Who is doing what where under the RAI3E grant?

  • National Government
  • Civil Society Organization
  • International Organization

Cambodia

Under RAI3E, USD 36.2 million has been allocated to Cambodia to support the following priorities:

Case Management
  • Community malaria workers receive training and support to conduct passive case management services and Information Education Communication (IEC)/Behaviour Change Communication (BCC) interventions in their home communities.  
  • As malaria cases decrease, Village Malaria Workers (VMW) are being integrated into broader community health platforms and are providing a larger range of health protection & promotion services. The decommissioning of VMW/Mobile Malaria Workers (MMW) into the network of village health strategic groups (VHSGs) is beginning where malaria incidence is lowest (strata one and two).  
  • Private sector practices are monitored to ensure correct referral of suspected malaria cases to public facilities.  
  • Radical cure treatment, with quantitative G6PD testing, adherence support and pharmacovigilance, is used to move towards elimination of P vivax malaria. 
  • Therapeutic efficacy surveillance is planned for all P falciparum cases, but there is currently only sufficient capacity for 50% of Pf cases.  
Vector Control and Personal Protection
  • Mass distribution of Long-lasting Insecticidal Nets (LLIN) is targeted to the highest risk areas (villages in risk strata three, four and five).  
  • Routine LLIN distribution is conducted to account for attrition and to target high-risk populations.  
  • Long-lasting Insecticidal Hammock Nets (LLIHN) have been introduced to address forest transmission in strata four and five. 
  • Forest-goers are also provided with forest packs, containing LLIHNs, topical repellents and health education materials.  
  • Entomological investigation is carried out in outbreak areas and in persistent transmission foci.  
Health Management Information Systems
  • The electronic data system (MIS) is a powerful real-time reporting tool to guide risk stratification and the deployment and scale-up of elimination interventions. 
  • The use of smartphones and tablets at the community level enables real-time geo-tagged sharing of epidemiological data and stock status.  
  • To help prevent stock-outs, automated forecasting of key commodities will be built into MIS. This update will be complemented by improved capacity for procurement and storage, and optimization of distribution to remote areas within the broader supply chain (not creating a parallel supply management system for malaria).  
High-Burden Areas
  • Community malaria workers conduct frequent visits to forest areas to conduct active case detection, treat and track positive cases, and provide health education. 
  • In persistent foci, mass and focal drug administration (three days Artemisinin Combination Therapy [ACT]) is implemented to interrupt transmission in high-risk groups.  
  • In high-burden border areas, malaria posts are deployed to reach mobile populations.  
Elimination Approaches
  • The aim is for all confirmed cases to be notified, investigated and classified within 24 hours, responded to within three days and new active foci to be investigated and classified within seven days.  
  • Focus investigation will be conducted for all P falciparum cases. Foci are classified based on receptivity and vulnerability.  
  • Foci management, based on foci classification, includes aggressive approaches to strategically move towards elimination, including synergistic combinations of targeted drug administration, door-to-door fever screening, intermittent preventive treatment, vector control and community mobilization. 
  • Case-based surveillance, diagnostic services and community sensitisation will be maintained after elimination to detect reintroduction and prevent re-establishment. 
Governance and Coordination
  • Outbreak preparedness is achieved through close coordination among partners, guidelines, Standard Operating Procedures (SOPs), training and keeping buffers of key commodities. 
  • Monthly review meetings are held with partners and donors to review program progress and improve collaboration. 
  • Despite a complex partnership landscape, coordination between partners is generally good, with clear mapping of implementation arrangements. Even stronger coordination will however be required for successful malaria elimination.

