ORGANIZATIONAL BRIEF

Overview APLMA Terms of Reference Access to Malaria Medicines and Technologies Task Force Terms of Reference Regional Malaria Financing Task Force Terms of Reference Deliverables and Monitoring Framework

OVERVIEW
CONTEXT
The Asia Pacific region has made significant progress in combating malaria but the disease remains a major cause of illness and death with an estimated 36 million new cases and around 49,000 deaths each year. Malaria is linked with poverty: the highest malaria mortality rates are in countries that have the highest rates of extreme poverty. The high rate of illness, loss of human life and selective distribution of the disease negatively affects economic and social development and household opportunities. In addition, malaria parasites resistant to artemisinin, the core ingredient in the worlds frontline drugs to treat malaria, are now found in geographic pockets in four countries in the Greater Mekong Subregion, primarily in border regions. Given population movement in the region as well as the widespread risk factors for developing artemisinin resistance, including poor quality medicines and drug utilization practices, the scope of the problem could quickly widen. Artemisinin resistant malaria is a regional public health threat that does not recognise national borders. It requires an urgent and coordinated approach to maintain the effectiveness of the worlds most effective malaria treatments (artemisinin-based combination therapies, or ACTs) and to prevent a resurgence of the disease in areas where it had been brought under control. If artemisinin resistance were to spread to or emerge in India or sub-Saharan Africa, the public health consequences could be dire, as no alternative antimalarial medicine is available at present with the same level of efficacy and tolerability as ACTs. Such resurgence would result in the loss of thousands of lives and billions of dollars. Addressing malaria and artemisinin resistance requires rapid scale-up of malaria interventions for all atrisk groups, careful surveillance and tracking of malaria cases, close monitoring of the efficacy of antimalarial medicines, and coordinated action to remove substandard and counterfeit medicines from markets. It also requires multi-sectoral action, including engagement of the private sector; cross-border collaboration; and sustained financing. Leaders in the region have called for sustained attention to malaria control and elimination, containment of artemisinin resistance and long-term financing for these efforts. The Asian and Pacific health leaders present at the Malaria 2012 conference hosted by the Australian Government in early November 2012 captured these concerns in their final statement calling for the creation of a leadership initiative and agreeing to work together to reduce by 75 per cent national malaria cases and deaths between 2000 and 2015, and to contain artemisinin resistance. Heads of Government gave even higher level endorsement to the urgency of the problem in signing the Declaration of the 7th East Asia Summit on Regional Responses to Malaria Control and Addressing Resistance to Antimalarial Medicines in Cambodia later that month.

ASIA PACIFIC LEADERS MALARIA ALLIANCE (APLMA)

To respond to this momentum, the Asia Pacific Leaders Malaria Alliance (APLMA) is being formed to translate the declaration into action. The Prime Ministers of Australia and Viet Nam are the Co-Chairs for the Alliance. The leaders of other malaria endemic and concerned countries in the Asia and Pacific region are encouraged to join. Membership connotes agreement at the highest-level of leadership to advocate for malaria control and containment of artemisinin resistance, and to annually review national and regional progress in reducing the malaria burden. Countries that do not have on-going malaria transmission can support the APLMA as members at the highest leadership level, or as observers. Recognizing the economic and social impacts of malaria, particularly artemisinin resistant malaria, and other trans-boundary communicable health threats, the Asian Development Bank (ADB) has agreed to host the Secretariat for the APLMA. The Secretariat will support the Co-Chairs and member countries in advocacy, including establishment of a Champions Group to support the APLMA in driving multi-sectoral engagement in malaria control; annual review of progress; convening of meetings, developing work plans and reporting results; and other tasks as agreed by the Alliance. The Secretariat will also support APLMA

task forces on access to quality malaria drugs and other technologies (AQMTF) and regional malaria financing (RMFTF) to achieve results in these important areas. APLMAs work will be carried out in close collaboration with the World Health Organization (WHO), which launched its Emergency Response to Artemisinin Resistance in the Greater Mekong Subregion in April 2013. The WHO has agreed to produce a semi-annual scorecard to track progress towards 2015 commitments and APLMA objectives. The scorecard will use country data submitted to WHO for the World Malaria Report, supplemented by other sources of information. The scorecard will be updated and published, along with technical recommendations for further progress, twice a year. The APLMA will also engage the United Nations Special Envoy for Financing the Health Millennium Development Goals (MDGs) and for Malaria; the Roll Back Malaria Partnership; the Global Fund to Fight AIDS, Tuberculosis and Malaria; other key malaria partners, regional organizations, the private sector and non-health sector actors. In Africa, the African Leaders Malaria Alliance (ALMA) was established in 2009 by 20 African heads of state and has since been expanded to include 49 leaders. The ALMA advocates for malaria control at the highest levels of government, and ensures accountability through quarterly monitoring and assessment of progress on malaria and other maternal and child health interventions. Recognizing that malaria issues in Asia and the Pacific are not as acute as those in the African subcontinent, the APLMA will review progress annually, and focus advocacy on issues of artemisinin containment, sustained financing for malaria control and elimination to prevent resurgence, improving the quality of antimalarial drugs and technologies used in Asia and the Pacific, and multi-sectoral action needed to address further progress on malaria control.

