Annex 3: Summary of Performance Assessment by Objectives as of March 2015 Results Result measurements Performance: achievements Key remaining issues/ challenges Validation of assumptions/ risk Project goal: Preservation of the effectiveness of Artemisinin Combination Therapies by containing and ultimately eliminating artemisinin resistant P. falciparum malaria parasites in the Greater Mekong Subregion Artemisinin resistance does not spread beyond the GMS. Decreased malaria burden in the GMS. Confirmed or suspected resistance (as defined by WHO) has not been detected in therapeutic efficacy studies (TES) conducted outside the GMS. (Source: TES reports) Falling prevalence/ incidence of confirmed falciparum malaria cases in every country in the GMS. (Source: survey and surveillance data) Project on except for Objective 6 and partly Objective 3. Progress in relation to Objectives 2 and 4, as core business of WHO, has been more rapid than progress in relation to other objectives. Project has caught up with the pace and recent dynamics of malaria elimination in the region. Contributed to enhancing awareness of ERAR and maintaining regional momentum for AR and malaria. Strategic products and activities provide a regional foundation to support the GMS countries to transit to malaria elimination. WHO has continued monitoring prevalence/incidence of confirmed Falciparum malaria cases in GMS through survey and surveillance. Suspected resistance outside the GMS are continued monitoring through TES. Need to translate the developed strategies, plans and tools into interventions targeting beneficiaries at regional and national levels. National ownership likely to be critical for successful achievement of the project goal. WHO’s technical coordination and support likely to be critical. This is because of differing stages of malaria containment/elimination, resources available, levels of commitments, and priorities of the affected countries and increased dynamics in regional integration. WHO’s technical and support should be in areas of WHO’s core business. Risks: Reduced funding from national budgets (and traditional donors) given the decline in malaria cases in most GMS affected countries. Wider emergence of artemisinin resistance and multi-drug resistance.
Increased number of industries in relevant sectors (including mining, construction and forestry) offering malaria services to workers. Objective 4: Facilitate the full implementation of the MARC framework Targets for key indicators for the management and coordination objective in the MARC framework reached. Integrated annual operational plans for containment, control and elimination developed for states/regions where artemisinin resistance has been identified ensuring that containment activities are increasingly integrated into the overall malaria control efforts. Key indicators for the management and coordination objective in the MARC framework. Surveillance data are shared and consolidated among partners. Surveys are carried out as planned, and results are analysed and disseminated. MARC task force meeting organized. Annual operational finalized and shared. On track to achieve results. ERAR’s support in management and coordination of the MARC framework as follows: Surveillance and monitoring enhanced and containment of AR increasingly integrated in overall malaria control efforts. Endorsement of the revised NSP. Coordination meetings for AR containment and development of integrated work Revised National Malaria Treatment Guidelines (to be finalised and endorsed in 2015). Developed surveillance protocol, data entry, and analysis. Mapping coverage of interventions, implementation of MDGs MARC program and RAI program. WHO Country Office (WCO) chronically weak and under-staffed in regards to malaria expertise.
Baseline survey for LLIN coverage among migrant mobile population. RBM-APLMA meeting on private sector engagement in malaria. Objective 5: Strengthen the response to artemisinin resistance in Vietnam Containment activities are strengthened and integrated into the overall malaria control efforts through the development of a national artemisinin resistance response plan. The response to national artemisinin resistance response plan improved through the establishment of National Artemisinin Resistance Containment body. Information on malaria burden and progress available from containment areas. National artemisinin resistance response plan finalized and shared. National Artemisinin Resistance Containment committee meetings. Biannually malaria surveillance and programme data includes data by tier from containment Malaria surveillance data showing that the proportion of malaria cases receiving direct observed treatment increases to 95% by 2015. Distribution data showing that 110000 LLINs were distributed to populations in endemic areas in tier 1 and 2. Training reports showing 200 private practitioners/drug sellers trained annually on new guidelines and drug resistance. Reasonably good progress. Nearly 70% of the expected Results achieved. 77.8% planned activities of the 2014 workplan achieved or ongoing. Finalised national plan for the response to AR. Comprehensive workplan with financial and programmatic gap analysis. Established National Artemisinin Resistance Containment committee with task force meetings held. Regular TES and updating of AR maps, developed and revised reporting form, case investigation form and forms for directly observed treatment. 31 malaria posts at strategic places in central and southern No data in the GMS ERAR data set/2013 scorecard to access “Proportion of malaria cases receiving direct observed treatment in tier 1 increases to 95% by 2015” (but proxy indicator included). Unlikely to achieve “200 private practitioners/ drug sellers trained annually on new guidelines and drug resistance” in project timeframe due to slow progress in engagement with private sector and delay in work with the Drug Administration of Vietnam to monitor of pharmaceutical producers as a consequence of late recruitment of the pharmaceutical staff based in China. Significant amount of work needs to be carried out with engagement of non-health sectors within the remaining project time. Risk: Reduced national budget, given a very low malaria cases risking sustainability of the achievements in malaria containment and achievement of malaria elimination.
Proportion of malaria cases receiving direct observed treatment in tier 1 increases to 95% by 2015. 110,000 LLINs distributed to populations in endemic areas in tier 1 and 2. 200 private practitioners/drug sellers trained annually on new guidelines and drug resistance. provinces with diagnosis, treatment. Procurement of 160,000 LLINs. Objective 6: Limit the availability of oral artemisinin-based monotheraphy, substandard and counterfeit antimalarial medicine while improving quality of ACTs Reduced availability of oral monotherapy (oAMT) in the containment areas. Data available on drug quality of artemisinin-based combination therapy (ACT) shared annually. Reduced number of companies producing Surveys in the containment areas showing fall in availability of oral artemisinin-based monotherapy. Meeting report showing available data shared on drug quality. Company survey showing reduced number of companies producing oral Number of countries in GMS started enforcing the ban on oral artesunate monotherapies. Unlikely to achieve within the project timeframe. Developed a 3-year action plan through a Stakeholder meeting on Pharmaceutical Systems Strengthening participated by medicines regulatory authorities, pharmaceutical law enforcement, NMCPs and key partners. Supported Cambodia, China, Lao PDR, and Vietnam to develop country strategies on how to eliminate oAMTs. Details for Only approximately 15% of the 2014 Workplan completed. Only one out of four milestones in 2014 achieved and two are ongoing. Need to address availability of quality anti-malaria drugs through improvements to the broader pharmaceutical system which is beyond a 3-year emergency project Three-year plan not fully funded. Need to look at an alternative so the objective is maintained, for example, Risk: High regional political commitment of the regional authorities not obtained and lack of funding to improve broader pharmaceutical system. Low enforcement of oAMTs bans of each country.