 591-8422 E-Mail: supawade@health.moph.go.th Ms Pornpimol Ngarmtao Chief of Surveillance Section Epidemiology Sub-Division, Maralia Division Ministry of Public Health Nonthaburi 11000 Thailand Tel: (02) 590-3127 Fax: (02) 591-8422 E-Mail: pornpim@health.moph.go.th
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Roll Back Malaria: Technical Support Networks in South-East Asia Ms Ketsiri Sombatwatanangkul Vector Borne Disease Control Office 2 Chiangmai 18 Boonreungrit Road Muang District Chiangmai 50200 Thailand Tel: (053) 221 529 Fax: (053) 212389 Partners Dr James Campbell Director U.S. Naval Medical Research Unit No.2 (U.S. Namru-2) Kompleks P2m/Plp Litbangkes R.I. Ji. Percetakan Negara No. 29 Jakarta 10560 Indonesia Tel: 62-21-421-4457 Through 4463 Fax: 62-21-424-4507 E-Mail: co@namru2.com campbell@smtp.namru2.go.id Dr Denis Caroll Senior Public Health Advisor Office of Health And Nutrition U.S. Agency For International Development Global Bureau Center For Population Health And Nutrition G/PHN/HN 1300 Pennsylvania Ave. N.W. Washington D.C. 20523-3700 USA Tel: 202 712-5009 Fax: 202 216-3702 E-Mail: dcarroll@usaid.gov Dr Frederick Gay Regional Co-Ordinator European Commission Regional Malaria Control Programme in Cambodia Laos and Vietnam 34 Hang Bai Street Hanoi Vietnam Tel: (84 4) 934 1642 Fax: (84 4) 934 1641 E-Mail: ec-rmcp@hn.vnn.vn Website: http://www.mekong-malaria.org Dr Akira Kaneko Department of Tropical Medicine Tokyo Women’s Medical University 8-1 Kawada-Cho Shinjuku-Ku Tokyo 162-8666 Japan Tel: 81 3 5269 7422 Fax: 81 3 5269 7422 E-Mail: akirak@research.twmu.ac.jp Mr Masatoshi Nakamura JICA Philippines Office 12th Floor Pacific Star Building Makati City Philippines P.O. Box 1026 MCPO Makati City Tel: 063-2-893 3081 Fax: 063-2-816 4222 E-Mail: bednet@pacific.net.ph WHO Secretariat WHO Geneva Dr Robert Bos PEEM/SDE/HQ World Health Organization Avenue Appia 20, 1211 Geneva 27 Switzerland Tel: 41 22 791 3555 Fax: 41 22 791 4159 E-Mail: bosr@who.int Dr Charles Delacollette RBM/CDS/HQ World Health Organization Av. Appia 20, 1211 Geneva Tel: 41 22 791 2766 Fax: 41-22-791 4824 E-Mail: delacollettec@who.int Mr Jean-Pierre Meert WHO/CDS/CSR Healthmap 20 Avenue Appia 1211 Geneva Switzerland Tel: 41 22 791-3881 Fax: 41 22 791-4777 E-Mail: meertj@who.ch
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Report of the Informal Consultative Meeting Dr Kamini Mendis Roll Back Malaria World Health Organization 27 Avenue Appia 1211 Geneva Switzerland Tel: 4122 791 3751 E-Mail: mendisk@who.int Dr Piero Olliaro Manager Drug Resistance and Policies Special Programme For Research and Training in Tropical Diseases (TDR) World Health Organization 27 Avenue Appia 1211 Geneva Switzerland Tel: 4122 791-3734 / 791-3735 Fax: 4122 791-4774 / 791-4854 E-Mail: olliarop@who.int Dr Leonard Ortega RBM/CDS/HQ Tel: (41 22) 791-2661 Fax: (41 22) 791-4824 E-Mail: ortegal@who.ch Dr Jean Regal Drug Resistance and Policies Special Programme For Research and Training in Tropical Diseases (TDR) World Health Organization 27 Ave Appia 1211 Geneva Switzerland Tel: 4122 791-3959 Fax: 4122 791-4774 / 791-4854 E-Mail: rigalj@who.int Dr Pascal Ringwald Anti-Infectious Drug Resistance Surveillance and Containment World Health Organization 27 Avenue Appia 1211 Geneva Switzerland Tel: 41 22 791-3469 Fax: 41 22 791-4878 E-Mail: ringwaldp@who.ch Dr Murtadda Sesay Essential Drugs and Medicines Policy Dept. Health