Progress with Roll Back Malaria by country

Progress with Roll Back Malaria by country

The tables below summarize the status of the Roll Back Malaria movement within each of the endemic countries, organized by WHO region. The second column of the tables below groups the current status into the following categories:

African Region

Angola	I	Despite the raging civil war, Angola has communicated its commitment to rolling back malaria and participating in the global movement. The country has participated in the regional consensus meeting in April 1999. The Partners, who met on 2 July, selected Angola as one of the spot light countries for partnership development in a complex emergency situation. The statement of intent is not yet finalized.
Benin	N	Has communicated commitment to rolling back malaria. The country is participating in a regional evaluation exercise on the utilization of insecticide treated materials. Statement of intent are not yet finalized.
Botswana	A	Successfully developed its statement of intent. Activities that in the process of implementation include a national stakeholders meeting, situation analysis, training of district personnel and the evaluation of the utilization of insecticide treated materials
Burkina Faso	N	Participated in regional consensus building meeting. Recently finalized discussions with WHO on statement of intent.
Burundi	I	Participated in regional consensus building meeting. Statement of intent not yet available.
Cameroon	N	The country has expressed commitment from the highest political levels. Preparation of the statement of intent is in progress in dialogue with WHO. The country has requested WHO to provide assistance with planning and management of a situation analysis exercise
Central African Republic	I	No information as yet
Chad	A	Commitment to RBM expressed from highest political levels. Participated in the regional consensus meetings. Has started implementation of its statement of intent.
Comoros	I	Political commitment expressed from highest levels. Participated in regional consensus meetings. Statement of intent not yet available.
Congo	I	No information as yet
Cote d'Ivoire	N	Strong political commitment expressed. Actively engaged in negotiations regarding statement of intent.
D.R. Congo	I	Selected by partners as one of the "spotlight" countries for partnerships in complex emergencies. Statement of intent recently submitted.
Equatorial Guinea	I	No information as yet
Eritrea	A	Strong political commitment expressed from highest levels. Participated in regional consensus meeting. Efforts are in progress for national advocacy starting with a national conference on RBM. Strong partnership movement in progress.
Ethiopia	A	The country has been very active in the introduction of RBM. Political commitment has been expressed from the highest levels of government. The Minister of Health has provided direct follow up for the process. The country is one of the examples where the RBM partnerships has been integrated into the partnership for Health sector development as in Tanzania, and Mozambique. Major action has included rapid situation assessments in affected zones and completion of strategic plans and budget. The country has also completed estimates of supplies for the impending epidemic. To spearhead the inception process, a malaria control support team with membership from key partners has been formed.
Gabon	I	No information as yet
Gambia	A	Political commitment expressed by highest political levels. Participated in the regional consensus meeting. Is involved in the development of a three-country initiative called " Health for Peace" in which Gambia will lead the RBM part of the initiative while the two other countries - Senegal and Equatorial-Guinea - will lead HIV/AIDS and NIDs/EPI respectively. Currently in active dialogue on the finalization of the statement of intent. Due to high rainfall this season, the country has an impending epidemic of malaria and needs an emergency supply of antimalarial medication. Partnership movement is developing steadily. The WB, ADB, UNDP, and UNICEF all have substantial resources available for health but have difficulties due to co ordination problems.
Ghana	A	Commitment has been expressed from the highest levels of political organization. The Minister has maintained close supervision of the inception process. Institutional mechanisms include the establishment of a secretariat headed by the Deputy Director of Public Health to oversee the implementation. Major action includes, sensitization and awareness meetings in two cities, desk analysis of existing information which was contracted out to local consultancy firms and individuals, a national seminar on environmental management which took place in September, and the first National Forum on RBM scheduled for November. In late September an event of great significance to RBM took place, the bi-annual meeting of partners involved in the Sector- Wide approaches. This presented an opportunity for country level partnership development for RBM. Ghana is also exploring partnerships with the private sector particularly for the local production of bed nets.
Guinea	I	No information as yet
Guinea-Bissau	I	Head of state has expressed commitment. Participated in the regional consensus meetings. Currently processing statement of intent. Intended action includes preparation of a plan of action for rolling back malaria, and a national consensus meeting.
Kenya	N	High level political commitment expressed. The country participated in the regional consensus meeting. Currently the country is in the middle of an epidemic and efforts to combat this have helped define the process for building country level partnership. The movement is now working well to contain the epidemic. Kenya is included among the spot light countries for country level partnerships.
