ASEAN COOPERATION ON HEALTH Health and Communicable Diseases Division ASEAN Secretariat

DAY 1 – SESSION 2: ASEAN SECRETARIAT PRESENTATION

PRESENTATION CONTENT What is the basis of the regional cooperation on Health? What are the regional priorities in Health? What are the implementing mechanisms? What are the regional priorities of AEGCD and AWGPD?

AEC Blueprint (November 2007) ASCC Blueprint (March 2009) APSC Blueprint (March 2009) 2 nd IAI Work Plan (March 2009) AEC CouncilASCC CouncilAPSC Council ASEAN Coordinatin g Council implementation / monitoring:

ASCC: ASEAN STRATEGIC FRAMEWORK ON HEALTH DEVELOPMENT Operationalizes the 55 health action lines of the ASCC Blueprint Regional activities in health involve: B3. Enhancing Food Security and Safety B4. Access to healthcare and promotion of healthy lifestyle (PD component included) B5. Improving capability to control communicable diseases (CD component included) B7. Building disaster-resilient nations and safer communities Xii. Promote multi-sectoral coordination and planning on PPR at the regional level including development of a regional multi-sectoral PPR plan

GUIDING PRINCIPLES - IMPLEMENTATION ASEAN SOCIO-CULTURAL BLUEPRINT ( ) Endorsed by ASEAN Summit STRATEGIC FRAMEWORK ON HEALTH DEVELOPMENT ( ) - Endorsed by 10 th AHMM WORK PLANS OF WORKING GROUPS and TASK FORCES

ASEAN Health Ministers Meeting (AHMM) Senior Officials on Health Development (SOMHD) 6 ASEAN Working Groups 4 Ad –hoc Task Forces Networks and Initiatives Institutionalization on ASEAN Health Development Health and Communicable Diseases Division, ASEAN Secretariat, Jakarta

ASEAN Health Ministerial Meeting (AHMM) Senior Officials Meeting on Health Development (SOMHD) ASEAN Expert Group on Communicable Diseases (AEGCD) ASEAN Task Force on AIDS (ATFOA) ASEAN Expert Group on Food Safety (AEGFS)

ASEAN Health Ministerial Meeting (AHMM) Senior Officials Meeting on Health Development (SOMHD) ASEAN Focal Point on Tobacco Control (AFPTC) ASEAN Technical Working Group on Pandemic Preparedness and Responses (ATWGPPR) ASEAN Working Group on Pharmaceutical Development (AWGPD)

ASEAN Health Ministerial Meeting (AHMM) Senior Officials Meeting on Health Development (SOMHD) Ad Hoc ASEAN Task Force on Mental Health Ad Hoc ASEAN Task Force on Maternal and Child Health Ad Hoc ASEAN Task Force on Traditional Medicine Ad Hoc ASEAN Task Force on Non- Communicable Diseases

FLOW OF HEALTH PROGRAMME CYCLE Strategic Framework Strategic Framework on Health Development, 2010 – 2015 (endorsed by AHMM, 2010) Planning & Implementation Annual Meeting of SOMHD Annual Meeting of TWGs/TFs/Networks AHMM every 2-year meeting Ad Hoc/’As needed’ Monitoring & Evaluation Implementation-based Monitoring (TWGs/TFs) Outcome Indicators: ASCC ‘Scorecard’ (ie. still in process of finalizing indicators for ASEAN)

IMPLEMENTING MECHANISMS lead country Strengthen Collaborati on with potential partners Strengthen roles of SOMHD/ Chairs of Subsidiary bodies Conduct consultative development partners’ meeting (s) Role of ASEC

IMPLEMENTATION MECHANISMS Lead Countries Host Countries Resources from Development Partners Funds from Dialogue Partners with MOU Support from SOMHD and other working groups Collaborative, Coordinative and Facilitative Role of ASEAN Secretariat

ASEAN EXPERT GROUP ON COMMUNICABLE DISEASES (AEGCD)_1 Initiatives started with the ASEAN Plus Three EID Program supported by AUSAid (program concluded last June 2010) 6 th AEGCD Meeting, Yangon, Myanmar: Outputs Updated the Medium Term Plan on Emerging Infectious Diseases (MTP EID - Work Plan ) Endorsed the 9 components of the MTP EID for Approved the Work Plans & Prioritized activities for 2012

ASEAN EXPERT GROUP ON COMMUNICABLE DISEASES (AEGCD) 6 th AEGCD Meeting, Yangon, Myanmar: Outputs Strengthened collaboration with WHO and other Development Partners Malaria Initiatives with WHO approved; Myanmar volunteered to be lead country; Thailand to be confirmed by senior officials Identified Regional Advocacy Initiatives