Lao PDR

Under RAI3E, USD 14.3 million has been allocated to Lao PDR to support the following priorities:

Case Management
  • Health workers at all levels (public, private, community and military) are trained and supported to provide diagnostic and treatment services, as well as conduct community engagement and education activities.  
  • Village-based forest-going populations are targeted for more regular testing and health education interventions. The enhanced response strategy also includes forest packs, tailored Information Education Communication (IEC) materials and mobile outreach visits.  
  • Radical treatment for P vivax is a high priority in the current strategic plan. Village Malaria Workers (VMW) assist referral to G6PD testing to enable access to radical cure. Radical cure is supported by pharmacovigilance systems and patient compliance monitoring.  
  • Active case detection will be undertaken as a core activity during outbreak response. 
  • Private sector providers are trained on diagnosis, treatment and elimination activities, and monitored for the use of counterfeit Artemisinin Combination Therapy (ACT) or artemisinin monotherapy. 
  • Lao PDR will focus on expediting the approval process for many different ACT regimens, as well as strengthening pharmacovigilance systems and conducting quality control, to ensure availability of quality and efficacious treatment. 
Vector Control
  • Mass distribution of Long-lasting Insecticidal Nets (LLIN) for all at-risk populations in strata three and four villages will be conducted in 2022, in combination with health education communication and LLIN coverage assessments. 
  • A central emergency stockpile of LLINs is maintained for active foci and outbreak response.  
  • Annual continuous distribution of LLINs/Long-lasting Insecticidal Hammock Nets (LLIHNs) is carried out to ensure universal coverage of high-risk populations.  
  • Indoor Residual Spraying (IRS) is only carried out in outbreak settings, or in active foci in elimination areas (if LLINs are unavailable). 
  • Entomological monitoring is conducted on a routine basis as well as part of foci and outbreak investigations. 
Surveillance
  • Malaria surveillance is integrated into the national health information system DHIS2 (District Health Information System 2).  
  • In addition to routine malaria data, the malaria module within DHIS2 has been expanded to include PPM, active case detection and elimination data, as well as information on integrated Drug Efficacy Surveillance (iDES) and the deployment of vector control tools. 
  • Integration of entomological surveillance data, Therapeutic Efficacy Studies (TES) results and drug resistance molecular markers is planned. 
  • The granularity of the surveillance system will be improved so that hotspot villages can be more rapidly identified. 
  • The use of new technologies, including mobile data collection and SMS reporting, enables real-time reporting, accurate micro-stratification, optimized intervention implementation, and rapid outbreak response. 
Elimination Approaches
  • The Public Health Emergency Operations Center (PHEOC) is being strengthened to transform malaria surveillance into a core intervention and improve accountability for progress on malaria elimination. The PHEOC’s incident management system is being improved to allow for rapid foci and outbreak response.  
  • Regular stratification and finer-scale mapping enables improved intervention planning and implementation. 
  • The 1-3-7 strategy will be revised to shift community case investigation and classification from district and provincial levels to the point of care, making the approach more pragmatic, dynamic and financially efficient. 
  • Aggressive strategies used to accelerate P falciparum elimination include Targeted Drug Administration (TDA), Intermittent Preventive Treatment for forest-goers (IPTf) and active house-to-house fever screening. 
Health and Procurement System Strengthening
  • The National Malaria Control Programme (NMCP) is working to include malaria surveillance and response in the Ministry of Health strategy to integrate disparate structures in the health system, including human resources, finances, service delivery, information systems and supply chains.  
  • Specifically, the village malaria worker responsibilities will be integrated into broader multi-tasked village health worker roles, working under the auspices of a national primary health care system.  
  • Stock levels are regularly monitored at health facility, district and provincial levels, and recorded in DHIS2, to improve the efficiency of the supply chain and avoid stock-outs. 
Governance and Coordination
  • The Department of Communicable Disease Control (DCDC), Civil Society Organizations (CSOs) and the Center for Malaria Parasitology and Entomology of Lao PDR (CMPE) plan to share training, supplies and funding to better integrate and coordinate approaches. 
  • CMPE advocates to Ministry of Health and government to improve political commitment and resource mobilization. 
  • The malaria programme is reviewed regularly, including through supervision visits, stakeholder interviews and meetings.   
  • Provincial coordination will be strengthened in burden reduction areas. Central coordination is relatively strong, with clear delineation of roles and responsibilities.  
  • Monthly coordination meetings are held with CMPE, Principal Recipients (PRs) and Sub-recipients (SRs) to track progress and discuss solutions to bottlenecks. 