Liberia	I	High level political commitment expressed. Country participated in the regional consensus meetings. Statement of intent not yet available.
Madagascar	I	High level political commitment expressed. Country participated in the regional consensus meetings. Statement of intent not yet available.
Malawi	I	High level political commitment expressed. Country participated in the regional consensus meetings. Statement of intent not yet available.
Mali	A	Selected as one of the RBM "spotlight" countries. Strong political commitment has been expressed from highest levels. Participated in the regional consensus building meeting. Has since finalized the statement of intent and is implementing some activities. Key activities include situation analysis in five districts, and development of a national strategy for RBM.
Mauritania	I	High level political commitment expressed. Country participated in the regional consensus meetings. Statement of intent not yet available.
Mozambique	A	Strong political commitment. Participated in and hosted the regional consensus meeting for Southern Africa. Strong partnership evolving that involves a strong UNICEF – WHO World Bank alliance as well as UNESCO. Major activities include completion of plan of action, situation analysis, evaluation of current vector control operations and review and development of curricula for schools.
Namibia	I	High level political commitment expressed. Country participated in the regional consensus meetings. Statement of intent not yet available.
Niger	A	High level political commitment has been expressed. Participated in the regional consensus meeting. Has begun implementing some inception activities.
Nigeria	N	High level political commitment has been expressed. Participated in the regional consensus meeting. Has begun finalization of statement of intent
Rwanda	N	High level political commitment has been expressed. Participated in the regional consensus meeting. Has begun finalization of statement of intent
Sao Tome and Principe	N	High level political commitment has been expressed. Participated in the regional consensus meeting. Has begun finalization of statement of intent
Senegal	N	High level political commitment has been expressed. Participated in the regional consensus meeting. Has begun finalization of statement of intent. Leading member of three country initiative on "Health for Peace"
Sierra Leone	N	High level political commitment has been received. Participated in the regional consensus meeting and has since entered into dialogue with WHO on the finalization of the statement of intent. The country is in a complex emergency situation. Currently efforts with NGOs are being made to ensure availability of supplies for displaced populations.
South Africa	I	Participated in regional consensus building meeting. Has produced jointly with Mozambique and Swaziland a proposal for managing cross border malaria problems to open up resources to economic development. Epidemic has been forecasted; limited access to SP
Swaziland	N	Political commitment has been expressed from highest levels. Participated in the regional consensus meeting for Southern Africa. Has completed drafting of a statement of intent and is in active dialogue with WHO. Has established high level steering committee, and identified a list of key stakeholders to be involved in the local partnership action to roll back malaria. Swaziland is also a member of the three-country (Lubombo) initiative to deal with cross border problems between itself, Mozambique and South Africa. The country intends to conduct an in-depth situation analysis and formulate an evidence-based strategy.
Togo	N	High level political commitment has been expressed. Participated in the regional consensus meeting. Has begun finalization of statement of intent
U.R. Tanzania	A	High level political commitment has been expressed. The country participated in regional consensus meeting. Inception activities are in process, beginning with the rapid assessment carried out jointly in 1998 by WHO, the Government and other agencies. RBM action is being integrated in the efforts for broad Health sector development. The partnership is also developing along the same process. The country has held a national consultative meeting on the integration of RBM into Health sector development and provided training of facilitators for situation analysis from the 6th to the 10th of September 1999. A network meeting on bed nets held in October.
Uganda	A	High level political commitment has been expressed. The country participated in the regional consensus building meeting. Inception activities are in process, beginning with the rapid assessment carried out in 1998 jointly by WHO the government and other agencies. RBM action is being integrated into efforts for broad health sector development. The partnership is also developing along the same process.
Zambia	N	High level political commitment has bee received. Participated in the regional consensus meeting and has since entered into dialogue with WHO on the finalization of the statement of intent. Partnership activity is growing among agencies involved in malaria action with joint financing by USAID and JICA, and joint planning for taking action to scale between UNICEF, WHO, USAID, JICA and the government of insecticide treated bed nets.
Zimbabwe	A	High level political commitment has been expressed. The country participated in regional consensus meeting. Inception activities are in process, beginning with the rapid assessment carried out in July. RBM action is being integrated into efforts for broad health sector development.

