Regional Action Plan for Malaria Control and Elimination in the ...

Regional Action Plan for Malaria Control and Elimination in the Western PacificWHO Library Cataloguing in Publication DataRegional Action Plan for Malaria Control and Elimination in the Western Pacific: (2010 - 2015).1. Malaria – prevention and control. 2. Malaria – epidemiology. 3. Regional health planning.4. Western Pacific.ISBN 978 92 9061 557 6 (NLM Classification: WC 765)© World Health Organization 2012All rights reserved. Publications of the World Health Organization can be obtained from WHO Press,World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264;fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translateWHO publications – whether for sale or for noncommercial distribution – should be addressed to WHOPress, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). For WHO WesternPacific Regional Publications, request for permission to reproduce should be addressed to the PublicationsOffice, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila,Philippines, (fax: +632 521 1036, e-mail: publications@wpro.who.int).The designations employed and the presentation of the material in this publication do not imply theexpression of any opinion whatsoever on the part of the World Health Organization concerning the legalstatus of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiersor boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be fullagreement.The mention of specific companies or of certain manufacturers’ products does not imply that they areendorsed or recommended by the World Health Organization in preference to others of a similar nature thatare not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished byinitial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the informationcontained in this publication. However, the published material is being distributed without warranty of anykind, either expressed or implied. The responsibility for the interpretation and use of the material lies withthe reader. In no event shall the World Health Organization be liable for damages arising from its use.

Regional Action Plan for Malaria Control and Elimination in the Western PacificTable of ContentsAcknowledgements.........................................................................................................................4Preface.............................................................................................................................................5Regional Committee Resolution WPR/RC60.R5, 2009.................................................................6Summary..........................................................................................................................................8Malaria situation in the Western Pacific Region.........................................................................12Key challenges and opportunities...............................................................................................15Development of the Regional Action Plan..................................................................................24Role of the Regional Action Plan.................................................................................................26Goal, Objectives and Targets of the Regional Action Plan....................................................... 28Regional Action Plan for Malaria Control and Eliminationin the Western Pacific (2010 – 2015) Logical Framework...........................................................32

Regional Action Plan for Malaria Control and Elimination in the Western PacificAbbreviationsACTMalariaAPMENAusAIDG6PDGFGMAPGMIHIV/AIDSThe Asian Collaborative Training Network for MalariaAsia-Pacific Malaria Elimination NetworkThe Australian Agency for International DevelopmentGlucose 6 Phosphate DehydrogenaseThe Global Fund to Fight AIDS, Tuberculosis and MalariaGlobal Malaria Action PlanGlobal Malaria IndicatorHuman Immunodeficiency Virus/Acquired ImmuneDeficiency SyndromeInterpolITNLLINM&EMCMDGsMEASUREMMPMVPRAPRBMRITMInternational Criminal Police OrganizationInsecticide Treated NetsLong Lasting Insecticidal NetsMonitoring and EvaluationMalaria ConsortiumMillennium Development GoalsMeasure/EVALUATIONMekong Malaria ProgrammeMalaria, other Vectorborne and Parasitic DiseasesRegional Action PlanThe Roll Back Malaria PartnershipThe Research Institute for Tropical Medicine of the Philippines2

Regional Action Plan for Malaria Control and Elimination in the Western PacificAbbreviationsSPCTDRThe Secretariat of the Pacific CommunityUNICEF/UNDP/World Bank/WHO Special Programme for Researchand Training in Tropical DiseasesUQUS CDCThe University of Queensland, AustraliaThe United States of America Centers for Disease Controland PreventionUSAIDWHOUnited States Agency for International DevelopmentWorld Health Organization3

Regional Action Plan for Malaria Control and Elimination in the Western PacificAcknowledgementsThe Malaria, other Vectorborne and Parasitic Diseases unit of the WHO Regional Office for the WesternPacific wishes to acknowledge with gratitude the significant inputs from the national malaria programmemanagers and representatives from the ministries of health from the 10 malaria-endemic Member Statesof the Western Pacific Region (Cambodia, China, the Lao People‘s Democratic Republic, Malaysia, PapuaNew Guinea, the Philippines, the Republic of Korea, Solomon Islands, Vanuatu and Viet Nam) and twoMember States from the WHO South-East Asia Region (Myanmar and Thailand).In addition, we acknowledge the collaboration of key stakeholders who were represented in severalmeetings during the entire planning process. These include the Asia Pacific Malaria Elimination Network,the Asian Collaborative Training Network for Malaria, the Australian Agency for International Development,the Eijkman-Oxford Clinical Research Unit/Jakarta, the Global Fund to Fight AIDS, Tuberculosis and Malaria,the Malaria Consortium, Measure/EVALUATION, the Secretariat of the Pacific Community, the ResearchInstitute for Tropical Medicine of the Philippines, the Roll Back Malaria Partnership, the Shell Foundation/Philippines, the Tropical Disease Foundation/Philippines, the United States of America Agency forInternational Development, the United States of America Centers for Disease Control and Prevention andthe University of Queensland/Australia.We would like to acknowledge the significant inputs from WHO headquarters, WHO South-East AsiaRegion and WHO Mekong Malaria Programme as well as the contributions of Dr John Storeyand Dr Sean Hewitt.Photo credits:Harrikrisna Anenden (page 8, left photo; page 22 left photo; and page 24, right photo).Ministry of Health Malaysia (page 11, left photo and page 26, left photo). You Yom (page 12, right photo).Lu Ming (page 18, right photo). Muhammad Shafique (page 31, right photo). WPRO Image Bank (page 24,left photo and page 25 photos). All other photos not credited were contributed by staff of the Regional andCountry Offices.Graphic design:We also acknowledge with gratitude the graphic design work for this publication, which was done by© Ms Silvia Kirchhof, Munich, Germany.4

Regional Action Plan for Malaria Control and Elimination in the Western PacificPrefaceThe Western Pacific Region has made considerable progress in recent decades in reducing malaria mortalityand morbidity. Currently, 10 of the 37 countries and areas of the Region are endemic with the disease. In 2009,255 593 confirmed malaria cases and a total of 1031 malaria deaths were reported by public sector healthfacilities. However, many cases and deaths were not recorded. From 2000 to 2009,the number of confirmed malaria cases was reduced by 36%, with a 56% decline in malaria deaths.Malaria incidence is reduced to such an extent that several countries are already moving towards malariaelimination. This transition will require careful planning and guidance. To meet these needs, Member Stateshave endorsed the Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010– 2015) through resolution WPR/RC60.R5 of the sixtieth session of the WHO Regional Committee for theWestern Pacific in September 2009. The plan is a product of extensive consultations and forums amongnational programmes and multiple stakeholders, which considered the lessons learnt and available evidencefrom decades of implementation in the Region. The result is a plan with a clear goal and objectives andevidence-based interventions. It also contains a regional malaria indicator framework to track implementationprogress and measure intended results.Affected countries are expected to use this strategic plan, which is subject to periodic review, as a guide toreview and update national malaria strategies to scale up control and include elimination objectives.The updated national plans will serve as advocacy tools to mobilize resources both internally and externally.Also, it should identify challenges and opportunities for malaria control and elimination in the Region.To implement the Regional Action Plan for Malaria Control and Elimination in the Western Pacific(2010 – 2015) most successfully, it will be important that Member States strengthen their health systems to beable to sustain gains achieved so far and further accelerate movement towards elimination.WHO strongly supports national malaria programmes and other stakeholders in their continuing efforts toimplement proven, cost-effective strategies and interventions that will accelerate malaria elimination from ourRegion.Shin Young-soo, MD, Ph.D.Regional Director5

Regional Action Plan for Malaria Control and Elimination in the Western PacificRegional Committee Resolution WPR/RC60.R5, 2009The Regional Committee,Concerned that malaria remains a significant public health problem in the Region, especially for the poorestrural populations;Acknowledging progress made by Member States in reducing malaria mortality and morbidity, withseveral Members States having changed their national malaria programme goals from malaria control toelimination;Aware of the unacceptably high burden of malaria in a few countries, the continued transmission in activefoci in many countries and the risk of malaria epidemics;Concerned with the emergence of artemisinin resistance in Plasmodium falciparum as a major global threatto malaria control and elimination;Further concerned with the wide availability of substandard and counterfeit antimalarial medicines and theirrational use of artemisinin derivatives, especially in the private sector;Recognizing the public health significance in the Western Pacific Region of malaria caused by Plasmodiumvivax, which currently is not adequately diagnosed and treated in many countries and which poses aparticular challenge for malaria elimination;Acknowledging the unprecedented amount of funding made available for malaria control and elimination;Further acknowledging the need to strengthen human resources and national surveillance systems and tosustain funding for malaria;Recognizing that effective malaria control and elimination require universal access of all at-risk populationsto effective prevention, diagnosis and treatment measures as well as strong community involvement;Aware of the importance of partnerships and intersectoral cooperation to achieve programme goals andmore cost-effective interventions through synergies;Recognizing the importance of the Regional Action Plan for Malaria Control and Elimination in the WesternPacific (2010 – 2015) 1 as a road map to guide national programmes, as a monitoring framework and as anadvocacy and resource mobilization tool;1Annex 1 of document WPR/RC60/86

