RFI-Cambodia_Malaria_Elimination_Project.pdf

SPECIAL NOTICE

REQUEST FOR INFORMATION (RFI)

The Office of Acquisition and Assistance (OAA) at USAID Cambodia has developed a DRAFT Statement Of Work for the purpose to provide industry and stakeholders an opportunity to review, comment, suggest and enhance areas in the SOW. The DRAFT Statement Of Work (SOW) is anticipated to result in finalizing the SOW that may lead to a formal solicitation for potential offerors. T he potential period of performance is for five years within an award range of $10-$24.99 million. The Draft SOW is provided in the following pages.

DISCLAIMER

THIS IS A REQUEST FOR INFORMATION ONLY. It is not a Request for Proposal, a Request for Quotation, an Invitation for Bids, a Solicitation, nor an indication OAA will contract for the items contained in the Special Notice. The RFI is an attempt to reach out to the market in an effort to determine the scope of industry capabilities and interest and will be treated as information only. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responses to this RFI are strictly voluntary and USAID will not pay respondents for information provided in response to this RFI. Responses to this RFI will not be returned and respondents will not be notified of the result of the review. If a Solicitation is issued, it will be announced on the Federal Business Opportunities website http://www.fbo.gov at a later date, and all interested parties must respond to that Solicitation announcement separately from any response to this announcement.

This RFI does not restrict the Government's acquisition approach on a future Solicitation.

INSTRUCTION

Responses (comments, suggestions, and enhancements) to this RFI are due to the procurement office identified below by June 5, 2015 at 4:00 pm, Phnom Penh time.

Interested parties shall provide one (1) electronic copy of their response; Electronic submissions, in Microsoft Word or Adobe Acrobat formats are acceptable. Please e‐mail responses to Honey Sokry at hsokry@usaid.gov with a copy to phnompenhoaa@usaid.gov with the subject title “Response to Cambodia Malaria Elimination Project RFI” http://www.fbo.gov/ mailto:hsokry@usaid.gov mailto:phnompenhoaa@usaid.gov

REQUEST FOR INFORMATION

DRAFT STATEMENT OF WORK

I. TITLE OF PROGRAM

The title of this program is “Cambodia Malaria Elimination Project”

II. INTRODUCTION

The President’s Malaria Initiative was launched in 2005 with the goal of reducing malaria-related mortality by 50% across 15 high-burden countries in sub-Saharan Africa. With the passage of the Tom Lantos and Henry J. Hyde Global Leadership against HIV/AIDS, Tuberculosis, and Malaria Act in 2008, PMI developed a U.S. Government Malaria Strategy for 2009–2014, which included a long-term vision for worldwide malaria eradication by 2040-2050. Under this strategy, four new sub-Saharan African countries and one regional program in the Greater Mekong Subregion (GMS) were added in 2011. The contributions of PMI, together with those of other partners, have led to dramatic improvements in the coverage of malaria control interventions in PMI-supported countries, and all 15 original countries have documented substantial declines in all-cause mortality rates among children less than five years of age.

In February 2015, an updated President’s Malaria Initiative Strategy (2015–2020) was launched which continues the vision of a world without malaria. Malaria prevention and control remains a major U.S.

foreign assistance objective and this strategy fully aligns with the U.S. Government’s vision of ending preventable child and maternal deaths and ending extreme poverty, and also with the goals articulated in the draft RBM’s second Global Malaria Action Plan and WHO’s draft Global Technical Strategy.

Under this new strategy, PMI will work with NMCPs and partners to accomplish the following objectives by 2020:

1. Reduce malaria mortality by one-third from 2015 levels in PMI-supported countries, achieving a greater than 80% reduction from PMI’s original 2000 baseline levels.

2. Reduce malaria morbidity in PMI-supported countries by 40% from 2015 levels.

3. Assist at least five PMI-supported countries to meet the WHO criteria for national or sub-national pre-elimination.

To achieve these objectives, PMI will take a strategic approach which emphasizes the following five areas: (1) Achieving and sustaining scale of proven interventions, (2) Adapting to changing epidemiology and incorporating new tools, (3) Improving countries’ capacity to collect and use information, (4) Mitigating risk against the current malaria control gains, and (5) Building capacity and health systems.

