Regional Artemisinin Initiative (RAI)
In 2009-2010, Myanmar reported suspected artemisinin resistance that was likely to flow from the Thai-Cambodia multi-drug resistant foci. The country took immediate action by developing the Myanmar Artemisinin Resistance Containment (MARC) framework during 2010-2011, which was endorsed by Ministry of Health (MOH) and partners/donors in April 2011. The Three Diseases Fund (3DF) provided initial funding for rolling out the containment activities in 2011. The budget for rolling out implementation by WHO and the national partners (within Department of Health (DOH)/MOH) during the period October 2011 to December 2012 was 2.4 mil. USD. As a continuation of MARC project from 2011/2012, a new proposal was developed with the expansion of containment activities to Tier 1 and 2 areas under 3MDG Fund for 2013. Subsequently the 3MDG project was extended upto 31 March 2014 (no cost extension).
In mid-year 2013, the Global Fund to Fight AIDS, Tuberculosis & Malaria (GFATM) has called for Concept Note from 5 Greater Mekong Sub-Region (GMS) countries including Myanmar for Artemisinin Resistance Initiative. The GFATM has pledged 100 m USD for 3 years from 2014 to 2016 for all GMS countries. It is planned by GFATM that Myanmar will receive 40 m USD for 3 years from 2014. Following this, Myanmar participated in the development of the Regional Concept Note on RAI in consultation with broad stakeholders (The National Malaria Control Programme, 3MDGF, UNOPS, NGO, INGO, etc.) in which WHO took lead in developing the Concept Note. The Regional Steering Committee (RSC) which is equivalent to the Regional Country Coordination Mechanism (CCM) was established on the 9th August 2013. RSC endorsed the content of the Concept note from Myanmar. The Concept Note of Myanmar was approved in November 2013 by GFATM.
UNOPS Myanmar was appointed as the Regional Principal Recipient by the RSC and several Sub recipients were selected including WHO. In this regard, GFATM, UNOPS Myanmar and the National Malaria Control Programme (NMCP) have proposed that WHO should provide technical assistance towards implementation of RAI project in the capacity of sub-recipient (SR). The Memorandum of Understanding between UNOPS and WHO has been prepared and it is planned to sign, following SEARO clearance, during second week of March 2014. The following main activities were proposed under RAI to be implemented by NMCP and other selected SRs in Tier 1 and 2 areas (in 52 townships) for the period of 2014 to 2016.
- Special activities to contain drug resistant P. falciparum (Pf) malaria among mobile and migrant population
- Distribution of Long Lasting Insecticide Treated Net (LLIN) to cover 100% in stratum 1 areas
- Investigate all Pf malaria cases in low endemic areas
- Comprehensive response package to all Pf malaria cases investigated
- Administration of modified direct observed therapy for the treatment of Pf patients
- Implement measures to quality assurance and quality control of Rapid Diagnostic Tests (RDTs), antimalarial drugs, microscopy
- Scale up availability of quality assured Artemisinin-based Combination Therapy (ACT) and RDT in the private sector (including banning of ACT monotherapy)
(Activities Nos 3, 4, and 5 are new to Myanmar and therefore, it is planned to conduct a pilot study before it is fully implemented)