AEGCD: 9 COMPONENTS OF MTP EID ASEAN EID Mechanism (AEM), (Thailand); EID website, (Indonesia); ASEAN Partnership Laboratories, (Malaysia) Risk Communication, (Malaysia) Human and Animal Health Collaboration, (Thailand and Lao PDR); Operationalisation of Minimum Standards of Joint Multi- sectoral Outbreak Investigation and Response, (Cambodia); Stockpiling of antivirals and PPE (ASEAN Secretariat), Field Epidemiology Training Network, (Thailand) WHO-EC Project on HPED particularly on cross-border collaboration, (Thailand and Lao PDR) Specific diseases including Rabies (Viet Nam), Dengue (Viet Nam and identified lead country for ASEAN Dengue Day), and Malaria (Myanmar, Thailand ?)

ENDORSED WORK PLANS ( ) ASEAN Plus Three Partnership laboratories (APL); Risk Communication; Animal Health and Public Health Collaboration; ASEAN Emerging Infectious Diseases Mechanism (AEM) and ASEAN EID Plus Three Website; Operationalization of Minimum Standards on Joint Outbreak Investigation and Response; ASEAN Plus Three Field Epidemiology Training Network (FETN); and Specific diseases including rabies and dengue with some revisions from lead country, Viet Nam

ASEAN WORKING GROUP ON PHARMACEUTICAL DEVELOPMENT (AWGPD) 27 th AWGPD Meeting, Hanoi, Viet Nam Outputs: Finalized the Work Plan for Prioritized Activities for 2012 Worked with AEGCD on Malaria Initiatives with focus on Drug Resistance Strengthened Collaborative Activities with WHO Finalized ASCC Scorecard Indicators Identified Regional Advocacy Initiatives

Impact of pharmaceutical on public health Improving access to medicine and healthcare services AWGPD Areas related to technical standards & harmonization PPWG Integration of TM into healthcare system Ad Hoc Task Force on TM ASEAN Bodies related to PD

Proposed components & activities Regional Strategies Lead country 1) The 3 rd Standard of ASEAN Herbal Medicine Area 1 & 3Indonesia & Thailand Proposal ) Development Programme to strengthen QA and Non-Pharmacopial Analytical Methods Area 1 & 3Malaysia 3) Building up & strengthening of PV Area 1 & 2Singapore & Thailand 2012

Proposed componentsRegional strategies Lead country 4) Rational Use of Drug ASEAN – WHO Consultative Meeting on RUM, 12 July 2011 Area 2 & 3Brunei, Singapore, Indonesia 4.1 Workshop on Rational Use of Anti-Microbial Agents Brunei, Singapore 4.2 ASEAN – WHO Collaborative Study on RUM in ASEAN Singapore WHO 4.3 To conduct an ASEAN Forum on Pharmaceutical Care and its Effective Implementation in ASEAN (2013) Indonesia WHO

Proposed components/activities Regional strategies Lead countries/ $ 5) Proficiency TestingArea 1 & 3Thailand Ongoing activity, donor ) Production of ARS Certified Reference Material Area I & 3Thailand Ongoing activity, donor ) Technical cooperation with USP Area I & 3Thailand/USP 2011 REMARKS: Activity 6 and 7 were combined: Thailand

Proposed components/activities Regional Strategies Lead countries/ $ 8. Building up and strengthening ASEAN ‘s capacity in GCP and Clinical trial Area 1 & 3Thailand & Indonesia, Philippines 9) ASEAN Collaboration in combating counterfeit drug Area 1& 2 & 3Indonesia & Laos WHO collaboration 10) Drug resistance in malaria Area 1 (policy advocacy) Laos & WHO, )Regional advocacyArea 2ASEC, 2011

DAY 1: FEEDBACK SESSION ON THE ‘JOINT ASSESSMENT’ & ‘REGIONAL FRAMEWORK’

RELEVANT MESSAGES TO BE CONSIDERED BY ASEAN GROUPS BASED FROM THE JOINT ASSESSMENT OF THE RESPONSE TO ARTEMISININ RESISTANCE_1 Engage with the pharmaceutical sector; Enforcement of policies on counterfeit drugs Information Sharing: Information on Drug Resistance should be shared to higher bodies in health of the region Funding from External Sources are available but complementary support from dialogue partners can be encouraged

Cross border issues on infectious diseases should also include the concern on artemisinin-resistance Identify main technical issues and gaps to be covered concerning artemisinin resistance and seek appropriate support from concerned partners ASEAN Community by 2015: ASEAN has a critical role in raising political commitment and economic implications in addressing concerns relevant to issues on artemisinin resistance R ELEVANT M ESSAGES TO BE CONSIDERED BY ASEAN G ROUPS BASED FROM THE J OINT A SSESSMENT OF THE R ESPONSE TO A RTEMISININ R ESISTANCE _1

