Consolidated_PMI_partner_feedback.pdf

Pre-MOP (FY16) Partner Templates

Purpose: The purpose of this Pre-MOP Partner template is to compile data and information from implementing partners on progress of planned activities in FY14 prior to the Malaria Operations Plan (MOP) visit which is tentatively scheduled for April 20 – May 1, 2015 in the Mekong sub-region. The template aims to collect information on the following:

1. Status of FY14 Planned activities – Please list out your planned (main) activities in FY14

2. Targets – What were the planned targets?

3. Achievements – What were the actual key achievements against those targets?

4. Challenges and areas for improvement – What were the challenges that you encountered for those activities? What are some areas that could be improved in the future?

Planned FY14 activities Planned Targets Actual achievements and status Challenges and Areas for Improvement

1. Feasibility and acceptability study of G6PD RDT use

Generate recommendations for CNM on optimal deployment of G6PD RDTs at community or health centre level

Full concept note prepared and submitted to PMI OR Committee for review. Submitted for review by Cambodia national ethics review committee.

Delays in review and approval of concept note by PMI ethical committee

2. Malaria in Pregnancy Delivery of analysis report describing burden of malaria identified during

ANC

Analysis and report in progress. Only aggregate data available from participating facilities, therefore detailed analysis of individual level factors will not be possible.

3. Directly Observed Treatment - desk review and analysis of data from pilot use of Malarone in Pailin

Report reviewing of completeness of DOT data collection forms, and adherence to DOT

Raw data received from CNM, data entry template designed, piloted and data entry complete.

During pilot implementation, SOPs were not prepared therefore challenges in understanding reasons for by VMWs.

missing data in forms completed by VMWs.

Additional field-level interviews with VMWs may be require to describe the challenges in detail

4. BCC assessment This activity is part of the regional BCC assessment (in MM, TH and KH)

Completed BCC assessment and report prepared

BCC assessment in Kamriang and Pailin completed in September 2014. Translation and analysis ongoing

High cost of translation of Khmer interview transcripts into English for review

1. Quality Assurance Program Development: Ensure quality assurance protocols and systems are in place and adhered to by private sector health-care providers treating febrile patients

Development of detailed QA checklist; EDAT trainings focusing on safe waste disposal; job aid algorithms for management of negative cases;

hiring of a QA team

Completed The development of the QA checklist and indicators/data elements for the DHIS2 was a straightforward process with solid support from HQ. Hiring the QA team was a bit more challenging, given the limited tranche of funding for the grant, so they were hired as consultants. This proved problematic moving into FY 15, when we brought them on as full time hires. The readjustment of training focus towards improved waste disposal, high quality case management and management of negative cases was an ongoing target, and successfully delivered.

2. DHIS Foundation Development:

Upgrade the current MIS system and data collection tools to ensure CNM has live access to data from the private sector as Cambodia moves from a control program to an elimination program.

Creation of a consolidated MIS system with open access

Completed DHIS2 has proven to be an excellent tool for PSI/PSK in regards to our ability to use data to make decisions at all levels. From the Department Director and Malaria TA, to QA officers, this tool can filter information at the level needed and it is easy enough to navigate that all levels do use it. Areas for improvement, such as continued training, would always increase the quality of the output, but generally, the system was well establish and continues to be well used.

Conduct sample collection of antimalarial (AMLs) and highly suspected antibiotics (ABTs) with quality problems in targeted geographical areas in the country. This MQM activity is also aiming to collect information on the availability of oral artemisinin antimalarial monotherapies as well and report to the relevant agencies, including DDF, and National Center of Parasitology, Entomology and Malariology

(CNM).

120 samples to be collected and tested by Minilab.

100% filed+100% doubtful+10% pass Minlab are to be confirmed at

NHQC.

30 AMLs to be collected

* 136 samples were collected from 6 provinces (Battambang, Pailin, Mondulkiri, Siemreap, Kampot & Kampongspeu).

* 124 samples were tested by Minilab*

* 52 samples were confirmed at NHQC Lab.

