Shared Solutions for Shared Challenges

The Asia Pacific Malaria Elimination Network (APMEN) Annual Meeting saw more than 200 international delegates from 29 countries gather in Bangkok, Thailand, to discuss the pressing issue of malaria elimination in the Asia Pacific. The event, which coincided with the organization’s 10^th anniversary, featured a range of experts sharing key lessons learned and identifying challenges and solutions to end malaria by 2030.

Incredible progress and new  opportunities for the “last mile”

Dr Preecha Prempree, Deputy Director of the Ministry of Public Health for host country Thailand, thanked participants for their commitment and tireless efforts to eliminate malaria. He reiterated Thailand’s efforts to end indigenous malaria within its borders by 2021, building upon the more than 25 districts already malaria-free within the country.

Dr Benjamin Rolfe CEO for the Asia Pacific Leaders’ Malaria Alliance (APLMA), emphasized this week’s meetings are taking place at a critical time for the effort to end malaria. Incredible progress has been seen throughout much of the region, including rapidly decreasing cases in India and Myanmar, and for the first time, zero malaria deaths in Cambodia last year. However, he cautioned that challenges will face the region in its “last mile,” including reaching India’s tribal belt and the ongoing malaria resurgence in Papua New Guinea and Melanesia. Amita Chebbi, Senior Director for APMEN, energized participants by reflecting on past successes and the renewed opportunity for APMEN to contribute substantively to stopping this disease through south-south cooperation.

APMEN partners accepted two new Country Partners, Afghanistan and Pakistan, and four new partner institutions, including Mahidol-Oxford Tropical Medicine Research Unit (MORU), Malaria No More India, University Research Co. LLC and Jiangsu Institute of Parasitic Disease (JIPD).

Countries discuss the  common challenge for malaria elimination

Delegates from China, Sri Lanka and Malaysia presented on the key lessons learned and major challenges in their respective journeys to elimination and near-elimination and followed up with Q&A with attendees.

The challenge of combatting imported cases emerged as a common theme across all presentations. Last year, China reported imported cases from 38 African countries, largely due to the significant population of Chinese workers in Africa. Closer to home, it also shares 4,000 kilometres in common borders with endemic countries, which contributes to cross-border transmission. Capacity sustainability is also a major challenge in China. Malaysia similarly faces challenges with imported malaria cases due to Malaysian workers working overseas in agriculture and logging sectors in endemic countries. Malaria becomes a forgotten disease in Sri Lanka and Anti-malaria Campaign (AMC) is facing a challenge of sustaining resources. The countries all agreed that malaria surveillance is the basic of operational activities, and where relevant, screening of high-risk groups to combat this challenge.

Bhutan, India and Cambodia also shared their experiences on tackling the challenge of cross-border transmission. Participants agreed that this is not just a programmatic issue but one that should be addressed in partnership with other ministries and agencies. Building on that theme, attendees later discussed the importance of detailed, high-quality and real-time data from surveillance efforts to strengthen strategy.

Bringing in diverse actors  to tackle challenges

Discussions on the importance of engaging communities and the private sector to ensure universal access to malaria commodities are crucial. The private sector providers are motivated to support malaria elimination efforts and have a valuable role in contributing to the overall health and well-being of their local communities. Viet Nam and Sri Lanka shared their experiences leveraging local communities to overcome barriers. For example, Sri Lanka shared how ten years ago, 70% of its population was in conflict, impacting health education, the malaria supply chain and surveillance efforts. The country leveraged the community’s access to reach the unreached population, as well as educate the masses for malaria prevention, playing a huge role in bringing the country to elimination in 2016.

As malaria cases decline, it is imperative that funding and political commitment remain the same otherwise, it will be difficult to sustain achievement and impact. APMEN recognizes that for countries nearing malaria elimination status, imported cases pose a real threat and increase the risk for re-introduction of malaria - surveillance is the key with cross border collaborations.

The principle of South-South collaboration will continue to guide APMEN’s efforts in facilitating peer to peer cooperation and technical assistance among countries and institutions in the region. Going forward, with lower levels of external aid, the ability to tap into flexible technical assistance financed by donors will become limited.  The region needs to become self-reliant in meeting technical assistance needs for malaria elimination.  Everyone has a part to play in the war against malaria. APMEN encourages partners — malaria volunteers, integrated health worker, governments, private sector and military — to deepen engagement and collaboration to address this borderless challenge.