Regional Action Plan for Malaria Control and Elimination in the Western Pacific1. ENDORSES the Regional Action Plan for Malaria Control and Elimination in the Western Pacific(2010 – 2015);2. URGES Member States where malaria is endemic:(1) to use the Regional Action Plan for Malaria Control and Elimination in the Western Pacific(2010 – 2015) to update national malaria control or elimination plans and as a framework formonitoring implementation and mobilizing resources;(2) to strengthen commitment at all levels to help ensure that adequate human and financial resourcesare made available to implement and sustain national malaria control or elimination programmesand incorporate health system strengthening whenever feasible;(3) to ensure universal access for all at-risk populations to appropriate and effective vector controlmeasures, early parasite-based diagnosis and safe and effective antimalarial treatment and tomaximize services utilization through appropriate communication and community mobilization;(4) to prohibit the marketing of artemisinin-based monotherapies and halt any further development andspread of artemisinin-resistant falciparum malaria;(5) to improve diagnosis and treatment of vivax malaria, including addressing the issue of glucose-6-phosphate dehydrogenase deficiency and supporting operational research to fill knowledge gaps;(6) to strengthen national surveillance systems to monitor malaria trends and programme impact,to detect and control outbreaks in a timely manner and to encourage regular and transparent datareporting and sharing;(7) to foster partnerships with nongovernmental organizations and technical agencies and supportintersectoral cooperation;3. REQUESTS the Regional Director:(1) to use the Regional Action Plan for Malaria Control and Elimination in the Western Pacific Region(2010 – 2015) to advocate among stakeholders and development partners for increased supportfor moving from malaria control towards a malaria-free Region;(2) to provide technical support to Member States to address barriers to the scaling up of malariacontrol and elimination programmes;(3) to report to the Regional Committee about progress in implementing the Regional Action Plan forMalaria Control and Elimination in the Western Pacific (2010 – 2015) and to report on necessaryrefinements, as required.7

Regional Action Plan for Malaria Control and Elimination in the Western PacificSummaryMalaria contributes significantly to child andmaternal morbidity and mortality. Therefore,the success of the fight against malariaimpacts positively on the achievement ofthe United Nations Millennium DevelopmentGoals. Malaria is directly related to MDG 6(combating HIV/AIDS, malaria, tuberculosisand other diseases). It is linked indirectly toMDG 4 (reducing child mortality) and MDG 5(improving maternal health) and remotelyrelated to other goals such as eradicatingextreme poverty and hunger (MDG 1), ensuringenvironmental sustainability (MDG 7) and buildinga global partnership for development (MDG 8).Effective control of malaria is exceptionally challenging inthe 10 endemic countries of the Western Pacific Region:Cambodia, China, the Lao People‘s DemocraticRepublic, Malaysia, Papua New Guinea, the Philippines,the Republic of Korea, Solomon Islands, Vanuatu andViet Nam. The epidemiology of the disease is extremelyvariable and different situations require differentmalaria control strategies adapted to various risk groups,vector behaviours, local health infrastructure andenvironmental conditions. Multidrug-resistantPlasmodium falciparum and the presence ofinappropriate, substandard and counterfeit antimalarialmedicines add considerably to the difficultiesassociated with this complex situation.8

Despite these difficulties, many countries in theWestern Pacific Region during the last decadehave been very successful in reducing the burdenof malaria. From 2000 to 2009, mortality in theRegion was reduced by 36% and the number ofconfirmed malaria cases was reduced by 56%.Nevertheless, the burden of disease remainsunacceptably high in some countries.Hyperendemic foci can still be found in manycountries, and the situation is particularlyMalaria control and elimination efforts in the Regionstill face a daunting array of challenges relating bothto technical and programmatic issues, to political andeconomic constraints, to environmentalchanges and to the rapidly evolving donor andpartner landscape. In addition, the new and longoverdue emphasis on improving the quality of malariadiagnostic and treatment services provided by theprivate sector places a considerable extra burden onthe various partners involved.serious in Papua New Guinea. Further,the risk of a significant resurgence of malaria remainsvery real in several areas.At the same time, the political profile of malaria has risendramatically since 2000 and funding has grown at anextraordinary rate, making this a time of great opportunity.9

Regional Action Plan for Malaria Control and Elimination in the Western PacificSummaryEfforts are now needed to further expandcoverage and strengthen the delivery of existingservices. Continued innovation is needed tomaximize coverage of hard-to-reach populationsvivax malaria. There needs to be an increasedemphasis on regional collaboration and onmultisectoral efforts if required out comesare to be achieved.at greatest risk. An immediate priority issueis halting the development and preventing the spreadof artemisinin-resistant malaria parasites in the borderareas of Cambodia, Thailand and in Southern VietNam. Another important Regionalfocus over the next five years will be building atransition towards phased malaria eliminationand one prerequisite will be to find feasiblestrategies to implement a radical cure forThe Regional Action Plan for Malaria Control andElimination in the Western Pacific (2010 – 2015)will be the Region‘s malaria road map for the nextsix years. The proposed regional goal is to reducemalaria mortality and morbidity by 50% by 2015compared with 2007 and to achieve the interruptionof malaria transmission in targeted areas in at leastseven countries.10

The Regional Action Plan is the result ofextensive consultations and forums involvingnational programmes and multiple stakeholders.It was endorsed by Member States at theis expected to serve not only as a frameworkfor updating national plans but also as a tool formonitoring national programmes and for mobilizinginternal and external resources.sixtieth session of the WHO Regional Committeefor the Western Pacific on 24 September 2009under resolution WPR/RC60.R5. It is in line with theMDGs, resolution WHA60.18 adopted by the WorldHealth Assembly on 23 May 2007 andthe Roll Back Malaria Partnership‘sGlobal Malaria Action Plan and resolutionA/RES/63/234 of the United Nations GeneralAssembly, adopted 13 March 2009. The plan11

Regional Action Plan for Malaria Control and Elimination in the Western PacificMalaria situation in the Western Pacific RegionAlthough sub-Saharan Africa bears the greatest burdenof malaria, the health and economicimpact of the disease in the Western Pacific Regionremains considerable. In all, 255 593 confirmed casesof malaria were reported by public sector healthfacilities in 2009. A total of 1031 malaria deaths werereported that year. However, lowcoverage of diagnostic services in some countriesand low reliance on public health services in others,exacerbated by low public sectorcoverage in many high transmission areas,mean that these figures grossly underestimatethe true burden of malaria.Effective control of malaria in the Western PacificRegion is exceptionally challenging. Epidemiologicalpatterns can be divided broadly into four groupsaccording to geographical location: central China andthe Republic of Korea, the Philippines and Malaysia,the Mekong region and Melanesia, and Polynesia. Buteven within these broad divisions, the epidemiology ofthe disease varies considerably from one populationgroup to another and, in manycases, the different situations require different malariacontrol strategies adapted to risk group and vectorbehaviour, local health infrastructure and environmentalconditions.12

Multidrug-resistant Plasmodium falciparum andthe counterfeit drugs add considerably to thecontrol into community-based health systems, havebeen key elements of this success.difficulties associated with this complexsituation. Nevertheless, many countries in theWestern Pacific Region during the last decadehave been very successful in reducing the burdenof malaria. Between 2000 and 2009, malariamortality was reduced by 36% and confirmedmalaria cases were reduced by 56%. Strongpolitical commitment, growing technical expertise, theavailability of funding and, therefore, theavailability of supplies, including antimalarialmedicines, diagnostics and insecticide-treatedmosquito nets, and the integration of malariaThe main strategies have included improving access toprompt diagnosis and appropriate treatment services,ensuring high coverage with insecticide-treated nets and,in some countries, focal indoor residual spraying withinsecticides for vector control. Effortsrelated to improving knowledge and promotingbehaviour change among target groups have resulted inincreased use of services. In addition, socio-economicdevelopment has contributed substantially to thedecline of malaria. Deforestation also has played asignificant role in reducing transmission in many areas.13

Regional Action Plan for Malaria Control and Elimination in the Western PacificMalaria situation in the Western Pacific RegionThe evolution of malaria control interventions is acontinuous process and a range of highly effectivenew tools and innovative approaches to servicedelivery are revolutionizing malaria control effortsglobally. Many of these new tools and approacheswere pioneered in the Western Pacific Region duringSupport for the provision of health care throughthe private sector and through community-basedvolunteer networks massively has improvedthe coverage of these new malaria controlmeasures and the malaria situation in manycountries.the 1990s. Long lasting insecticidal nets, easy-tousemalaria rapid diagnostic tests, artemisinin-basedcombination therapies and heat-stable suppositoriescontaining artemisinin derivatives are all having aprofound impact on the prevention diagnosis, andtreatment of malaria in the Region and beyond.14

Key challenges and opportunitiesAlthough there recently has been an overallimprovement in the malaria situation in theWestern Pacific Region, the burden of diseaseremains unacceptably high. Hyperendemic foci stillcan be found in many countries, and inPapua New Guinea the situation is particularlyserious. Further, the risk of a significant resurgenceof malaria remains very real in several areas. MalariaMoreover, the new and long overdue emphasison improving the quality of malaria diagnostic andtreatment services provided by the private sectorplaces a considerable extra burden on the variouspartners involved. At the same time, the politicalprofile of malaria has risen dramatically since 2000and funding has grown at an extraordinary rate,making this a time of great opportunity.control and elimination efforts in theWestern Pacific Region still face a daunting arrayof challenges relating both to technical andprogrammatic issues, to political and economicconstraints, to environmental changes and to therapidly evolving donor and partner landscape.15