American Region

Argentina	I	Malaria not a major problem except for the northern border areas. WR has engaged in discussions on RBM process during launch in 1998. Malaria control priority action is ongoing – attack phase
Belize	I	Some malaria control activities are ongoing (residual spraying, case management), but they have a heavy reliance on external supplies. There is a necessity to expand coverage and supervised treatment.
Bolivia	N	WR engaged in discussions on the RBM process during launch in 1998. Priority actions are ongoing. Participated in inception meeting in Peru in October 1999, focusing on health care for indigenous peoples. Major constraints: budget, human capacity, uncontrolled mining and migration
Brazil	N	WR engaged in discussions on RBM process during launch in 1998. Priority actions are ongoing: case detection and treatment, house spraying, health education, elimination of breeding sites. High malaria incidence in ecological areas of rain forests with remote farms, mining areas, and intense internal migration (epidemiological risk factors that determine transmission). Participated in Amazona inception meeting in Peru in October 1999, focusing on health care for indigenous peoples. Largest burden in Americas.
Colombia	N	WR engaged in discussions on RBM process during launch in 1998. Ongoing priority actions: house spraying and impregnated nets. Participated in Amazona inception process in Peru in October 1999, focusing on indigenous peoples. Persistence of transmission due to social and political factors, mining and migration, lack of health services and illegal crops. Increased number of cases in 1998.
Costa Rica	I	Three out of 81 cantons are in high risk areas. Malaria control activities are ongoing: radical treatment; focal and aerial spraying; social participation; promotion programs. Border areas with illegal migratory movements, increasing number of susceptible, asymptomatic infection, poor community participation are causing the persistence of transmission.
Dominican Republic	I	Only 3 out of 54 municipalities are in high risk areas. The WR has been engaged in discussions on the RBM process during its launch in 1998. Malaria control activities are ongoing. They have intramural spraying and spatial fogging. Migration between Dominican Republic and Haiti favors malaria. There are favorable conditions for mosquito vector.
Ecuador	N	WR engaged in discussions on RBM process during launch in 1998. Ongoing priority actions: house spraying (though incomplete), environmental problems. Participated in Amazona inception meeting in Peru in October 1999, focusing on indigenous peoples. Increased number of cases in 1998.
El Salvador	I	NO HIGH RISK AREAS (MODERATE OR LOW RISK ONLY)
French Guiana	N	WR engaged in discussions on RBM process during launch in 1998. Ongoing priority actions. Participate in Amazona inception meeting in Peru in October 1999, focusing on indigenous peoples. Together with Suriname and Guiana, has highest risk of transmission.
Guatemala	I	Malaria control activities are ongoing (diagnosis and radical treatment of suspected and confirmed cases; control of breeding sites; house spraying; larvicides) but there is lack of commitment to implement Global Malaria Control Strategy in local health services. Limited coverage of general health services in malaria in endemic areas and little inter-sectoral co-operation.
