The RAI4 Elimination Grant

The RAI grant supports Cambodia, Lao PDR, Myanmar, Thailand, and Viet Nam. For details on activities supported in each country, see below. 

The RAI4 Elimination (RAI4E) grant began in January 2024 and will end in December 2026 with the following Goal:

To eliminate malaria in all GMS countries by 2030. P falciparum elimination achieved in 2023 for Lao PDR, Cambodia and Viet Nam will be consolidated with the prevention of re-establishment, and P falciparum elimination will be achieved in Thailand by 2025 and Myanmar by 2026.​

The grant aims to do this through:

  • safe treatment of 100% of cases
  • effective personal protection for high-risk populations
  • intensified and accelerated elimination strategies
  • epidemiological surveillance
  • prevention of re-establishment of indigenous transmission
  • a strengthened enabling environment
  • regional collaboration​

Cambodia

Under RAI4E, USD 30.7 million has been allocated to Cambodia to support the following priorities:

Case Management
  • Providing facility-based diagnosis and treatment services.
  • Hospital referral of severe malaria cases.
  • Village malaria workers and migrant malaria workers providing diagnosis and treatment in the community.
  • Training and supervision of health facility staff and community malaria workers.
  • Referral of P. vivax cases from the community to health facilities for G6PD testing and radical cure.
  • Plans to implement 7-day primaquine (PQ) for G6PD-normal using a stepwise approach to scale up, including intensified pharmacovigilance.
  • Continued investment in the community health worker network, including mobile malaria workers (MMWs) bringing services to hard-to-reach areas and populations.
  • Training and quality assurance to strengthen and maintain microscopy for diagnosis.
  • Regularly updating National Treatment Guidelines based on the latest evidence.
Vector Control and Personal Protection
  • Both continuous and mass distributions of insecticide-treated nets (ITNs).
  • Long-lasting insecticidal nets (LLINs), long-lasting insecticidal hammock nets (LLIHNs) and forest packs targeted to households and forest goers in highest-risk strata, as well as to all pregnant women in endemic areas.
  • Top-up LLIN/LLIHNs as part of foci response.
Programme and Grant Management
  • Regular coordination meetings, including partners from across government and partner organisations as appropriate.
  • Creating a new National Strategic Plan 2026-2030 based on Malaria Program Reviews. 
  • Training to build and maintain subnational capacity on financial reporting.
Intensified and accelerated strategies
  • Revision of protocols for case and foci investigation and classification. 
  • Reactive Drug Administration (RDA) after confirming local transmission. RDA is targeted at adult males in hotspot areas to interrupt onward transmission.
  • Community malaria workers conduct Reactive Case Detection and Treatment (RACDT) following confirmation of a positive malaria case (all species and case classifications).
  • Intermittent preventive treatment for forest-going populations (IPTf) prior to their travel to the forest to prevent infection. 
  • Regular active case detection (ACD) in forest areas. 
  • Active fever screening (AFS) in active foci to promptly diagnose and treat infections.
  • Entomological investigation as part of foci response to better understand the factors contributing to transmission.
Routine reporting and surveillance systems
  • Regular surveys to assess the coverage of key interventions and highlight gaps. 
  • Integrated drug efficacy surveillance (iDES) and laboratory testing of molecular markers to carry out drug resistance surveillance.
  • Entomological surveillance, including mapping of vector species’ distribution and insecticide resistance monitoring. 
  • Improvement of surveillance forms to collect the necessary data to enable evaluation of intervention effectiveness.
  • Integration or interoperability between the malaria information system (MIS) and the pharmacovigilance database.
  • Enhancing the data visualisation capacity of the dashboard and encouraging use of the dashboard to inform decision making.
  • In-depth analyses of accelerator initiatives to refine their application.
  • Coordination with other government departments to make malaria a notifiable disease.
Elimination, POR, and sustainability
  • Preparation for elimination certification and prevention of reestablishment (POR) activities.
  • Enhancing the Malaria Information System to include all data required for elimination certification.
  • Integration of village malaria workers into the health system and expanding their tasks to include other vector-borne diseases, maternal and child health, health education and health promotion. 
Community Engagement
  • Social and behaviour change (SBC) communication, using surveillance data to target interventions to at-risk populations. 
Stock Management and Forecasting
  • Strengthening stock reporting and supply chain management, extending stock monitoring to the community level and integrating quantification and forecasting modules into the MIS.