Regional Action Plan for Malaria Control and Elimination in the Western PacificKey challenges and opportunitiesThe key issues facing malaria control in the Region are many and varied:Diagnosis plays a central role for the rational treatmentof malaria (and non-malarial fevers), yet diagnosticissues have been given low priority by someprogrammes and funding agencies. Presumptiveantimalarial treatment for any fever with no obviousalternative cause is widely practised and leads tosignificant overuse of antimalarial medicines. Withartemisinin-based combination therapy now thefirst line treatment for malaria, this high level ofoverdiagnosis has serious cost implications. It also hasvery serious health implications because it isassociated with a failure to adequately treatalternative causes of infection.Oral artemisinin monotherapy continues to be widelyavailable in the Region, exerting pressure for theselection of artemisinin-resistant parasites.Artemisinin-resistant falciparum malaria hasemerged along the Cambodia-Thailand border andin the south of Viet Nam. All of WHO’s recommendedregimens for the management of uncomplicatedfalciparum malaria globally are now dependent onartemisinin-based combination therapies, and thereare currently no viable alternatives.The spread ofartemisinin-resistant P. falciparum would havedisastrous consequences on malaria treatment andelimination globally.16

The continuing artemisinin-resistance containmenteffort in the Region is therefore a global priority.Evidence is emerging that vivax malaria may not beas benign as previously thought. Because of theexistence of dormant liver stages, vivax malaria isCounterfeit antimalarials are still being producedand marketed in the Region, but multisectoral effortsto halt this are now advancing. In 2007, OperationJupiter, an international collaboration betweenscientists, public health workers and police, led to thearrest of producers anddistributors of fake artesunate. Investigationscoordinated by Interpol in cooperation with WHO andpartners are continuing.more difficult to control than falciparum malaria.As a result and as control efforts in the Regionadvance, it is pro gressively becoming thepredominant malaria species. The situation is furthercomplicated in northern areas of the Region by strainsof P. vivax, which are characterized by laterelapses (which may occur years after initialinfection). In addition, high incidence of glucose 6phosphate dehydrogenase (G6PD) deficiency 11This enzyme deficiency can lead to a potentially fatal reaction to primaquine, the only drugcurrently available for the treatment of the dormant liver stages of vivax malaria.17

Regional Action Plan for Malaria Control and Elimination in the Western PacificKey challenges and opportunitiesin the human population in some areas precludesthe general use of primaquine, the only drugcurrently available for the radical cure of vivaxmalaria. More emphasis needs to be placed onto be achieved. A comprehensive policy forprivate sector strengthening providing clear andlocally appropriate strategies needs to beformulated urgently.developing effective tools for vivax control andelimination.Although the use of conventional bednets is high inmost countries, insecticide-treated bednet coverageThe private sector plays a major role in pro vidinghealth care in many countries; however, the servicesoffered are often critically weak. Engaging theoverall is still low in the Region. Increasing coveragewith long lasting insecticidal nets should therefore bea primary objective of future efforts.private sector represents a huge opportunity todecisively improve health care delivery across theboard and must be a key focus over the next fewyears if malaria control and elimination targets areDespite recent improvements to road networks inmany countries in the Region, accessibility remainsthe key issue for some. The many diferent categories18

of mobile groups in the Region present a particularchallenge to health services. They are difficult totarget and malaria prevention tools such as longlasting insecticidal nets and delivery mechanisms suchas community-based diagnostic and treatmentservices are not well-suited to their transient nature.Major development projects such as hydro electric dams,new roads, pipelines and other large-scaleinfrastructure improvements can also lead to thecreation of important new transmission foci, as canchanging agricultural practices and mining activities.National programmes need to maintain a high degree ofvigilance and work closely with multisectoralEarly indications from Papua New Guinea suggest thatglobal warming may be resulting in increased malariapartners to prevent the development of newtransmission foci.transmission in the highlands, where unstable seasonaltransmission is now found in areas that until recentlywere free of malaria. Programmes must monitorepidemio logical trends and respond promptly to anychanges that might occur.Regional policies relating to a number of key issuessuch as malaria in pregnancy, the role of the privatesector in malaria control and special interventions forvulnerable groups are overdue.19

Regional Action Plan for Malaria Control and Elimination in the Western PacificKey challenges and opportunitiesThis can be attributed largely to the scarcity ofquality operational research on these key issues.This situation has been hampered in many countriestools and to adapt existing tools and associateddelivery strategies to suit the various targetpopulations at greatest risk.by the myriad of competing priorities and insufficienttechnical capacity for operational research at thenational level, sometimes further complicated byuncoordinated partner-driven research agendas.Even though the key issues listed above long havebeen a high priority, there are still no effective malariacontrol measures for some vulnerable groups, suchAdequate human resources are crucial to achievingprogrammatic success. Staffing levels within mostnational malaria programmes fell dramatically in thepost-eradication years. Although there has been somerecovery in recent years, a serious shortfall remains inmost endemic countries.as mobile populations. In addition, maternal and childhealth and mortality are still not adequately addressed.There is clearly a role for continuedinnovation. Further work is needed to develop newMost malaria programmes in the Region tend to bevertical in nature. The integration of activities is generallylimited and valuable opportunities for synergy often20

are lost as a result. The massive increase in fundingearmarked for malaria as a consequence of its recentprioritization on the global health agenda may increasethis verticality unless special means are established toacross health programmes in order to take full advantageof all opportunities for life-saving synergies betweenmalaria and other health initiatives and to strengthenhealth systems generally.encourage programmes to integrate activities, whereappropriate. Many other areas are under-resourced.For example, village-based diagnosis and treatmentfor malaria is now availaleat the community level in many of the Region’stransmission hotspots, but children in these samecommunities do not have access to treatment foracute respiratory tract infections or diarrhoea. Greaterefforts are needed to work out practical mechanismsto operate integration effectivelyIt is especially difficult to sustain political commitment andmaintain funding levels as malaria control moves to malariaelimination and to the prevention of the re-introduction ofmalaria. There are a number of well-documented cases inrecent years in which a reduction in the malaria burden hasled to political complacency, withdrawal of funding and,ultimately, a major resurgence of disease. Strenuous effortswill be required to secure continued funding as the malariasituation improves.21

Regional Action Plan for Malaria Control and Elimination in the Western PacificKey challenges and opportunitiesPolitical factors also present a number of importantchallenges to malaria control and elimination in theWestern Pacific Region. For example, unrestformation of strategic partnerships and strongleadership of national programmes, will be requiredif these problems are to be avoided.currently hampers local malaria control efforts in someparts of the Region.Efforts are needed to further expand coverageand strengthen the delivery of existing services,With so many new organizations now involved inmalaria control and with so many new partnershipsand networks in existence, there is a risk ofduplication of efforts, unnecessary competition,confusion and loss of strategic direction. Significantimprovements ininteragency coordination, together with theincluding long lasting insecticidal nets, providinghealth facility-based public sector health care,community-based diagnostic and treatmentservices and providing private sector health care.Continued innovation is needed to maximizecoverage, adapting newly-fashioned tools andservice delivery mechanisms to suit the various22

target populations at greatest risk. Animmediate priority issue is halting the buildup andpreventing the spread of artemisinin-resistantmalaria parasites in border areas of Cambodiaand Thailand and other areas with evidence ofartemisin in resistance. Another importantregional focus over the next five years will besecuring the way for a move towards phasedmalaria elimination. There will need to beincreased emphasis on regional collaborationand on multisectoral efforts if requiredoutcomes are to be achieved.23

Development of the Regional Action PlanThe Regional Action Plan for Malaria Control andElimination in the Western Pacific (2010 – 2015)is the result of extensive consultations andforums involving national programmes and variousstakeholders. The issues described above werethe Lao People‘s Democratic Republic, Malaysia,Papua New Guinea, the Philippines, the Republic ofKorea, Solomon Islands, Vanuatu and Viet Nam) andtwo Member States from the WHO South-East AsiaRegion (Myanmar and Thailand).discussed at various levels and the Action Plan wasput together based on those discussions.The final draft was analysed and refined in July2009 during a five-day workshop attended bynational malaria programme managers andrepresentatives from the ministries of healthfrom the 10 malaria-endemic Member States of theWestern Pacific Region (Cambodia, China,In addition, key stakeholders were represented,including APMEN, the Asian CollaborativeTraining Network for Malaria (ACTMalaria),the Australian Agency for InternationalDevelopment (AusAID), the Eijkman-OxfordClinical Research Unit/Jakarta, the Global Fund toFight AIDS, Tuberculosis and Malaria, the Malaria24

Consortium, Measure/EVALUATION, the Secretariatof the Pacific Community, the Research Institute forTropical Medicine of the Philippines, the Roll BackMalaria Partnership, the Shell Foundation/Philippines, the Tropical Disease Foundation/Philippines, USAID, the United States of AmericaIt is in line with the United Nations MDGs,resolution WHA60.18 adopted by the World HealthAssembly on 23 May 2007, the Roll Back MalariaPartnership‘s Global Malaria Action Plan andresolution A/RES/63/234 of the United NationsGeneral Assembly, adopted on 13 March 2009.Centers for Disease Control and Prevention andthe University of Queensland/Australia.The Action Plan was endorsed by MemberStates at the sixtieth session of the WHORegional Committee for the Western Pacific on24 September 2009 under resolution WPR/RC60.R5.25

