ACTMalaria Foundation, Inc.

FINAL TECHNICAL REPORT PMI/USAID-Funded ACTMalaria Support Project

Grant Agreement 2012 GENERAL Contract Report of PO Number 200589157

Period Covered: April – December 2012

1/30/2013

This report documents the accomplishments of the PMI/USAID-Funded ACTMalaria Support Project, with focus on the improvement of skills in QA/ QC malaria diagnosis and M&E Surveillance, covering the period April to December 2012, submitted in pursuant of the provision in the WHO-ACTMalaria Grant Agreement funded by PMI/USAID, signed June 7, 2012.

About ACTMalaria ACTMalaria is an inter-government network of eleven (11) National Malaria Programs in Southeast Asia and Mekong Region, namely Bangladesh, Cambodia, PR China, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, Timor Leste and Vietnam. The network has 2 primary objectives: (1) provide collaborative capacity building to address the needs of malaria control and elimination in Southeast Asia and in the Mekong Sub-region, and (2) improve exchange of information and communication on malaria problems affecting the member countries and neighboring areas. The vision of ACTMalaria is for countries to work together in sustained, equal partnership towards eliminating malaria as a major public health problem in the region; its mission is to improve the quality and effectiveness of Malaria country programs in the control and eventual elimination of the disease.

List of Abbreviations

AAMI Australian Army Medical Institute ACTMalaria Asian Collaborative Training Network for Malaria AIRC ACTMalaria Information Resource Center APMEN Asia Pacific Malaria Elimination Network AusAID Australian Agency for International Development BVDTC Bureau of Vector-Borne Disease Training Center CDC Center for Disease Control and Prevention DFINTL Development Finance International ECA External Competency Assessment EQA External Quality Assessment GF Global Fund GMS Greater Mekong Sub-region JHPIEGO John Hopkins Program for International Education in

Gynecology and Obstetrics LQMS Laboratory Quality Management System MC Malaria Consortium MEASURE Monitoring and Evaluation to Assess and Use Results M&E Monitoring and Evaluation MMFO Management of Malaria Field Operations MMP Mekong Malaria Program MSB Malaria Slide Bank NMCP National Malaria Control Program PHO Provincial Health Office PMI President’s Malaria Initiative QAS Quality Assurance System RBM Roll Back Malaria RITM Research Institute for Tropical Medicine RMIF Regional Malaria Indicator Framework SEARO South-East Asia Regional Office SOP Standard Operating Procedure UNICEF United Nations Children's Fund USAID United States Agency for International Development VBDC Vector-Borne Disease Center VBDRT Vector-Borne Disease Research and Training Center VBDU Vector-Borne Disease Unit WHO World Health Organization WPRO Western Pacific Regional Office

Executive Summary

ACTMalaria continues to play a key role in enhancing various managerial and technical expertise in malaria among countries in the GMS as well as in other countries in Southeast Asia and the Pacific. Since its inception in 1996, ACTMalaria has worked in collaboration with various partners like WHO, Malaria Consortium, MEASURE, CDC/Atlanta, academe and research institutions in the member countries in in updating ACTMalaria Courses (e.g. Management of Malaria Field Operations, Broadening Involvement Team Training Workshop and Transfer of Training Technology) and in developing new courses such as the Monitoring and Evaluation Training, based on the needs of the programs. Main objectives of the support to ACTMalaria: To build capacity for strengthening or maintaining quality assurance systems,

monitoring and evaluating program strategies geared towards integration and program re-orientation from malaria control to elimination. To strengthen the appropriate use of parasite-based diagnosis of malaria in the GMS countries;

To strengthen national malaria diagnosis quality assurance systems, regional coordination of EQA of malaria diagnosis, and provide technical support at regional and country levels.