Cambodia is one of six countries in the GMS including: Burma, China (Yunnan Province), Lao People’s Democratic Republic, Thailand, and Vietnam. Malaria remains a major contributor to the public health and economic burden in Cambodia due in large part to the development and spread of malaria parasite resistance to artemisinin drugs, the principal component of the combination therapies for malaria that now are the first-line treatment for malaria throughout the GMS. Evidence of Plasmodium falciparum resistance to artemisinin drugs has now been identified in multiple locations in the country; treatment failures to artemisinins have been reported from multiple sites on the Thai-Cambodian border and also in the north and northeast along the Lao-Cambodian and Cambodian-Vietnam borders.

III. PURPOSE

The purpose of this contract is to enhance malaria control activities by providing technical assistance and support CNM to develop and evaluate an evidence-based Model Elimination Package for malaria, which can then be implemented in other appropriate ODs. Simultaneously, the Project will work in five target ODs, to be determined in consultation with CNM and PMI, where accelerated control activities will be scaled up with the goal of reducing the Annual Parasite Incidence (API) for Pf to < 1. Depending on the availability of funding and in consultation with PMI and CNM, these activities may be expanded to as many as three additional ODs. The Cambodia Malaria Elimination Project has four primary objectives:

1) Develop a scalable, evidence-based elimination model in Sampov Loun and support its dissemination and replication for malaria elimination in Cambodia;

2) Support scale-up of high quality malaria control and prevention interventions in five to eight ODs, where gaps in coverage or quality exist;

3) Strengthen national malaria surveillance systems and M&E appropriate for malaria elimination and control activities;

4) Build capacity of Ministry of Health (MOH) to manage, intensify, and sustain malaria control and elimination efforts particularly at the OD level.

This project is intended to contribute to the overall efforts of CNM and partners to eliminate malaria from Cambodia by 2025. It is recognized that several factors may impede progress towards malaria elimination-- including intensifying resistance to ACTs, waning finances for malaria elimination activities, and social and economic factors that are beyond the control of this project. Nonetheless, the tools, approaches and the strengthened surveillance systems developed through this project will enable Cambodia to move closer to the goal of elimination and equip CNM and partners to move quickly to address such challenges as they arise.

The Project will support elimination activities in one pilot OD, Sampov Loun (SPL), in Battambang Province. In SPL OD, only 456 confirmed cases were reported in 2014. This low burden allows for program reorientation toward malaria elimination. The district has a network of village malaria workers (VMWs) and a public-private mix (PPM) program, currently managed by the PMI-funded CAP-Malaria Project. Intense resistance and treatment failures to ACTs have been identified in sentinel sites in proximity to Sampov Loun. This resistance takes the form of both resistance to artemisinin drugs and the two partner drugs most widely deployed as part of ACT regimens—mefloquine and piperaquine.

Data from western Cambodia TES studies reflect cure rates to DHA-piperaquine of only 59-69%. Thus, elimination efforts in SPL must not only ensure that case numbers are reduced, but also include measures to mitigate the further selection of resistant P. falciparum strains. Such measures could include: adoption of low-dose primaquine radical cure treatment, if ongoing studies demonstrate its safety, and implementation of directly observed therapy (DOT) and active follow-up of patients to ensure adherence and cure.

IV. BACKGROUND

1. General Overview

The recent 2014 results from the Demographic and Health Survey (DHS) showed that many of Cambodia’s key health indicators have significantly improved as the country’s economy has developed.

Over the period 2000 – 2014, infant mortality rates (IMR) have decreased from 95 per 1000 live births (2000) to 28 per 1000 live births (2014). Similarly, under-five mortality has decreased from 124 per 1000 (2000) to 35 per 1000 (2014). Seventy-three percent of children 12-23 months are fully vaccinated. Malaria nevertheless remains a significant burden. Of the country’s estimated fifteen million people, eighty percent of the population lives in areas without malaria transmission, but around 20% (approximately 2.9 million people) either live permanently in the forested endemic areas or are “forest dependent” for additional income. The 2013 Cambodia National Malaria Survey estimated a malaria prevalence of 0.9% in high-risk areas (<2km from the forest).