Regional Action Plan for Malaria Control and Elimination in the Western PacificRole of the Regional Action PlanThis Regional Action Plan for Malaria Control and Eliminationin the Western Pacific (2010 – 2015) will bethe Region‘s malaria road map for the next six years.The Action Plan will not only serve as aframework for updating national plans but also as aIt sets out the goal, objectives and main activities,together with goal- and objective-level indicatorsand targets. Most of the indicators in the ActionPlan are “global malaria indicators” that are reported toWHO annually by all malaria-endemic countries.tool for monitoring national programmes and formobilizing internal and external resources.The Action Plan is a living document that will beupdated periodically, as appropriate (the mostrecent version will be available online at theWestern Pacific Regional Office‘s malaria webpagehttp://www.wpro.who.int/topics/malaria/enIn addition, a number of other indicators have beenestablished during extensive consultations andincluded to provide essential Region-specific information.The Regional Malaria Indicator Framework isbeing used for country adaptation to review countrytargets in 2011.26

A detailed description of each indicator will beavailable as an appendix to the Action Plan on theWestern Pacific Regional Office‘s malaria web page.27

Regional Action Plan for Malaria Control and Elimination in the Western PacificGoal, Objectives and Targets of the Regional Action PlanThe goal of the Regional Action PlanThe overall goal of the Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010 –2015) is toconsolidate and build on the recent achievements in malaria control in the Region and progressively eliminate malaria,where possible. This will be achieved through the implementation of activities grouped under seven objectives.The objectives of the Regional Action PlanObjective 1Strengthen malaria programme management basedon firm political commitment and strong partnershipsIt will be achieved through comprehensive means.Malaria control policies, strategies, guidelines and standardoperating procedures will be strengthened. Legal frameworkswill be upgraded where necessary to support malariacontrol and elimination. Commitment to malaria controlwill be increased at all levels through advocacy. Fundingsources will be identified andadequate financial support secured. Technical andadministrative management capacity will bestrengthened through a combination of recruitment andtraining. Partner coordination will be improved and keytechnical support networks reinforced. Cross-bordercollaboration will be strengthened. Programmaticmonitoring and evaluation will be improved and needsbasedoperational research will be coordinated tomaximize relevance and minimize duplication.Objective 2Ensure full coverage of the population at risk withappropriate vector control measuresIt will be achieved through the implementation of two keystrategies: universal coverage of populations at risk withlong-lasting insecticidal nets and insecticide-treated bednetsand, spraying homes in selected areas withresidual insecticides. Supporting activities will include qualityassurance of insecticides and netting, riskmapping, strengthening the management and judicious useof insecticides and needs-based operationalresearch. Integrated vector management will beencouraged where feasible.28

Objective 3Objective 4Maximize utilization of malaria services (through appropriateinformation, education and communicationand/or behaviour change communication) and dramaticallystrengthen community mobilization effortsIt will be achieved through the implementation of two keystrategies: comprehensive behaviour changecommunication and community mobilization. Bothstrategies will be supported by periodic evaluationsand needs-based operational research.Ensure access for all to early diagnosis and affordable,safe, effective and prompt antimalarial combinationtreatments through active public and privatesector initiativesIt will be achieved through the implementation of two keystrategies through both public and private sector healthcare channels: providing quality parasite-based diagnosisand safe effective antimalarials for treatment of allspecies of malaria, including radical treatment for vivaxmalaria. Supporting activities will include capacity-building,supervision, quality assurance, raising awareness about theprevention of artemisinin resistance and withdrawal of oralartemisinin monotherapy from the public and private sector,strengthening differential diagnosis of fevers, improvingprocurement and supply management and conductingrelevant operational research.29

Regional Action Plan for Malaria Control and Elimination in the Western PacificGoal, Objectives and Targets of the Regional Action PlanObjective 5Ensure comprehensive coverage of vulnerable, poorand/or marginalized populations at high risk ofmalaria with appropriate malaria control measuresIt will be achieved through a number of different means:target groups and existing public health interventions willbe reviewed and mapped. Comprehensive new interventionmechanisms, covering prevention, diagnosis and treatmentand behaviour change communication and communitymobilization, will be worked out(based on integrated primary health care models, whereappropriate) and implemented. This includes intermittentpreventive treatment for malaria during pregnancy (IPTp)through antenatal care services in high-transmissionareas. Supporting activities will include the formulationof national policies and strategies, creating regionalcooperation frameworks, advocacy, monitoring andsupport for relevant operational research (including buildingcapacity for social research). A focal person will beassigned at the national programme level to manage theseactivities and to coordinate capacity-building.Objective 6Establish and/or strengthen the routine malaria surveillancesystem (all species) and ensure adequateoutbreak response capabilityIt will be achieved through a number of activities:biregional (WHO South-East Asia and Western PacificRegions) guidelines on malaria surveillance and outbreakpreparedness and response will be finalized, adapted tosuit national circumstances and endorsed at nationalstakeholder workshops. The national capacity forimplementation of these guidelines will be strengthened,progress will be monitored, national malaria riskstratifications will be worked out (where necessary)and regularly updated, antimalarial drug efficacy andinsecticide resistance will be monitored and the sharing ofmalaria epidemiological information among Member Stateswill be facilitated.30

Objective 7Accelerate malaria (all species) elimination efforts inparticipating countriesIt will be achieved through a number of means: the globalmalaria elimination guidelines will be adapted to the AsiaPacific context and these will be adopted and implementedby participating countries; strong technical collaborationnetworks will be built; intercountry coordination and harmonizationwill be supported; rigorous elimination-specificsurveillance will be established; progress will be monitored;and needs-based operational research carried out. Thisobjective also incorporates the containment and ultimateelimination of artemisinin-resistant P. falciparum.Detailed activities associated with each of these objectives arepresented in the logical framework below.Successful implementation of programme activities isexpected to result in the following achievements:(1) Deaths due to malaria (number and rate) will decrease byat least 50% by 2015 compared with the 2007baseline.(2) Confirmed malaria cases (number and rate) will bereduced by at least 50% by 2015 compared with the 2007baseline.(3) Percentage of cases due to P. falciparum will bedecreased compared with the 2007 baseline.(4) Admitted malaria cases (number and rate)will drop by at least 50% by 2015 compared with the 2007baseline.(5) Malaria test positivity rate (for microscopy and rapiddiagnostic tests) will be reduced to less than 5% in at leastsix countries by 2015.(6) At least seven countries will have achieved interruption ofmalaria transmission in targeted areas by 2015.31

Regional Action Plan for Malaria Control andElimination in the Western Pacific2010 – 2015Note: [GMI] denotes ‘global malaria indicator’ to be reported at least annually to WHO. All indicators are health information systemor programme indicators unless specified otherwise.Planning elements Indicators Verification source Assumptions and risksOverall regionalgoal:To consolidate and build onachievements in malariacontrol in the Region andprogressively eliminatemalaria where possible.1. Deaths due to malaria(number and rate) [GMI].Regional target: reduction by atleast 50% by 2015compared to 2007 baseline.2. Confirmed malaria cases(number and rate) [GMI].Regional target: reduction by atleast 50% by 2015 compared to2007 baseline.Member States‘ regularreports to WHONational reports onverification of interruption ofmalaria transmissionGlobal financial crisis does notaffect funding for malaria duringthis period and inthis Region.Political commitment for malariacontrol and elimination is increasedand sustained.National counterpart resourcesare increased at all levels.3. Cases due to Plasmodiumfalciparum, Plasmodium vivaxor other malaria parasite spezies(number and percentage) [GMI].Regional target: decrease inpercentage of P. falciparumcases compared to 2007baseline.Sustained interest in partnershipsby key stakeholders.Political and security situationsdo not interfere with programimplementation.4. Admitted malaria cases(number and rate) [GMI].Regional target: reduction by atleast 50% by 2015compared to 2008 baseline.5. Malaria test positivity rate (formicroscopy and rapiddiagnostic tests) [GMI].Regional target: by 2015 atleast six (out of 10) countrieshave a test positivity rateof

Regional Action Plan for Malaria Control andElimination in the Western Pacific2010 – 2015Note: [GMI] denotes ‘global malaria indicator’ to be reported at least annually to WHO. All indicators are health information systemor programme indicators unless specified otherwise.Planning elements Indicators Verification source Assumptions and risksObjective 2:Ensure full coverage ofthe population at risk withappropriate vector controlmeasures.1. Percentage of populationat risk covered by long lastinginsecticidal net or insecticide-treated bednet distribution[GMI].Annual malaria programmereportsPolicies are applied byMember States.Malaria tools continue to beeffective.2. Percentage of population atrisk covered by re-treated nets.No shortage of long lastinginsecticidal nets.3. Percentage of population atrisk covered by indoor residualspraying [GMI].Sustained interest in partnershipsby key stakeholders.4. Percentage of target populationcovered by indoor residualspraying [GMI].5. Percentage of households atrisk of malaria with at least onelong lasting insecticidal net orinsecticide-treatedbednet and/or sprayed byindoor residual spraying in thelast 12 months.Periodic household survey34

Regional Action Plan for Malaria Control andElimination in the Western Pacific2010 – 2015Planning elements Indicators Verification source Assumptions and risksObjective 5:Ensure comprehensive coverageof vulnerable, poorand/or marginalizedpopulations at high risk ofmalaria with appropriatemalaria control measures.1. Comprehensive interventionsfor vulnerable populations athigh risk of malaria (pregnantwomen, children under fiveyears, ethnic minority groups,mobile or migrant populations,HIV-positive persons andothers, as applicable) areimplemented according topolicy.Annual reports from malariaor other involved programmesPolitical commitment foraddressing malaria invulnerable populations is increasedand sustained.Political and security situationsdo not interfere withprogramme implementation.2. Percentage of vulnerablepopulations at high risk ofmalaria covered by long lastinginsecticidal net or insecticidetreatedbednet distribution[GMI].Annual reports from malariaor other involved programmes3. Percentage of pregnantwomen attending antenatalcare receiving at least twodoses of intermittent preventivetherapy [GMI].Note: Only for high transmissionareas in Pacificcountries.Monthly health informationsystems or malariaprogramme reports37