Lao PDR

Under RAI4E, USD 16.2 million has been allocated to Lao PDR to support the following priorities:

Case Management
  • Providing facility-based diagnosis and treatment services.
  • Community malaria workers provide early diagnosis and treatment in high-risk strata villages.
  • Training and supervision for facility staff and community malaria workers.
  • Public-private mix partners provide case management in burden-reduction districts and refer patients to public facilities in elimination districts.
  • Referral from the community to health centres for any severe cases and all P. vivax cases.
  • G6PD testing carried out in health facilities and hospitals, with 7-day and 8-week PQ radical cure treatment as appropriate. 
  • Quality assurance for malaria microscopy.
  • Migrant Malaria Workers (MMWs) and Kato Malaria Workers (KMWs) recruited and trained to conduct case management.
Vector Control
  • Mass distributions of ITNs carried out in high-risk strata.
  • Continuous distribution to top-up losses from mass distributions, and targeted specifically to pregnant women, uniformed personnel and mobile, migrant and ethnic vulnerable populations (MMEVPs) (LLIHNs for forest-goers). 
  • Indoor residual spraying (IRS) as part of outbreak and foci response. 
Programme and Grant Management
  • Annual training for central staff on forecasting, procurement and supply chain management.
  • Annual meetings with key partners to share lessons learned and discuss challenges.
  • Field monitoring and verification visits to improve financial management at the subnational level.
Intensified and Accelerated Strategies
  • Case investigation focus investigation and response (CIFIR) carried out in all elimination districts.  Case investigation and classification will be expanded to burden reduction districts.
  • IPT for mobile and migrant forest and farm goers, provided by MMWs and KMWs.
  • RACD and TDA carried out during outbreaks, alongside top-up LLIN distribution and IRS. 
  • Accelerator strategies for P. vivax, including four rounds of TDA annually in target villages. For P. falciparum, two TDA rounds annually in target villages. IPTf and AFS are carried out monthly for both species. 
  • District Anti-Malaria Stations (DAM) carry out monthly supervision visits in accelerated-strategy villages.
Routine reporting and surveillance systems
  • Conducting iDES to monitor drug resistance trends.
  • Entomological surveillance carried out in malaria hotspots and outbreak areas.
  • Training on surveillance using District Health Information Software (DHIS2) provided to all districts and provinces. Health centre staff are trained on DHIS2 data entry and reporting.
  • VMWs, MMWs, and KMWs are trained to carry out community-led monitoring and surveillance.
  • Bed net surveys are conducted in selected districts after mass distributions.
  • Mapping of high-risk and hard-to-reach populations carried out as part of outbreak and foci responses.
  • Epidemic alert systems and Emergency Operations Centres (EOC) are supported to detect and swiftly respond to outbreaks.
Elimination, POR, and sustainability
  • Village malaria workers in lower-risk strata are integrated in the broader health system with an expanded set of responsibilities, including pneumonia, diarrhoea and nutrition.
  • Transition planning and advocacy for domestic funding for malaria through ongoing discussions and meetings with the Ministry of Health and Ministry of Finance. 
  • Training of national level staff on elimination certification requirements.
Community Engagement
  • SBC communication for at-risk populations.
Stock Management and Forecasting
  • National and subnational trainings to strengthen logistics management and prevent stock outs.

