Information document Sixty-seventh session of the Regional Committee RC67/INF/2 Reference for WPR/RC67/6 Malaria 31 August 2016 __________________________________________________________________________________
SUMMARY OF EVALUATION OF REGIONAL ACTION PLAN FOR MALARIA CONTROL AND ELIMINATION IN THE WESTERN PACIFIC (2010–2015) Background In 2009, the Regional Committee for the Western Pacific endorsed the Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010–2015), which served as a road map for efforts to combat malaria in the Region (WPR/RC60.R5). The Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010–2015) had an overall goal of progressively eliminating malaria, where possible, by building on progress achieved earlier through the implementation of activities grouped under seven objectives. Progress achieved was monitored through the five impact-level indicators, which are: number of malaria cases, number of deaths due to malaria, proportion of falciparum malaria cases, test positivity rate and annual blood examination rate.
Methodology The evaluation was conducted through a survey of countries, with follow-up consultations carried out via teleconferencing. Additional information was collected through face-to-face interviews conducted in selected countries. Data from the regional database for malaria in the WHO Regional Office and from the World Malaria Report (2008–2015) were obtained to fill the data gaps and to identify longer-term trends.
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Findings Between 2009 and 2015, a 48% reduction in the number of cases and an 85% reduction in the number of deaths due to malaria were observed in the Western Pacific Region (excluding data from Papua New Guinea). During this period, Papua New Guinea significantly strengthened case surveillance with the roll-out of rapid diagnostic tests and, as a result, reported a fourfold increase in the number of cases. Nine out of 10 malaria-endemic countries achieved the targets of the Millennium Development Goals. In many administrative units of malaria-endemic countries the disease has been either eliminated or the burden reduced significantly. Such reductions in disease transmission through strengthening national capacities are also likely to have contributed to the containment of multidrug-resistant falciparum malaria to the Greater Mekong Subregion. There has also been increased political commitment for malaria elimination, reflecting both the effective action to reduce morbidity and mortality at the country level, and the impact of new initiatives such as the Asia Pacific Leaders Malaria Alliance. All 10 malaria-endemic countries have included a goal of malaria elimination in their most recent national strategic plans, and leaders at the Ninth East Asia Summit in 2014 agreed on the goal of an Asia Pacific region free of malaria by 2030. Reductions in disease transmission and strengthened national capacities likely contributed to the fact that multidrug resistant falciparum malaria remains limited to the countries of the Greater Mekong Subregion. These efforts were also guided by the Emergency Response to Artemisinin Resistance in the Greater Mekong Subregion: Regional Framework for Action 2013-2015, developed by WHO with Member States and key partners. Besides the number of cases and deaths due to malaria, the other impact-level indicators subject to monitoring included the proportion of falciparum malaria cases and test positivity rates, both of which have decreased in nearly all endemic countries, and annual blood examination rates. Helped by investments in scaling up diagnosis, annual blood examination rates have been maintained in most countries, although the decrease in total malaria cases has resulted in some countries not maintaining these rates. Member State and expert consultations concluded that the action plan contributed to an overall strengthening of malaria control in countries and helped the Region to achieve the MDG
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targets. The Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010–2015) played an important role in guiding all 10 endemic countries to update their national strategies. The plan provided a framework to guide national actions to tackle malaria through investments in diagnostics, access to effective treatments and preventive vector control interventions. The updated national strategies were also used for preparing grant proposals for submission to the Global Fund to Fight AIDS, Malaria and Tuberculosis and other donors. This influx in funding, the availability of which was indirectly supported by the action plan, contributed to improving access to diagnostics and effective treatment, and moving towards universal coverage with preventive vector control interventions. Although significant progress has been reported in the Region, it is clear that large numbers of people are still at risk of malaria. Some marginalized population groups still bear a high burden of the disease. While several countries have achieved significant progress in the battle for malaria control during the period of the implementation of the plan, future progress and achievement of elimination will require additional domestic funding in most, if not all, Member States.
Conclusions Significant progress has been made, but key challenges remain. Leaders in the Asia Pacific region have set 2030 as the target date for the elimination of malaria in the region. In keeping with the targets defined in the Global Technical Strategy for Malaria 2016–2030, countries must invest in establishing and strengthening key technical elements over the next five years. More specifically, strengthening essential health system elements, such as surveillance, outbreak response capacity, and procurement, supply and logistics management systems will be needed. And finally, although the major immediate focus continues to be on falciparum malaria in most of the Region, the elimination goal will not be achieved without addressing the significant burden of vivax malaria.
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