Myanmar

Under RAI3E, USD 99 million has been allocated to Myanmar to support the following priorities:

Case Management
  • The majority of cases are tested and treated in the community by Integrated Community Malaria Workers (ICMVs).  
  • ICMVs receive training and supervision to deal with a multitude of infectious diseases, minor injuries and ailments, integrating them into broader community health platforms as part of universal health coverage (UHC) reforms. 
  • Active case detection and treatment is conducted in burden reduction areas.  
  • Reactive (RACD) and proactive (PACD) case detection are also conducted as mobile outreach services, engaging with forest-goers to test co-travelers and family members.  
  • An advocacy fact sheet on malaria elimination will be developed. Information Education Communication (IEC)/Behaviour Change Communication (BCC) materials will be produced in local languages and be made accessible for those with sensory impairments and disabilities. 
  • Two reviews of whether the program is removing human rights and gender-related barriers to case management are funded, the first in 2021 to recommend necessary actions and the second in 2023 to measure progress.  
Vector Control
  • Mass distribution of Long-lasting Insecticidal Nets (LLINs) to the entire population living in strata 3 townships will be conducted in 2022. Mass campaigns of LLINs will also be conducted as part of foci and outbreak responses. 
  • LLINs are continuously distributed to key populations such as pregnant women and forest goers.  
  • Long-lasting Insecticidal Hammock Nets (LLIHNs) are being trialed with forest-goers as a pilot approach. 
  • Indoor Residual Spraying (IRS) is used in outbreak response, and in active foci in elimination settings.  
  • Routine entomological monitoring is replaced with epidemiology-led entomological surveillance to investigate outbreaks and persistent transmission foci and develop appropriate solutions. 
Surveillance
  • Myanmar is moving to a case-based web-based surveillance system that is integrated with other disease reporting within DHIS2 (District Health Information System 2).  
  • The new web-based reporting tool will also require data to be disaggregated by gender, with the aim that all partners reporting gender-disaggregated data will enable a better understanding of gender-related barriers.  
  • ICMVs are provided with mobile phones and/or tablets to enable near real-time case-based reporting.  
  • Migrant mapping exercises are conducted to better understand the location, mobility and needs of migrant populations. 
Health Product Management
  • The issue of stock-outs at both public and private health facilities and the community level needs to be addressed through improved forecasting, procurement, supply chain management, training and supervision. 
  • The electronic health product management system ‘mSupply’ is being expanded to the township level, which requires technical support and staff training. 
  • Storage warehouses will be renovated to improve storage and distribution capacity.  
  • Commodity distribution arrangements for different disease programs will be integrated to increase the efficiency of supply chains.  
Elimination Approaches
  • In low-transmission townships, rapid and complete case and focus investigations are critical to interrupt transmission. 
  • Myanmar pursues a 1-7 elimination strategy due to the remote geography of many elimination areas, whereby case notification, investigation and classification are done at the point of care within one day, and focus investigation, classification and response are merged into a single package of interventions to be conducted within seven days.  
  • Forest goer packs, including a LLIN/LLIHN, IEC/BCC materials and standby treatment, are provided to those working and/or sleeping in forests. 
Governance and Coordination
  • Implementing partners attend regular review and planning meetings to assess the impact of ongoing programs and plan for the next implementation period in an integrated way. 
  • Civil Society Organizations (CSOs) collaborate with and build the capacity of Ethnic Health Organizations (EHOs) and Ethnic Community-Based Organizations (ECBOs) to deliver quality prevention and control services to vulnerable ethnic minority populations. 