Myanmar

Under RAI4E, USD 48.2 million has been allocated to Myanmar to support the following priorities:

Case Management
  • Providing facility-based diagnosis and treatment services.
  • Integrated Community Malaria Volunteers (ICMVs) provide community-based case management. Ethnic health organisations provide diagnosis and treatment services in remote areas, as well as at border crossings and along migrant routes.
  • ICMVs refer severe cases to health facilities.
  • Training and supervision of health facility staff and ICMVs.
  • Providing radical cure treatment, including adherence support through directly observed treatment and shifting from the 14-day to the 7-day PQ regimen. 
  • Quality assurance and control for diagnosis by microscopy in township hospitals in endemic areas.
  • Strengthening private sector case management through incentives. Map and engage with providers, provide supervision, conduct routine monitoring, and supply RDTs and antimalarials. 
Vector Control
  • Mass campaigns to distribute ITNs universally to high-risk populations, reactive campaigns in response to outbreaks or disasters and to protect people in new settlements.
  • Continuous ITN distribution to address attrition between mass campaigns, to mobile forest workers in the informal sector, and to pregnant women through antenatal care.
  • Selective IRS deployment in high-risk areas with suboptimal ITN coverage and reactively in the case of outbreaks or transmission foci.
Programme and Grant Management
  • External malaria programme review.
  • Attending WHO technical meetings.
  • Biannual progress review, including revision of strategies, guidelines and standard operating procedures as necessary.
  • National target setting and forecasting workshops. 
  • Six-monthly planning and evaluation meetings.
  • Six-monthly meetings with the PR, NMCP and all SRs.
  • Technical assistance to strengthen NMCP capacity on surveillance for malaria elimination.
Intensified and accelerated strategies
  • Conducting case investigation, foci investigation and response (CIFIR) and case investigation and reactive case detection (CIRCD) on a 1-7 timeline.
  • ICMVs implement TDA, IPTf and AFS in high-risk villages, including in remote and inaccessible areas. 
  • International and non-governmental organisations and township health teams support intensified case detection in IDP camps, prisons, and migrant work sites in endemic areas.
  • Conducting a household census to plan intensified and accelerated activities.
  • Community engagement activities to increase awareness and understanding of intensified and accelerated activities.
Routine Reporting and Surveillance systems
  • Expanding and strengthening the electronic surveillance system through linkage of web-based reporting and technical assistance for geo-enabling.
  • Developing an outbreak field implementation manual and conduct training on outbreak preparedness, detection and response.
  • Monitoring drug resistance.
  • Responsive entomological assessments led by epidemiology. 
  • Workshops on surveillance, database management and microstratification.
  • Monthly epidemiological situation analyses to inform implementation.
  • Technical assistance to develop a pharmacovigilance system.
Elimination, POR, and Sustainability
  • Developing a strategy and guidelines for POR in townships where local transmission has been interrupted.
  • Maintaining malaria services in malaria-free areas through integrated approaches.
  • Advocacy and coordination with other ministries and external funding partners to sustain financing until elimination has been achieved.
Community Engagement
  • Strengthening SBC to better reach migrant populations and people in worksites and temporary shelters.
Stock Management and Forecasting
  • Reducing the risk of malaria stockouts by increasing buffer stocks and working with the private sector through corporate social responsibility (CSR) modalities.
  • Conducting drug outlet surveys and sample testing to detect sub-standard and falsified antimalarials.

Thailand

Under RAI4E, USD 15.2 million has been allocated to Thailand to support the following priorities:

Case Management
  • Providing diagnosis and treatment services in malaria clinics and public hospitals.
  • Conducting G6PD screening at facility-level to support radical cure treatment.
  • Pilot of tafenoquine radical cure at selected district hospitals.
  • Village health volunteers (VHVs) and Malaria Post Workers (MPWs) provide diagnosis and treatment in the community.
  • Referral of severe cases in the community to local hospitals.
  • Mobile teams provide malaria screening and health education at border crossings.
  • Training, quality control and quality assurance mechanisms for microscopy, PCR and other forms of malaria diagnosis. 
Vector Control
  • IRS in the highest-risk villages and worksites.
  • Focal spray in new foci, persistent foci and P. falciparum foci, and as part of reactive case detection.
Programme and Grant Management
  • Capacity strengthening training for the national disease control programme.
  • Development of guidelines and manuals.
  • Conducting field monitoring visits.
  • Meetings with multisectoral partners.
  • Conducting an end-line survey and malaria programme review.
Intensified and Accelerated Strategies
  • MDA in high-risk provinces.
  • PACD in at-risk populations, both in the community and at health facilities. 
  • RACD is conducted when an index case of P. falciparum is reported.
Routine Reporting and Surveillance Systems
  • Strengthening real-time reporting by updating the MIS and improving information linkages. 
  • Improving the data visualisation interface with MIS to support data-driven decision making.
  • Conduct area classification exercises to improve and verify area stratification.  
  • Conducting iDES to carry out drug resistance surveillance. 
  • Entomological surveillance, including vector surveys and insecticide resistance testing.
  • Distribution of LLINs, LLIHNs and forest packs to at-risk populations.
  • Enhancing the use of mobile applications for data collection and foci mapping.
  • Developing and strengthening the national reference laboratory.
  • Improving 1-3-7 implementation, including in terms of data quality.
Elimination, POR, and Sustainability
  • Integration of malaria services in to the broader health system.
  • Improving capacity for malaria management and response at the sub-national and sub-district levels. 
  • Organising workshops on POR for malaria-free provinces.
Community Engagement
  • SBC communication, using epidemiological data to target efforts at the highest risk groups.
  • Implementing school-based malaria activities, in collaboration with CSOs and community groups.
Stock Management and Forecasting
  • Improving the inventory and stock system, including online procurement and supply management (PSM) and commodity hubs.

Vietnam

Under RAI4E, USD 14 million has been allocated to Viet Nam to support the following priorities:

Case Management
  • Providing facility-based diagnosis and treatment services.
  • Training to maintain microscopy diagnostic capacity.
  • Community case management through commune health staff, including malaria post workers.
  • Community referral of severe cases and P. vivax cases for initiation of radical cure.
  • Training and supervision of health facility staff and commune health staff.
  • Follow-up and provision of adherence support for confirmed cases.
  • Updating diagnosis and treatment guidelines.
Vector Control
  • Continuous distribution of family LLINs in active foci and single LLINs to uniformed personnel.
  • Mass distribution of LLINs in high-burden communes.
  • Assessment of the effectiveness of forest packs for mobile and migrant workers. 
Programme and Grant Management
  • Annual programme reviews and planning workshops at national and provincial levels. 
  • Soliciting annual external audits.
  • Conducting supervision visits from provincial to district levels and from district to commune levels on malaria operations and program management.
  • Training on program management at the provincial level.
Intensified and Accelerated Strategies
  • Chloroquine MDA in target areas in Lai Chau Province.
  • Pyramax TDA in target areas in the central region, targeted at forest goers.
  • Case investigation, focus investigation and response, including in villages, forest work sites, and in residual foci.
  • Focal screening and treatment (FSAT) in villages and forest work sites.
  • ACD for P vivax transmission in remote and isolated ethnic minority areas thought to be very low burden or malaria free.
  • Community health workers trained to provide TDA, MDA and forest packs. 
  • Entomological investigation as part of foci response to better understand the factors contributing to transmission.
Routine Reporting and Surveillance Systems
  • Training, supervision and capacity building on use of the electronic Communicable Diseases System (eCDS), particularly in low-performing communes.
  • Training on data collection to validate malaria elimination at the sub-national level.
  • Entomological surveillance, including annual mapping of vector distribution.
  • Conducting iDES to monitor drug resistance trends.
Elimination, POR, and Sustainability
  • Preparing for elimination certification and POR activities.
  • Advocacy meetings and transition planning to maintain and increase domestic malaria elimination funding commitments.
  • Integration of malaria services within existing health service delivery pathways. 
Community Engagement
  • SBC communication.
  • Community systems strengthening led and implemented by civil society organisations. For example, Malaria Community Observers (MCO), such as village heads and teachers, receive small incentives to refer suspected cases to VMWs.