Technology And Pharmaceuticals Cluster World Health Organization 27 Avenue Appia 1211 Geneva Switzerland Tel: 41 22 791-3676 / 791-3893 E-Mail: sesaym@who.int Dr Walter Taylor Drug Resistance and Policies Special Programme for Research and Training in Tropical Diseases (TDR) World Health Organization 27 Avenue Appia 1211 Geneva Switzerland Tel: 4122 791-3959 Fax: 4122 791-4774 / 791-4854 E-Mail: taylorw@who.int WHO/AMRO Dr Renato Gusmao PAHO/AMRO Regional Advisor 525 Twenty-Third St. N.W. Washington D.C. 20037, USA Tel: (202) 974-3259 Fax: (202) 974-3688 E-Mail: gusmaore@paho.org] WHO/SEARO Dr Hadi Abednego Consultant RBM WHO SEARO World Health House M. Gandhi Marg, New Delhi 110002 India Tel: (91-11) 331-7804 / 331-7823 Fax: (91-11) 332-7972 E-Mail: habednego@hotmail.com abednegoh@whosea.org Dr P.R. Arbani Regional Office for South East Asia World Health House Indrapshtra Estate , Mahatma Gandhi Road New Delhi 110002 India Tel: (9111) 331-7804 Fax: (9111) 331-8607 E-Mail: arbanip@whosea.org
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Roll Back Malaria: Technical Support Networks in South-East Asia Dr E.B. Doberstyn WR Office Thailand Ministry of Public Health Tiwanond Road A. Muang Nonthaburi 10110 Thailand Tel: (66 2) 591-1524 590-1514 (Direct) Fax: (66 2) 591-8199 E-Mail: registry@whothai.moph.go.th Dr Methsiri V.H. Gunaratne Regional Advisor – Communicable Diseases World Health Organization Regional Office for South East Asia World Health House I.P. Estate Ring Road New Delhi 110 002 India Tel: 331-7804 To 331-7823 Fax: 91 11 331-8607 / 331-8412 (Dir) E-Mail: gunaratnem@whosea.org Dr Chusak Prasittisuk Regional Advisor Vector Borne Disease Control (VBC) World Health Organization Regional Office for South East Asia World Health House I.P. Estate Ring Road New Delhi 110 002 India Tel: (91 11) 331 7804 To 331-7823 Fax: (91 11) 331 8412 / 332-7972 E-Mail: chusakp@whosea.org WHO/WPRO Dr Kelvin Palmer RA-MVP World Health Organization P.O. Box 2937 Manila 1000 Philippines Tel: (632) 528 9725 Fax: (632) 521 1036 E-Mail: palmerk@wpro.who.int Dr Allan Schapira Regional Adviser - Malaria World Health Organization Western Pacific Regional Office P.O. Box 2932 Manila 1099 Philippines Tel: (632) 528-8001 / 528-9945 (Direct) Fax: (632) 521-1036 E-Mail: schapiraa@wpro.who.int
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Report of the Informal Consultative Meeting
Annex 2 STANDARD CASE DEFINITIONS AND CORE EPIDEMIOLOGICAL AND OPERATIONAL INDICATORS AS RECOMMENDED BY THE MEETING FOR THE MEKONG COUNTRIES (A) Case definitions: In areas without access to laboratory-based diagnosis1: • Probable severe malaria : a patient who requires hospitalization for symptoms of severe malaria and receives antimalarial treatment, or a patient who is hospitalized for symptoms of malaria and receives antimalarial treatment 2. Probable uncomplicated malaria : a patient with symptoms of malaria who 3 is prescribed antimalarial treatment, but is not classified as severe malaria. Probable malaria death: Death of a patient classified as probable severe malaria. Confirmed severe malaria: a patient with laboratory confirmation of diagnosis who requires hospitalization for symptoms of severe malaria, or is hospitalized for malaria 2. Confirmed uncomplicated malaria : a patient with symptoms of malaria with laboratory-based confirmation of diagnosis, who is not classified as severe malaria.