Both malaria morbidity and mortality rates have declined over the last decade due to increased government commitment together with substantial additional financial and technical support from the international community. National statistics reported to the World Health Organization (WHO), indicate that between 2002 and 2012, the number of probable and confirmed cases and the number of malaria related deaths fell by 76 percent (from 100,194 to 45,553 in public health facilities) and 90% (from 457 to 45), respectively. The health information system (HIS) and Village Malaria Worker (VMW) malaria data for 2012 indicate a further reversal of the P. falciparum: P. vivax ratio (37%: 48% in 2012 compared to 46%: 38% in 2011) confirming the continuation of the long-term decline in the malaria burden in the country.

Figure 1: Trend of Reported Malaria Confirmed Cases in Cambodia (2009-2013)

The national case management policy in Cambodia prioritizes access to quality diagnosis and treatment of malaria-confirmed cases with the artemisinin-based combination therapy (ACT), DHA-piperaquine, which has been made available in public health facilities and through trained VMWs. In Cambodia, ACTs are used to treat both uncomplicated P. falciparum and P. vivax malaria infections.

In response to the finding of reduced efficacy of DHA-piperaquine in Pailin, the national treatment guidelines (NTGs) were revised in 2012 authorizing the use of atovaquone/proguanil (Malarone) in that province. Unfortunately, molecular genotyping revealed the presence of atovaquone resistance mutations within six months of introduction, necessitating the discontinuation of Malarone, and reversion back to DHA-piperaquine. With documentation of subsequent therapeutic efficacy studies (TES) demonstrating unacceptably high DHA-piperaquine failure rates in four additional operational districts/provinces, further change in the malaria treatment policy, with artesunate-mefloquine (ASMQ) now recommended as first-line treatment in those areas. Procurement of ASMQ to implement this policy is currently underway.

2. Current Epidemiological Situation

The total number of treated malaria cases in the public sector (i.e., all cases treated based on clinical as well as microscopic or rapid diagnostic test (RDT) confirmation in government facilities) was halved from 115,614 in 2001 to 74,166 in 2012 and was further reduced by 40% in 2013 to 44,203 with roughly half of the malaria cases being tested and treated by the extensive network of VMWs. At the end of 2013 the annual malaria parasite incidence was 2.94 per 100,000 and the number of deaths had dropped to 12 compared to 46 in 2012 (a 74% reduction) (Figure 1). In some areas the reduction has been even more rapid. However, a significant proportion of the population, though, first seeks care in the private sector. Although efforts are increasing to work with private providers, it remains difficult to know with certainty the numbers of malaria cases seen by both formal and informal private providers.

Until recently P. falciparum was the predominant species among confirmed malaria cases but in 2012 the proportion shifted and for the first time P. vivax accounted for more than 50% of confirmed case:

55% in 2012 and 58% in 2013. P. malariae is rare and P. knowlesi has been reported sporadically, although its distribution and the number of human infections are not known.

Malaria in Cambodia is primarily a disease of young males 15-49 years of age who live or work in forested areas or on private farms near the forest. They often travel between endemic and non-endemic areas increasing risk-taking behaviors. Poverty also increases susceptibility to malaria as do changing land use and sometimes-illegal status leading to reductions in care seeking behavior. These factors contribute to the high incidence of malaria among mobile and migrant populations (MMPs) when compared with a resident population of similar socio-economic and demographic profile.

Roughly 15 percent of malaria cases in 2013 were adult females. These are predominantly residents of villages in or near forests or are cases due to secondary transmission from forest goers that return to towns and cities. Children under 5 years of age constituted only 3% of total malaria cases.

Cambodia's malaria burden continues to be disproportionately borne by ethnic minorities, mobile, migrant, and cross-border populations, representing a huge challenge for prevention and control.

Despite efforts to ensure availability of high quality ACTs and a ban on oral artesunate monotherapies, substandard antimalarials can still be found in the unregulated private sector in Cambodia. Efforts to remove poor quality malaria treatments from the market and replace them with quality-assured ACTs has improved the situation in recent years however a recent study by the Artemisinin-based Combination Therapy (ACT) Consortium published in the American Journal of Tropical Medicine and Hygiene indicate that up to 30% of antimalarials in Cambodia may be sub-standard quality.