Thailand

Under RAI3E, USD 21 million has been allocated to Thailand to support the following priorities:

Case Management
  • Malaria services, including testing, treating and referral, are delivered in the community through village-based Malaria Posts (MPs), MP workers (MPWs) and Village Health Volunteers (VHVs).  
  • Service delivery is increasingly shifted from the vertical malaria program towards integrated people-centered health services and more decentralized management of malaria control and elimination efforts.  
  • MPWs perform proactive case detection to increase service coverage for migrants, refugees and forest-goers. 
  • Case management is also performed at public and private hospitals, where staff are trained on the national treatment guidelines, hospital-based surveillance, case notification and the 1-3-7 approach. 
  • To support appropriate targeting of interventions, mapping of risk groups, forest worksites and forest-based settlements will be carried out by health staff, MPWs and Civil Society Organizations (CSOs) using a purpose-designed mobile application. 
  • MPW/VHVs use tailored social and behavioural change communication (SBCC) in community engagement on risk awareness, health seeking behaviour, personal protection, early diagnosis and treatment adherence. 
  • Radical cure treatment is supervised in the community to maximise adherence and samples taken at follow-up are examined to monitor treatment efficacy as part of routine integrated Drug Efficacy Surveillance (iDES).  
Vector Control
  • Long-lasting Insecticidal Nets (LLINs) are continuously distributed in focal areas, together with strategic SBCC to promote the use of LLINs.  
  • LLIHNs are procured and distributed to those exposed to outdoor transmission.  
  • Indoor Residual Spraying (IRS) is conducted in villages and worksites in at-risk areas. Focal spray is conducted as part of Reactive Case Detection (RACD).  
  • To increase vector control coverage, the program will seek stronger collaboration with the formal sector (military, forest rangers, border guards, wildlife protection) and use volunteers from informal groups (hunters, foragers, rubber tappers).  
  • Routine entomological monitoring in sentinel sites is replaced with epidemiology-led entomological surveillance for investigation of outbreaks and persistent active foci and development of locally appropriate mitigation measures. 
Surveillance
  • Near real-time case-based reporting and monitoring will be improved at the focus and household level through the adoption of a mobile application for surveillance, which will be integrated into the ‘malaria online’ system. 
  • Cases identified at district and sub-district level hospitals and health facilities are captured through the national disease surveillance system, which is linked to ‘malaria online’. 
  • Strengthened malaria case-based surveillance enables annual microstratification based on foci classification. 
  • Outbreak alert thresholds are updated with declining incidence for timely notification to local authorities and communities. 
Health System Strengthening
  • RAI3E strengthens the national reference laboratory and funds capacity building on microscopy and G6PD diagnostics. 
  • Stock-outs of malaria commodities at public, private and community facilities are planned to be addressed through improved forecasting, procurement, supply chain management, training and supervision.  
  • To improve health product management, an electronic logistics management system (eLMIS) is being developed.  
Elimination Approaches
  • The 1-3-7 approach, involving case notification by day one, case investigation by day three and focus response by day seven, is used to accelerate progress towards malaria elimination. 
  • Reactive case detection (RACD) is conducted in response to case notification for additional case finding.  
  • In hard-to-reach areas or among high-risk populations, RACD is implemented flexibly to maximise coverage, such as through engaging with co-travelers or conducting activity in the evening or at night to capture specific risk groups. 
  • Foci investigation in P falciparum foci is complemented by mass screening and testing (MSAT) through malaria mobile clinics. 
Governance and Coordination
  • Advocacy and capacity building aim to promote sub-national management and investment in malaria elimination and to strengthen local capacity to reach elimination and prevent re-establishment.  
  • Regular coordination meetings are held between government representatives and Civil Society Organizations (CSOs) to align objectives, develop annual work plans and coordinate activities to ensure optimal coverage of interventions. 
  • Guidelines for outbreak and epidemic preparedness, detection and response are revised to reflect increased decentralization and integration of authorities and responsibilities.  
  • In border areas, cross-border coordination and data sharing is strengthened through the twin city/village approach.  