Regional Action Plan for Malaria Control andElimination in the Western Pacific2010 – 2015Note: [GMI] denotes ‘global malaria indicator’ to be reported at least annually to WHO. All indicators are health information systemor programme indicators unless specified otherwise.Planning elements Indicators Verification source Assumptions and risksObjective 6:Establish and/or strengthenthe routine malariasurveillance system(all malaria species) andensure adequate outbreakresponse capability.1. Completeness of monthlyhealth facility reports on surveillanceand logistics [GMI].2. Country has functional systemfor outbreak detection, preparednessand timely response.3. The country‘s malaria riskstratification is developedand updated at least every fiveyears, based on the surveillancedata (confirmed cases).Monthly health informationsystems reportsAnnual malaria programmereportsStratification (or re-stratification)reportPolitical commitment all levelsavailable.Human resources can be rapidlymobilized and trained.Sustained interest in partnershipsby key stakeholders.4. Systematic monitoring ofantimalarial drug efficacy iscarried out at least every two tothree years, according to WorldHealth Organization protocol.Annual antimalarial drugefficacy monitoring report5. Systematic monitoring ofinsecticide resistance iscarried out at least every two tothree years, followingWorld Health Organizationguidelines.Annual malaria programmereports, regional insecticideresistance monitoringnetwork reports38

Regional Action Plan for Malaria Control andElimination in the Western Pacific2010 – 2015Planning elements Indicators Verification source Assumptions and risksObjective 7:Accelerate malaria(all species) eliminationefforts in participatingcountries.1. Country has an eliminationstrategy in line with regionalguidelines.2. Country has reoriented thenational malaria control programmetowards anelimination programme in targetedareas.3. Percentage of administrativeunits in a country with anannual parasite incidence of

ActivitiesResponsibleObjective 1: Strengthen malaria programme management based on firm political commitment and strong partnerships1.1 Strengthen malaria control policies, strategies,guidelines and standard operating procedures.1.1.1 Review and update national malaria policies, strategies,guidelines and strategic plans and carry outan independent or joint review, at leastevery five years.1.1.2 Review the malaria programme managementstructure to achieve programme outcomes at alllevels, taking into account decentralization anda programme‘s move to malaria eliminationwhere applicable.1.1.3 Develop a comprehensive human resource capacitydevelopment plan, taking into account decentralizationand malaria elimination, and include it in the nationalmalaria control and elimination strategic plan.1.1.4 Carry out a monitoring and evaluation needsassessment, using the Monitoring and EvaluationSystem Strengthening Tool, and develop plans forstrengthening the overall national monitoringand evaluation framework.1.1.5 Develop and/or strengthen a rational approach forintegrating malaria programme activities into relevanthealth programmes at various levels of the healthsystem (e.g. Integrated Management of ChildhoodIllnesses).1.1.1 National Malaria Control Programme andMinistry of Health, World Health Organization.1.1.2 National Malaria Control Programme andMinistry of Health.1.1.3 Ministry of Health and public service departments(World Health Organization to facilitate).1.1.4 National Malaria Control Programme and Ministry ofHealth.1.1.5 Ministry of Health, National Malaria ControlProgramme and other relevant programmes.1.2 Ensure that the legal framework is adequate formalaria control and elimination.1.2.1 Review existing legal frameworks regarding publichealth legislation, insecticides, medications, etc., andamend if required.1.2.2 Ensure adequate implementation of legal systemsregarding public health legislation, insecticides,medications, etc., as required, including enforcementprocesses to address counterfeiting of medicines.1.2.1 National Malaria Control Programme and Ministry ofHealth, other government sectors, WorldHealth Organization.1.2.2 National government and partners, including Interpol.1.3 Strengthen commitment for malaria control andelimination at all levels through advocacy.1.3.1 Document and consolidate malaria programmeexperiences, best practices, successes and lessonslearnt for use in advocacy, and disseminate amongstakeholders.1.3.2 Provide regular briefings to high-level governmentoffcials and opinion leaders.1.3.3 Implement appropriate communication strategiestargeting all partners of malaria programmesat all levels within each country.1.3.4 Promote the malaria agenda through high-levelpolitical regional forums.401.3.1 National Malaria Control Programme and Ministry ofHealth, World Health Organization and partners.1.3.2 National Malaria Control Programme and Ministry ofHealth, other government sectors.1.3.3 National Malaria Control Programme and Ministry ofHealth, partners.1.3.4 World Health Organization, United Nations SpecialEnvoy and partners.

ActivitiesResponsibleObjective 1: Strengthen malaria programme management based on firm political commitment and strong partnerships1.4 Identify funding sources and secure adequatefinancial support.1.4.1 Have a costed national malaria strategy in the shortandmedium-term.1.4.2 Identify funding gaps.1.4.3 Secure flexible, consistent and adequate fundingfrom internal and external sources to ensuresustainability of programmatic efforts.1.4.4 Support countries to secure adequate funding,for example, through technical support for proposalwriting.1.4.5 Incorporate malaria as a key agenda item in otherdevelopment initiatives.1.5 Strengthen technical and administrativemanagement capacity.1.5.1 Strengthen human resources (based on the humanresource plan, see activity 1.1.3 through recruitment,retention, professional development, training,super vision and other methods to improve staffcapacity [Special emphasis on capacity developmentwill be required in countries adopting a malariaelimination approach].1.5.2 Ensure adequate infrastructure and strengthenlogistics capability to support malaria programmeoperations.1.5.3 Strengthen financial management.1.6 Strengthen country and international stakeholdercoordination.1.6.1 Strengthen national coordination of malariaprogramme activities.1.6.2 Promote integration of malaria control and eliminationwith other public health programmes, maximizingsynergies where possible.1.6.3 Develop mechanisms for intersectoral cooperation,and promote integration of malaria control, involvingthe private sector and nongovernmentalorganizations.1.4.1 National Malaria Control Programme and Ministryof Health, other relevant government andnongovernment sectors.1.4.2 National Malaria Control Programme and Ministry of Health.1.4.3 National Malaria Control Programme and Ministryof Health, other relevant government andnongovernment sectors.1.4.4 World Health Organization and other partners.1.4.5 National Malaria Control Programme and Ministryof Health, other relevant government andnongovernment sectors.1.5.1 Ministry of Health and National Malaria ControlProgramme, public service departments and humanresource specialists in the health sector.1.5.2 National Malaria Control Programme and Ministryof Health, partners.1.5.3 National Malaria Control Programme and Ministryof Health, Ministry of Finance.1.6.1 National Malaria Control Programme and Ministryof Health, World Health Organization.1.6.2 National Malaria Control Programme, Ministryof Health and relevant public health programmes.1.6.3 National Malaria Control Programme and Ministryof Health, relevant sectors and partners, World HealthOrganization.1.6.4 Incorporate malaria into environmental impact assessments for all major development projects, and workclosely with multisectoral partners to preventthe development of new malaria transmission foci.1.6.5 Promote and facilitate regional, sub-regional andinter-regional cooperation and coordination ofmalaria control and elimination programmes.1.6.4 National Malaria Control Programme and Ministryof Health.1.6.5 World Health Organization, Mekong Malaria Program, RollBack Malaria Partnership, Association of Southeast AsianNations, Asia-Pacific Malaria Elimination Network, andother regional and sub-regional networks.41

ActivitiesResponsibleObjective 1: Strengthen malaria programme management based on firm political commitment and strong partnerships1.7 Strengthen key technical support networks.1.71 Promote dissemination, adoption and implementationof best practices through technical networks(see activity 1.3.1).1.72 Develop annual workplans and sustainable financingmechanism for implementation of designated activitiesat World Health Organization collaborating centres.1.7.3 Collaborate with existing and emerging regional andsub-regional malaria networks (e.g. ACTMalaria,Asia Vivax Network, Asia-Pacific Malaria EliminationNetwork, SEAMEO TROPMED).1.7.1 World Health Organization and partners.1.7.2 World Health Organization, Member States,collabora ting centres and partners.1.7.3 Member States, World Health Organization andpartners.1.8 Strengthen programmatic monitoring and evaluation.1.8.1 Improve and implement monitoring and evaluationfor the malaria programme based on the nationalmonitoring and evaluation plan, through the routinehealth information system and other methods asappropriate (including periodic malaria indicatorsurveys, sentinelsite surveillance).1.8.2 Prepare annual reports for the malaria programmeand submit them to key stakeholders including WorldHealth Organization.1.8.3 Harmonize regional malaria minimum data-sets.1.8.4 Conduct regular malaria programme reviews.1.9 Strengthen cross-border collaboration.1.9.1 Develop and implement cross-border malaria actionplans, and synergize with existing cross-bordercollaborations, both internationally and nationally(interprovincial collaboration).1.9.2 Support international and national border meetings atdistrict, provincial and central levels.1.9.3 Monitor progress based on identified meetingrecommendations and cross-border actions.1.8.1 National Malaria Control Programme, Ministryof Health and partners.1.8.2 National Malaria Control Programme and Ministryof Health.1.8.3 World Health Organization to facilitate.1.8.4 National Malaria Control Programme and Ministryof Health, World Health Organization and partners.1.9.1 National Malaria Control Programme and Ministryof Health, Ministry of Foreign Affairs, relevantgovernment sectors and partners.1.9.2 Member States, World Health Organization andpartners.1.9.3 World Health Organization, National Malaria ControlProgramme and Ministry of Health.1.10 Coordinate operational research and set priorities.1.10.1 Periodically identify regional, sub-regional and nationalresearch priorities (with special attention to socialscience gaps including gender).1.10.2 Support regular technical reviews of national researchfindings and update national plans, policiesand research priorities accordingly.1.10.3 Promote the conduct of joint operational researchbetween the malaria programme and academiato fill programmatic gaps.1.10.4 Support advocacy for bi-regional, regional andsub-regional malaria research initiatives.421.10.1 World Health Organization and partners (regional),National Malaria Control Programme and Ministryof Health and partners (national).1.10.2 National Malaria Control Programme and Ministryof Health and partners.1.10.3 World Health Organization, National Malaria ControlProgramme, Ministry of Health and partners.1.10.4 World Health Organization and partners.