3. Overview of the Health System in Cambodia

The National Centre for Parasitology, Entomology, and Malaria Control (CNM) sits within the Ministry of Health (MOH). The leadership of malaria control activities within Cambodia rests at the central level;

however, with the MOH’s Decentralization and Deconcentration Strategy, more emphasis is being placed on building the capacity of the Provincial Health Department (PHD) and Operational District (OD) malaria supervisors to plan and implement activities at the local level. Active participation of VMWs, Mobile Malaria Workers (MMWs) and local authorities help to improve the availability and access to malaria services, including early diagnosis and treatment, the provision of long-lasting insecticidal nets (LLINs), and malaria health education.

4. National Malaria Control Program Strategy: Moving from control to elimination

Following the Prime Minister’s announcement that Cambodia will seek to eliminate malaria by 2025, Cambodia developed a new malaria strategy. This strategy, the National Strategic Plan for Elimination of Malaria, aims to achieve the following goals:

• Short-Term (by 2015) To move towards pre-elimination of malaria across Cambodia, with special efforts to contain artemisinin resistant P. falciparum malaria.

• Medium-Term (by 2020) To move towards elimination of malaria across Cambodia with an initial focus on P. falciparum malaria and ensure zero deaths from malaria.

• Long-Term (by 2025) To achieve a phased elimination of all forms of malaria in Cambodia.

Figure 2: Phased approach from malaria control to pre-elimination and elimination in Cambodia

The strategic objectives of the National Strategic Plan for Elimination of Malaria are:

1. To ensure universal access to early malaria diagnosis and treatment services with an emphasis on detection of all malaria cases (including among mobile/migrant populations) and ensure effective treatment including clearance of P. falciparum gametocytes and dormant liver stage of P. vivax.

2. To halt drug pressure for selection of artemisinin resistant malaria parasites by improving access to appropriate treatment and preventing use of monotherapies and substandard drugs in both public and private sectors.

3. To ensure universal access to preventive measures and specifically prevents transmission of artemisinin resistant malaria parasites among target populations (including mobile/migrant populations) by mosquito control, personal protection and environmental manipulation.

4. To ensure universal community awareness and behavior change among the population at risk and support the containment of artemisinin resistant parasites and eliminate all forms of malaria through comprehensive BCC, community mobilization, and advocacy.

5. To provide effective management (including information systems and surveillance) and coordination to enable rapid and high quality implementation of the elimination strategy.

During the implementation period covered by this strategic plan, Cambodia’s National Strategic Plan will transition from control to elimination phase. In concert, PMI will support the development of an evidence-based, Model Elimination Package that can be provided to CNM, to be scaled up in selected geographies with an initial focus on P. falciparum elimination.

To successfully implement the National Strategic Plan for Elimination of Malaria, CNM recognizes that every malaria control intervention needs to be implemented with the highest degree of coverage and quality. Accordingly, CNM has developed revised national treatment guidelines (NTGs) for malaria incorporating updated information presented at national malaria drug policy meetings held in December 2013 and January 2014. The policy focuses on further aggressive reduction of malaria morbidity and mortality as it approaches malaria elimination. In addition, the policy aims to reduce the impact of resistant malaria strains and preserve the current arsenal of malaria treatments by optimizing drug regimens and extending case management to follow up patients in high-risk areas to assure successful cure. The policy also promotes more aggressive diagnostic testing to accurately diagnose and treat a larger proportion of malaria cases. To achieve these objectives, updates in the 2014 treatment document will include:

● Targeting DHA-piperaquine and Malarone for uncomplicated P. falciparum by province to assure patient cure;

● Replacing existing co-blistered Malarone with a fixed dose combination once it is available;

M o n I t o r I n g, E v a l u a t I o n & R e s e a r c h

PRE-ELIMINATION WITH AN

INITIAL

FOCUS ON P.FALCIPARUM

(2016-20)

PHASED

ELIMINATION OF ALL

FORMS OF MALARIA

(2021-25)

SCALE UP INTERVENTIONS

TO ACHIEVE UNIVERSAL

COVERAGE, ARREST

ARTEMISININ

RESISTANCE & MOVE

TOWARDS PRE-ELIMINATION

(2011-15)

1. CONTROL 2. Pre ELIMINATION 3. ELIMINATION

● Emphasizing directly observed therapy (DOT) and ensuring clearance as an essential part of case management;

● Enhancing timely surveillance to inform drug treatment policy;

● Adopting low-dose primaquine for radical cure of P. falciparum malaria in compliance with 2012

WHO guidelines and amending P. vivax radical cure dosing options.