* 40 AMLs were collected and tested

* 1 failed sample was recalled from market and removed its liscencing, and share to BREMERE countries memeber.

* None of oral artemisinin is found during samples collection in the field.

Global Fund discontinued its financial support which made MQM activity can be only carried out by USP/PQM through USAID's financial source

Purchase and replenish essential Minilab and some QC lab supplies (reference substances, comparator products, HPLC columns, UV lamps, etc.) to maintain the surveillance activities and confirmatory analyses

Replenish Reference Standard (RS) and reagents to Minilab site and QC lab

* RS : DHA+PIP, Amoxicillin and Cephalexin were replenished to Minilab sites :

Battambang, Pailin, Mondulkiri and NHQC

* Glass Microcapillary, TLC plate, UV Lamp 254nm, and Aluminium foil were supplied.

*Ethylacetate, Acetone, Methanol, Amniac solution were supplied

Global Fund discontinued its financial support which made MQM activity can be only carried out by USP/PQM through USAID's financial source

Conduct 4-5 supervisory and monitoring visits to the sites in the field by PQM country and/or regional Consultant(s) with representative from DDF, NHQC and CNM.

Number of site visits performed and documentation of type of technical guidance provided to specific sites

10 supervisory and monitoring visite to sites in the field were conducted, in total.

[* Local consultant joint with DDF,CNM and NHQC, conducted sampling in 5 privinces (Battambang, Mondulkiri, Pailin, Kampongspeu, and Kampot).

* Local consultant and program manager, joint with DDF, conducted drug inspection to drug outlets in Kampot and Pursat province.

* Local consultant attended GPP training (as observor) in Siemreap, Battambang and Kandal provinces.

* Local consultant attend training for drug inspectors in Kampongcham province.]

Data analysis and produce end-of-fiscal year technical reports by each country and by PQM.

PQM is updading the MQDB for Cambodia and analysing them to make evidence-based conclusion on quality situation/status

A team of PQM Quality Management System (QMS) will continue to provide technical assistance to support the NHQC to implement the road map of achieving ISO- 17025 which was jointly developed and agreed between PQM and NHQC in 2012.

This activity will entail a visit to the meet with the NHQC management and verify the progress.

Quality Manual (QM) and some 24 SOPs required in the scope of ISO accreditations

* Quality manuals already reviewed.

* SOPs on Document management, Notebook, equipement policy, safety, workflow, are in process of review

* 8 SOPs are already reviewed

NHQC new lab facility is under construction with support from the World Bank. This construction is delayed from time to time, almost 2 years ago. Now, NHQC had moved their facility to another temporary place, and planned to move into their new building at the end of 2015. The delay of construction leads to delay of many activities to be done by NHQC.

Provide technical guidance to the final stage of the new lab construction which may, and not limited to, include positioning the major lab equipment, theirqualification and calibration; and determine the training needs for NHQC staff.

Arc2 lab to provide technical guidance to ensure the construction and equipment installation, qualification and training needs are adequate.

Await for completion of building construction.

It's expected to be done at the end of 2015.

idem as above

Support the in-country BREMERE communication, coordination and joint investigation on all counterfeit and substandard medicines (CSMs) (with main emphasis on antimalarials) cases among the Inter- ministerial Committee (IMC) members as well the Provincial Sectoral Committee (PSC) members at the provincial level.

All case of poor/failed quality medicines to report to BREMERE countries members

* 10 poor quality medicines were shares within the period

* information were shared by e-mail to each focal point in the countries.

However, the flow of information dessimination is limited to public. It would be more effective to have a mechanism to share/joint automatically to international system (e.g.

ASEAN PMS or WHO RAS...)

Inter-country and regional BREMERE support and beyond, including ASEAN Post-marketing Surveillance Alert System on pharmaceutical products and the INTERPOL through timely information sharing, evidence data provision, joint investigation and enforcement.

