Successful communicable disease control not only depends on strong national surveillance and preventive efforts but also on the collective actions of neighboring countries to coordinate monitoring and response. The Second Greater Mekong Subregion (GMS) Regional Communicable Diseases Control Project was the second project of the Asian Development Bank (ADB) in the subregion that supports stronger national CDC systems and regional cooperation for CDC, with the participation of Cambodia, the Lao People’s Democratic Republic (Lao PDR), and Viet Nam (together, the CLV countries). It built on the successful experiences of the first project to further enhance regional collaboration systems (Output 1), improve CDC along borders and economic corridors (Output 2), and implement integrated project management (Output 3). The project’s expected outcome was timely and adequate control of communicable diseases of regional relevance. Its outcome and outputs sought to contribute achieving improved health of the GMS population, as impact. Approved in November 2010, the project was financed by $49 million in grants and a loan, all from ADB, and $5 million in counterpart funds from the CLV governments. Additional ADB financing of $9.5 million was approved in October 2015, extending support to malaria elimination.
Most output targets were achieved or substantially achieved. However, achievements across CLV countries were low on three targets: (i) provincial-level full compliance with International Health Regulations–Asia Pacific Strategy for Emerging Diseases (IHR–APSED), (ii) all women of reproductive age and under-5 children receive micronutrients and deworming drugs, and (iii) joint cross-border activities increased to 2 or more per district per year. While the project made earnest efforts to support the strengthening of provincial surveillance and response (S&R) systems, an assessment of full compliance with IHR–APSED at national level was conducted only lately. A joint external evaluation with the World Health Organization revealed that national compliance had improved substantially in the CLV countries, although progress varied, and to reach full compliance, the countries need to further strengthen their human resource capacity, intersectoral collaboration and coordination, and formalization and documentation of procedures.
Joint cross-border activities were conducted satisfactorily under the project. However, the agreement to conduct cross-border activities by cluster provinces for efficiency may have limited the opportunities for districts to fully participate. In addition, as joint cross-border simulation exercises require substantial resources and coordination to organize, cross-border activities were conducted mainly in the form of information-sharing meetings. Nevertheless, partial achievement of cross-border output targets did not affect the overall effectiveness of the project.
Substantial output achievements allowed the project to contribute to significant improvements in the national and provincial S&R systems. As a result, nearly 100% of all disease outbreaks were reported to the respective ministries of health (MOH) and the regional coordination unit (RCU) within 24 hours, and investigated and responded to within 48 hours. Cambodia and Viet Nam achieved this in 100% of cases, while the Lao PDR did so in 84% of cases. The efficiency and reliability of the outbreak reporting system, which relies on the technical judgment of frontline health workers to identify potentially important outbreaks, and to follow a standardized protocol to report and respond, is a critical cornerstone of effective CDC. The project’s technical training for CDC staff; investment in capacity development, including formulation of guidelines, standards, and protocols; and provision of necessary tools such as internet and phone call credits enabled this achievement.
Besides mobilizing support and institutionalizing regional cooperation mechanisms for cross-border CDC, the project also helped improve hygiene and prevention in the villages through the model health villages. Malaria incidence in all targeted provinces declined dramatically because of the targeted interventions supported by ADB additional financing and other development partners.
The project thus succeeded in contributing to improving the health of the GMS population. No major outbreaks of communicable diseases of international concern occurred since 2011, with only scattered cases of cholera, Japanese encephalitis, and avian influenza. By 2017, the burden of communicable diseases in the GMS had decreased significantly.
The project had the MOH in each country as executing agencies (EAs). An integrated project management system, overseen by a regional coordination unit and composed of project management units and/or project implementation units within the EAs, operationalized the project.