Guyana	N	WR engaged in discussions on RBM process during launch in 1998. Ongoing priority actions: early diagnosis and treatment, spraying with DDT, bednets. Major problems: mobile populations, mining activities, houses that cannot be sprayed, cross-border population movements. Participated in Amazona inception meeting in Peru in October 1999, focusing on health care for indigenous peoples. Together with Suriname and F. Guyana has greatest risk of transmission in L. America.
Haiti	I	Falciparum malaria is a big problem, but there is a enormous lack of information.
Honduras	I	WR engaged in discussions on the RBM process during its launch in 1998. Malaria control activities are ongoing. They are using integrated measures, like drug treatment, different spraying methods for physical and larval control, community participation. There is a lack of stratification in control strategies, lack of supervision due to budgetary constraints, lack of personnel in high risk areas.
Mexico	I	WR engaged in discussions on the RBM process during its launch in 1998. Malaria control activities are ongoing. A malaria program called PAIS- Integrated and Simultaneous Actions for Malaria Control exists in the southern area specifically for malaria-stable areas. There is a necessity to expand coverage of this program into other areas and to promote its integration into general health services. They call on aerial and house spraying, individual and mass radical treatments, as well as environmental management. Persistence of transmission continues due to lack of health care services and/or coverage, and in-country migration.
Nicaragua	I	WR engaged in discussions on the RBM process during its launch in 1998. Malaria control activities are ongoing. The system of early diagnosis and prompt treatment by community health workers has been disrupted by hurricane Mitch. Some areas are hard to access.
Panama	I	NO HIGH RISK AREA (MODERATE OR LOW RISK ONLY)
Paraguay	I	Malaria not a major problem – 3 out of 18 provinces are high risk. Ongoing priority actions: residual intramural spraying of insecticides. Weak health surveillance systems.
Peru	N	WR engaged in discussions on the RBM process during its launch in 1998. Malaria control activities are ongoing: early diagnosis and prompt treatment by general health services infrastructure. Heavy migration and new colonization of the rain forest area are causing increased malaria incidence. Falciparum malaria is increasing. Participated in the RBM inception process in Peru in October, 1999, which planned for RBM in the Amazon region, focussing on health care for indigenous people.
Suriname	N	WR engaged in discussions on the RBM process during its launch in 1998. Malaria control activities are ongoing: residual house spraying and impregnated bednets. There is a high migration in the interior, gold mining and irregular control activities in malarious areas. Participated in the RBM inception process in Peru in October, 1999, which planned for RBM in the Amazon region, focussing on health care for indigenous people. Together with French Guyana and Guiana, it has the greatest risk of transmission in Latin America.
Venezuela	N	The WR has been engaged in discussions on the RBM process during its launch in 1998. Malaria control activities are ongoing. One pilot project in one Amazon state (Bolivar state), Local health System in Indigenous area. Participated in the RBM inception process in Peru in October, 1999, which planned for RBM in the Amazon region, focussing on health care for indigenous people. Dispersal of indigenous population, transient miners, P. falciparum resistance to chloroquine, intense migration in endemic areas, lack of human resources and finance.