Idem idem as above

Engage pharmacy faculty members (5-6) and final year students (100) of two universities Faculties of Pharmacy in Phnom Penh in the PQM efforts to improve practices concerning pharmaceuticals in various settings through curriculum/syllabi improvement.

N/A idem as above

As deemed necessary, PQM relevant staff/consultant and/or a country representative from the DDF or NHQC or CNM to participate and present PQM’s work, progress and achievements at regional or international technical/scientific conferences/meetings on medicines quality issues.

1. USAID’s workshop on “Introduction to USAID’s Legal Regulation, Financial Management and Procurement Policies” which was conducted on March 19, 2014 in Phnom Penh.

2. Meeting with USAID’s evaluator team on March 28, 2014 to provide information on CAP-Malaria project which PQM had collaborated with, in order to evaluate CAP- Malaria’s project in Cambodia.

3. Workshop on Orientation of Master of Pharmaceutical Sciences which was conducted by University of Health Sciences. The objectives of this Master Course is to: (1) train drugs specialists in the fields needed in Mekong sub-region (Cambodia, Laos and Vietnam) such as Public Health, Hospital, Industry; and (2) to offer the possibility to PhD studies.

4. Meeting of Cambodia Pharmacy Council to announce the members of National and Provincial Committee board.

5. Refresher Training for Drug Inspectors on

Drug Law and Regulation, and Law Enforcement to ban Anti-malarial Monotherapy conducted on August 26-27, 2014 in Kampong Cham province.

6. Dissemination Workshop on Guideline of Adverse Drug Reaction (ADR) Monitoring and related matters, and Recall pharmaceutical products for Import-Export pharmaceutical companies, private and public hospitals.

7. Assessment to two manufacturers (PPM and CPE) in May 2014, which were conducted by GMP and PQM managers, in order to: (1) obtain rough idea and to understand the current situation of these two manufacturer,

(2) quick review on their facilities, and (3) quick review on documents available at their facilities.

Provide technical guidance to the DDF to develop training materials and take part as instructor(s) to deliver a national workshop on QA/QC of antimalarial medicines covering Good Pharmacy and Good Storage and Dispensing Practices and inspections of supply and distribution chains to all DDF (approx.

30 from both national and provincial levels) and selected provincial inspectors and key pharmacists (approx. 25) from artemisinin-resistant containment areas.

* review GPP guideline

* review training materials for GPP training

* GPP guideline is reviewed and approved.

1,500 copies were printed.

* In total, during July-December 2014, 717 pharmacist and drug sellers were trained (from 11 provinces).

* Due to workload of DDF's drug inspectors within last quarter of 2014 (calendar year), there's some delay in GPP training which was planned to cover country wide before the end of 2014.

Continue to provide technical assistance to the NHQC to successfully pursue preparing and strengthening its national laboratory’s quality management system toward achieving the accreditation on ISO- 17025.

* Reiew SOPs, QM, Documents control

*Continuous communication between QMS expert at USP HQ and NHQC management team.

* Lab assessment was done by QMS expert from USP HQ

* Due to workload of NHQC and their limited capacity/knowledge on ISO accreditation, development of SOPs and quality document control is late.

* It may need hand-on training and onsite assistance within 1 month period of time to create/develop SOPs.

Provide support to project central level procurement of PMI funded commodities

Filling commodity gaps for CNM and partners Drug and diagnostic registration

Coordinate and communicate regularly with CNM, donors and partners on malaria program plans and commodity needs/gaps

Workshop pending- improved coordination on quantification activities between CNM and partners

Could benefit from a series of workshops- CNM has limited capacity in this area

Support CNM to improve collection and reporting of logistics data on malaria commodities

Procurement of MIS server/software underway

Improving acess to LMIS data needs support from MoH collect and report data from CNM and other partners on availability of malaria commodities

National level logistics data from CNM and partners reviewed on a regular basis

Logistics data needs to be collected from CNM more consistently to better manage stock

Future Plans: Are there any new activities/opportunities that you would like PMI to consider in the future?