Key activities included in this grant were: (1) support to the maintenance of the regional slidebank in RITM; (2) Assessment of Quality Assurance/Quality Control (QA/QC) systems (performance) in the Mekong countries, i.e. Cambodia, Lao PDR, Thailand and Vietnam; (3) Planning workshop in strengthening quality assurance system of Giemsa Malaria Microscopy in ACTMalaria member countries and in the countries of the Pacific; (4) Organization and coordination of External Competency Assessments(ECA) in Vietnam and People’s Republic of China, Burma (Myanmar), Cambodia, Thailand Malaysia, East Timor and Philippines; (5)Support to country microscopy training in PMI cross border focus areas in the Greater Mekong Sub-region (GMS)i.e Thailand, Cambodia and Burma (Myanmar) (6) Regional training in strengthening M&E and surveillance capacity of the country Monitoring and Evaluation (M&E) teams of the ACTMalaria member states and the Pacific; (7) Provision of technical assistance in curriculum refinement and course management hosted by member countries; and (8)Strengthening Networking and Information Exchange. Key outcomes or products of the support included the following: Strengthen Regional QAS 1.1 Support to the maintenance of the malariaslidebank(MSB) in RITM (Report 1)

The establishment of the regional malaria slide bank is a collaborative

undertaking with the Research Institute for Tropical Medicine (RITM) and

theWorld Health Organization-Western Pacific Regional Office (WHO/WPRO). Its

maintenance includes regular infusion of well-characterized slides (cross-checked

and PCR-confirmed), review and updating of the MSB standard operating

procedures, and development of a teaching video showing the steps involvedin

establishing a malaria slide bank. MSB ensures that panels of high quality slides

are continuously available for External Competency Assessments (ECA) and for

inter-country/regional malaria microscopy training.

1.2 External Competency Assessments (ECA) facilitated by Mr. Ken Lilley,

consultant/assessor (Reports 2, 3, 4)

Part of the support to QA strengthening activities include the malaria microscopy accreditation scheme or ECA which is supported by two of the WHO Collaborating Centers in the region, the Regional malaria slide bank at the RITM, and the Australian Army Medical Institute (AAMI). Current technical and financial support was focused in the GMS i.e. Vietnam, PR China, Burma (Myanmar), Cambodia, and Thailand. Other ECAs planned and coordinated in 2012 were in Malaysia (WHO/USAID-Identify supported), Philippines (WHO-Phil/AusAID) and Timor Leste (GF-Malaria). Lt. Col Ken Lilley, AAMI QA Laboratory Manager, served as the external assessor/consultant in the ECAs conducted in the countries.

Level of Competency of Malaria Microscopists in Vietnam (12), Philippines (24), Malaysia (12), East Timor (12), Burma (4), Cambodia (4), Thailand (4) were ascertained, results as shown in Table 1 below. Other areas of identified weaknesses were proposed to be acted upon accordingly.

Table 1 List of Malaria Microscopists who participated in the ECAs conducted in

2012

Countries Microscopist Certification

Grading Month

Certificate Number

Philippines Batch 1

Marie CrisModequillo Level 1 Apr 697 Alicia Gallegos Level 1 Apr 698

Jocelyn Pascua Level 1 Apr 699 MingkieAbdurahman Level 1 Apr 700

John Fiel Porto Level 1 Apr 701 Jo-Anne Bibit Level 1 Apr 702 Ronald Espina Level 1 Apr 703 ChonaBulalaque Level 1 Apr 704 Elaine Jane Colobong Level 1 Apr 705 Zenaida Grad Level 1 Apr 706 Arlene Leah Santiago Level 1 Apr 707 Alice Amba Level 2 Apr 708

Countries Microscopist Certification

Grading Month

Certificate Number

Philippines Batch 2

Sherwin Galit Level 1 June 709 Jeffrey de Guzman Level 1 June 710 Roy Fiaching Level 1 June 711 Shirlyn Perez Level 1 June 712 RegieBaga Level 1 June 713 Erna Cravajal Level 1 June 714 RappaiBallaho Level 1 June 715 Gilbert ZaldyMagalgalt Level 1 June 716 Joel Kamlian Level 2 June 717 DonatoEsparar Level 2 June 718 OrbelsonCostibolo Level 3 June 719 Jonathan Basadre Level 3 June 720