Eastern Mediterranean Region*

Afghanistan	I	Represented at the Baku co-ordination meeting on prevention of malaria between selected countries of EMRO and EURO. Prevailing challenges of malaria in Afghanistan include a) absence of a central core of malaria control programme, b) breakdown of the infrastructure, and c) inaccessibility of many areas due to conflicts. Formulated the action plan for malaria control program for 1999 in consensus among all stakeholders as part of the National Planning Workshop. WHO, in close collaboration with WFP, Kabul municipality, a Dutch NGO – HealthNet International – and other NGOs has been supporting malaria control activities through capacity building in six regions, distribution of medical supplies, strengthening of laboratories, distribution of ITNs and revitalization of vector control activities. WHO facilitated the establishment of the Regional Technical Committees on malaria and leishmaniasis in Kabul, Jalalabad and Kunduz as coordinating structures for stakeholders. The Institute of Malaria and Parasitic Diseases – the main treatment center in Kabul – has been reactivated. Will participate in the September Regional Consultation meeting on RBM.
Bahrain	I	Interruption of malaria transmission achieved. Need to maintain the malaria-free status of the country through adequate surveillance.
Cyprus	I	Interruption of malaria transmission achieved. Vector densities are low, but receptivity to a reintroduction of malaria still exists. Circumstantial evidence indicates that importation of cases of P. vivax from Turkey is not uncommon.
Djibouti	N	Represented at the Nairobi Consensus Building and Inception Meeting. Statement of intent awaited
Egypt	N	Represented at the Nairobi Consensus and Inception meeting. Statement of intent awaited.
Iran (Islamic Republic of)	I	Participated in the Baku co-ordination meeting in which areas of concern pertaining to malaria transmission on the borders between Iran, Azerbaijan and to some extent Armenia were discussed. Common strategies to control these cross-border transmissions were developed. Will participate in the September Regional Consultation meeting on RBM.
Iraq	I	The area centered in North Iraq has a chronic problem of P. vivax, sometimes escalating to epidemic proportions. It concerns mostly four northern governorates of Iraq and parts of southeastern Turkey, with repercussions on Syria and, to a lesser extent Iran, along its western borders. Participated in the September Regional Consultation meeting on RBM
Jordan	I	Interruption of malaria transmission achieved. Adequate surveillance to be ensured.
Kuwait	I	Interruption of malaria transmission achieved. Adequate surveillance to be ensured.
Lebanon	I	Interruption of malaria transmission achieved. Adequate surveillance to be ensured
Libyan Arab Jamahiriya	I	Limited transmission in some areas. Participated in the Regional Consultation meeting on RBM.
Morocco	N	Participated at the Nairobi Consensus Building and Inception meeting. Activities include advocacy and sensitization within the wider health sector. A statement of intent has been submitted to the EMR Regional Office, focusing on a) the elimination of malaria by 2002, b) prevention of reintroduction of malaria after elimination, and c) setting up a standardized strategy for the prevention and control of imported malaria. The contents of this statement of intent were reviewed during the September Cairo meeting.
Oman	I	Mostly P.falciparum. Transmission greatly reduced during the 1990s, due to intensified malaria control. Eradication has been set as a goal. Problems are: the massive importation of malaria from the Indian subcontinent (mostly P.vivax) and Africa, south of the Sahara (mostly P.falciparum, including strains resistant to chloroquine). Participate in the September Regional Consultation meeting on RBM
Pakistan	I	Participated in the September Regional Consultation meeting on RBM. Major challenges include massive importation of malaria from Afghanistan, resistance of P. falciparum to chloroquine and vectors to insecticides.
Qatar	I	Interruption of malaria transmission achieved. Adequate surveillance to be ensured.
Saudi Arabia	I	Malaria is still endemic in the southwestern areas bordering Yemen. Participated in the September Regional Consultation meeting on RBM.
Somalia	N	Represented at the Nairobi Consensus Building and Inception Meeting. Statement of intent awaited
Sudan	N	Participated in North and East Africa in the Consensus Building and Inception meeting. A draft statement of intent describing the process of rolling back malaria in Sudan was developed, reviewed, finalized and submitted for support. Advocacy within the wider health sector is being intensively pursued. Existing national co-ordination structure is being strengthened. At the community level, multi-sectoral structures in States, Provinces and Localities are being established. Roundtable Conference to review a draft strategy document on RBM successfully held in collaboration with UNICEF, UNFPA, WHO, the private sector and other multilateral agencies. Technical Support Network on complex emergencies has fielded a consultancy to assess the current status with a view to stimulating strategy development for rolling back malaria.
Syrian Arab Republic	I	Participated in the Baku co-ordination meeting. Areas bordering northeastern Syria, Iraq and Turkey are of concern for the transmission of P.vivax. Participated in the September Regional Consultation meeting on RBM.
Tunisia	I	Interruption of malaria transmission achieved. Adequate surveillance to be ensured.
United Arab Emirates	I	Ministry of Health, in collaboration with WHO, plans to implement biological vector control measures as part of its malaria control strategy as opposed to using chemical insecticides. Participated in the September Regional Consultation meeting on Roll Back Malaria.
Yemen	N	Represented at the Nairobi Consensus and Inception meeting. A finalized statement of intent is being awaited. Collaborative efforts, involving WHO, the University of Liverpool and other agencies, are being instituted during the last quarter of the year to adequately assess the situation to help stimulate the development of an effective strategy.

* An inception meeting is being planned to develop strategies against re-introduction of malaria for all countries that achieved interruption of malaria transmission.