Proposed activities for FY16

Why you proposed this activity? How you will implement it? Challenges

1. Continued Surveillance/ mHealth Programming

The current funding is laying a valuable foundation for an important piece of elimination programming; surveillance. It would be tremendously detrimental to the long term elimination efforts to begin an innovative and technologically sound response to data capture, only to abandon it under subsequent rounds of funding. The tool will evolve and improve based on experience and feedback loops, and will serve as an example for the national program as they roll out their own Day 0 surveillance tools under the Global Fund.

Day 0 Surveillance implementation will seamlessly pick up where FY15 programming drops off. 100 providers will already be providing real time reports, QA and Med Rep teams will be on standby and guided by the programmatic team and CNM as a Response Unit, and the next step will be to evaluate the feasibility of taking the intervention to scale across the entire PPM/PMW network.

Challenges for this activity should be limited, as the process is already being set in motion under FY15. The introduction of new technology required close monitoring and a high degree of change management.

for FY16

Why you proposed this activity? How you will implement it? Challenges

2. Continuation of Plantation Malaria Program

The Plantation Malaria Worker (PMW) program was initially funded under the Global Fund. However under the New Funding Model, this work package has been bundled with VMWs, so in 2016, our existing 200 PMWs will be dissolved; or best case scenario, absorbed by another funding cycle. GF laid the foundation for PMWs to operate across plantations in seven provinces of the northeast, conducting early diagnosis and treatment, referrals and data collection, and the Gates Foundation has funded the supplementation of the package of health services available from PMWs to include diarrhea treatment kits, deworming and condom distribution.

This program is current managed using the existing framework of Plantation Officers, Medical Detailers and QA Officers. Continuation of the program would include refresher trainings to PMWs, liaising with Plantation owners and managers, demand creation activities, on-the-job supportive supervision from the medical detailing team, and standard assessments from the QA team. This suggested activity provides an essential link to a key affected population that is otherwise difficult to target.

Access to plantations is the most commonly faced challenge, along with ensuring that the “right” PMW is selected for the job. PSI/PSK have built a reputation for a quality service with minimally invasive approaches, and this is well received among plantation owner and managers running a business and wanting to avoid disturbances. Selecting the right PMW is essential to establish a close link with the target community, build trust and generate a demand for services.

3. iCCM/iCM in outlets and on plantations

Gates Foundation is already funding the phased rollout of integrated case management of malaria, diarrhea, and soil transmitted helminths on 100 PSK – managed plantations. As malaria prevalence declines, it becomes increasingly important for providers to maintain their relevance through the provision of other commodities that matter and impact the lives of beneficiaries. Additional funding to round out the toolbox of services offered by providers (for pneumonia or nutritional supplements, for example), means that these providers will maintain their links to the community, the PSK malaria program, while continuing to gather data, and offer a much needed service to address other key diseases.

Full integration would involve the development of new job aids (manuals, leaflets, register books/ reporting tools), the development and pretesting of integrated case management training curriculum, refresher training for all providers in the operational area (depending on whether or not we use to roll this across the whole network, or just a sub sect), and on-going monitoring and evaluation to ensure that the expansion of services do not lead to a drop in the quality of service provision.

When adding “tasks” or additional health area coverage to community health workers or private providers, there can be the risk of overburdening. In the case of the PPM providers, purchasing a “basket” of commodities would be easy and convenient, however for the less professional Plantation Malaria Worker, the addition of new tasks/skills and reporting requirements might prove challenging/ overwhelming. To

Why you proposed this activity? How you will implement it? Challenges mitigate this risk, it would be essential to gain feedback from providers very early on, and to pretest/ pilot the intervention and training materials.

4. Cross-border Coordination

Cross border migrant workers are increasingly flagged as a target population. PSI is working in all GMS countries, and it would make sense to link our private sector networks (plantation or PPM) in order to improve communications and potentially track infection trends across borders.