Vietnam

Nguyen ThiXuan Thu Level 2 June 721 Vo Tan Loi Level 2 June 722 Nguyen ThiNho Level 2 June 723 Nguyen Thi Ha Level 2 June 724 Vu Thi Sang Level 2 June 725 Pham ThiHanh Level 2 June 726 Nguyen Thi Thu Van Level 2 June 727 Vu KhacAnh Dung Level 2 June 728 Pham Hoang Trung Level 3 June 729 Nguyen DucThang Level 3 June 730 Vu ThiAnhTuyet Level 3 June 731 Tran Thi Hong Thanh Level 4 June 732

Malaysia

Norizat Bin Yaa’kub Level 1 Sept 733 Ahmad Fikri Bin Ahmad Razi Level 1 Sept 734 Nor HalizahBtYahya Level 1 Sept 735 JimriBini Level 2 Sept 736 RozitaBtKamarudin Level 2 Sept 737 Shamsuddin Bin Mohamed Nasib

Level 2 Sept

738

HjhNoraizanBintiMohdDesa Level 2 Sept 739

Yen SiewMoey Level 2 Sept 740 MohdDzulFikry Bin Japar Level 2 Sept 741 Mohamad Bin Samsuriah Level 2 Sept 742 Fatimah BtIdris Level 4 Sept 743 MohdKharmi Bin MuhamedJusoh

Level 4 Sept

744

Countries Microscopist Certification

Grading Month

Certificate Number

Timor Leste

VirgilioMendonca Level 2 Sept 757 Leonilde Barros Falcão Level 2 Sept 758 Antonio Gomes Level 2 Sept 759 Gregorio Rangel Level 2 Sept 760 ZitaCorreia Level 3 Sept 761 Marcos Martins da Silva

Level 3 Sept 762

RuiModoCastanheira Level 4 Sept 763 Armindo Pacheco Level 4 Sept 764 Angelino da Costa Level 4 Sept 765 Feliciano Soares Level 4 Sept 766 Oryance Martha Beno Level 4 Sept 767 Rafael Fernandes Level 4 Sept 768

P.R. China

Huang Fang Level 1 Nov 769 Wang Zhenyu Level 1 Nov 770 Liu Hui Level 1 Nov 771 Liu Ying Level 1 Nov 772 Tang Feng Level 1 Nov 773 Sun Dingwei Level 2 Nov 774 Jiang Jingjing Level 2 Nov 775 Lu Lidan Level 2 Nov 776 Wang Yongbin Level 2 Nov 777 Lin Kangming Level 3 Nov 778 Yan He Level 3 Nov 779

Cambodia

You Yom Level 1 Dec 789 VaSoch Level 2 Dec 791 Mam Montha Level 2 Dec 793 Kim Marath Level 2 Dec 794

Myanmar

Nang May Lwin Level 2 Dec 795 Yin Nwe Level 2 Dec 796 MyintShwe Level 3 Dec 799 Saw Moe Kyaw Aye Level 4 Dec 800

Thailand

PongwitBualombai Level 2 Dec 790 RujiraLerdprom Level 2 Dec 792 PonlawatRuangsirarak Level 3 Dec 797 Patcharin Boon-In Level 3 Dec 798

1.3 Assessment of QA/QC systems (performance) in the Mekong countries, i.e.

Cambodia, Lao PDR, Thailand and Vietnam (Report 5)

Malaria Microscopy QA/QC systems (performance) was assessed in the 4 Mekong countries i.e. Cambodia, Lao PDR, Thailand and Vietnam, results of which were disseminated or presented during the Regional Planning Workshop on Strengthening Giemsa Malaria Quality Assurance organized at the RITM.

