CAMBODIAN NATIONAL MALARIA CONTROL PROGRAM

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CAMBODIAN NATIONAL MALARIA CONTROL PROGRAM
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OUTLINE OF PRESENTATION

• Burden of Malaria
• National Malaria Control Program (NMCP)
• Contribution made by GF Grants to National
  Targets
• Obstacles and challenges faced
• Innovative Interventions
• Bottleneck
• Partners
• Future Perspective

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Malaria Disease Burden in Cambodia
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Average 9.7 annual reduction of (reported)
malaria cases since 2004.
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Malaria Disease Burden in Cambodia (contd.)
Transmission is high and seasonal being
associated with the rainy season
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Malaria Disease Burden in Cambodia (contd.)
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Organizational structure of NMCP (Public Sector)
The National Malaria Control Program is a
vertical program led by CNM, but it is
decentralized administratively with
responsibilities for activities assigned to
provincial and district health departments.
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Functions decentralized by CNM
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Goal Reduction of malaria mortality by 50 in
2014 and malaria morbidity at least by 30 in
2014 (consistent with the Round 2 overarching
goals)

• Strategies
• Strategy 1 Improving access to preventive
  measures (LLINs and LLIHNs) that protect the
  population at risk
• Strategy 2 Increasing access to early diagnosis
  and treatment (EDAT) for malaria throughout the
  country by scaling up the VMW project approach.
• Strategy 3 Increasing community awareness and
  improving care-taking practices on malaria
  prevention and control with promotion of proper
  health seeking behavior in malaria endemic areas.
  
• Strategy 4 Strengthening the institutional
  capacity of the national malaria control program
  at all levels.

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CONTRIBUTION OF GF GRANTs TO NATIONAL MALARIA
PROJECTS
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Obstacles/challenges faced by NMCP

• Widely availability of counterfeit/ substandard
  drugs in the private sector
• Irrational use of anti malarial- especially in
  the private sector
• Emergence of Artemisinin resistance especially in
  the Cambodia- Thailand
• Reach to mobile and migrant populations and other
  vulnerable populations in remote areas

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History of Drug Resistance

• Drug resistant malaria parasites have frequently
  emerged from the border area between Cambodia and
  Thailand.
• It started in the 1970s with resistance to
  chloroquine, followed by sulfadoxine-pyrimethamine
  , and then mefloquine.
• There is recent evidence of increasing parasite
  clearance times to the current nationally
  recommended artemisinin-combination therapy
  (ACT). This may signal the beginning of drug
  resistance to artemisinin-derivatives.

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Proportion with treatment failure of Artesunate
Mefloquine, Coartem (2001-2007)
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PCT in Pailin study 2007 (n40)
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Innovative Intervention

• Implementation of an innovative short term
  project to contain artemisinin resistant
  parasites
• Enhancement of banning monotherapy nationwide
• Scaling up the VMW strategy to accelerate the
  EDAT at the community level
• Development of private sector strategy
• Piloting Public- Private Mix Strategy
• Proposal submitted on piloting AMFm strategy

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Containment Project
The containment implementation area includes 10
provinces in Cambodia along the border with
Thailand.
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Targeted populations in Zones 1 and 2

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Program Policies Strategies

• Diagnosis use of combo-RDTs at public health
  centers and by
• VMWs. Microscopy at former district
  hospitals Referral Hospitals.
• Social Marketing of Malacheck combo-RDTs in
  the Private sector
• through PSI
• Treatment ACT at public health facilities
  (DHAPiperaquine in
• Zone 1 and AM in the rest of the country)
  and through VMWs .
• Zone 1 Ban of sale of monotherapy in the
  private sector.
• Rest of the country Malarine social
  marketing through PSI.
• Vector Control Public sector LLINs and LLIHNs
  in villages within
• 2km of the forest plus retreatment of
  existing conventional nets.
• Focal IRS in containment zones.
• Private Sector Bundling strategy (treatment
  of bed
• nets imported/distributed) by PSI

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Program Policies and Strategies (contd.)

• IEC Combination of mass media (TV, Radio, Video
  and audio
• spots), group education (through VHVs) and
  interpersonal
• communication (through health staff at health
  facilities). Special
• emphasis on training of school teachers
  health
• education of school students.
• ME Efficient use of HIS and strengthening of
  malaria
• information system and surveillance.
  Computerization of
• malaria information at central, provincial
  and OD level.
• Private Sector Cooperation Mainly mobilized
  through NGOs.
• Involvement of private importers
  distributors proposed (AMFm)
• Capacity Development/training Health staff
  involved in
• treatment and prevention of malaria motivated
  through a wide
• range of training, supervision, mentoring
  facilitating
• working environment as well as financial
  incentives.

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ACT Bottleneck Looking forward

• Due to changes in Global Fund Q/A Guidelines, the
  current co-blistered ASMQ will no longer be
  eligible for repackaging at Cipla.
• The national program would like to switch from a
  co-blistered to co -formulated ACT.
• Currently, there is not another WHO Prequalified
  drug that is efficacious in Cambodia.
• The national program has applied for the first
  phase of the Affordable Medicines
  Facility-malaria (AMFm), which is expected to
  start in mid-2010.
• Problems in procuring artesunate suppositories
• According the national treatment guidelines,
  artesunate suppositories to be used as the
  pre-referral treatment of severe malaria (this is
  in the line of WHO malaria treatment guidelines)

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Future Perspective
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Major Donors Partners of NMCP

• Health Unlimited
• Implementing NGO in 2 provinces (GF R4, R6 RCC)
• Partners for Development
• Implementing NGO in 2 provinces (GF R4, R6 RCC)
• URC
• - Training for QA
• NIH
• Research
• PSI Cambodia
• Social marketing of Malarine and Malacheck
• FHI
• Implementing NGO

• GFATM
• R4, R6 R2 RCC Grants
• USAID Cambodia
• Donates to CNM through the WHO (mainly drug
  resistance)
• WHO
• Technical assistance
• HSSP (WB/ADB/DFID)
• Strengthening PH Systems
• BMGF
• -Containment of Artemisinin resistance
• Pasteur Institute
• Research

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THANK YOU!