FEEDBACK: REGIONAL FRAMEWORK_1 Consider the framework to be inclusive of the ASEAN region rather than the GMS Flexibility in the use of the funds beyond GMS to address issues on artemisinin resistance and malarial initiatives in the region Elevate to appropriate and higher bodies the issues on malaria initiatives and the challenge faced with artemisinin resistance with leadership from ASEAN Member States Consider the economic impact: Elevating the issue of malaria to be one of the point of interest of the national agenda can be a concern if it is not a priority by the national government. But if we link this health issue to economic implications, then we can make this one of the priorities.

FEEDBACK: REGIONAL FRAMEWORK_2 Objective 1: ASEAN has a comparative advantage in coordinating efforts on malaria initiatives Drug resistance can be placed in the context of ‘Elimination of Malaria’ Objective 2: Awareness and information sharing enhanced at the level of technical working groups initially and then to other higher bodies Objective 3: System of monitoring can be done for malaria initiatives that is similar to MS JMOIR Support mapping and strengthen surveillance Classify ASEAN Member States according to appropriate tiers

FEEDBACK: REGIONAL FRAMEWORK_3 Objective 5: Vector control in the context of promotion of integrated vector management (IVM) Add a narrative that this objective will complement prevention of transmission of resistant strains

FEEDBACK: REGIONAL FRAMEWORK_4 Objective 6: Elevate issue of malaria concerns to the focus area of Migrants Health and Increase Access to Health Care during the workshop led by Indonesia SOMHD Explore involvement of private sector in the open sessions of the AWGPD and AEGCD meeting on matters concerning malaria Objective 7: 7.1 consider ‘regional level’ rather the ‘GMS’ Include Economic Analysis of the impact of artemisinin resistance in the GMS and beyond

DAY 2: FOLLOW-UP/NEXT STEPS

RECOMMENDATIONS/AGREEMENTS General Comments/Agreement: Consider the following inputs in coming up with a set of recommendations/agreements: “Facts” on Malaria by WHO is needed to level standard of information among participants Consider the issues below that were discussed in Day 1: Contextualized in the elimination of malaria Migration issues Cross-border issues Economic implications Workshop Document should contain the following: I. Background Facts WHA Resolution 2007 II. Challenges III. Key Recommendation IV. Way Forward

RECOMMENDATIONS/AGREEMENTS I. Background Facts WHA Resolution 2007 II. Challenges (NOTE: for ranking) Awareness (community, border to decision level) Lack of cross sectoral interaction Access and quality of medicines/ Stock outs Migrants Health and Cross-border concerns Illegal trade across countries/ smuggling Economic implications Resource gap Limited alternative medicines Implications of rapid economic development to health situation including the issue of re-emerging diseases (malaria in particular) Global Warming (?) III. Key Recommendation IV. Way Forward WHA: ASEAN sideline meetings (exchange) leaflets

RECOMMENDATIONS/AGREEMENTS III. Key Recommendation (NOTE: for ranking) Ensure effectiveness of ACTs Every member state to monitor therapeutic efficacy of medicines Removal of artermisinin monotherapy (import, ban of production and export) Standardization of quality of ACT Private sector involvement Strengthen regional cooperation on regulations and monitoring of cross-border concerns such as trade of pharmaceuticals, migrants issues Assessment of impact of the disease burden as it relates to economic implications Involvement also of the private sector and research Focus on migrants health and mobile populations Common regional regulatory framework on medicines Ensure bilateral cooperation will take into account regional cooperation/agreements

RECOMMENDATIONS/AGREEMENTS III. Key Recommendation (NOTE: for ranking) Ensure initiatives on elimination of malaria be included in the regional priorities of ASEAN subsidiary bodies Lead countries of concerned subsidiary bodies on AWGPD and AEGCD to proposed work plan activities relevant to malaria initiatives Relevant subsidiary bodies within ASEAN will also be involved in cross-sectoral collaborative activities Strategy to strengthen prevention and control to reduce transmission Strategy to maintain free malaria status Ensure adequate resources for the elimination of malaria including artemisinin resistance Involvement also of the private sector

NEXT STEPS WHO to finalize the workshop document – 2 weeks Circulate the workshop document to participants of the workshop – 2 weeks Seek concurrence from the appropriate ASEAN health subsidiary bodies (ie. AEGCD, AWGPD) – within May/June 2012 Elevate recommendations of AEGCD and AWGPD to SOMHD – within May/June 2012 SOMHD recommendations to be elevated to AHMM – within June 2012