One of the critical components of Cambodia’s elimination strategy is accurate diagnosis and treatment, and rapid reporting and response to every case. This must be coupled with simultaneous efforts to reduce transmission in highly endemic areas, which may be a source for re-introduction of malaria cases to districts with low malaria endemicity. Achieving malaria elimination will require the concerted effort and commitment of the government, affected communities, and local and international partners.

PMI’s support for malaria control and elimination in Cambodia leverages support from the Global Fund, which has been the major external financier of malaria control activities. Two new two-year Global Fund grants are currently being negotiated and are due to start in mid-2015 under the RAI and Single Stream Funding (SSF). Other bilateral donors include the Asian Development Bank, which is funding malaria elimination activities in Preah Vihear and the Clinton Health Access Initiative (CHAI), which provides technical assistance to CNM at national level. Other regional donors supporting malaria activities that impact Cambodia are Australia’s Department of Foreign Affairs and Trade (DFAT) and the Bill & Melinda Gates Foundation who jointly support the WHO Regional Emergency Response for Artemisinin Resistance (ERAR) Hub , as well as key basic and operational research and technical assistance to malaria control programs throughout the region.

National malaria activities are also complemented by other PMI-funded activities and broader health systems work funded by USAID and other donors. The Malaria Elimination Project will complement therapeutic efficacy studies, drug quality assurance, entomology technical assistance and quantification of malaria commodities Specifically, USAID-funded health systems strengthening projects support the MOH in licensing and regulation of private health care providers, strengthen the HIS and its interoperability with vertical disease program information systems, assist the MOH to deliver social health protection schemes and develop stronger logistics management information systems (LMIS).

The Malaria Elimination Project is expected to complement and coordinate with these cross-cutting projects.

V. DRAFT STATEMENT OF WORK

The Cambodia Malaria Elimination Project is expected to develop an evidence-based, Model Elimination Package, building upon and refining activities currently being implemented and piloted in SPL by PMI CAP-Malaria Project. During the course of the proposed Project, the Model Elimination Package-- with all of its tools, technical guidelines, manuals, standard operating procedures (SOPs), and outline of best practices and lessons learned-- will be evaluated and costed before being provided to CNM and other partners for adoption and onward implementation, as appropriate.

At the same time, the Cambodia Malaria Elimination Project will work in an additional five ODs that will be identified in consultation with CNM, PMI and other donors, as appropriate. The project will work with these OD staff to fully scale up control and prevention interventions, including strengthening surveillance systems and intensifying control measures with the goal of significantly reducing API for P.

falciparum to pre-elimination levels. Depending on the availability of resources, PMI may request further expansion of Project activities to an additional three ODs.

At the start of the Cambodia Malaria Elimination Project, SPL is expected to already be implementing some parts of the Model Elimination Package and piloting others. All tools, manuals, SOPs and documentation of best practices developed and/or piloted in SPL will be provided to the contractor by PMI CAP Malaria Project. The contractor will continue to validate, refine, and then scale-up fully this Model Elimination Package within this OD by the end of project year 2, in consultation with CNM and

PMI. The project will work closely with appropriate staff at CNM and other appropriate partners during the further development and finalization of these tools.

VI. PROGRAM OBJECTIVES, TASKS AND TARGETS

Objective 1: Develop a scalable, evidence-based elimination model in Sampov Loun and support its dissemination and replication for malaria elimination in Cambodia.

Tasks

1. Ensure universal coverage with LLINs. Activities would include supporting the distribution of LLINs through campaigns and routine systems, as appropriate, to ensure access by all targeted permanent residents and MMPs.

2. Support early diagnosis and appropriate treatment of all clinical malaria cases. Support training, supervision, and quality assurance of health facility clinical and laboratory staff, VMWs, and MMVs to ensure that all suspected malaria cases are correctly assessed, tested with high-quality microscopy and/or RDTs, and provided appropriate treatment in line with the 2015 National Treatment Guidelines.