European Region

Armenia	N	Classification: Malaria epidemics. Strong political commitment: participated in recent cross border meeting in Baku (delegation led by deputy Minister of Health, officially at war with Azerbaijan). Partnership under development. Received assistance for malaria control activities from the Government of Norway and Italy. Participate in inception meeting. Substantial technical support from RBM to establish control programme and control epidemics. Recent cross-border meeting for malaria control. Participate in regional training on malaria control in Samarkand in October 1999.
Azerbaijan	I	Classification: Malaria epidemics. Very strong political commitment. Hosted the recent cross-border meeting on malaria and polio. Major partner is ENI (Oil Company): other partners include government of Italy, UNICEF, 3 NGOs (MSF-B, IFRC & ECHO). Inception process not yet organized. Received consistent support from WHO regional office to develop malaria programme and in its implementation has led to substantial reduction in malaria epidemics. Participated in Regional course for malaria managers in Samarkand for one month in October 1999
Georgia	I	Classification: High risk of re-establishment of malaria. Strong political commitment. Participated in recent cross border meeting in Baku. Partnership not yet established. Inception process has not taken place. Received support from WHO regional office to establish malaria programme and training of staff and provision of drugs and equipment. Participated in Regional course for malaria managers in Samarkand for one month in October 1999
Kazakhstan	I	Classification: High risk of re-establishment of malaria. Strong political commitment. Participated in Inception meeting. Partnership being developed. Inception process not yet established. Have received technical support from WHO regional office. Participated in Regional course for malaria managers in Samarkand for one month in October 1999
Kyrgyzstan	I	Classification: High risk of re-establishment of malaria. Strong political commitment, attended RBM inception meeting in Tashkent. Key partner is Italy. Inception process not yet established. Received technical support to control outbreaks and training for malaria programme staff. Participated in Regional course for malaria managers in Samarkand for one month in October 1999
Russian Federation	I	Classification: High risk of re-establishment of malaria. Moderate political commitment. Participated in cross-border meeting in Baku. Partnership not yet established. Inception process not yet established
Tajikistan	I	Classification: Malaria epidemics. Very strong political commitment. Participated in inception meeting in Tashkent and cross-border meeting in Baku. Active partners include: Japan, Italy and NGOs, ACTED (providing bednets). Inception process not yet established. Received active support for the development of the malaria programme. A WHO consultant has been working with the country programme for 4 months this year already. Supplies of drugs and equipment through funds provided to WHO by bilateral partners. Substantial reduction in malaria epidemics in 1999. Participated in Regional course for malaria managers in Samarkand for one month in October 1999
Turkey	I	Classification: Malaria epidemics. UNDP strengthening the malaria programme and general health services in the GAP region, focus of malaria transmission. Inception process not yet established. Received technical support from the WHO regional office, training of malaria control staff. Participated in Regional course for malaria managers in Samarkand for one month in October 1999
Turkmenistan	I	Classification: Malaria epidemics. Very strong political commitment. Participated in inception meeting in Tashkent and cross-border meeting in Baku. Partnership and inception process not yet established. Received technical support from the WHO regional office in addition to the supply of drugs and equipment. Participated in Regional course for malaria managers in Samarkand for one month in October 1999
Uzbekistan	A	Classification: High risk of re-establishment of malaria. Very strong political commitment Participated in inception meeting in Tashkent and cross-border meeting in Baku. Partners include Italy and UNICEF. Hosted inception meeting. Regional office provides technical support and it is systematically strengthening the Isaev Institute as the regional training center. Participated in Regional course for malaria managers in Samarkand for one month in October 1999

