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Sandii Lwin 12 May 2014 Hong Kong

APLMA Regional Financing Task Force Role of Public Private Partnership in Infectious Disease Control. Sandii Lwin 12 May 2014 Hong Kong. Presentation Outline. Malaria in Myanmar Financing Landscape and Funding Gap Myanmar Health and Development Agenda The Role of Private Sector

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Sandii Lwin 12 May 2014 Hong Kong

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  1. APLMA Regional Financing Task ForceRole of Public Private Partnership in Infectious Disease Control Sandii Lwin 12 May 2014 Hong Kong

  2. Presentation Outline • Malaria in Myanmar • Financing Landscape and Funding Gap • Myanmar Health and Development Agenda • The Role of Private Sector • Accreditation Scheme under PPP Arrangement • CSR Programs • TOTAL Oil and Gas Company • High Tech Concrete Technology • SUN Quality Health Franchise • ACT subsidy scheme and social marketing • Challenges and Needs for Future Research & Action • Opportunities for Private Sector Delivery

  3. 1. Myanmar Overview • Sweeping political, economic and social reforms • Increased international engagement and multilateral and bilateral support • 149/168 on Human Development Index • Lowest donor investment in the region - $4 per capita in Myanmar (compared to $57 per capita in Laos, $40 per capita in Cambodia). • 80% out of pocket health expenditure

  4. 1. Malaria in Myanmar • 50% of malaria burden in the Mekong Region and ¾ of malaria related deaths • More than 80% of 330 townships are malaria endemic • Migrant and mobile population (1.2m – 1.6m) increase the risk of artemisinin resistance • Hot spot for artemisinin resistance (Thai-Myanmar border) MOH presentation, November, 2013

  5. 1. Improved Malaria Situation in the Region 2002-2010 Annual Parasite Index, GMS, 2002 Annual Parasite Index, GMS, 2010

  6. 1. Myanmar: Reduction in Malaria Deaths 2002-2010

  7. 1. The urgency of containment of Artemisinin Resistance

  8. 2. Financing Landscape and Funding Gap Current partners and donors include the Global Fund, US President’s Malaria Initiative (PMI), 3MDG Fund, JICA, UNICEF, WHO, and the Bill and Melinda Gates Foundation.

  9. 3. Myanmar: Post 2015 Development Agenda

  10. Presentation Outline • Increased FDI, large scale infrastructure projects (oil and gas, mining, highways etc.)

  11. Presentation Outline

  12. 3. Malaria and Myanmar:Why is it important for us? • At the cross roads of health and development paradigm • Increased FDI, large scale infrastructure projects (oil and gas, mining, highways) and other private sector activities in the initial stages can increase vector population • FDI increased from $1.9b to $2.7b in 2012-2013 (World Bank) • 2015 ASEAN Free Trade Agreement and ASEAN Economic Community will open up borders with other countries • Without private sector involvement, we cannot effectively reach critical populations at risk, including the workers, migrant and mobile populations.

  13. 4. Private sector delivery mechanisms in Myanmar • Accreditation Scheme under a Private Public Partnership arrangement • Malaria Forum for corporate sector engagement • Corporate Social Responsibility (CSR) Programs • TOTAL Oil and Gas Company • ShweTaung Group of Companies: High Tech Concrete Technology • Social Franchising model • PSI SUN Quality Health Franchise clinics • ArtemisininMonotherapy (AMT) Replacement project • Artemisinin-based Combination Therapy (ACT) subsidy schemes under ACT Watch

  14. 4A. Malaria Forum Malaria Forum on “Corporate Sectors and Non State Actors Response to the threat of Artemisinin Resistance in Myanmar” held on November 25-26, 2013 Organized by UMFCCI, MBCA, MHDC and MOH. Sponsored by Roll Back Malaria Partnership, 3MDG Fund, the Global Fund to fight AIDS, Tuberculosis and Malaria, Sumitomo Chemicals, Shwe Taung Development Co., and MSP Catepillar. Meeting Output: To reach agreement on an accreditation scheme that will incentivize companies to take part in the Global Emergency Response to Artemisinin Resistance.

  15. 4A. Malaria Forum • First PPP Malaria Forum in the country to engage the corporate sector to discuss malaria control activities for their workforce and to support the containment of artemisinin resistance. • Over 170 representatives from private sector, civil society, government, multilateral and bilateral agencies, research, and media agencies attended this forum. • 17 companies and organizations signed up to promote universal district health coverage, and towards free provision of quality assured malaria diagnosis, treatment and prevention.

  16. 4A. Corporate Sector Representation • Associations/Business coalitions • Oil and Gas • Rubber Plantations • Fishery • Pharmaceuticals • Banks • Infrastructure (Deep Sea Port) • Timber • Hotel & Tourism • Palm Oil Plantations 70% participation from corporate sector

  17. 4A. Private Sector Mapping Initiative

  18. 4A. Example: Mapping mining companies

  19. Map of population distribution against business interests in Tanintharyi. Myanmar

  20. Map of P. falciparummalaria against business interests in Tanintharyi, Myanmar

  21. 4A. Malaria Forum: Next Steps • MHDC and MBCA in collaboration with UMFCCI, MOH will work to promote private sector engagement for malaria control and containment of artemisinin-resistance. • Plan a similar forum with the Mandalay Chamber of Commerce, to raise awareness and to engage the corporate sector in the Mandalay Division. • Plan to scale up and broaden the reach to at least 100 companies and organizations by the end of 2015. • Expand private sector mapping in other states and divisions. • Select one or two large corporations/companies to jointly develop a mechanism for tracking mobile workers which could serve as a model for replication. • Improve information availability in Myanmar language, as well as advocacy and outreach through media, documentation of best practices, including PPP and CSR and community awareness programs etc.

