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All systems go for ERAR hub in Phnom Penh, Cambodia

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ERAR staff members with donor partners in Phnom Penh.

ERAR staff members with donor partners in Phnom Penh.

WHO’s Emergency Response to Artemisinin Resistance in the Greater Mekong Subregion (ERAR-GMS) hub is now fully staffed.

The first meeting of the World Health Organization ERAR –GMS staff from across the sub-region took place at the Intercontinental Hotel, Phnom Penh, Cambodia from 27-28 January 2014. It was held back-to-back with a meeting with development partners where the finalized ERAR work plan was presented for inputs. The meeting was well attended with 30 participants from the Western Pacific Region, the South East Asia Region and WHO Headquarters in Geneva.

During the two-day ERAR hub staff meeting, discussions focused on each of the thematic area work plans for 2014, namely the coordination of the hub, advocacy and communication, therapeutic efficacy monitoring and operational research, access to services for migrants and mobile populations, support to the implementation of the Myanmar Artemisinin Resistance Containment (MARC) framework, strengthening the response to artemisinin resistance containment in Viet Nam and limiting the availability of oral artemisinin-based monotherapies, substandard and counterfeit antimalarial medicines while improving the quality of ACTs. The related plans were presented by their respective focal points.

In his concluding remarks, Dr. Pieter Van Maaren, the WHO Representative in Cambodia at the time, expressed his confidence that WHO-ERAR will convince donors that WHO can and will deliver on key targets as planned. WHO’s Western Pacific Regional Director of Communicable Diseases Control, Dr. Mark Jacobs, who chaired the two-day meeting, placed emphasis on the emergency context within which the hub has been created, and stressed that rapid action is crucial.

Following the staff meeting, another meeting was held with development partners on 29 January 2014, also at the Intercontinental Hotel in Phnom Penh, to present the work plans. In attendance were representatives from the Bill & Melinda Gates Foundation (BMGF), the Australian Government’s Department of Foreign Affairs and Trade (DFAT), the United States Agency for International Development (USAID), the Asian Development Bank (ADB) and Malaria Consortium. The meeting provided an opportunity for WHO to update donors and partners on ERAR implementation progress.

Major achievements include the launching of the WHO Emergency Response to Artemisinin Resistance. Regional Framework for Action 2013 – 2015, the establishment of the ERAR Regional Hub with its full staff component, the organization of an informal consultation on operational research for accelerating malaria elimination in the context of artemisinin resistance in December 2013, with the identification of priority research topics for countries in the GMS, and the initiation of a situation analysis on the access to malaria services for migrant and mobile populations in the context of ERAR.

In his concluding remarks, WHO’s Dr. Mark Jacobs, who also chaired this meeting, expressed the organization’s appreciation for the support provided by the development partners and underscored the importance of continued collaboration to achieve a coordinated and effective response to the threat posed by artemisinin resistance.

Dr. Kazadi also informed the development partners that the ERAR website* was launched in January 2014 to serve as a key information resource, and reiterated that WHO is committed to providing technical assistance and coordination support to existing and emerging AR initiatives in the region. (*ERAR website URL:

As a way forward, the following action items were recommended:

ERAR hub coordination:

  • Work with GMS countries to develop a budgeted national artemisinin resistance work plan;
  • ERAR Hub to facilitate country ownership of plans, budgeting and implementation efforts;
  • Efforts on establishing/updating country databases to be in line with national health information system (HIS) plans;
  • With other development partners, work towards establishing a contingency stockpile of essential commodities;
  • ERAR Hub to document and share lessons learnt in the GMS in the form of stakeholder analysis/mapping, to showcase local solutions to local problems (government, NGO, partners and other stakeholders). This can also be used as an advocacy tool with the Asia-Pacific Leaders Malaria Alliance (APLMA);
  • WHO to work with the Australian government’s (DFAT) consultants at the country level to assess challenges and needs. In-country gaps will be identified and prioritized and appropriate budgets for technical advice will be costed in the work plan.