South East Asia Region

Bangladesh	A	Classification: Malaria epidemics; Increasing chloroquine resistance. Strong political commitment but problem of political instability affecting capacity to respond. Strong relations between health development partners as a result of Sector Wide Approach. Inception process underway now and strong social movements at district level. Received technical support from WHO/SEARO and a recent visit by RBM Cabinet project staff
Bhutan	I	Classification: endemic. Malaria is a problem in southern belt of 30-50 km and few valleys. 50% of cases are P. falciparum. Some foci of falciparum resistant to chloroquine and SP. The mountainous northern and central zone of the country is free from malaria. Since 1994, malaria situation is continuously improving. Only around 7000 lab confirmed cases have been reported during 1998. In last three years, no epidemics reported. Not engaged in RBM process.
Democratic People's Republic of Korea	I	Malaria has been completely eradicated since 1970s. Due to epidemic in S. Korea, the areas of Kaesong city, Kwangwon province and South Hwanghae province bordering S. Korea and 4 provinces (North Hwanghae province, South and North Pyongan provinces and Nampo City) have become malaria risk areas. During 1998, 2000 malaria cases were reported in areas along the southern border. Not engaged in RBM process but will be taken up at upcoming border meeting between SEARO and WPRO, in Kunmin, China in November 1999.
India	A	Classification: Malaria epidemics – focal (especially North East and West Coast) and endemic in many states, with increasing P.falciparum. Vertical malaria control programme. Strong political support at Federal and State level for effective action. Partnerships vary from state to state. RBM inception action being taken forward initially in 5 districts; emphasis on Malaria Control and Health Sector Development linkage. Strong partnership established between national researchers (ICMR) and the control programme and national level RBM coordinating committee formed.
Indonesia	A	Classification: Endemic and epidemic. Problem in forest areas of the Outer Islands, particularly in the eastern provinces, where 50% of the cases are P.falciparum. Resistance to chloroquine is widespread where a few S-P resistant foci also found. In 1997, more than 1.5 million clinical cases were reported from the outer islands and a major epidemic occurred in highland areas of Irian Jaya Province, affecting 27,500 people causing 888 reported clinical cases and 102 deaths. In 1996 there were about 6 million reported clinical cases. The RBM inception process is underway, with preparations for action plans being made in several districts, based on situation analyses. Will be ready to implement RBM action in early 2000.
Maldives	I	Has achieved tremendous success in malaria control. No indigenous transmission since 1984. However, 10-25 lab-confirmed imported cases (mostly from neighboring countries such as Sri Lanka, India and Pakistan) are being reported every year. In order to keep the country malaria free, malaria control activities like larviciding, etc. are still being maintained. Not engaged in RBM process.
Myanmar	A	Classification: Endemic and epidemic: major problems with very high morbidity and mortality. Major source of multi-drug resistant malaria for neighboring countries. Strong political support but (1) instability and (2) problems of donor funding. Is the major focus of the RBM Mekong initiative. Partnerships are minimal, and emphasis on community level action is limited - however both are being addressed through country planning for RBM Mekong which focuses on 33 districts bordering China, Thailand and Lao PDR.
Nepal	A	Classification: Endemic. Mostly reported from the Terai areas, i.e., Central Western and Far Western region bordering in India. Although the central region is reporting the highest number of cases, the malaria situation appears to have generally improved since 1992. P.falciparum proportion is about 15% which is the lowest in the region. Certain foci of chloroquine resistant malaria falciparum has been found. Reported clinical malaria cases have been ranging between 25,000-30,000 annually, but have dropped to 7,000 - 9,000 annually. During 1996 and 1997, there have been focal outbreaks in Western and Far Western regions with around 11,000 clinical cases and 17 deaths. Fully engaged in the RBM inception process. Plans for the preparatory phase of RBM in selected areas have been funded by WHO/SEARO.
Sri Lanka	A	Classification: endemic. High malaria case incidence with about 20-50% of P.falciparum in various districts. Malaria in war-torn areas posing a major problem. Effective and decentralized health system, with malaria activities being correspondingly but partially integrated. Low case fatality rates due to effective delivery. Engaged in RBM. Preparatory plans in selected districts supported financially by RBM.
Thailand	A	Classification: endemic. Almost half of its malaria burden is at borders with Myanmar and to a lesser extent Cambodia. Very effective but costly malaria control programme. Has engaged in RBM planning, introducing much more of a partnership approach and community level action and monitoring. Major component in RBM Mekong.

