Regional Malaria and other Communicable Diseases Threats Trust Fund (RMTF)

A Health System Strengthening Approach towards Malaria Elimination

Dr. Sonalini Khetrapal

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Communicable Diseases threatens Economic Progress

ADB Strategy to focus on Regional Cooperationand Communicable Disease Control

Dengue

Ebola MERS

Zika

Corona

MalariaTuberculosis

The Regional Malaria and Other Communicable Diseases Threats Trust Fund

http://reliefweb.int/sites/reliefweb.int/files/resources/malaria-elimination.pdf 3

• RMTF duration: 2014 to June 2018

• Donors: Australia, UK, Canada

• Total amount: $28.7M

• Regional coverage: Asia Pacific

with a focus on GMS

ADB’s malaria and other communicable diseases threats trust fund has 6 outcomes

Trust fund contributions are ending in June 2018.

Leadership and Governance APLMA, Investment Cases and Toolkit

Service Delivery• Health services

for migrants and mobile population groups

Healthcare Financing • Additional ADB grants

and loans• Health Bond

Health workforce• Academia and regional expert

networks

Medical products and technology• sustainable post market surveillance capacity

and tools• Integrated regulatory information systems

Information and research• Surveillance for

malaria elimination Geo-enabled health information systems, Digital health governance,

• Interoperable information systems

RMTF addresses systemic health systems failures

LeadershipS t r e n g t h e n e d l e a d e r s h i p , d e c i s i o n - m a k i n g a n d

a c c o u n t a b i l i t y f o r m a l a r i a e l i m i n a t i o n a n d a d d r e s s i n g c o m m u n i c a b l e d i s e a s e t h r e a t s

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RMTF Mobilizes Leadership

Commitment to Malaria Elimination

Heads of States, Senior Officials, APLMA

Malaria elimination dashboard and roadmapInvestment cases and toolsPolicy dialogue

HOW

WHO

WHAT

FinancingIncreased funds for malaria elimination andaddressing communicable disease threats

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The RMTF leveraged ~$200m financingRMTF $28,7m

Jan 2014 Dec 2017/June 2018

GMS Health Security Loan $124m2017

2022ADF Health Security Grants $52,5m

2022

2017ADB Health Bond $100m OCR

Parallel co-financing with the Global Fund

2018

2018

• ADB grant support to the poorest countries will increase by 70% over the period 2017-2020 as compared to the previous 4 years.

Modality 1: Results Based Grant Financing (Unlocking counterpart funding): GF financing is available and aligned with Project Loan Indicators

Modality 2: Loan or Interest Buy-downsGrant repays % of principal before interestOr repays interest component resulting in reduced loan repayments

ADB issued this type of Bond for the first time ever

Investing in Health Bonds will support financing of health

projects by Government and targeted private sector in Asia and the Pacific. This will be of

10 year duration

MedicinesI m p r o v e d q u a l i t y a s s u r a n c e a n d p o s t - m a r k e t

s u r v e i l l a n c e o f m e d i c i n e s f o r m a l a r i a a n d o t h e r c o m m u n i c a b l e d i s e a s e s

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Center of Regulatory Excellence (CoRE)Applied Research for Strengthening Regulatory Systems

Phase I

Mapping the Regulatory Landscape•Regulatory Systems Profiling•Learning Needs Analysis

Phase II

Building Capacity•Training and Developing Key Stakeholders•Providing Customised Education Programmes

In 2014, CoRE and ADB initiated a collaboration to strengthen the capacities of National Regulatory Agencies (NRAs) in the Greater Mekong Sub-region (GMS).

Collaboration with USP and WHO – SSFFC reporting • Capacity development to report into the WHO SSFFC surveillance and monitoring

project rapid alert system (RAS)

• Database provides evidence to guide market surveillance, develop laboratory tests and identify those medicines most at risk

• Reporting from Asian countries is weak

• Given the challenge of SSFFC antimalarial products in the region, it is important that this RAS be strengthened in the region to complement regulatory capacity development and support for post-marketing surveillance activities.