Monitoring and evaluation (M&E):

  • Work to translate the M&E indicators into existing national systems. The M&E framework in ERAR gives ownership to countries, which in turn translates into sustainability. ERAR indicators will be incorporated into M&E Plans as National Strategic Plans are updated with findings from programme reviews and studies.
  • ERAR will work closely with other initiatives on artemisinin resistance e.g. APLMA and the Regional Artemisinin Initiative (RAI) to harmonize relevant indicators in the scorecards.
  • M&E Technical Working Groups, which are to be established, will provide support to strengthen M&E systems at country level. Membership will comprise of representatives of key development partners with an M&E mandate such as The Global Fund, Malaria Consortium, ADB, University Research Co., etc.
  • Incorporate vector surveillance and insecticide resistance monitoring in the ERAR work plan as a way forward for malaria elimination.

Advocacy and communication:

  • A calendar of events that will include both malaria-related events and other events that could provide opportunities for advocacy and monitoring.
  • Collaborate with APLMA’s proposed “Champions Group” to facilitate high-level advocacy with policymakers/leaders.

Migrants and mobile populations (MMPs):

  • Take needed practical steps to increase access of MMPs to timely diagnosis and treatment. There is a need to acknowledge that migration patterns in the GMS are complex and migrants fall into a range of different categories from irregular, short-term migrants to long-term migrants with many sub-groups in between.
  • Need innovative ways to carry out surveillance among mobile migrants using peer groups.
  • ERAR could look into national issues/policies and help overcome barriers in identifying mobile communities and providing targeted information and health care to these communities. This will include conducting political as well as anthropological research to identify push and pull factors for cross-border migration.
  • Country initiatives, including NGO activities, that increase mobile and migrant populations’ access to health services should be reviewed, documented and shared appropriately.

Therapeutic efficacy studies (TES):

  • The time to translate TES findings to drug policies could be quick (e.g. in the case of Cambodia) or delayed for up to 2-3 years depending on the readiness of the country, among other factors such as selection time from several appropriate alternatives and delayed procurement of new selected first line drugs. WHO recommends a 10% treatment failure rate as a threshold (i.e. 10% of Day 3 positives after appropriate treatment of recommended ACT is commenced).
  • ERAR’s role is to facilitate shortening the lead time between the identification of antimalarial drug resistance and change in drug policy.

Operational research (OR):

  • Countries are encouraged and supported to develop proposals and share plans with donors. The Bill & Melinda Gates Foundation is interested in OR and will help in organizing donor support.
  • The results and recommendations from operational research should be used to expand the knowledge base of National Strategic Plans of GMS countries. ERAR should work more closely with policy-making and regulatory bodies in countries and at regional levels to quicken decision-making.

Myanmar Artemisinin Resistance Containment (MARC) implementation:

  • Coordination of several efforts by different players in Myanmar is a challenge. WHO is strengthening effective coordination with the RAI budget for programme management and M&E support for activities under RAI.

Artemisinin resistance containment in Viet Nam:

  • Multi-sector involvement in resource mobilization in Viet Nam is currently limited. ERAR should engage ministries other than Health, including Planning and Finance.


  • There is need for a contingency plan for up-to-date stock management bearing in mind that medicines may expire if not utilized on time as a result of reduction in P. falciparum cases as transmission becomes lower.
  • ERAR needs to take inventory of all the first line drugs used in the GMS and then maintain a rotating stock.
  • One way of dealing with stockout is through an electronic management system of stockpile control.
  • Strengthen capacity for drug regulation systems across the GMS.
  • As a mechanism to coordinate the quality assurance of drugs, ERAR needs to assess quality at the point of use, especially when it comes to cross-border migrants.

In closing, Dr. Michael O’Dwyer of the Australian government’s Department of Foreign Affairs and Trade said he was encouraged by the ERAR hub’s work plan and pledged DFAT’s continued support for ERAR. The WHO Representative in Cambodia, Dr. Pieter Van Maaren, expressed his satisfaction at the comprehensive inputs and positive feedback received from development partners. He was appreciative of the renewed commitment of partners and stakeholders to support the ERAR Coordination Hub to enable it to achieve its targets and goals.

The meeting was declared closed by Dr. Jacobs, the Director of Communicable Diseases, WHO WPRO.



Written by malariacontainment

May 8, 2014 at 4:57 pm

Posted in Uncategorized

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