Regional

Under RAI4E, USD 21.9 million has been allocated to the regional component to support the following priorities:

Package 1: Elimination-Focused Service Delivery

Objective: Ensure equitable access to quality malaria services across the GMS for elimination and prevention of re-establishment.

Package 1.1

Ensure equitable access to quality case management among hard-to-reach and mobile migrant populations in border areas, including through:

  • accelerated elimination activities
  • integrated community health workers
  • community case management (RDTs, ACT)
  • data driven-targeting of vector control (LLINs)
  • support for P. vivax radical cure

Services financed by this sub-package are provided directly by CSOs or CSO-managed VMW networks, in border areas that are challenging to reach for NMCPs. This confers the necessary agility to provide services to mobile populations and to respond to sudden outbreaks or population movements.

Package 1.2

  • Ensure program quality, surveillance, community engagement, filling gaps and troubleshooting, and capacity strengthening through roving and embedded technical support.
  • Technical assistance provided through this sub-package will be critical to translating normative guidance into protocols tailored to the local context, as well as helping to design the necessary systems, tools and trainings.
  • The aim is to strengthen the capacity of national programs to employ appropriate interventions and mount targeted responses to shifts in epidemiology, informed by data review and assessments of intervention effectiveness.
  • The sub-package also supports the CSO Platform, a mechanism to coordinate among CSOs, strengthen CSO capacity and service provision, and ensure the voices of malaria-affected communities are represented in national and regional forums. 
  • The CSO Platform also translates technical guidance into community-level language and ensures the approach is tailored to community needs. Further, the CSO Platform supports assessments to identify gender, sociocultural and rights-based barriers to accessing services. 
  • The CSO Platform contributes to sustainability efforts by supporting the integration of VMWs in the broader health system.
  • In RAI4E, the CSO Platform will explore community-led monitoring can complement existing monitoring and evaluation of malaria interventions.
Package 2: Better Data for Decision-Making

Objective: Effective and timely data collection and analysis to inform evidence-based decisions

Package 2.1

Malaria and drug resistance surveillance through:

  • Malaria Elimination Database maintenance and expansion to include tracking of additional data points relevant to P. falciparum and P. vivax elimination
  • Facilitating data sharing between countries to better address transmission in border areas
  • Publishing monthly epidemiology summaries
  • Optimising regional and country-level surveillance by strengthening malaria information and surveillance systems
  • Drug efficacy and resistance monitoring (TES or iDES as appropriate)
  • Genomic surveillance, including the use of molecular markers, to identify imported cases, track resistant strains, determine the cause of outbreaks and map transmission networks.
  • Regional thematic conference on TES, iDES and malaria surveillance to strengthen capacity and share best practices

Package 2.2

Achieving elimination certification and preventing re-establishment through:

  • Guidance and training
  • Practical implementation and technical support to NMPs
  • Developing country-specific elimination certification protocols based on WHO requirements
  • Strengthening national and subnational surveillance systems
  • Regional thematic conference on elimination, certification, and prevention of re-establishment attended by NMPs, CSOs and technical partners
Package 3: Governance, Strategic Monitoring and Management

Objective: Share lessons learned for rapid regional iteration and response

Package 3.1

  • Support to the Regional Steering Committee (RSC) and RSC Secretariat, to continue to serve as an important forum for information sharing, collaboration and coordination.
  • Advocacy and communications to share experiences and lessons learned, aligned with other influential partners in the region.

Package 3.2

  • Strategic monitoring and evaluation in RAI4E will be led by the Independent Monitoring Panel (IMP), which provides independent assessment of grant progress and deployed interventions, with the aim to identify critical issues or bottlenecks and propose remedial actions.
  • The IMP analyses data from various sources, tracks emerging research, and conducts country visits and in-field reviews.

Package 3.3

Grant management, including essential oversight, ongoing capacity strengthening efforts, budget monitoring, compliance and reporting, in order to:

  • Ensure continual compliance with Global Fund rules and regulations.
  • Assess and monitor risks and prevent and respond to threats against effective RAI4E implementation.
  • Ensure high-quality implementation, monitoring, evaluation and management of grant investments.