ActivitiesResponsibleObjective 2: Ensure full coverage of the population at risk with appropriate vector control measures.2.1 Achieve and maintain universal coverage of theat-risk population (static and mobile) with free longlasting impregnated materials, e.g. long lastinginsecticidal nets, hammock nets or conventionalnets treated or re-treated with long lasting insecticideto achieve effective vector control.2.1 National Malaria Control Programme, World HealthOrganization Pesticide Evaluation Schemeand qualified quality assurance facilities, partners.2.1.1 Develop standard operating procedures.2.1.2 Conduct periodic planning and quantification of needs.2.1.3 Procure commodities.2.1.4 Develop human resources as necessary.2.1.5 Conduct quality assurance for commoditiesincluding tenacity and bursting strength for nets.2.1.6 Develop and implement distribution and re-treatmentplan (macro and micro).2.1.5 National Malaria Control Programme and otherstakeholders. World Health Organization PesticideEvaluation Scheme to facilitate.2.1.7 Monitor quality and coverage of service delivery andutilization of nets.2.2 Develop and periodically review quality assurancefor vector control products using standard protocols(World Health Organization Pesticide EvaluationScheme, Global Malaria Programme), and identifyand certify quality assurance laboratories.2.3 Implement high quality preventive and/orresponsive indoor residual spraying whereappropriate, based on vector behaviour andmalaria risk stratification (see 6.5).2.2 World Health Organization Global Malaria Programme,World Health Organization Pesticide Evaluation Scheme.2.3 National Malaria Control Programme, supported byWorld Health Organization and technical partners.2.3.1 Develop regional guidelines on the use of indoorresidual spraying and the combined use of longlasting insecticidal nets and indoor residual spraying.2.3.2 Develop standard operating procedures.2.3.3 Conduct geographical reconnaissance, planningand quantification of needs.2.3.4 Procure insecticides and equipment.2.3.5 Develop human resources as necessary.2.3.6 Conduct quality assurance for insecticidesand equipment.2.3.7 Implement indoor residual spraying as appropriate.2.3.8 Monitor quality and coverage of indoorresidual spraying.43

ActivitiesResponsibleObjective 2: Ensure full coverage of the population at risk with appropriate vector control measures.2.4 Strengthen management and judicious use ofpublic health insecticides.2.4.1 Adhere to World Health Organization Pesticide EvaluationScheme recommendations during procurementof insecticides.2.4 National Malaria Control Programme, supportedby World Health Organization (including WorldHealth Organization Pesticide Evaluation Scheme),Food and Agriculture Organization and technicalpartners.2.4.2 Develop and implement guidelines on managementand judicious use of public health insecticides,including annual reporting of insecticide usage(to the World Health Organization) and safe disposalof expired insecticides.2.5 Introduce Integrated Vector Management whereappropriate.2.5.1 Conduct vector control needs assessment.2.5 National Malaria Control Programme, supported byWorld Health Organization (including NeglectedTropical Diseases and Vector Ecology and Managementunits) and technical partners.2.5.2 Develop and implement regional and nationalIntegrated Vector Management strategic planwhere appropriate.2.5.3 Build national capacity to implement Integrated VectorManagement principles and practices.2.6 Conduct needs-based operational research onvector control and personal protection.2.6.1 Develop innovative and appropriate vector control andpersonal protection measures with special emphasison high-risk groups and high-risk behaviour(epidemiological, entomological and social research).2.6.2 Develop improved quality assurance assay methodologiesfor long-lasting insecticidal nets and residualinsecticides.2.6 National research institutions and groups (includingNational Malaria Control Programme) and WorldHealth Organization at the global level (TropicalDisease Research, Global Malaria Programme,World Health Organization Pesticide EvaluationScheme) and at the Western Pacific Regional Office(Healthy Settings and Environment, Health SystemsDevelopment, Malaria and other Vector-borne andParasitic Diseases).2.6.3 Investigate the additional impact and cost-effectiveness of combining long-lasting insecticidal nets andindoor residual spraying interventions.2.6.4 Conduct environmental and climate impact studies onmalaria transmission and investigate the role of malariavectors in development projects.2.6.5 Develop an approach and mechanisms for dealing withold long lasting insecticidal nets.44

ActivitiesResponsibleObjective 3: Maximize utilization of malaria services (through appropriate information, education and communication and/orbehaviour change communication) and dramatically strengthen community mobilization efforts.3.1 Implement comprehensive health promotion andbehaviour change communication campaigns.3.1.1 Develop and/or update the policy or strategy for healthpromotion and behaviour change communication.3.1.2 Regularly assess behaviour change communicationmethodology and approaches and revise asappropriate.3.1 National Malaria Control Programme, centres forhealth education, other government programmesand departments, nongovernmental organizationsand civil society, supported by World HealthOrganization, United Nations Children‘s Fundand other partners.3.1.3 Strengthen capacity in relation to behaviour changecommunication.3.1.4 Coordinate behaviour change communication activitieswith relevant partners and with other healthprogrammes.3.1.5 Implement targeted behaviour change communicationcampaigns and/or activities for key aspects of themalaria programme, including:Key messages on diagnosis and treatment forproviders and the population at risk:- diagnosis before treatment;- early diagnosis and treatment;- correct medicines, dosages and compliance;- awareness about counterfeit medicines.Key messages on vector control for the populationat risk:- importance of habitual use of long lastinginsecticidal net or conventional insecticide-treated net;- regular insecticide re-treatment of conventionalmosquito nets;- importance of compliance with indoor residualspraying.3.2 Implement comprehensive communitymobilization activities.3.2.1 Engage communities to ensure ownership andparticipation in comprehensive malaria controland elimination activities.3.2 National Malaria Control Programme, nongovernmentalorganizations, partners, and governmentat all levels.3.2.2 Engage local government units and other keystake holders to ensure smooth implementationand sustainability of the malaria programme.3.3 Carry out periodic evaluations to assess theimpact of information, education and communicationmaterials and behaviour change communi-cation on the utilization of malaria controlservices.3.4 Conduct needs-based operational research(e.g. community preferences and acceptability ofvarious vector control measures).3.3 National Malaria Control Programme and Ministryof Health, and partners.3.4 National Malaria Control Programme, researchorganizations and technical partners.45

ActivitiesResponsibleObjective 4: Ensure access for all to early diagnosis and affordable, safe, effective and prompt antimalarial combinationtreatments through active public and private sector initiatives.4.1 Ensure country-wide coverage with qualityparasite-based diagnosis (microscopy and malariarapid diagnostic tests), including for P. vivax.4.1.1 Ensure adequate coverage of quality diagnosticservices at health facility and community levels,as part of the national health system.4.1.2 Develop policies and implement quality assuranceof diagnostics (microscopy and rapid diagnostic tests).4.1.3 Expand and maintain regional quality assurance inmalaria diagnostics (including management ofslide bank).4.2 Ensure uninterrupted availability of antimalarialmedicines and diagnostics at all publichealth facilities serving populations at risk, aswell as at community level where appropriateand in the private sector where possible.4.2.1 Develop and/or update procurement and supplymanagement guidelines.4.2.2 Support timely procurement of quality diagnosticsand antimalarials, including quantification.4.2.3 Improve storage, regular stock management anddistribution of diagnostic and antimalarial suppliesat all levels.4.2.4 Improve the storage of rapid diagnostic tests andartemisinin-based combination therapy at theperipheral level where electricity is not available, e.g.through the use of cooler boxes, and monitortheir implementation.4.1.1 Ministry of Health, National Malaria ControlProgramme.4.1.2 Ministry of Health, National Malaria ControlProgramme, World Health Organization.4.1.3 World Health Organization, Foundation for InnovativeNew Diagnostics, Research Institute of TropicalMedicine of the Philippines, Pasteur InstituteCambodia and other laboratories, Asian CollaborativeTraining Network for Malaria.4.2.1 Ministry of Health, National Malaria Control Programme,Food and Drug Administration, WorldHealth Organization.4.2.2 Ministry of Health, National Malaria ControlProgramme, World Health Organization, UnitedNations Children’s Fund.4.2.3 Ministry of Health, National Malaria ControlProgramme, central medical stores, hospitals.4.2.4 Ministry of Health, National Malaria ControlProgramme.4.3 Ensure access to safe and effective antimalarialcombination treatment for all populationsat risk, including for P. vivax.4.3.1 Regularly review and, if necessary, update nationalmalaria treatment guidelines based onavailable evidence (see activity 6.6), in the contextof elimination where appropriate.4.3.2 Provide antimalarial treatment according to nationaltreatment guidelines.4.3.3 Incorporate community-based treatment targetinghard-to-reach populations (including ethnic minorities)into national health systems (including financing).4.3.1 Ministry of Health and National Malaria ControlProgramme, supported by World Health Organization.4.3.2 Ministry of Health, National Malaria ControlProgramme.4.3.3 Ministry of Health.46