Positive cases of P. falciparum and P. vivax should receive DOT. Thereafter, cases should be followed weekly until Day 28 for P. falciparum. Upon favorable results from safety and G6PD feasibility OR studies, PQ should be deployed, in line with national guidelines for radical curative treatment. Project will develop training materials on PQ administration and safety monitoring, and support training of health facility workers, VMWs, and MMWs.

3. Supportmalaria case reporting, investigation, and response. The Project will develop a system to enable rapid reporting of all diagnosed malaria infections, conduct an investigation of every case, and carry out response activities, including assessment and testing of all household members. If the case patient had traveled into the forest, any persons who traveled with him/her should also be followed-up and assessed for malaria. The target will be to report every case in one day, conduct a case investigation in three days, and complete response within seven days (the so-called“1-3-7” approach).

This activity would include adoption and/or development of appropriate information technology to facilitate reporting and follow-up in consultation with CNM.

4. Strengthen case management and reporting of all malaria cases in the private sector. In line with CNM policies and guidance, support will be provided to ensure that all malaria cases identified by private sector providers and outlets are rapidly diagnosed and treated; and cases reported, investigated, and response conducted in the same manner as will be done with cases diagnosed in the public sector. This will include supporting supervision of private providers and conducting quality assurance activities to ensure diagnostic testing is done with the highest quality.

5. Build capacity and strengthen systems to manage elimination activities. Support will be provided for the development of a Special Working Group for Elimination at Operational District level to engage key malaria stakeholders, develop action plans, assign roles and responsibilities, and mobilize communities to support elimination goals. Targeted support to build necessary management capacity and information systems at OD and PHD level also will be provided. CNM at central level should be engaged and oversight these elimination activities as well.

6. Strengthen behavior change communication. Support implementation of behavior change activities for malaria elimination through appropriate channels, including through interpersonal communication, community mobilization and dialogues, and other appropriate means. Particular focus should be placed on MMPs and innovative approaches to reach that population should be tested. Development of improved messaging to encourage continued use and adherence to malaria prevention and control activities in very low prevalence settings also will be needed.

7. Support civil society and community-based organizations to implement malaria control activities. As appropriate, support will be provided to community-based organizations and groups to conduct behavior change and social mobilization activities to promote consistent bed net usage and to encourage rapid access to malaria services, particularly in ethnic minority communities.

8. Conduct operations research. In consultation with CNM and PMI, appropriate OR activities will be carried out to answer key technical questions and address key implementation challenges towards achieving the goal of elimination. PMI Cambodia will provide technical direction regarding research questions and guidelines for operations research. Findings and data from the program are to be properly evaluated, documented, and shared with PMI, CNM, and all interested partners.

9. Document, cost and disseminate of Model Elimination Package. As tools, manuals, training materials, and SOPs are refined and finalized, they should be provided to CNM and PMI, and disseminated to other interested partners through appropriate forums, meetings, and workshops, as appropriate. In addition, a detailed costing of the inputs required for the implementation of the Model Elimination Package should be carried out. Dissemination of all tools and materials should be completed by the end of Project Year 1, and costing completed by the end of Project Year 2.

Illustrative Targets

1. All M&E forms are tested, adapted and revised for the model elimination package by the end of Year 1 of the project.

2. 90% of all HFs and the associated VMWs in the affected communities in the elimination OD of Sampov Loun are completing the case reporting forms within one day of diagnosis for all diagnosed malaria cases by the end of Year 1 of the project.

3. 90% of all malaria cases are investigated within 3 days by the end of Year 2.

4. 90% of all household contacts of malaria reported malaria cases are evaluated for malaria and treated as appropriate within 7 days by the end of Year 3.

5. 90 % Households in targeted, at-risk villages have sufficient treated mosquito nets (i.e. at least one ITN/LLIN for two persons)

6. 90 % Population living in targeted, at-risk villages who slept under an ITN/LLIN the previous night.

7. 95 % Population living in targeted, at-risk villages who had fever in the last two weeks and had a diagnostic test for malaria according to national policy within 24 hours of the onset of fever

8. 90 % Health facilities report no stock-outs of first-line antimalarial medicines and diagnostics during the last 3 months

9. 85 % Registered Private Medical clinics that received supervision during the last year.