Vietnam

Under RAI3E, USD 29.7 million has been allocated to Vietnam to support the following priorities:

Case Management
  • RAI3E supports facility-based diagnostic and treatment services through the provision of commodities, training and supervision.  
  • Integrated community case management is conducted by commune health staff and through malaria posts to reach mobile, migrant and hard-to-reach populations. Approaches are tailored according to the specific risk group. 
  • Health workers also engage communities on malaria prevention and control through Information Education Communication (IEC)/Behaviour Change Communication (BCC) sessions. 
  • Village Health Workers (VHWs) receive training on how to conduct screening, support treatment adherence and provide health education. 
  • Radical cure of P vivax will be supported by following up each patient to ensure treatment compliance. 
  • The programme actively engages with private sector providers in endemic provinces to conduct surveys on service delivery, provide training on updated diagnosis and treatment guidelines, and monitor the use of substandard, counterfeit or monotherapy medicines.  
Vector Control
  • Mass distribution of Long-lasting Insecticidal Nets (LLINs) is conducted every three years to cover all at-risk populations in zones four and five, and in communes in zone three with active foci.  
  • Continuous LLIN/Long-lasting Insecticidal Hammock Nets (LLIHN) distribution is provided to special high-risk populations and to account for attrition between mass distributions.  
  • Forest-going populations are offered single LLIN/LLIHNs bundled with repellents.  
  • In the event of an outbreak or confirmed transmission foci in elimination areas, top-up LLINs are provided. 
  • The programme will implement a shift from routine entomological monitoring in sentinel sites to epidemiology-led entomological surveillance. Entomological assessment will be carried out in outbreaks and persistent foci. 
Surveillance
  • Case-based surveillance has been rolled-out, in line with World Health Organization (WHO) guidelines on malaria elimination. 
  • RAI3E continues to invest in MMS (Malaria Management System), integrated with the existing electronic Communicable Disease System (eCDS), to better collect and visualize case notification, case investigation and focus investigation data, and thus target elimination activities. 
  • Private sector data is integrated with the national malaria surveillance system.  
Burden Reduction
  • In communes with the highest risk, Special Investigation Teams conduct frequent visits to forest sites to perform active case detection, test, treat and track positive cases, provide preventative tools, and raise awareness. 
  • A NIMPE/IMPE ([National] Institute of Malariology, Parasitology and Entomology) task force oversees field operations in high-risk communes during peak transmission periods. 
  • Focal Screening and Treatment (FSAT) will be provided in high endemic areas in the peak season. 
  • Outbreak preparedness is maintained through training and the provision of buffer stocks of key commodities.  
  • Guidelines and Standard Operating Procedures (SOPs) for outbreak preparedness, detection and response will be revised.  
Elimination Approaches
  • Case investigation and classification is conducted at the point of care across the country, while focus investigation is restricted to malaria elimination ‘end game’ settings and is led by district level staff. 
  • 100% of foci are investigated and classified. Response is done within seven days of detection and includes active case detection, treatment and follow-up. 
  • Case-based surveillance and diagnostic capacities, as well as community sensitization and engagement, will be maintained in areas that have eliminated malaria to detect reintroduction and prevent re-establishment. 
Governance and Coordination
  • Supportive supervision visits are conducted routinely at all levels.  
  • Coordination between CSOs, and between CSOs and NIMPE, will be strengthened under RAI3E through regular coordination meetings at all levels and regular information sharing.  
  • Annual program review and planning workshops are held at provincial and district levels. 
  • Technical Working Groups review guidelines and update training materials, training curriculums and operational manuals. 
  • Financial management training is provided to build capacity at the central, provincial and district levels, in order to improve accountability, efficiency and appropriate resource allocation and utilization. 