• •
In areas with access to laboratory-based diagnosis: •
•
1 2
Microscopy, rapid diagnostic test ("dipstick") or other reliable method. Countries that currently distinguish severe from uncomplicated malaria in their surveillance should continue to do so. Countries reporting complicated malaria only, rather than severe malaria, may continue to do so, using complicated malaria as a substitute for severe malaria. Countries that do not currently make any distinction of severe/complicated malaria in surveillance may use hospitalized malaria as substitute. The word prescribed is used instead of receives, because the patient is a malaria case irrespective of the presence of antimalarial drugs at the facility where the diagnosis is made. The word prescribe does not necessarily imply the involvement of a medical practitioner.
3
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Roll Back Malaria: Technical Support Networks in South-East Asia
• •
Confirmed malaria death: death of a patient classified as confirmed severe malaria. Asymptomatic malaria : A person with no fever or recent history of fever who has a laboratory confirmed parasitaemia. Suspected malaria case: a patient with symptoms of malaria, who is either prescribed antimalarial treatment without being tested, or examined for malaria with a laboratory-based method. Patient tested for malaria: a patient with symptoms of malaria, who has a slide or "dipstick" taken and examined 4.
Definition of auxiliary categories •
•
(B) Data items that should be provided annually by each national programme for each geographical unit in the Mekong Region for calculation of all core indicators Based on the definitions (A), the data items that must be recorded for calculation of the core indicators (C) can be tabulated as follows: Data Item (a) (b) (c) (d) (e) Mid-year population Population at risk of malaria No. of suspected malaria cases No. of patients tested for malaria No. of confirmed malaria cases (severe + uncomplicated) (among D) No. of falciparum malaria cases (among E) No. of probable malaria cases (severe + uncomplicated) (C − D) Slides and rapid diagnostic tests. If many rapid tests: separate reporting Including P.f. mixed with other parasites Comment Best estimate of real (not administrative) population Nationally applied definition of population at risk should be stated
(f) (g)
4
In programmes that do not use "dipsticks", this figure may be approximately equal to the number of slides examined.
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Report of the Informal Consultative Meeting
Data Item (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) No. of severe malaria cases (probable + confirmed) No. of confirmed severe malaria cases (among H) No. of malaria deaths (probable + confirmed) No. of confirmed malaria deaths (among J) No. of asymptomatic patients tested No. of asymptomatic malaria cases (among L) No. of asymptomatic falciparum cases (among N) Number of epidemics not timely detected or not controlled Number of epidemics early detected and controlled Doses of antimalarial drugs distributed .
Comment
Only if active case detection
Inform location, time, cases, deaths
Calculated for each treatment as drug quantity distributed by public system to health facilities/adult dosage. Sum for all treatments. Tally reports from operations Survey-based Sum of tallies of persons in each house sprayed
(r) (s) (t)
No. of nets treated in at least one round Average number of persons per net Number of persons protected by house spraying
Currently, some programmes will not distinguish how many of the severe cases and deaths are confirmed and how many are probable. In that case, they should only fill in the total number of severe cases and malaria deaths. Some programmes only record confirmed cases, and should show this by filling in for example H = I and J = K. Most of the programmes that include Active Case Detection do not currently distinguish between confirmed malaria cases and asymptomatic carriers. Over time, they are expected to introduce this distinction and fill in L, M and N, instead of including asymptomatic cases under D, E and F.