Collectively, we can create an ecosystem that encourages a sustained approach to tackling malaria in Asia and the Pacific.

At the second day of the APMEN annual meeting, thought-provoking presentations with robust discussions revolved on three key areas:

• Operationalizing the new  APMEN business model to strengthen the way we deliver APMEN support to malaria programs and what will be the delivery mechanisms;
• Strategic Approach for Impact through APMEN working groups to empower countries towards malaria elimination; and
• Country/ Regional Support Partner to harness unique capabilities of the network.

Operationalizing the new  APMEN business model

Ms Amita Chebbi discussed how APMEN operates on 4 guiding principles which focuses on encouraging Country Ownership, South-south collaboration, responsiveness to individual country needs and laying the foundation for regional health security through development of sub regional support. The objectives and achievement for the past ten years were thoroughly reviewed to serve as a foundation for the new business model.

Based on the recommendations from the review, APMEN has developed potential areas of work to address the challenges faced by member countries such as hard to reach population, private provider engagement, and quality assurance of programs. The Network will play a role in uniting program teams and providing policy pathways through key guiding principles and approaches, working towards a joint strategy with Asia Pacific Leaders Malaria Alliance (APLMA) for better integration of activities in the region.

Strategic Approach for Impact

APMEN will implement in 4 focus areas: (1) Surveillance and Response by adapting and scaling up evidence-based approaches for border malaria; (2) Vector Control through capacity building to address resistance issue, residual malaria issues through establishing regional centres of excellence; (3) Program Management with development of strategies for engagement with the private providers; and (4) Radical cure for P. Vivax with data-driven advocacy to support new product introduction. 

As the network is expanding, APMEN felt the need to operationalize a sub-regional delivery model that moves closer to the countries.  The new delivery model would allow country partners to articulate specific gaps, priorities and tools needed for action towards malaria elimination and also provide a mechanism for APMEN to provide the support needed through a more targeted, coordinated approach by leveraging the expertise available within the Network.

RBM Partnership

Dr Daddi Wayessa, Country/Regional Support Partner Committee (CRSPC) Manager of RBM Partnership presented a high-level overview of the work of the global partnership to end malaria and the alignment with APMEN focus and strategies. The purpose of the CRSPC is to provide a platform to engage the RBM Partnership community in coordinating support to countries and regions as they execute their malaria control/elimination implementation programs.

CRSPC’s support will be tailored to suit the requirements and existing capacity in each region and country. The purpose of providing this support is to ensure that countries have sufficient funding, capacity and political commitment to implement their national plans. For countries in-need of technical support, RBM provides support in Country-level Resource Mobilisation, National Strategic Plans, Programmatic gap analysis, situation analysis, and Return on Investment, etc., political accountability through EMCs and parliamentary committees, Country implementation support to address bottlenecks and Regional Coordination and collaboration.

RBM and APLMA are partners and now in the process of entering into an MOU to formalize the engagement with APMEN, particularly around technical assistance to countries.

Conclusion

At the APLMA Senior Officials’ Meeting the following day, there was a consensus among all countries that there is a need for increased and continued political commitment and recommended adding malaria elimination to the agenda to appropriate regional platforms such as ASEAN + 3, SAARC, GMS Ministerial Conference, among others.  The APLMA Leaders’ Dashboard can be used as a tool to measure progress towards malaria elimination.

Our ability to get to malaria-free region is dependent on existing health systems in-country.  APMEN called for increased investments in strengthening health systems capacity, especially around human resources, training, health reporting systems and greater financial resources at sub-national levels.

At the Senior Officials the following day, APMEN urges the government officials to prioritize cross-border collaboration between countries in the region.  To address border malaria effectively, we need senior political leadership to facilitate co-operation between countries, in the form of data sharing through appropriate regional platforms, establishing mechanisms such as bilateral committees and networks for agreed areas of work and identifying focal points at national, state and district levels for cross-border collaboration.

To access the agenda, click here, and photos Day1 and Day 2.

Visit www.apmen.org for more information about malaria elimination  in Asia-Pacific by 2030