The first step is gathering origin information from positive cases. If people are transiting across borders (Laos/Cambodia – Steung Treng, for example) this intervention could enter data through the PPM program in Cambodia, gather origin information, and feed it back across the PSI partner network across the border, for response and follow up.

Working regionally requires a high degree of coordination

Prevention and BCC

ITN monitoring and topping up (HH, Farm & Company)

National distribution campaign in 2015 (10% damaged in year 1) Top up ITNs for new comers from non-endemic areas, Net damage and lose Encourage constant use of ITNs

Through ITN monitoring and topping up by VMW/MMW to HH, Farm & Company

Optimal coverage and approriate use of ITN among MMP

BCC/Education, focusing on IPC and community mobilization

Raise awarreness on malaria prevention and appropriate seeking behavios and treatment compliance

Through routine services and outreach activities Reaching MMP

Diagnosis and Treatment

Why you proposed this activity? How you will implement it? Challenges

Case management and diagnosis training (HF Staff, VMW/MMW and PPs)

Refresher training for some of the current health workers and for replacers

Need assessment through routine supervision/monitoring Joint training organized by CAP-M and CNM

Can't foresee change of treatment regimen

Microscopy QA (Continued with current 94 HFs)

For quality diagnosis and treatment follow up (Parasite counting, Referral and 2nd treatment)

Through quarterly supervision by provincial lab supervisor

Low malaria case and DRT preference

Malaria diagnosis case management and complete follow up (Test, Treat and Track)

Improve quality case management for resident and migrant population, Eliminate resistant malaria parasite

Through trained VMWs/MMWs, HF staff and PPs Turnover of health workers Follow up MMP

Targeted suspected malaria cases detection response (According to NTG)

To early detect malaria cases and reduce malaria transmission Targeting hot pop and hot spot

Response team and focal health workers at hot spot Low parasitemia

MMP

VMW Meetings Supply replenishment and data collection, capacity building, problem encountered and solution and feedback

Monthly meeting at HF led by HF/OD staff and CAP-M

Local Procurement (Office, Vehicle maintenance, Motorbike, Materials, Documents, Stationeries)

Strategic Information, Monitoring and Evaluation (M&E)

Why you proposed this activity? How you will implement it? Challenges

OD AOP

Development and Progress Review Information sharing through result dissemination/wor kshop

Planning and monitoring tools for progress update and use of strategic information

Through local forum at OD/Provincial level and national forum

Delay approval of country work plan

Technical supervision (OD-

>HF->VMW/ MMW

& PPs) in both endemic and non-endemic HFs

Improve program management and quality services

Monthly/Quarterly visit by HF/OD/CAP-M

Information sharing through result dissemination workshop (Diagnosis & case management, Microscopy QA, PPM, Technical supervision, RDQA)

For strategic information use and adequate response

Monthly meeting at HF, OD, Pro.TWGH, CNM annual conference and CAP-M supported workshops

Time consuming and availability of key participants

Surveillance: Case investigation (Case classification, Dead and Outbreak)

For strategic information and adequate response

HIS, MIS, mHealth/Alert system Accuracy and timeliness of the database

Endline and scheme evaluation

Project achievement, lessons learnt and documentation

With assistance from TA (BCC, QI, SI/M&E) Improving documentation and use of SI

Multisectoral/Inter-country collaboration

Why you proposed this activity? How you will implement it? Challenges

Provincial/District special working group for malaria elimination

Advocacy and collaboration Regular meeting and follow up Commitment of special working group

Inter-country information sharing and collaboration

Malaria interventions at border areas to contain AMR back & forth

Regular meeting and joint planning and monitoring Commitment and ownership

Basic Essential Package for Malaria Pre- Elimination Activities in Sampov Loun OD

Package recommended by MOP and RDMA and supported by CNM

Develop and implement model, draw lessons learnt, document and share with CNM and stakeholders

Approach in the context of ARM

Exit Plan of CAP-M Project

Cooperative agreement and recommendation of RIG

Prioritize activities and phase over target to CNM (6 ODs by endof year 4 and other 5 ODs by end of year 5)

Readiness of parties to take over the activities

Conduct Good Pharmacy Practices training workshops to public sector health facilities:

Referal hospitals, provincial hospitals, OD warehouse, HC units

Because of limited availability of antimalarials in private sector, most malaria patients receive health treatment, including medicines, in public facilities where they play important role in drug dispensing to patients. Bad practices in their warehouse/facilities lead to poor quality medicines, error in dispensing medicines etc.