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Roll Back Malaria: Technical Support Networks in South-East Asia
(C) Core epidemiological and operatio nal indicators Category Incidence Indicator Incidence of probable malaria (uncomplicated + severe) Incidence of confirmed malaria (uncomplicated + severe) Annual Parasite Incidence (confirmed malaria + asymptomatic carriers) Incidence of falciparum malaria (confirmed falciparum malaria + asymptomatic falciparum carriers) Mortality Prevalence/ Burden Severity Malaria mortality (probable + confirmed) Slide (test) positivity rate ((confirmed cases + asymptomatic carriers)/(persons tested by slide or "dipstick")) Proportion of severe cases (probable + confirmed) among all malaria cases (probable + confirmed) Case fatality rate of severe malaria (probable + confirmed) Case fatality rate of falciparum malaria (confirmed malaria deaths/falciparum cases) Disease management Number of doses of antimalarial treatment distributed by public health system to curative services (public/ private/ community-based) Number of suspected malaria cases recorded per year related to at-risk population Number of persons tested by slide or "dipstick" per year related to at-risk population 6
Calculation G/A E/A (E+M)/A (F+N)/A J/A (E+M)/(D+L)
5
H/(E+G) J/H K/F Q
Case fatality
C/B D/B
5 6
From data elements in B. Multipliers (100, 1 000 or 100 000) omitted.
As long as most programmes record few results of rapid diagnostic tests, these can be included in the calculation of the slide positivity rate. However, if a substantial number of rapid diagnostic tests are included, it is preferable to separate a slide positivity rate and a rapid test positivity rate. This is particularly important, if the tests are positive only for P.falciparum .
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Report of the Informal Consultative Meeting
Category Prevention
Indicator Number of nets treated per year Proportion of population at risk covered by insecticide-treated nets, or by insecticide treated nets or spraying R
Calculation R×S/B (R×S +T)/B
5
Population denominators For all incidence rates (including mortality), the population denominator is the total mid-year population living in the area covered by the report, including migrants and temporary visitors irrespective of nationality. The population at risk is not a suitable denominator for international reporting of incidence rates, although it is important in malaria control planning and as a denominator for operational indicators. Rates and ratios 'Incidence' and 'mortality' are used here as meaning reported incidence (morbidity) and mortality rates. Conventionally in malaria control, incidence rates are calculated per 1 000 person-years and mortality rates per 100 000 person-years. Ratios (e.g. case fatality rates) are expressed as percentages. (D) Recommended geographical units for international malaria reporting in the 7 Mekong Region by country Country Cambodia China Lao PDR Myanmar Thailand Vietnam Geographical unit Province County Province District Province Province
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Annex 3 WORKPLAN 2000 – 2003 TSN ON TRANSMISSION RISK REDUCTION Priority Areas and Activities 1. Establishment of regional core groups on TSN -TRR Expected Outcomes 2000 2001 2002 2003 Q1 Q 2 Q3 Q4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q 3 Q 4 Q1 Q 2 Q3 Q 4
1.1 Identification of core group of experts 1.2 Establishment of effective communication links 2. Establishment of functional national TSN-TRR
Composition of regional TSN-TRR established Communications Established TSN-TRR functional in each Member Country Work plan developed and updated yearly Partners support TSNTRR
2.1 Identification and networking of institutions, organizations, and experts 2.2 Development of detailed work plan in each Member Country and annual update of the plan 2.3 Linking with partners for resources 3. Development of regional guidelines on prioritized issues
Guidelines developed Guidelines developed Guidelines developed Guidelines developed
Roll Back Malaria: Technical Support Networks in South-East Asia
3.1 Monitoring and evaluation of interventions 3.2 Insecticide -treated net programme 3.3 Insecticide policy 3.4 Stratification and selective targeting of house- spraying
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Page 30 Priority Areas and Activities Expected Outcomes 2000 2001 2002 2003 Q1 Q 2 Q3 Q4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q 3 Q 4 Q1 Q 2 Q3 Q 4
Guidelines developed Guidelines developed
3.5 Vector resistance monitoring and management 3.6 Minimum requirements for health impact assessment of development projects 3.7 Integrated vector control Guidelines developed 4. Common framework to initiate action at country level 4.1 Mosquito nets