10. 90% of all malaria cases diagnosed by private providers are reported to MIS.

Key deliverables

1. At the launch of the Project, the contractor will conduct a rapid assessment of status of current elimination activities in SPL, including an evaluation of all existing tools and materials and an assessment of the quality of case management and reporting practices. A report of this assessment should be provided within six months of project launch.

2. All tools, training materials, and SOPs for elimination activities that were provided to the Project by the PMI CAP-Malaria Project will be assessed, revised, piloted, and finalized, as required, and provided to CNM and USAID by the end of Year 1.

3. Report of costing of the Model Elimination Package should be provided to USAID by the end of Project Year 2.

Objective 2: Support scale-up of high quality malaria control and prevention interventions in five to eight ODs, where gaps in coverage or quality exist.

Tasks Target ODs will be selected, in consultation with CNM and PMI, from the 45 malaria endemic ODs in the country.

1. Conduct a rapid situational analysis in selected ODs. The assessment should focus on identifying the coverage levels and quality of key malaria control interventions and the capacity and systems readiness at the OD level to conduct accelerated malaria control activities. Particular focus should be given to mobile and migrant populations. This assessment should be conducted in close collaboration with the CNM and OD staff and PMI.

2. Ensure universal coverage with LLINs. Activities would include supporting the distribution of LLINs through campaigns and routine systems, as appropriate, to ensure access by all targeted permanent residents and mobile/migrant populations.

3. Support early diagnosis and appropriate treatment of all clinical malaria cases. Support training, supervision, and quality assurance of health facility clinical and laboratory staff, VMWs, and MMVs to ensure that all suspected malaria cases are correctly assessed, tested with high-quality microscopy and/or RDTs, and provided appropriate treatment in line with the 2015 National Treatment Guidelines.

When and where programmatically feasible, positive cases of P. falciparum should receive DOT and cases followed weekly until Day 28. Upon favorable results from safety and G6PD feasibility OR studies and in consultation with CNM and PMI, PQ for radical cure treatment should be implemented in line with national guidelines.

4. Improve quality of malaria case management in private sector clinics. The contractor will assist OD staff to provide training and supervision to private medical providers and outlets to ensure appropriate malaria diagnosis and treatment with a quality system in place for patients seeking care at those facilities. Capacity also will be developed to enable regular reporting of malaria cases to the OD.

5. Build capacity and strengthen systems to manage malaria control activities. Targeted support will be provided to build necessary management capacity and appropriate information systems at OD and PHD level.

6. Strengthen behavior change communication. Support implementation of behavior change activities for malaria control through appropriate channels including through interpersonal communication, community mobilization and dialogues, and other appropriate means. Particular focus should be placed on mobile/migrant populations.

7. Support civil society and community-based organizations to implement malaria control activities. As appropriate, support will be provided to community-based organizations and groups to conduct behavior change and social mobilization activities to promote consistent bed net usage and to encourage rapid access to malaria services, particularly in ethnic minority communities.

8. Conduct operations research. In consultation with CNM and PMI, appropriate OR activities will be carried out to answer key technical questions and address key implementation challenges. PMI

Cambodia will provide technical direction regarding research questions and guidelines for operations research. Findings and data from the program are to be properly evaluated, documented, and shared with PMI, CNM, and all interested partners.

Illustrative Targets

1. 90 % Households in targeted, at-risk villages have sufficient treated mosquito nets (i.e. at least one ITN/LLIN for two persons).

2. 85 % Population living in targeted, at-risk villages who had fever in the last two weeks and had a diagnostic test for malaria according to national policy within 24 hours of the onset of fever.

3. 90 % Health facilities report no stock-outs of first-line antimalarial medicines and diagnostics during the last 3 months.

4. 85 % Registered Private Medical clinics that received supervision during the last year.

5. 90% of all malaria cases from private providers are reported to MIS.

6. 90% of public health facility malaria cases are reported on time to the MIS.

7. 95 % HFs that receive structured supervision on malaria at least twice in the last year.

8. Reduction of API in selected ODs (target of this reduction is based on negotiation with PMI and

CNM).

Key Deliverables: Report of rapid situational analyses in target ODs.

Objective 3: Strengthen national malaria surveillance systems and M&E appropriate for malaria elimination and control activities.