  22. 4B. CSR: TOTAL Oil and Gas Company CSR commitments include: • Professional management of stakeholder relationships focusing on neighboring communities • Controlling and reducing the impact on socio-economic environment • Optimizing TOTAL’s contribution to local and community development • Socio-economic program covers health, education, agriculture, breeding, infrastructure development and microfinance activities costing an estimate of USD 30.84 million from 1995 - 2012. • Malaria program in Yadanapipeline area on Thailand border focuses on detection, treatment and prevention. Doctors present at clinics on work sites conduct RDTs and Day-3 parasitaemia for early treatments in accordance with Department of Health guidelines. LLINs are distributed with 97% coverage for 25 villages along with larva control activities and routine health talks. Since 1997, 58,988 out-patients and 5,004 in-patients have been treated.

  23. 4B. CSR: TOTAL Oil and Gas Company • Integrated healthcare delivery programs include: • regular doctor visits, treatmentand referrals; • hospitalization for orphanages and foster homes; • Blindness Prevention Program with Helen Keller International; • HIV Care Program with UNION; • TB diagnosis and treatment; • vaccination programs; • growth monitoring and antenatal care etc.

  24. 4B. CSR: TOTAL Oil and Gas Company • Healthcare coverage for both staff and their families include 100% reimbursement on vaccination and immunization, annual medical examinations, hospitalization in-country or overseas, and HIV blood test and treatment. Reimbursement (80%) for x-ray, lab tests, dental and eye care, and consultation and medicines. • CSR to neighboring communities include upgrading Kanbauk hospital facilities (e.g. water supply and staff housing, establishing 8 village clinics and 16 sub-village clinics, supplying medicines, ambulance, radio communications, and providing over 1.13 million free health consultations).

  25. 4B. CSR: High Tech Concrete Technology ShweTaung Group of Companies include: • Construction • High Tech Concrete and Cement manufacturing • Energy and • Infrastructure Investments Services (trading and logistics). • Company-owned Asia Royal hospital employs nurses and medical doctors to project sites who carry out malaria testing and treatment. Medical expenses and hospital bills are reimbursed.

  26. 4B. CSR: High Tech Concrete Technology • National malaria control and prevention activities are carried out at hydropower project sites along Baluchaung River, Kayah State (Tier 1) . • Blood test results and monthly patient lists reported to Kayah State Malaria Prevention and Control Department. Employers are entitled to paid sick-leave for up to 5 days. • Residual spraying at labor barracks and administrative office and fumigation of mosquitoes on site camps done 5 times annually. Workshops, distribution of insecticide tablets and LLINs throughout workforce.

  27. 4C. PSI SUN Quality Health Franchise In Myanmar, 60% - 75% of population seek basic healthcarein the private sector. Social franchises are networks of private health providers utilizing commercial franchising methods with the goal to: • Improve quality of healthcare; • Increase access to care; • Expand affordability of services; • Rapidly increase number of delivery points for public health services. The main advantages of PSI’s SUN franchise for malaria control & elimination are: • Qualified health professionals agree to adhere to a set of minimum standards; • Professionals are trained, supervised and monitored; • Data is shared with Ministry of Health.

  28. 4D. PSI ACT subsidy scheme and social marketing Monotherapy Replacement Project implemented by PSI with funding from DFID and BMGF, is an incentive mechanism for private sector drug vendors to sell quality assured artemisinin-based combination therapy instead of oral ArtemisininMonotherapy (oAMT). • ACT market share increased from 3% to 73% within a nine month period The reach, speed, scale, and cost-efficiency of informal distribution model for monotherapy replacement is due to: • A robust and centralized supply chain; • An effective and sustained donor subsidy; • An enforced FDA ban on oAMT importation; • Intensive provider and consumer behaviorand change in communications and promotional activity; • Effective communication between all partners.

  29. 5. The four types of private sector delivery mechanisms

  30. 5. Need for further research& action • Business, workforce, GPS mapping especially in newly designated Tier 1 area. • Evidence for building a strong business case for malaria prevention for companies and corporate sector to prioritize malaria in their programs (in declining malaria incidence scenario). • Use of Technology and Innovative Approaches through mhealth and ehealth applications to strengthen real time reporting and improve monitoring and evaluation systems • Strengthen disease surveillance system using information technology – mhealth and ehealth applications – for improved data sharing and management. • Provide increased support for human resources in public sector through training, providing equipment and financial support to malaria volunteers and village health workers.

  31. 6. Opportunities for Private Sector Delivery • Expand strategic Private Public Partnerships (PPP) with corporate sector, private foundations, business alliances (global, regional and country levels). • Explore innovative mechanisms (e.g. engagement with telecom sector - crucial timeline 2014-2015) • Less than 10% of the population has access to mobile phones. Approx. 3,000 towers planned in the next two years. Within 2-5 years, it is envisaged that 95% of the population will have connectivity. • Explore opportunities with chambers of commerce including: • establishing linkages with the UN Global Compact programand • Health Impact Assessments in Environmental and Social Impact Assessment (ESIA)

  32. Thank you…

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