Report of the Informal Consultative Meeting
Inventory report available Guidelines developed
4.1.1 Inventorize information on ITN operationalization (standardize parameters, identify knowledge gaps) 4.1.2 Formulate evidence-based guidelines for programme implementation (decisionmaking criteria for ITN purchase, logistics for focused delivery and maintenance) 4.1.3 Set a research agenda and strategy for resource mobilization to implement it Research conducted 4.2 Insecticides
4.2.1 Review the knowledge base and decision- making procedures for judicious use of pesticides
Knowledge gaps identified
Priority Areas and Activities
Expected Outcomes
2000 2001 2002 2003 Q1 Q 2 Q3 Q4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q 3 Q 4 Q1 Q 2 Q3 Q 4
4.2.2 Advise on the modalities for the operationalization of selective/integrated approaches with optimal complementarity of chemical and non-chemical TRR interventions 4.2.3 Inventorize regional insecticide resistance and provide guidance on resistance management 4.3 Targeted training
Recommendations provided
Guidelines on insecticides resistance management developed Recommendations for training Training materials developed
4.3.1 Identification of training needs and resources at different levels 4.3.2 Development of curricula, training modules and advocacy and IEC materials 4.4 Cytotaxonomy and vector biology (special problems relating to An. dirus, An. minimus, and An. fluviatilis
Knowledge gaps identified and strategy developed Regional prototypes on ecosystem-based TRR approaches developed
Roll Back Malaria: Technical Support Networks in South-East Asia
4.4.1 Complete a regional picture of sibling species and develop a strategic approach to fill knowledge gaps 4.4.2 Coordinate, stimulate and document at least five case studies on ecosystem-based TRR approaches to serve as regional prototypes
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Page 32 Priority Areas and Activities Expected Outcomes 2000 2001 2002 2003 Q1 Q 2 Q3 Q4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q 3 Q 4 Q1 Q 2 Q3 Q 4
4.4.3 Develop mapping and possible TRR interventions in dirus/ fluviatilis/minimus settings 4.5 Monitoring and evaluation
Interventions developed
Report of the Informal Consultative Meeting
4.5.1 Review the regional situation with respect to TRR indicators and their use, and assess the potential to upgrade and/or harmonize indicators 4.5.2 Inventorize GIS resources (both health sector/outside the health sector) for ongoing and potential monitoring/ evaluation activities 4.6 International borders
Consensus on core indicators
Inventory of GIS resources
4.6.1 Technically support and assist in the synchronization of field operations in the border areas. 4.6.2 Review and promote experience-sharing of existing mechanisms and partnerships for crossborder collaboration in TRR operations. Improved crossborder field operations
Improved crossborder field operations
Priority Areas and Activities 4.7 Health Impact Assessment/Health Risk Management
Expected Outcomes
2000 2001 2002 2003 Q1 Q 2 Q3 Q4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q 3 Q 4 Q1 Q 2 Q3 Q 4
Recommendations on HIA/HRM
4.7.1 Coordinate national activities (assessments, workshops) to review, adjust and harmonize development policy frameworks to promote HIA/HRM 4.7.2 Adapt existing generic HIA guidelines for specific use at the country level 4.7.3 Set a research agenda on TRR interventions through intersectoral action Local adaptation of generic HIA guidelines Research agenda available
WORKPLAN 2000 – 2003 TSN on SURVEILLANCE, INFORMATION MANAGEMENT AND EPIDEMIC PREPAREDNESS AND RESPONSE Priority Areas and Activities 1. Networking at country level Expected Outcomes 2000 2001 2002 2003
Q1 Q 2 Q3 Q 4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q 3 Q4 Q1 Q 2 Q3 Q 4
TSN-SIE in each Member Countries functional Country plans developed and updated yearly
Roll Back Malaria: Technical Support Networks in South-East Asia
1.1 Identify institutions and experts that will comprise the TSN-SIE and establish working mechanisms 1.2 Develop detailed country plans based on the generic regional SIE plan and update yearly as necessary
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Page 34 Priority Areas and Activities Q1 Q 2 Q3 Q 4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q 3 Q4 Q1 Q 2 Q3 Q 4 Expected Outcomes 2000 2001 2002 2003
1.3 Linking with partners for resources 2. Surveillance System
Partners support TSN-SIE Finalized set of core indicators Modified reporting format in use Improved reporting of malaria deaths (CFR) Improved coverage and accuracy of surveillance