ActivitiesResponsibleObjective 4: Ensure access for all to early diagnosis and affordable, safe, effective and prompt antimalarial combinationtreatments through active public and private sector initiatives.4.3.4 Develop appropriate training and information, educationand communication materials to improve the acceptabilityand use of artemisinin-derivative suppositoriesfor pre-referral treatment of suspected severe malaria.4.3.5 Develop and implement appropriate strategies toaddress G6PD deficiency in P. vivax radicalcure treatment.4.3.6 Establish and maaintain pharmacovigilance system.4.3.7 Conduct regular quality monitoring of antimalarialmedicines (public and private sector).4.3.8 Support appropriate actions in case substandard orcounterfeit antimalarials are found, includingenforcement of legislation.4.3.9 Participate in inter-country and regional coordinationefforts on case management issues.4.4 Build awareness and ensure commitment at alllevels to prevent development and spreadof artemisinin resistance.4.4.1 Promote rational use of artemisinin-based combinationtherapy for uncomplicated malaria among careproviders and users.4.4.2 Withdraw oral artemisinin monotherapy from publicand private sector and enforce this.4.3.4 National Malaria Control Programme.4.3.5 National Malaria Control Programme, hospitaldepartment, Ministry of Health.4.3.6 Drug Regulatory Authority and Ministry of Health.4.3.7 Drug Regulatory Authority, National Malaria ControlProgramme, partners.4.3.8 Drug Regulatory Authority, National Malaria ControlProgramme, Police, Customs, Interpol, World HealthOrganization.4.3.9 National Malaria Control Programme, Ministry ofHealth, World Health Organization, partnersand networks.4.4.1 Ministry of Health, National Malaria Control Programme,Drug Regulatory Authority, training institutions,partners.4.4.2 Ministry of Health, Drug Regulatory Authority.4.5 Engage the private sector in effective diagnosis,treatment and reporting of malaria.4.5.1 Develop regional and national policies to engage withthe private sector in malaria diagnosis, treatmentand reporting (including task forces, countrypilots and evaluations).4.5.2 Evaluate and document existing private sectorinitiatives.4.5.1 Ministry of Health, National Malaria Control Programme,Drug Regulatory Authority, hospital department, medicaland pharmacists associations, supported by World HealthOrganization and technical partners.4.5.2 Ministry of Health, National Malaria Control Programme,World Health Organization, medical and pharmacistsassociations.4.5.3 Establish and expand engagement of the privatesector in malaria diagnosis and treatment, whereappropriate.4.5.3 Ministry of Health, National Malaria Control Programme,medical and pharmacists associations,medical registration boards, partners.4.5.4 Coordinate with the Affordable Medicines Facilitymalaria (AMFm) to ensure that treatment will belinked to parasite-based diagnosis.4.5.4 National Malaria Control Programme, Drug RegulatoryAuthority, Ministry of Health.47

ActivitiesResponsibleObjective 4: Ensure access for all to early diagnosis and affordable, safe, effective and prompt antimalarial combinationtreatments through active public and private sector initiatives.4.6 Build and maintain human and health systemscapacity at all levels for adequate managementof malaria and other febrile conditions(differential diagnosis).4.6.1 Conduct training and regular refresher training,covering parasite-based diagnosis, microscoperepair and maintenance, supplies quantification,procurement and supply management, treatmentof uncomplicated and severe malaria, etc.4.6.2 Conduct supportive supervision during integratedsupervisory visits, including follow-up on trainingeffectiveness.4.6.3 Expand differential diagnostic and treatmentcapacity of febrile illnesses and ensure adequatesupplies and equipment at health facility andcommunity levels.4.6.4 Develop and share training modules.4.6.1 National Malaria Control Programme, medical traininginstitutions.4.6.2 National Malaria Control Programme,Ministry of Health.4.6.3 National Malaria Control Programme, Ministryof Health, Centre for Disease Control, Maternal andChild Health.4.6.4 National Malaria Control Programme, ACTMalaria,World Health Organization, training institutions.4.7 Ensure adequate monitoring and evaluation ofdiagnostic and treatment coverage and practicesand supply management at health facilityand community levels.4.7.1 Update monitoring and evaluation guidelines,including those for the community level.4.7.2 Strengthen routine monitoring of malaria treatmentquality and diagnostic practices, e.g. through the useof a malaria patient card.4.7.3 Strengthen routine monitoring of the management ofof antimalarial medicines and diagnostics, includingat the community level.4.7.4 Conduct surveys to evaluate diagnostic and treatmentpractices and availability of supplies and equipment.4.7.1 National Malaria Control Programme, Ministryof Health, World Health Organization, partners.4.7.2 National Malaria Control Programme, Ministryof Health.4.7.3 National Malaria Control Programme, central medicalstore, drug regulatory authority, Ministry of Health.4.7.4 National Malaria Control Programme, Ministryof Health, institutes of public health, World HealthOrganization, partners.48

ActivitiesResponsibleObjective 4: Ensure access for all to early diagnosis and affordable, safe, effective and prompt antimalarial combinationtreatments through active public and private sector initiatives.4.8 Conduct relevant operational research related tomalaria diagnosis and treatment, including:4.8.1 Develop a simple and rapid test for G6PD deficiency.4.8 National Malaria Control Programme, Ministry ofHealth, research institutions, national and internationalpartners including World Health Organization.4.8.2 Conduct surveys of G6PD deficiency and mapfindings.4.8.3 Develop and execute a series of research studies(clinical and laboratory) leading to the safest possibleapplication of primaquine against P. vivax malaria, bycountry, including short-course treatment.4.8.4 Evaluate therapies for radical cure that may be appliedto either P. falciparum or P. vivax malaria or both.4.8.5 Explore improved adherence to national treatmentguidelines, including those for P. vivax (packaging,formulation, supervised treatment, training,information, education and communication andbehaviour change communication).4.8.6 Assess the feasibility and acceptability of use ofprereferral artemisinin-derivative suppositories forsevere malaria.4.8.7 Evaluate and document experiences with communitybasedmalaria diagnosis and treatment in countriesacross the Region.4.8.8 Assess local causes of non-malaria febrile illnesses fordevelopment of case management algorithm.4.8.9 Complete development and validation of the coolerbox system for rapid diagnostic tests andartemisinin-based combination therapy storage.49

ActivitiesResponsibleObjective 5: Ensure comprehensive coverage of vulnerable, poor and/or marginalized populations at high risk ofmalaria with appropriate malaria control measures.5.1 Identify and characterize target groups, theirhealth problems and their basic health behaviours.Vulnerable groups who live in or move into malaria riskareas include:• pregnant women;• children under five years;• ethnic minority groups;• mobile and/or migrant populations, includingminers and forest goers;• people living with HIV/AIDS;• neglected, poor and marginalized groups;• military;• prisoners;• refugees;• island populations;• others where applicable.5.1 Ministry of Health, National Malaria ControlProgramme, other programmes and sectors,partners including World Health Organization.5.2 Review and map existing public healthinterventions for these groups, examining:• stakeholders and partners within and beyondthe health sector;• infrastructure;• existing public health intervention and othernon-health-related resources.5.3 Develop and implement comprehensive interventionpackages for the target populations which:• are innovative, evidence-based and costeffective(e.g. impregnated hammock nets,standby treatment, impregnated blankets,new approaches to surveillance);• include appropriate delivery systems(e.g. community outreach);• include appropriate community empowermentand mobilization and information,education and communication materialsand/or behaviour change communication;• are gender sensitive;• include appropriate training models targetingcommunities and health care providers.50

ActivitiesResponsibleObjective 5: Ensure comprehensive coverage of vulnerable, poor and/or marginalized populations at high risk of malariawith appropriate malaria control measures.5.4 Develop integrated service delivery wherepossible, building on existing initiatives whereappropriate, to increase coverage of vulnerablepopulations at different levels(e.g. for pregnant women and small childrenthrough Integrated Management of ChildhoodIllnesses, maternal and child health and/or antenatalcare clinics; for HIV-positive persons through voluntarycounseling and testing and antiretroviral treatmentcentres; outreach).5.4.1 Introduce intermittent preventive treatment forpregnant women (IPTp) living in high transmissionareas in antenatal care facilities.5.4 Ministry of Health, National Malaria ControlProgramme, other health programmes (e.g. ExpandedProgramme on Immunization, Mother and Child HealthProgramme, Integrated Management of ChildhoodIllnesses), other sectors and partners.5.4.1 Mother and Child Health Programme, in cooperationwith National Malaria Control Programme.5.5 Establish a focal point in the National MalariaControl Programme to manage activities in 5.3and 5.4 and coordinate capacity development.5.6 Monitor intervention success by disaggregatingrelevant data by vulnerable group.5.7 Raise the profile of these groups andmobilize resources.5.5 Ministry of Health, National Malaria ControlProgramme.5.6 Ministry of Health, National Malaria ControlProgramme, health information systems unit.5.7 Governments, Ministry of Health, partners includingWorld Health Organization.5.7.1 Support advocacy for inter-programmatic andintersectoral cooperation through groups includingAsia-Pacific Economic Cooperation (APEC) andAssociation of Southeast Asian Nations (ASEAN)(e.g. through intersectoral task forces).5.7.2 Implement advocacy campaigns promotinginter-programmatic and intersectoral cooperation.5.7.3 Mobilize resources from the Asian Development Bank,World Bank, bilateral donors, Global Fund to FightAIDS, Tuberculosis and Malaria, private sector andothers.5.7.4 Stimulate the development of meaningfulpublic–private partnerships.51