Collaborate with DDF and provincial health department (PHDs), establish the certifiaction mechanism (including re-certification after certain period of years to maintain good practices) to those complete GPP training and its application in their practices

Inadequate storage conditons of medicines warehouses/storage rooms/cabinets in some facilities with no airconditoning system and/or electricity fee is expensive.

Why you proposed this activity? How you will implement it? Challenges

Follow up the implementation of GPP in the private sector respective pharmacy outlets and Depots (whose operators were trained in 2014- 2015). This will entail developing/adaptin g the M&E tool and indicators to evaluate the training on GPP impact on their daily practices.

Even with limited availability of antimalarials, private drug outlet is first accessible place of patients who seeks medical treatment.

Inappropriate practices hinders the malaria control efforts

Collaborate with DDF, PHDs, drug outlet. * renovation of pharmacies/drug store cost more money. Store owner always complain that there's competition between same seller, therefore the income from selling medicines is less and is not enough to pay for renovation of their facilities nor to pay for electricity fee if it's equped with A/C

Training workshop on management system and technical requirement to meet ISO/IEC 17025

Poor practices in operating pharmaceutical quality testing leads to unreliable results. Inadequate quality management system and applications

Collaborate with NHQC and QMS expert * Limited human resources at NHQC, there are few capable key staff.

Majority of staff need more training.

Replace with:

Assist they NHQC transition to the new building (equipment re-calibration and re-qualifications on those being used)

Collaborate with USP PQM Lab services team and/or service providers available in the region.

Why you proposed this activity? How you will implement it? Challenges

Develops Laboratory Management Information System for NHQC , including accounting module, Website development, Server, computers, network cables, Server UPS, UPS, etc.

Informatic system is needed to control and facilitate the working process in

NHQC.

Currently, there are duplications of writing from step to step (receiving sample, send sample to test, test, and provide test result back to client).

Documents control in NHQC is not well organized/arranged.

Collaborate with NHQC, IT private company N/A

Revitalize 13 sentinel sites of Medicine Quality monitoring activities to strengthen the post-marketing surveillance system for enforcement actions. Replenish RS and reagents, confirmatory testing and law enforcement

Cambodia imports many medicines from various countries with different quality. Post market surveillance is very important to check the quality of medicines at the end user level.

Without quality testing result, DDF- MoH can't have evidence data to take legal action.

* collect 520 samples (including AMLs + common antibiotics) from 13 provinces, tested by Minilab and selected to confirmatory test (number of selected samples is done according to protocol)

* Use testing result to take immediate action (by DDF- MoH) in case of found counterfeit medicines

* in both private and public sector, we can find mostly same batch number of AMLs. This may cause the number of AMLs samples to be collected is less than other common samples

* Beside AMLs, other medicines are not allowed to collect from public sectors/facilities

Why you proposed this activity? How you will implement it? Challenges

Provide TA to DDF to strengthen its capacity in pharmaceutical products dossier reviewing and registration using user-friendly and customisable computerised software being used in some African countries supported by PQM

Weak registration practices with inadequate human resources qualification for product dossier evaluation.

Adapt already field tested/pilotted in Africa SHUYAH solftware and system for drug registration; training DDF registration officers on its application and maintenance

Inadequate experience and skills of evaluators and IT infrastucture.

Transitionaing from manual/Excel based process to fully computerised requires hands training, desk tops and follow up.