Report of the Informal Consultative Meeting
2.1 Develop protocol and provide technical assistance in piloting and validating the indicators in selected RBM districts 2.2 Review and if necessary, recommend modification of existing format for reporting of malaria deaths 2.3 Develop mechanisms to strengthen hospital -based reporting of malaria deaths (CFR) 2.4 Develop strategies to collect malaria data from private sector for incorporation into the surveillance system 3. Information Management
3.1 Identify and link up with centres of excellence 3.2 Comprehensive needs assessment and planning for computerized information management system 3.3 Develop methodology for piloting test parameters in at least one district per country 3.4 Develop training modules Training modules developed
Linkage with centres of excellence established Plan for computerized information management system developed Methodology developed
Priority Areas and Activities Q1 Q 2 Q3 Q 4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q 3 Q4 Q1 Q 2 Q3 Q 4
Expected Outcomes
2000
2001
2002
2003
3.5 Provide technical assistance in training of personnel on information management 4. Epidemic preparedness and response
Personnel trained
4.1 Determine thresholds for epidemics 4.2 Set up early warning system 4.3 Evaluate and improve the early warning system 4.4 Develop guidelines on rapid response team and assist and evaluate its implementation 5. Information exchange and networking
Epidemic thresholds established Early warning system established Early warning system improved Rapid response team functional
5.1 Identify information needs for sharing 5.2 Publication of SIE information at RBM web site 5.3 Sharing of RBM experiences through annual regional meetings 6. Research
Information needs for sharing identified SIE information available at RBM web site SIE network strengthened
6.1 Identify priority research needs 6.2 Develop standardized research proposals 6.3 Conduct priority research Research proposals developed Research conducted
Research agenda
Roll Back Malaria: Technical Support Networks in South-East Asia
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WORKPLAN 2000 – 2003 TSN on DRUG RESISTANCE AND POLICIES
Priority Areas and Activities 1. Establishment of TSN-DRP in member countries
Expected Outcomes
2000
2001
2002
2003
Q1 Q 2 Q3 Q 4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q3 Q4 Q1 Q 2 Q3 Q 4
Report of the Informal Consultative Meeting
1.1 Identification and networking of experts and institutions who will comprise the TSN-DRP 1.2 Development of detailed country plan of work to be updated yearly 1.3 Linking with partners for resources 2. Data banking and information exchange on:
TSN -DRP functional in each Member Countries Country plan of work developed Partners support TSN-DRP
2.1 Directory of national experts relevant to DRP 2.2 Drug policies and drug regimens 2.3 Drug resistance data 2.4 Standardization of the format for reporting and exchange of information 2.5 Activities of the network Network activities monitored Improved information exchange Data utilized Drug policies shared
Directory established
Priority Areas and Activities Q1 Q 2 Q3 Q 4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q3 Q4 Q1 Q 2 Q3 Q 4 3. Capacity building
Expected Outcomes
2000
2001
2002
2003
3.1 Facilitate training professional staff in malaria control programmes and at province/district levels on programme management in the context of anti-malarial drug policy 3.2 Train staff on drug resistance monitoring 3.3 Support infrastructure development for monitoring drug resistance 3.4 Build national capacity on anti-malarial drug quality assurance 4. Procurement and distribution system for anti-malarial drugs and rapid diagnostic tests
Key staff trained
Improved monitoring of drug resistance Improved monitoring of drug resistance Drug quality monitored
4.1 Review of existing systems 4.2 Explore the feasibility of pooled procurement at regional level 4.3 Social marketing to promote the use of affordable and effective anti-malarial drugs and rapid diagnostic tests Improved access to drugs and RDTs Recommendations made
Recommendations made
Roll Back Malaria: Technical Support Networks in South-East Asia
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Page 38 Priority Areas and Activities Q1 Q 2 Q3 Q 4 Q1 Q2 Q 3 Q4 Q 1 Q2 Q3 Q4 Q1 Q 2 Q3 Q 4 5. Operational research Expected Outcomes 2000 2001 2002 2003
5.1 Setting of research agenda 5.2 Review and facilitate research funding 5.3 Conduct operational research 5.4 Develop and evaluate strategies to contain the spread of drug resistance Containment of drug resistance Research conducted Research funded
Report of the Informal Consultative Meeting
Research agenda available