Dr Char Meng Chuor CNM Director Email: mengchuor@gmail
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Dr Char Meng ChuorCNM Director
Email: [email protected]
Regional Malaria Financing Task Force (RFMTF) MeetingHong Kong, 12 May, 2014
Benefits to National Malaria Programs from Regional Support:
The Cambodia case
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Country background malaria epidemiologic status• 181,135 Spkm • 14,7 million inhabitants • 22.9% live below poverty line• 3.1 million household with
Malaria mortality/100,000:2000: 5.2 2010: 1.72011: 0.66 < (MDG (2015:0.78)2013: 0.08
Forest cover map 57%
Malaria Map
Reported Malaria Case treated by Public health facilities per 1000:2000: 11.0 2010: 4.22011: 4.0 = MDG (2015:4.0)2013: 1.5
Group specific incidence rate: in creased risk among male adult
71% has forest or hunting activities
71% has forest or hunting activities
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Three major challenges arePf. Resistance
not just a treat to
Cambodia but = Global treat
Pf. Resistancenot just a treat to
Cambodia but = Global treat
Vivax in G6Pd liverVivax in
G6Pd liver
Core issue: Migrant & or
MobileNot just victim but also carry Pf./Vx
more effective than mosquito
Core issue: Migrant & or
MobileNot just victim but also carry Pf./Vx
more effective than mosquito
Hot spot resistance: We know it is in NW but not sure about the rest of the country
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Government leading processIntegration of malaria program integrated to the health system in the context of government
decentralization policies
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Government resource share to health and malaria program
Gov. expenditure on health has increased 4-fold over the last 10 years. Its % share of health budget is already among the highest in the world
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Externally assisted projects: Money “actual” amount, building networks, outcome…
Reduction in malaria prevalence Research projects (AFRIMS, BMGF, CHAI, ITM, MC, MSF, NIH, MORU, NAMRU2, UBS, US-CDC, WHO) were vital for CNM policy decision).
A 3-fold decrease in prev every 3 yrs in the W region, mostly ARCE provinces compared to a less than 2-fold decrease in the E region
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Four pillars on private Sector (Medical and selected non-medical sectors)
1. Regulation: Ban on monotherapy, anti-malaria drug registration licensed to CNM only2. social marketing of RDT/ACT and insecticides (PSI)3. Non-medical-sector: Mosquito net loans, taxi drivers….4. Private health providers (MoU) on supplies, training, diagnostic and treatment, report
and referring severe case to public health facilities
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Challenges with additional government financing for malaria program ?
• Health expenditure share of Government Expenditure was 12%: among the highest compared to other low/middle income countries
• Annual Operational Plan 2014: Of US$384 million total budget CDC get US$64.7 million including malaria (US$21.9 million) while Non-CDC get US$2.65 only. Number of death related with non-CDC is much higher than other diseases (Incl. external aids)
Competing priorities within Government and within heath sector
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Challenges with externally assisted projects
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Challenges with externally assisted projects
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Lessons learned
"Cambodia’s effort to eliminate eventually point the way toward a goal that’s shared by many of us in the global health |...| A lot more work needs to be done in the years to come. But I left Cambodia thinking that if we can be successful there, it will be a giant step toward the long-term goal of wiping out malaria everywhere."
Overall, key factors of successes : •High-level political will and support; •Universal bed net coverage (1 net per person in all malaria risk areas); •Community-based Early Diagnosis and Treatment (Village Malaria Workers); •Health Facilities well stocked with diagnostics and drugs.
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Interventions Control phase e.g. Pre-elimination/elimination e.g.Prevention and BCC:
• Relies on net distribution campaign
• IRS based on available resource
- Campaign + & continuous net coverage and regular monitoring/supervision of appropriate net use
- Systematic IRS and repellent distribution and use monitoring
Diagnosis and treatment
Passive case detection and treatmentNo Primaquine
- Aggressive/active case detection (ACD) and systematic DOT
- Primaquine deployment and use- Special screening among prioritized vulnerable groups
(e.g. Pregnant women)- Explore feasibility of targeted MDA
Surveillance system
Pilot surveillance on malaria cases
- Systematic surveillance of all individual detected cases and comprehensive response
- Surveillance on local malaria vectors “Foci transmission”
We are making consensus on what exactly additional programmatic activities in pre-elimination and how these will be managed with flexible funding modality. See sample matrix below
Financing ++ As available and as possible mobilization and unpredictable
++++ Confirmed funding from relevant and specific stakeholders with very flexible approach
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WHAT ACTIVITIES SHOULD BE ADDRESSED REGIONALLY
• Explore support to South-South partnership arrangement in CDC and pharmaceutical markets e.g. MBDS, incentivize private sector to keep prices of commodities down and to promote/offer vector control services and diagnosis before treatment…
• Support of expansion of monitoring: Regular tracking of molecular markers (K13) to support policy decision (Drug policy…), Joint ACT Watch…
• Intervention on migrant workers mobility and expand the coverage and access to malaria prevention & treatment, where possible linkage with K13.
• Iincentivise the private sector and keep prices of commodities down and to promote vector control services and diagnosis before treatment;
• Resource mobilisation for the regions based on a credible financial gap analysis and exploring how to raise resources;
• Advocacy or participation in harmonization of various regional initiative in fight against malaria in collaboration with SEARO & WPRO;
• Possibly, a reserve fund for rescue supplies in case of stock-out;
"Resistance to artemisinin […] has now emerged or spread across Southeast Asia. Radical measures in Southeast Asia will be necessary to prevent resistance to artemisinins and their partner drugs spreading to the Indian sub-continent and then to Africa“ (MORU. Article Submitted for publication 5 April 2014).
Whether or not this quotation is accepted by all, I would to suggest:
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WHAT ISSUES SHOULD A REGIONAL FINANCING TASK FORCE EXAMINE TO ASSIST CAMBODIA NATIONAL PROGRAM
• Funding support to re-estimation of Financial Needs and Identification of Financial Gaps, and in resources mobilization for the pre-elimination phase (2015-2020) of the National Strategic Plan for Elimination of Cambodia 2015-2025;
• Pilot local elimination in selected district to complement with the existing initiative (AFRIMS/BMGF, URC/PMI, MORU)
• Ensure close involvement in the already established joint partnership working group led by CNM, involving members from all development partners including government and non-government sector
• Pilot model of joint programmatic intervention based on VMWs network: Malaria, Dengue, NTD, MCH, HIV…)
• Continue support to Dengue, NTDs and other public health treat such as AF…• Support to Independently assesse all key interventions to ensure effective prioritisation and
maximize cost • Support to intervention on private sector both medical and non-medical.• Support to pharmaceutical management based at Department of Food and Drug (MOH)
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Thanks for your attention!