Identified areas of weaknesses were used as basis for developing the first multi-country refresher course for malaria microscopy trainers from Cambodia, Thailand and Myanmar organized in the Bureau of Vector-borne Disease Training Center (BVDTC) in Saraburi, Thailand.

1.4 Planning Workshop in Strengthening Quality Assurance System Of Giemsa

Malaria Microscopy in ACTMalaria Member Countries and in the Countries Of The Pacific (Report 6)

The planning workshop in strengthening quality assurance system of Giemsa Malaria Microscopy in the ACTMalaria member countries and in the countries of the Pacific was jointly organized by the Department of Health-Philippines, in collaboration and with support from ACTMalaria, World Health Organization Mekong Malaria programme, the Western Pacific Regional Office (WPRO) and the South East Asia Regional Office (SEARO), in Manila, Philippines, from May 2 to 4, 2012. The workshop was attended by 43 representatives from the participating member countries and the Pacific as well as staff from WHO (SEARO, WPRO, MMP and WHO country office in Nepal), representatives from URC-Cambodia, AMI, DOH-Philippines and RITM. During the workshop an overview of the structural components of Laboratory Quality Management System (LQMS) and Quality Assurance System (QAS) for Malaria Microscopy was provided, strengths and weaknesses and remaining gaps in the existing QAS in the countries based on the standard tool for assessing capacity of national QAS and plans developed by the programs in 2011 were identified; Countries with existing systems shared their internal QA procedures (cross-checking) appropriate to the different situations and conditions. Country programs discussed the proposed Standard Operating Procedure (SOP) for Parasite Counting and for conducting a national competency assessment, establishment of a national reference slide bank for malaria. The outputs of the meeting included the development of country quality assurance system work plans for malaria microscopy of the participating countries. At the end of the workshop, a visit to the RITM’s WHO Collaborating Center on QA for RDT and Regional Malaria Slide bank was conducted. A video presentation of the slide bank development and maintenance was also shown prior to the visit to the laboratory for the practical demonstration of slide bank establishment.

1.5 Support for country microscopy QA training in at least 3 Mekong Countries

with emphasis on PMI cross-border focus areas (Report 7)

The refresher training on malaria microscopy was held at Vector-Borne Disease Research and Training Center (VBDRT), Saraburi, Thailand with the aim of updating the knowledge and skills of malaria microscopists involved in training and quality assurance in their respective national programs. The participants of the activity included 5 from Thailand , 4 from Myanmar and 4 from Cambodia . The training team was composed of WHO-certified Level 1from the Philippines (Ms. Arlene Leah Santiago (team leader) and Ms. Marie Cris Modequillo); Mr. Montri Arsanok, Medical Research Technologist from AFRIMS, Bangkok,Thailand; and Mr. Paisan Fuxfair, Medical Technologist from BVBD-Thailand.

The pre- and post-course evaluations, both for the theoretical and practical examinations were carried out to get the degree of improvement of each participant. The microscopy series, which accounts for 80% of the total grade of the participants, uses blood smears from the Regional Slide bank of the WHO in Manila, Philippines. Each participant was graded according to his/her performance in the theoretical and practical post-course examinations and the microscopy series consisting of 4 sets of slides with different species of human Plasmodia, with varying densities. Each participant was allotted 10 minutes for each slide to be examined. The training team used the presentation intended for the Refresher Training curriculum. Review of parasite quantification and actual basic laboratory techniques demonstration were not done to give more emphasis on species identification which was the identified weakness of many of the participants during the pre-test practical and the initial test series. After combining the scores from the post-course theoretical and practical examinations and the microscopy series, only 8 of the 13 microscopists achievedthe grade of 80%. It was, therefore, strongly recommended that similar refresher courses should be regularly conducted for the microscopists to maintain their competency. Likewise, as microscopy trainers, they should strictly adhere to WHO recommended laboratory procedures. Those whose scores are below 80%, should attend an induction or basic course or should be given slides to practice on to improve their level of competency. Unless, this is done, those microscopists should not be involved in training others or in cross-checking of slides.