Western Pacific Region

Cambodia	A	Classification: Endemic and Epidemic. Severe multi-drug resistant falciparum problem in west and southeast. Problems also related to weak health services and large scale population movements as the country is still in a process of social stabilization following decades of warfare. Uncontrolled importation of antimalarial drugs and suspicion of fake artesunate on the markets. Strong national political support for RBM. Key partners include EC and WHO, World Food Programme and a number of NGOs. WHO's work has until now been supported by UK, but this direct support is now channeled through HQ's RBM project. USA and Japan are potentially important partners. UNICEF has become strongly involved this year in the context of the WHO/UNICEF Mekong Region Roll Back Malaria Project. RBM inception process: under Government leadership, there is now joint planning of support to RBM among all external partners. A national RBM meeting including main partners was held in Sihanoukville on 20 August 1999. National Malaria Control Programme, EC, UNICEF and WHO are working intently on starting pilot deployment of rapid test diagnosis of falciparum malaria and blister-packed combination treatment in a pilot project which will start in 1999. Engaged in RBM Mekong initiative.
China	N	Classification: endemic and epidemic. Greatest malaria burden with 60-80% of P.falciparum is in the southern province of Yunnan. Hainan is now the only other province with endemic falciparum malaria. Severe multi-drug resistance in Yunnan, possibly even reduced susceptibility to artesunate. Private sector is very active and there is lack of co-operation between private and public services. The province programme is intent on shifting from DDT spraying to insecticide-treated nets, and wishes to introduce rapid diagnostic tests for falciparum in peripheral health facilities. With support from MOH and Institute of Parasitic Diseases in Shanghai, Yunnan province is actively engaged in the RBM Mekong initiative. Plans of action have been reviewed and will form part of the consolidated RBM Mekong plans.
Lao People's Democratic Republic	A	Classification: endemic and epidemic. High falciparum incidence, as more than 50% of the population is at risk of malaria. Weak or absent health services in remote, impoverished highland areas. Substantial donor support from EC, Japan, ADB and World Bank. Considerable needs for national capacity building. Engaged in Mekong initiative. In consultation between concerned departments of MOH and main partners, a plan of action for a UNICEF/WHO project is ready, and will be a part of the consolidated RBM Mekong regional plan. This project focuses on UNICEF support to Government and partners in the field of IEC and WHO support on a unified malaria HIS and MIS including GIS designed to become part of a national, non-specialised HIS.
Malaysia	I	Classification: endemic. Most of the malaria problem is now in Sabah, the Government has made good progress in recent years with its National Malaria Control Programme, which in increasingly oriented towards involvement of the communities and the general health services. There is strong Government commitment for malaria control, and it has not been found necessary to establish any RBM initiative, although, of course, the RBM concepts have a positive influence on the orientation of the National Programme and the position in malaria control efforts in relation to health systems reform.
Papua New Guinea	N	Classification: endemic with intense transmission in many areas and epidemics in highlands. Generally very severe malaria burden especially for young children and pregnant women; health systems are weak and in some areas deteriorating. However, thanks to yearly house spraying, highland epidemics have been prevented in recent years. Antimalarial drug policy has been changed based on therapeutic efficacy studies and now includes combination first line treatment (chloroquine/amodiaquine + sulfadoxine-pyrimethamine). Main partners are Ausaid, Japan, Rotary, UNICEF, mining companies and NGOs including religious missions. Government commitment to RBM is strengthening and UNICEF will join WHO in the inception process.
Philippines	A	Classification: endemic and epidemic in small foci. Malaria is a problem in some regions, particularly in Mindanao and southwestern islands with chronic political and security problems, Palawan with multi-drug resistance and northeastern Luzon with deep poverty. Control efforts hampered by inadequate Government funding and decentralization. Main partner presently Japan, but interest in RBM expressed by USA. With support from RBM Cabinet Project/HQ, a thorough inter-sectoral RBM situation analysis and preparation of plan of action for Region XI (eastern Mindanao) has been started; it will be finalized in November 1999.
Republic of Korea		Has reported indigenous malaria since 1997 (only vivax). Most cases are found near the demilitarized zone in the North. Collaboration with DPR Korea will be taken up at the bi-regional SEAR/WPR malaria meeting in Kunming, China in November 1999.
Solomon Islands		Endemic and epidemic. The very severe malaria burden significantly reduced in the past few years due to partnership action mediate by WHO/WPRO. Population movements following severe unrest in May -June 1999 may lead to increased malaria problems unless current efforts are maintained and reinforced in certain areas. Partners include Ausaid, UNDP, NGOs and Rotary. RBM concepts have been adopted, but there is no formal RBM inception process, since, in many ways, Roll Back Malaria has been practiced in the country for some years, though until 1998, without the name.
Vanuatu		Endemic malaria with moderately intense transmission. Remarkably good results of malaria control efforts in recent years. Malaria mortality has been eliminated (audit and verification procedures being established) and falciparum malaria may be eliminated from several islands over the coming decade. Partners include Rotary and NGOs. Like the Solomon Islands, the RBM language and approach has been adopted. A formal inception process has not been needed.
Viet Nam	A	Classification: Epidemic and endemic. Malaria is a high political priority. Hosted the inception meeting for the Mekong Roll Back Malaria initiative in Ho Chi Minh City in March 1999. Malaria control efforts successfully partially decentralized. Considerable partner support including EC, World Bank, Ausaid, Belgium, Germany, Netherlands, but still concerns about sustainability. UNICEF/WHO project planned for certain districts with persistently severe malaria problems will focus on village health services equipped with rapid diagnostic tests and training materials based on IMCI concepts. This will be part of the consolidated RBM Mekong plan.