Eliminating Malaria in the Greater Mekong Subregion

Malaria in the Mekong

In 2016, the Asia-Pacific region had an estimated 16.2 million malaria cases, of which 30,300 ended up fatal, according to estimates of the World Health Organization.

High concentrations of drug resistance are common in the forest borders of Cambodia, Myanmar, Thailand, and Viet Nam. Malaria in Myanmar is highest, and the country could be the gateway of drug-resistant malaria into South Asia and Africa.

Malaria detection and treatment also needs vast improvements, especially for mobile and migrant populations. Lack of timely and comprehensive disease surveillance across countries, a proliferation of low quality and fake medicines, and lack of capacity of national regulatory agencies and medical institutions hamper the countries’ efforts to contain and eliminate malaria.

A steady flow of flexible financing is vital for cross-border initiatives, multi-sector cooperation, and multi-country interventions.

Multi-country, Cross-border, and Multi-sector Solutions

ADB has a solid track record for the successful management of trust funds for sector specific infrastructure projects and has managed dozens of trust funds that funnel donor resources into one area with great catalytic success. The Regional Malaria and Other Communicable Disease Threats Trust Fund (RMTF) was established under the ADB Health Financing Partnership Facility. Building on ADB’s experience, communicable diseases control and malaria elimination was a strategic entry point for future health trust fund interventions. 

The RMTF’s thrusts were aligned with the 2015-2030 Malaria Elimination Strategy developed in the GMS supported by the World Health Organization. The strategy aimed to eliminate malaria by 2030, reduce malaria in high transmission areas and maintain malaria-free status, and prevent reintroduction once transmission has been interrupted. RMTF interventions worked towards:

• Strengthening regional leadership through support for regional cooperation, knowledge development, and knowledge sharing, building towards a malaria-free region by 2030;
• Increasing financing through pooling public and private sector finance for malaria elimination, particularly for scalable initiatives that can help strengthen health systems and support countries to attain universal health coverage;
• Countering low quality medicine, which are a major contributor to drug resistance in the GM, through stronger national drug regulation;
• Adopting technologies for a more robust digital Health infrastructure for malaria surveillance and producing essential data for planning, monitoring, and evaluating interventions for malaria and other communicable diseases;
• Improving national capacity to detect, test, treat, and track malaria and other communicable disease cases, particularly in border areas; and
• Addressing malaria in development through improved practice of health impact assessments to include malaria and communicable disease prevention in large commercial and development projects.

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Numbers and facts

• 14 leaders in Asia and the Pacific commit to the malaria elimination road map
• From $90 million (2013) to more than $300 million increased domestic funding for malaria elimination in the GMS
• $124 million available loan financing for eligible GMS countries through the first ADB health bond
• 6 universities in the GMS offered Health Impact Assessment (HIA) certificate course targeting 262 future practitioners
• 696 government and nongovernment staff trained to meet the needs of effective health impact assessments
• 692 staff of national regulatory agencies trained in various areas such as pharmacovigilance, medical device regulation, bioequivalence, standardized approach to medicine reviews, and in chemistry, manufacturing, and control

No Room for Malaria

The RMTF’s flexibility and adaptability allowed for the successful delivery of tangible results, despite the timing, capacity, and funding challenges. It offered opportunities for government, development agencies, academic institutions, and the private sector to work together not only against malaria but also to ensure that the disease does not go beyond the GMS through building a more robust health sector in the region.

The RMTF supported ambitious and complex projects in a time-bound, multi-country, cross-border, multi-sector context and across both specific disease interventions and regional health system strengthening. Some of the lessons it offered are:

Improve timeliness of disbursement of resources. While the RMTF offered flexible financing, not all resources were disbursed as planned. Changes in donor funding commitment resulted in the re-design of some of the project components and intense scrutiny from donor partners. This helped to sharpen the RMTF’s focus, funds management and accountability. The fund developed the “accounting for results” dashboards that helped to communicate the value for money of the fund.

Explore the limits of available technology. The inclusion of activities, particularly on information systems not contemplated at the outset, but proven to have been essential to the attainment of some of the outcomes, was a strategic invention in the RMTF’s implementation. For example, through GIS mapping, a harmonized malaria registry was developed and proved to be an essential tool for governments to have.

Regional Malaria and Other Communicable Disease Threats Trust Fund: Final Report https://www.adb.org/publications/malaria-trust-fund-report

Regional: Results for Malaria Elimination and Control of Communicable Disease Threats in Asia and the Pacific https://www.adb.org/projects/48001-001/main

Publication: Malaria Elimination https://www.adb.org/publications/rmtf-malaria-elimination