2. International Capacity Building Support 2.2 Regional Training in Strengthening Monitoring And Evaluation Of Country

M&E Team Of The ACTMalaria Member Countries And The Countries Of The Pacific (Report 8)

A regional training in strengthening M&E and Surveillance capacity of the country M&E team of the ACTMalaria member countries and the Pacific was jointly organized by ACTMalaria with support and in partnership with Malaria Consortium, the Center for Disease Control and Prevention (CDC), the WHO, MEASURE/Evaluation and in collaboration with the Bureau of Vector Borne Disease Center of Thailand in Chiang Mai, Thailand, from September 20-28, 2012. The training was attended by 22 participants from ACTMalaria member countries and the Pacific countries. The training aims to equip the participants with the knowledge and skills to ensure effective developments and implementation of national M&E plans, utilizing standardised tools and other standards of practice. The objectives of the training were 1) to impart appropriate monitoring and evaluation skills required for national programmes to track progress for malaria control and elimination in ACTMalaria member countries; 2)to provide adequate training for the implementation of the Regional Malaria Indicator Framework (RMIF) that is in line with National M&E Strategic Plans; 3) and support the creation of a cadre of regional level experts in M&E and Surveillance who can provide technical assistance in M&E (with a focus on implementation of the RMIF) at national and district levels and continuous support to National Malaria

Programmes. At the end of the training, a field visit to Chiang Rai’s malaria center, PHO, VBDC and VBDU was conducted to evaluate their M&E system. The output of the training included the development of country action plan to strengthen M&E system of the respective countries. Funding support for participants from outside the GMS was provided by Malaria Consortium, Global Fund Malaria-Philippines and Vietnam and WHO Country Office of Solomon Islands, PNG and WHO/RBM-Philippines.

2.3 Technical Support/Consultancy of Course Development & Training

Technical support was provided by Lt. Col. Ken Lilley of AAMI during the QAS Planning Workshop, having drafted and presented the proposed SOP for Malaria Parasite Counting and the general recommendations for QAS strengthening in the countries which were assessed in the past years. ACTMalaria has also provided technical support during the refinement of the curriculum of Monitoring and Evaluation Training held in Bangkok, Thailand and the Management of Malaria Field Operations (MMFO) held in Ayutthaya, Thailand. Adopted curriculum for the M&E training conducted in Chiang Mai is included as annex in the M&E report. Report on the MMFO Curriculum revision is attached as Report 9.

3. Strengthening Networking and Information Exchange

3.1. Annual Executive Board and Partners Meeting (Report 10)

The 16th ACTMalaria Annual Executive Board and Partners Meeting was held at Central Hotel, Yangon, Myanmar on March 20-21, 2012 participated in by national malaria program managers and key contacts, partners and stakeholders. The meeting was attended by 40 participants, represented by the program managers and directors of member states and the esteemed partners and stakeholders (ie. SEARO, Malaria Consortium, UNICEF, WR Nepal, Jhpiego, BestNet, BASF, DFINTL). The annual meeting aims to further advance co-operation in capacity strengthening and information sharing in the control and eventual elimination of malaria in this region. The group reviewed the activities of the network since the institutionalization of the network in 2003 and perform a capacity inventory as part of the continuing training needs assessment for the development of new strategic direction for the network. The member countries agreed to come into a consensus as to the training activities that should be continued, i.e. Management of Malaria Field Operations as one of the top priority along with Monitoring and Evaluation Training, updating of Transfer of Training Technology as a Training of Trainers. Members also proposed the development or inclusion of new technical areas in its portfolio e.g. introduction of new technologies that maybe relevant to malaria elimination.