ActivitiesResponsibleObjective 5: Ensure comprehensive coverage of vulnerable, poor and/or marginalized populations at high risk of malariawith appropriate malaria control measures.5.8 Conduct relevant operational research toaddress issues.5.8.1 Map vulnerable populations, and map malaria burdenin vulnerable populations.5.8 Research organizations, National Malaria ControlProgramme and partners, including World HealthOrganization.5.8.2 Define barriers to access.5.8.3 Conduct intervention research on malaria controlstrategies for different categories of mobile and/or migrant populations, including feasibility and useof standby treatment.5.8.4 Assess delivery of malaria control to vulnerablepopulations in decentralized systems.5.8.5 Explore strategies for controlling malaria atinternational borders.5.8.6 Conduct economic analysis of requirements toadequately address vulnerable populations.5.8.7 Assess the use of chemoprophylaxis to preventmalaria in pregnancy in low to moderatetransmission areas.5.8.8 Assess the effectiveness of routine screening ofpregnant women for malaria in low to moderatetransmission areas.5.8.9 Continue to evaluate the effectiveness of intermittentpreventive treatment for pregnant women(IPTp), including for P. vivax, in areas of moderate tohigh malaria endemicity.52

ActivitiesResponsibleObjective 6: Establish and/or strengthen the routine malaria surveillance system (all malaria species) and ensureadequate outbreak response capability.6.1 Finalize biregional guidelines on malariasurveillance (specific to programme stage)and outbreak preparedness and response(WHO South-East Asia and Western Pacific Regions).6.1 World Health Organization withstakeholders and partners.6.1.1 Identify essential components of country malariasurveillance (incorporating gender and age) andoutbreak preparedness and response systems.6.1.2 Draft guidelines on malaria surveillance and malariaoutbreak preparedness and response.6.1.3 Harmonize guidelines with those of other diseasesystems where possible (Communicable DiseaseSurveillance and Response, Expanded Programmeon Immunization, dengue, etc.).6.1.4 Hold consensus workshop, then finalize guidelinesand disseminate.6.1.5 Develop training module.6.2 Facilitate country ownership of malariasurveilance systems and outbreak preparednessand response guidelines.6.2 Ministry of Health, National Malaria ControlProgramme and partners.6.2.1 Establish and support technical working group to adaptmalaria surveillance and outbreak preparedness andresponse guidelines to fit national context.6.2.2 Draft, endorse and finalize national malaria surveillanceand outbreak preparedness and response guidelines.6.2.3 Explore opportunities to integrate malaria surveillanceinto the overall health information system.6.3 Strengthen national capacity and implementmalaria surveillance and outbreak preparednessand response strategies.6.3 Ministry of Health, National Malaria ControlProgramme and partners.6.3.1 Strengthen national capacity to achieve datamanagement requirements (e.g. malaria caseregister, case investigation form, laboratory register,national malaria database).6.3.2 Draft and finalize malaria surveillance and outbreakpreparedness and response training modules(based on World Health Organization andACTMalaria prototypes).6.3.3 Conduct training of trainers.6.3.4 Train national and sub-national staff on malariasurveillance and outbreak preparedness and response.6.3.5 Ensure adequate staff and technical assistance tosupport implementation of malaria surveillance and outbreak preparedness and response (including informationtechnology support for national malaria database).53

ActivitiesResponsibleObjective 6: Establish and/or strengthen the routine malaria surveillance system (all malaria species) and ensureadequate outbreak response capability.6.4 Monitor and report on progress of implementingthe activities described in the guidelines.6.5 Develop and regularly update national malariarisk stratification and estimates of thepopulation at risk.6.4 National Malaria Control Programme.6.5 National Malaria Control Programme with World HealthOrganization and partner support.6.6 Periodically monitor antimalarial drug efficacyincluding P. vivax in strategic sentinel sites.6.6.1 Strengthen capacity for in-country antimalarial drugefficacy monitoring, following the World HealthOrganization standard protocol, includingmolecular markers.6.6.2 Conduct monitoring.6.6.3 Advocate for continued support to regionaland subregional surveillance activities.6.7 Systematically monitor insecticide resistanceand bionomics of malaria vectors.6.8 Effectively share malaria surveillanceinformation among Member States (especiallyacross borders between administrative units).6.6.1 National Malaria Control Programme with World HealthOrganization and partner support.6.6.2 National Malaria Control Programme.6.6.3 World Health Organization, partners.6.7 National Malaria Control Programme with partner supportincluding World Health Organization, ACTMalaria.6.8 National Malaria Control Programme, World HealthOrganization.54

ActivitiesResponsibleObjective 7: Accelerate malaria (all species) elimination efforts in participating countries.7.1 Adapt global malaria elimination guidelines forthe Asia Pacific Region and develop appropriatestandard operating procedures (biregional – WHOSouth-East Asia and Western Pacific Regions).7.2 Countries committed to malaria eliminationin the Region adopt modified biregional guidelines.7.1 World Health Organization and Asia-Pacific MalariaElimination Network, other stakeholders and partners.7.2 National Malaria Programme, with support of WorldHealth Organization and partners.7.2.1 Align national malaria elimination strategies withbiregional guidelines (once these become available).7.2.2 Ensure adequate technical support to adjust and/orimplement the national strategy for malaria elimination.7.3 Implement progressive elimination of malariafrom selected geographical areas.7.3 National Malaria Programme with partner support.7.3.1 Re-orient the malaria programme.7.3.2 Familiarize public sector, private sector and otherstakeholders with elimination strategy andassociated roles and responsibilities.7.3.3 Mobilize and sustain community support, participationand resources.7.3.4 Establish fast, effective communication systems forhealth workers at all levels.7.3.5 Establish and maintain monthly collection of malariadata from all private sector health care providers.7.3.6 Establish a geographical information system forplanning and monitoring progress in elimination.7.3.7 Implement comprehensive investigation for allcases identified through routine passive case detectionand follow-up.7.3.8 Conduct prompt in-depth investigations in allsuspected transmission foci according toelimination guidelines.7.3.9 Provide timely and effective focal indoor residualspraying according to standard operating procedures.7.3.10 Ensure radical treatment for all P. vivax cases identified,and gametocyte treatment for P. falciparum cases.55

ActivitiesResponsibleObjective 7: Accelerate malaria (all species) elimination efforts in participating countries.7.4 Ensure strong technical cooperation withcountries, relevant networks and researchinstitutions committed to malaria elimination.7.4 World Health Organization with stakeholdersand partners.7.4.1 Formulate and coordinate an elimination researchagenda (with special attention to P. vivax).7.4.2 Provide necessary technical support.7.4.3 Disseminate annual progress and technical reports.7.4.4 Encourage and support the development and fundingof cross-border elimination operations.7.5 Monitor progress to malaria elimination.7.5.1 Establish a national malaria elimination monitoringcommittee to monitor progress.7.5 National Malaria Program with World HealthOrganization, Asia-Pacific Malaria Elimination Networkand other partners.7.5.2 Conduct joint planning and monitoring withWHO Western Pacific and South-East Asia RegionalOffices, Asia-Pacific Malaria Elimination Networkand experts from countries which are implementingelimination.7.5.3 Support intercountry malaria elimination meetings.56

ActivitiesResponsibleObjective 7: Accelerate malaria (all species) elimination efforts in participating countries.7.6 Contain and ultimately eliminate artemisininresistantmalaria parasites (P. falciparum)in affected areas.7.6 National Malaria Programme in containment area,World Health Organization with stakeholdersand partners.7.6.1 Eliminate artemisinin-resistant parasites bydetecting all malaria cases in target areas andensuring effective treatment and gametocyte clearance.7.6.2 Decrease drug pressure for selection ofartemisinin resistant malaria parasites.7.6.3 Prevent transmission of artemisinin-resistantmalaria parasites by high coverage mosquito controland personal protection efforts.7.6.4 Limit the spread of artemisinin-resistant malariaparasites by effectively targeting mobile and/ormigrant populations.7.6.5 Support containment and/or elimination of artemisininresistantparasites through comprehensive behaviourchange communication, community mobilizationand advocacy.7.6.6 Undertake basic and operational research to fillknowledge gaps and ensure that containment and/or elimination strategies applied are evidence-based.7.6.7 Provide effective management and coordination toenable rapid and high-quality implementation of thecontainment and/or elimination strategy.7.6.8 Explore mechanisms that would trigger internationalreporting under the International Health Regulations(IHR) in the context of artemisinin resistance.7.7 Conduct operational research to supportelimination efforts as appropriate.7.7 Research organizations, National Malaria Programme,partners, World Health Organization.7.7.1 Develop, assess and/or adapt feasible highlysensitive diagnostic tests for mass screening.7.7.2 Conduct economic analysis of targeted eliminationover the medium-term.7.7.3 Conduct operational research aimed at developinga strategy for the elimination of zoonoticPlasmodium knowlesi.57

WHO Western Pacific RegionPUBLICATIONISBN-13 978 92 9061 557 6