1. Learning Unit 7 Health systems and inter-sectoral and cross-border collaboration 14 August 2014 Part 1 Dr. Leonard I. Ortega Regional Adviser, Malaria WHO-SEARO

2. Learning Objectives By the end of this Unit, the Participant should be able to: Explain how the different components of the health systems relate to effective malaria control and elimination Give examples of common weaknesses in health systems that constrain malaria elimination and identify ways to overcome those weaknesses Describe measures for re-orienting the health system towards the needs of malaria elimination Determine the roles of different actors including the private sector, the community, different sectors and inter-country collaboration Identify suitable topics for operational research related to elimination

3. Introduction “Malaria elimination is war!” “We have the responsibility but we do not have the authority” “Health system” “Systems thinking”

4. Health system: definition and building blocks

5. Health System (1) (1) Governance: ensuring strategic policy frameworks combined with effective oversight, coalition building, accountability, regulations, incentives and attention to system design (2) Health workforce: responsive, fair and efficient given available resources and circumstances, and available in sufficient numbers

6. Health System (2) (3) Health financing: raising adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them (4) Medical technologies: including medical products, vaccines and other technologies of assured quality, safety, efficacy and cost- effectiveness, and their scientifically sound and cost-effective use

7. Health System (3) (5) Health information: ensuring the production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status (6) Service delivery: including effective, safe, and quality personal and non-personal health interventions that are provided to those in need, when and where needed (including infrastructure), with a minimal waste of resources.

8. Analyzing and improving quality of service delivery

9. The Health System and Malaria Elimination Health system componentMalaria elimination 1. Governance 2. Workforce 3. Financing 4. Technologies 5. Health information 6. Service delivery People

10. Public Health Service Delivery System in Myanmar Source: Health in Myanmar 2014

11. Township Public Health Department (under consideration)

12. Public Health System in Viet Nam

13. The private health care sector Who? What are their roles? Some examples… Malaria elimination in the GMS: key interventions 1.Case detection and management 2.Disease prevention in transmission areas 3.Malaria case and entomological surveillance

14. Inter-sectoral collaboration Malaria is not just a health problem; it is a socio- economic development issue Collaboration with other sectors is important; some examples: – Business/corporate sector (in Bhutan; Cambodia; Indonesia; Myanmar; the Philippines; etc ) – The military (in Sri Lanka; Thailand; etc) – Civil societies/FBO/NGOs (in Cambodia, Lao PDR, Myanmar; the Philippines; Thailand; etc) – Other government sectors (in Bhutan; the Philippines, Thailand)

15. Inter-country collaboration Multi-country – ASEAN – Asia Pacific Malaria Leaders Alliance (APLMA) – Greater Mekong Sub-region – BBINMS (Bangladesh, Bhutan, India, Myanmar, Nepal, Sri Lanka) – South Pacific Community – Mekong Basin Disease Surveillance – Lower Mekong Malaria Initiative (Cambodia, Myanmar, Thailand) – ACTMalaria – Asia Pacific Malaria Elimination Network Bilateral – Myanmar-Thailand – India-Nepal – India-Bhutan

16. Learning Unit 7 Health systems and inter-sectoral and cross-border collaboration 14 August 2014 Part 2 – Inter-sectoral Collaboration Dr. Risintha Premaratne Director, Anti-Malaria Campaign Sri Lanka

19. http://au.news.yahoo.com/thewest/a/-/breaking/16053899/sri-lanka-rescues-138-stranded-on-sinking-boat/

21. Cluster of vivax malaria among pakistani immigrants Over 1000 immigrants screened 23 cases identified Regular screening continues Over 1000 immigrants screened 23 cases identified Regular screening continues

28. Learning Unit 7 Health systems and inter-sectoral and cross-border collaboration 14 August 2014 Part 3 – Group Exercise Group 1 – Exercise 7.1 and 7.2 Group 2 – Exercise 7.3 and 7.4 Group 3 – Exercise 7.5