The special board meeting was called for the possible expansion membership with the participation of NEPAL. The country members agreed that the National Malaria Program of Nepal should send a letter to the Secretariat indicating their interest and intent to become a member.

3.2 and 3.3 Office Operations and Staff Support (Report 11)

The ACTMalaria secretariat and ACTMalaria Information Resource Center is still presently managed and operated by the Executive Coordinator, the Executive Assistant, the Administrative Assistant/IT support staff and an information resource specialist. ACTMalaria Secretariat still maintain day-to-day physical and virtual operations and submits all its reportorial requirements (Financial Audited Report, Annual Securities and Exchange Commission Reportorial Requirements, Bureau of Internal Revenue Registration, Local Government Non-profit Registration Requirements, etc.) and participates in regional/national activities (USAID core partners meeting, WPRO and SEARO Malaria Program Managers Meeting, APMEN meeting) that is in line with mission of the network. Maintenance of ACTMalaria website continues to be outsourced while the ACTMalaria Information Resource Center (AIRC) is maintained by a full time information resource specialist. Both were supported by the in-house information technology/administrative assistant who serve as the virtual contact for the infonetwork while managing the local area network and on-site and on-line databases. The information resource specialist continues to be responsible for the publication or quarterly release of ACTMalaria newsletter and build up of collection of contributions from partner libraries and other sources. The contributed resource is reviewed/abstracted by the information resource specialist and editors before it is uploaded in the resource center database. An information resource consultant provides technical assistance, as needed, in case problem arises in the maintenance and updating of the AIRC. As of end of 2012, AIRC added to the database 583 resource materials, 223 online requests; Of the 16,716 online hits received, 14,482 have unique IP address.

Limitations/Conclusions and Recommendations In the invitation of participants to the regional trainings and workshops organized this year, i.e. QA workshop, M&E Training and the Refresher Training of Malaria Microscopy Trainers, the continuing challenge was ensuring that the right participants based on set criteria for selection are identified and nominated. Constraint in responding to country needs for follow-up support in undertaking their proposed action plans developed during the trainings and workshops.

For the nationally organized activities, the challenge is to ensure that all regional or national micrsocopists involved in training and cross-checking in the country are included in the assessment and negotiating for counterpart local support in the local cost for organizing the ECAs.

Table 1 Summary of Accomplishment

Description Period Covered Objective 1 Support to Regional Cooperation and Capacity-building

1.1 Strengthen Regional QAS

1.1.1 Maintenance of regional slide bank at RITM

April – November 2012

1.1.2 Assessment of QA/QC systems (performance) in at least 4 Mekong countries

April-May 2012 5 Member Countries Visited (Cambodia, Lao PDR, Vietnam and Thailand)

1.1.3 External competency assessments in at least 4 Member countries (2x/year, facilitator cost) through ACTMalaria Foundation, Inc.

April-May 2012 Nov 2012; Dec 2012 8 Member Countries Represented

1.1.4 Support for country microscopy QA training in at least 3 Mekong countries with emphasis on PMI cross-border focus area

Nov 28-Dec 2, 2012 3 Member Countries Represented – Thailand, Myanmar, Cambodia

1.1.5 Regional meeting on malaria diagnosis QA

May 2-4, 2012 7 Member Countries Represented

1.2 Capacity Building Support

1.2.1 Training Workshop on Monitoring and Evaluation

September 20-28, 2012 8 Member Countries Represented

1.2.2 Technical Support/Consultancy of Course Development & Training

March-December 2012

1.3 Strengthening Networking and Information Exchange

1.3.1 Annual Executive Board and Partners Meeting

March 20-21, 2012 10 Member Countries Represented

1.3.2 Inform and exchange information (AIRC and office operations)

15 March-30 to December, 2012

1.3.4 Staff support (secretariat: EC & EA; AIRC: IT & IRO)

15 March-30 to December, 2012