Strengthen and sustain the nation's pharmceuatical law enforcememt capacity against violators producing, distributing, and selling counterfeit, substandard, and falsified medicines

Timely follow up and address the medicine quality issue; improve and ensure the quality of pharmaceutical products for priority health programs and actively participate in the regional and international initiatives (e.g., BREMERE, ASEAN PMS, WHO -led SSFFC) in combating the poor quality medicines, especially antimalarials

Enpower BREMERE's network to deep and wider through the annual meeting, publishing the new letter, public media with special- targets inter-country & inter-region coodinations and collaboration. Keep the member countries conmitted, and

Roll out the improved curriculumn teaching courses for last year of pharmacy student being implemented with the IU to Faculty of Pharmacy in the

Equip pharmacy pre-work force with adequate knowledge and skill in QA/QC of medicines as they are the front line of health care professionals/distributors/retailers in both public and private sectors with potential contribution to the malaria control efforts.

Work with IU, DDF, Education Ministry and MOH, Univ. of Health Sciences Faculty of Pharmacy. The course to be incorporated in the school academic study credits

Identifying suitebale faculty members and translation of materials into Khmer and/or French

Why you proposed this activity? How you will implement it? Challenges public sector

1. Implemen t updated malaria treatment guidelines including developing surveillance materials and SOPs.

• National malaria treatment guidelines are updated based on January 2014 national drug policy workshop’s recommendations, now need to implement at all level.

• Conduct ToT training

• Translating the NTG in Khmer through CNM

• Printing and distribute the national malaria treatment guidelines through CNM

• Train health facility and community level volunteers on updated treatment guidelines.

• Prequalified product not always available

• Procurement process can be very slow

• Primaquine safety ness study for providing radical cure of Pv malaria still yet to be done

• To detect G6PD status for all malaria patients.

2. National policy on artemisinin resistance containment policy in harmonization with the GMS ERAR project;

• The GMS elimination strategy will be finalized in 2015

• It is relevant to update /amend Cambodia malaria elimination strategies in the line of GMS strategy

• Organizing stakeholders workshop to amend the strategy

• Small working group meetings to finalize the costed framework

Tier-1 area is constantly expending in Cambodia as well as in other GMS countries.

3. Conduct routine Therapeutic Efficacy Study (TES) in sentinel sites.

• It is an important routine activity to monitor the efficacy of first line anti-malaria medicines

Provide technical support to develop study protocol and monitor the implementation in the selected 5 sentinel sites

Due to reduction of Pf malaria, it is difficult to enroll required number of eligible patients for the TES studies in

Why you proposed this activity? How you will implement it? Challenges defined period.

4. Implemen t QC/QA malaria diagnosis (RDT lot testing and blood slide cross checking) and first line antimalarial medicine

• Ensure Lot testing prior/upon arrival of RDT in the country.

• Quality control of 1st line anti-malarial before arriving drugs in the country.

• Collect sample from the store and from the filed for quality control

Provide support CNM to ensure the quality control prior arrival and also collecting samples from the store and send to NLDQC and IPC for testing the quality.

Time consuming for sending abroad for cross checking the quality control of anti-malarial

5. Monitor the implementation of artemisinin resistance elimination strategy including the detection and treatment of asymptomatic malaria;

• A significant cases are asymptomatic

• Without addressing asymptomatic cases it’s not possible to move towards elimination especially in the context of artemisinin resistance Pf parasites

Provide technical support to CNM in conducting focal screening including in the cross border areas

Tools to detect asymptomatic malaria in the field setting.

Support CNM to secure fund and re-introduce FSAT to asymptomatic malaria.

6. In collaboration with PMI/URC project further update the package of malaria interventions targeting internal and cross border cross-border activities,

• Forest linked mobile/migrant population are the highest risk of malaria

• Cross border movement is increasing that contributes in spreading the of artemisinin resistance

• Current MMP strategy needs to be updated that includes regular re-mapping of mobile/migrant

Provide technical assistance to further update the MMP and cross border strategy

Strong collaboration requires with other ministries/departments (ministry of agriculture/ forestry/ MoND and MoI) and strong collaboration between cross border provinces of the neighboring countries.