The current work aims to assess

LOMWRU - Rapid Detection of Poor Quality Medicine: Filling the Gap

Detailed investigations of new devices to allow National Regulatory Agencies (NRA)

URGENT NEED

• to decide if these new technologies are appropriate • by whom and at what position within the medicine

surveillance system they are best used

of different portable and handheld devices across a variety of medicines commonly used in treatment of Malaria

accuracy ease of use

cost effectiveness

Information SystemI n c r e a s e d u s e o f q u a l i t y d a t a , i n f o r m a t i o n t o o l s a n d

t e c h n o l o g i e s t o i m p r o v e m a l a r i a a n d o t h e r c o m m u n i c a b l e d i s e a s e i n f o r m a t i o n s y s t e m s4

RMTF supports critical elements of digital health information system management

Information System Governance and Architecture

Geographic Information

Identification

Policy dialogue for leadership and strategic architecture, convergence of information silos, enterprise architecture, data standards, privacy and security policies, HIS and ICT governance

Shared information assets, shared registries, geo-enabled information systems

Unique ID assessments, unique ID design

Health Information ExchangeMalaria

Information Systems

CD Information

System

National Health Management

Information Systems

Information assets which are important for malaria elimination

LABORATORY DIAGNOSTICS AND SURVEILLANCEI m p r o v e d c a p a c i t y o f l a b o r a t o r y d i a g n o s t i c s a n d

s u r v e i l l a n c e s y s t e m f o r m a l a r i a a n d o t h e r c o m m u n i c a b l e d i s e a s e s , i n c l u d i n g c r o s s - b o r d e r

c o o r d i n a t i o n

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Output 1 - Enhanced Regional CDC systems

National malaria programs are strengthened and harmonized – organize regional workshops focusing on information sharing and harmonization of malaria policies and strategies, the countries expand the malaria surveillance and response system and information exchange between countries.

WHOOutput 2 - Improved CDC along borders and economic corridors

Malaria program activities are reinforced and coordinated with local CDC programs to increase efficiency incase detection and treatment management in villages.

Output 3 – Integrated project managementNational malaria program managers ensure better coordination and complementarity, both at the centraland local levels.

CDC2 Additional Financing Grant $9.5M

Malaria and CDC in the GMS focused on Myanmar – $4.5M• Improve Myanmar ‘s malaria surveillance and diagnostic systems• MMP specific needs in Cambodia, Lao PDR and Myanmar• Improve regional coordination on malaria and CDC among GMS countries

• University Research Co. LLC (URC), IOM Myanmar, IOM Cambodia, IOM Lao PDR, Ministry of Health (CAM, LAO, MYA), WHO

• NMCP (National Malaria Control Program), • Ministry of Labor, Public Security, Home Affairs, Woman Affairs, Planning, Mines and

Energy, Agriculture, Forestry and Fisheries, Rural DevelopmentWHO

WHAT

• Improved Myanmar malaria surveillance and diagnostic systems• Address migrant and mobile populations’ specific needs for malaria prevention and

treatment• Reinforce the mechanisms for cross-border information sharing on malaria and

communicable disease outbreaks,

HOW

Prevention – Health Impact Assessment

I n c r e a s e d c a p a c i t y t o a d d r e s s c o m m u n i c a b l e d i s e a s e s i n i n f r a s t r u c t u r e p r o j e c t s

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Develop tools and integrate HIA in sector guidelines and policies

Capacity Dev through training in ADB and DMCs

Demonstrate HIA good practice in selected projects

Improving ADB HIA practice

MODEL BUILDING:

DEVELOP SKILLS:

INSTITUTIONALIZE:

Objectives of the RMTF Workshop

• Share achievements under the RMTF in Supporting Health

System Strengthening efforts in GMS

• Highlight Best Practices and Innovative Solutions

• Provide a platform for engagement to be applied beyond the GMS

countries

• Focus on mechanisms sustainable beyond the implementation

period of the trust fund