Regional

Under RAI3E, USD 28.4 million has been allocated to the regional component to support the following priorities:

Package 1: Access to quality case management and prevention for hard to reach populations
  • Through sub-package 1.1, partners coordinate to provide a tailored package of prevention, testing and treatment services to hard-to-reach migrant and mobile populations in remote forested border areas. 
  • Case management is delivered by community health workers in high-risk border villages, as well as along common travel routes. Health workers also deliver health education and behaviour change interventions.  
  • Long-lasting Insecticidal Nets (LLINs) are distributed continuously at malaria posts. 
  • Mass screening and treatment is targeted to areas of high malaria burden amongst settled populations lacking routine access to malaria services.  
  • Community points of care collect data that is standardized and shared at the regional level. Geo-coded knowledge of where points of care are located is used to better understand incidence and other case management indicators. 
  • Sub-package 1.2 aims to strengthen cross-border collaboration through increased involvement and leadership of local authorities and local Civil Society Organizations (CSOs) to develop joint operational approaches and strategies.  
  • Technical assistance is provided at the sub-national level to develop long-term decentralized capacity to manage surveillance, harmonise approaches and share expertise and strategic information with cross-border counterparts.  
Package 2: Operational Research
  • RAI3E funds a limited number of innovative and focused operational research studies. 
  • The RAI3E Operational Research (OR) projects focus exclusively on 1) adjusting the grant during its lifetime, 2) preparing for the post-2023 period, 3) prioritising OR with strong regional implications, and 4) ensuring strong country buy-in and creation of regional OR leadership.  
  • Key research themes are the integration of malaria programs into health systems, P vivax radical cure, optimal tools for vector control, and effectiveness of reactive surveillance and response strategies. 
  • OR will be embedded in program design and supported by an appetite to bring proven interventions to scale. 
Package 3: Permanent availability of quality health commodities across the GMS
  • Therapeutic Efficacy Studies (TES) inform the development of malaria treatment policies (funded under sub-package 3.1).  
  • Studies examining the prevalence of molecular markers associated with resistance to specific drugs are also funded. 
  • Efficient registration processes enable the rapid adoption and procurement of new effective commodities. At the regional level, existing networks of regulators are leveraged to advocate for synergies in countries’ regulatory approval processes. 
Package 4: Strengthening regional surveillance
  • World Health Organization (WHO) maintains the Mekong Malaria Elimination Database (MEDB) as the core data repository for the GMS.  
  • Planned improvements include a shift to weekly data sharing, integration of more granular data and other data sets.  
  • The MEDB will also become more interactive and access will be available to a larger set of key partners.  
  • The aims of the package are to unify methods for data collection, cleaning, collation, integration and analysis across the region to better facilitate data sharing and inform planning and response. 
Package 5: Enhancing partnership with community and non-health sectors
  • Sub-package 5.1 supports a regional Civil Society Organization (CSO) platform to address access to services in the community. The Platform acts as a convener for CSOs to enhance coordination and collaboration with National Malaria Control Programme (NMCPs) and other implementing partners.  
  • Sub-package 5.2 expands innovative engagement with the non-health corporate sector to support malaria elimination. 
  • Examples of corporate engagement in malaria elimination include development of a mobile platform to enable real-time case and stock management, negotiation of improved rates for Village Malaria Workers (VMWs) to use digital wallets and utilising the fast-moving consumer goods supply chain for elimination commodities.  
Package 6: Governance, management and monitoring
  • The Regional Steering Committee (RSC) is a multi-stakeholder governance body that provides oversight and guides implementation of the RAI3E. It is supported by the RSC Secretariat. The RSC and its Secretariat are funded under sub-package 6.1. 
  • UNOPS, the Principal Recipient of RAI3E, funded under sub-package 6.2, works with national programmes to effectively manage RAI3E resources. 
  • The Independent Monitoring Panel provides independent expertise to assess RAI3E implementation and make recommendations for remedial actions.