7. Resource mobilization for Cambodia National Malaria Program to

Currently available/committed fund is not enough to move forward the agenda of elimination of Pf malaria by

Provide /mobilize short term TA to technical assistance to develop proposal for submission to the

Fund from revenue budget is not sufficient. Commitment of potential

Why you proposed this activity? How you will implement it? Challenges achieve the target elimination of malaria.

2020. potential donor agencies.

Organize stakeholders meetings/ country consultations for developing proposals.

Mobilize necessary fund donors to donate huge amount of fund.

The proposal development process especially for submission to GF is extremely long compared to the round based proposal preparation and submission.

8. Coordinati on: Facilitate sub-technical working group - CNM meetings;

• MoH has issued a letter to CNM on 06 January 2014 to organize sub-technical working group –CNM meetings where WHO’s role has been specified as the key facilitator.

• Provide support to CNM to organize bimonthly STWG-CNM meetings to discuss the issues of malaria, dengue and NTDs.

Though STWG_CNM was first established in 2006 but it was not functioning. In earlier 2014, MoH has circulated the revised ToR of STWG- CNM and it functioned better and requires constant support to CNM to keep the STWG –CNM meetings functional.

9. Coordinat e in compiling and reviewing data for world malaria repot

• World malaria report is very useful since it is considered as one of the reference/ guidance documents for national malaria programs

• As member state of WHA, Cambodia is also in an agreement to share malaria data to WHO.

• Cambodia malaria data will be reviewed and compiled for the World Malaria report 2016.

• Clarifications/additional information will be provided as requested by the WHO HQ for finalizing the WMR2016

• It would be relevant to standardize the definition of the population at risk of malaria. But it’s not easy to standardize since the countries use different criteria in defining the malaria risk zones.

10. Advocacy:

for policy development (e.g.

G6PD testing, use of primaquine) and scaling up the successfully proven

Phased introduction of routine screening for G6PD prior to commencing radical cure in vivax infected patients so that the appropriate primaquine dose is given based on G6PD status. G6PDd patients

Provide technical support to CNM to pilot the studies This regimen (0.75mg/kg) should not be used indiscriminately for radical cure and would also pose a risk of used at this dose for transmission blocking of P. falciparum.

Why you proposed this activity? How you will implement it? Challenges interventions (community involvement in malaria control);

receiving weekly primaquine should be monitored closely.

11. Net-working for sharing lessons-learnt, success stories, best practices, and new evidence based interventions

• Preventable and curable common diseases like diarrhoea and ARI especially among children under 5 years old.

• The project is already implementing in remote villages by CNM in collaboration with IMCI unit.

• Provide technical support to revise/update the diarrhoea and ARI treatment guidelines

• Provide support for providing training to VMWs.

• Mobilize fund for procurement of drugs and medical supplies

Though GF fund money can be used for training for diarrhoea and ARI integrated with but other fund to be to procure drugs and medical supplies.

12.

Accelerated malaria elimination especially in the areas where evidence of multi-drug resistant falciparum malaria.

• The gains in transmission reduction of P. falciparum will be easily lost if not prevent the spread and eliminate the emergence of both artemisinin and ACT partner drug resistance,

• Alarmingly high treatment failure rates have been reported with the use of DHA-Pip.

• Very few treatment options are now left for several provinces.

• Without effective treatment, e.g. with the continuation of DHA-Pip, there will be a quick resurgence of Pf malaria

• The resurgence of Pf malaria will be very difficult to treat because of the multi-drug resistant nature, these parasite strains can also spread to neighboring provinces and

• Provide national malaria program in developing polices, strategies, guidelines, of phased elimination of malaria where the evidence of multidrug resistance of malaria parasites are confirmed.

• Unavailability of highly efficacious antimalarial.

• Rationale/ethical issues of providing MDA with full course of anti-malarial and compliance of MDA among healthy individuals.

Why you proposed this activity? How you will implement it? Challenges countries, ultimately challenging global malaria control.