Tasks

1. Refine M&E reporting forms and support consistent use by public and private healthcare providers.

Case reporting and investigation forms that have been piloted by PMI CAP-Malaria Project will be further refined and piloted during the first year of the project. Once finalized and adopted by CNM, the project will support scaling up of validated reporting systems and tools in targeted ODs.

2. Technical assistance on data management and use. The contractor will provide training and technical assistance to CNM, PHD/OD staff, and key partners, as requested by PMI and CNM, on the analysis and use of reported case and case investigation data for program management and planning.

It is also critical that appropriate data quality and assurance systems are in place.

3. Support further development and implementation of electronic data reporting platform. It is anticipated that by the start of this project, CNM and key partners will have developed a new web-based reporting infrastructure for the MIS. The Project will support, as directed by PMI and CNM, any further refinement and piloting of the electronic reporting platform and then support implementation of the system in the targeted ODs, which could include training and supervision of staff and installation of software packages.4. Strengthen capacity to conduct entomologic monitoring. The contractor will provide necessary technical assistance and implementation support to develop the capacity of CNM and other relevant staff to conduct basic entomologic monitoring with a focus on assessing for the presence of insecticide resistance and monitoring the durability and residual insecticidal activity of LLINs.

Illustrative Targets

1. All case reporting forms are piloted, finalized, and provided to CNM by the end of Project Year 1.

2. Over 90% of health facilities in all districts in target provinces reporting all cases of malaria on time to MIS.

3. 95 % of all HFs and the associated VMWs in the concerned communities in the elimination OD of Sampov Loun are trained in the use of the case investigation form by the end of Project Year 1.

4. All ODs are trained and equipped to use the web-based reporting platform by the end of Project Year 2.

5. LLIN durability monitoring carried out in targeted ODs in line with CNM and PMI guidance.

6. 90% of all malaria cases diagnosed by private providers are reported to MIS.

Objective 4: Build capacity of MOH to manage, intensify, and sustain malaria control and elimination efforts, particularly at the PHD and OD levels.

Tasks

1. Develop a plan to strengthen management capacity at National, PHD and OD levels. The contractor will develop and implement a plan to strengthen management capacity in each targeted OD and PHD.

This will include identifying and strengthening key staff capacity at national, OD, health facility, and community levels in topics such asplanning, budgeting and implementation of the standard control and prevention malaria program in their Annual Operational Plan (AOP), and to incorporate the intensified surveillance and response techniques crucial for elimination. This will include resource allocation, financial management, personnel management, training, supervision, commodities, logistics, communications and monitoring/evaluation.

2. Provide training and other support to build management capacity. In coordination with CNM, training, supervision or on-the-job mentoring will be provided to targeted OD and PHD staff to strengthen capacity to manage malaria control and prevention activities.

3. Strengthen malaria policies and guidelines. The contractor, at the national level, must provide technical assistance to CNM to develop, review and update policies, strategies and guidelines to scale up proven malaria interventions indicated under tasks C.5.2.1. In addition, the contractor must participate in all national level malaria Sub/Technical Working Groups and meetings.

Targets

1. All planned trainings completed.

2. All targeted ODs develop AOP, review and implement based on the cycle of AOP process by the end of Project Year 1.

3. 85% of planned case management supervisory visits conducted at health facilities and with VMWs in all targeted ODs in Year 1, increasing to 90% by the end of Year 2

4. OD Malaria Manager and health facility chiefs understand the basic essential elimination package in SPL, and able to explain and interpret the quarterly OD data (cases, commodities and ACT stock management) within their area.

Key Deliverables

1. Assessment of management capacity strengthening needs provided to CNM and PMI within 180 days of the Project launch. This report must identify the health system deficiencies at PHD and OD levels and make recommendations on how to address them.

2. A management capacity strengthening plan will be provided to CNM and PMI within six months of Project launch. This plan must identify activities to strengthen targeted OD and PHD staff ability to plan, budget, implement, and monitor all areas of the malaria program.

3. A Quarterly OD Bulletin Report is developed and used to reflect the overall picture of malaria elimination approaches, surveillance and response actions in SPL, control and intervention activities in selected ODs.

(END OF SECTION C)

(END OF SECTION C)