ASIA PACIFIC LEADERS MALARIA ALLIANCE

TERMS OF REFERENCE
BACKGROUND
1. The Asia-Pacific region has made significant progress in reducing the burden of malaria since 2000. However, malaria remains a major killer in the Asia-Pacific with approximately 36 million new cases and 49,000 deaths each year. Malaria is largely a disease of the poor. 2. The emergence of resistance to artemisinin, the core ingredient in the worlds frontline drugs to treat malaria, is of major concern. 3. The leaders attending the Malaria 2012: Saving Lives in the Asia Pacific hosted by the Government of Australia in November 2012 agreed to: a. accelerate progress toward the goal set by member states of the World Health Assembly of a 75 per cent reduction in malaria cases and deaths by 2015, thus contributing to the United Nations Secretary Generals goal of near zero deaths from malaria worldwide; and b. urgent collective action to contain drug resistant malaria. 4. The leaders also called for greater regional political leadership and collaboration to drive progress, to address the challenges of malaria drug resistance and ultimately eliminate malaria from the region. To do this it was agreed to establish the Asia Pacific Leaders Malaria Alliance (APLMA). 5. The East Asia Summit (EAS) leaders agreed on the 20th November 2012 to the Australian-proposed declaration on Regional Responses to Malaria Control and Addressing Resistance to Antimalarial Medicines and have given further political leadership and support to this issue.

PURPOSE

6. The APLMA will motivate high-level commitment, mobilize country and regional action, track progress and ensure accountability in meeting regional and national malaria targets by 2015 to: a. reduce malaria cases and deaths by 75 per cent from 2000 levels; and b. contain artemisinin resistant strains of malaria. 7. Specifically, the APLMA will: a. drive and review progress on malaria targets (annual review of country and regional scorecards); b. review options and make recommendations for improving access to quality antimalarial medicines and technologies and for closing the financing gap for malaria control and elimination; c. ensure appropriate engagement across sectors to combat malaria; and d. consider the value of and lessons learned from engaging leadership for broader regional health security.

APPROACH
8. The APLMA will meet annually to review progress and consider outcomes, and will inform relevant regional political groupings, e.g. the East Asia Summit (EAS) and the Pacific Islands Forum (PIF), on progress in meeting malaria targets. In 2014 and 2015, annual meetings will be held on the margins of already planned leadership meetings (e.g. the East Asia Summit, UN General Assembly) as agreed by the Co-Chairs and a majority of members. 9. The APLMA, supported by national ministries, will work to engage existing regional political fora such as the ASEAN+, EAS, APEC leaders, and PIF as appropriate on malaria targets and progress.

10. To support the APLMA in accomplishing these goals, it will: a. Establish an APLMA secretariat to undertake the membership and coordination work of APLMA; b. Convene a regional taskforce to recommend options to improve access to quality antimalarial medicines and technologies; c. Convene a regional taskforce to explore options to close the financing gap; and d. Advocate expanding the coverage of effective malaria interventions in partnership with civil societies, the private sector and non-health sector actors. 11. The APLMA will have an initial mandate through to the end of 2015, before which time, a review will inform decisions about the ongoing need for and structure of the APLMA.

MEMBERS
12. Concerned leaders of countries with a high burden of malaria, artemisinin resistant malaria or highrisk of resistant malaria will be encouraged to participate. APLMA will be open to other leaders who wish to support APLMA on issues of regional malaria control and containment of artemisinin resistance.

SECRETARIAT
13. The Asian Development Bank (ADB) has agreed to host the APLMA Secretariat. The Secretariat, with support from national government officials, will support the APLMA leaders to manage the Alliance to obtain results, build regional cooperation on malaria and other communicable diseases, oversee work plans and progress of the task forces, and ensure a cross-sectoral approach to resolving financing and malaria drugs issues. 14. The Secretariat will also provide logistical and knowledge management functions for the APLMA, including organizing meetings, convening task forces, and ensuring access by leaders to up to date technical material, advocacy advice and s upport as well as links to the UN Secretary Generals Special Envoy for Financing the Health MDGs and for Malaria, the World Health Organization (WHO), the Roll Back Malaria Partnership, and other relevant partners.

PRINCIPLES

15. The APLMA will advocate for approaches to combat malaria that are consistent with building overall health system strengthening capacity. Its mandate sits in the context of countries ability to respond to infectious and emerging disease threats more broadly. 16. A group of high level and influential leaders a Champions Group from the Asia and Pacific region may be formed by the UN Secretary Generals Special Envoy for Financing the Health MDGs and for Malaria to assist the APLMA in its work and advocate across sectors. It could include influential leaders from business in the region and representatives from across public and private sectors (e.g. health, tourism, finance, industry, research). 17. The Taskforces on Access to Quality Medicines and Other Technologies and Regional Malaria Financing will be convened by the APLMA Secretariat. Each Taskforce will have two co-chairs at the senior level, and membership will consist of leading experts, technical agencies, and relevant stakeholders. The recommendations resulting from the work of the Taskforces will be communicated to the APLMA via its Secretariat.

ACCESS TO QUALITY MEDICINES AND OTHER TECHNOLOGIES TASKFORCE

TERMS OF REFERENCE
PURPOSE
The Access to Quality Medicines and other Technologies Taskforce (AQMTF) will advise the Asia Pacific Leaders Malaria Alliance (APLMA) on options for improving the availability of, and access to, quality medicines, diagnostics and other products to assist in, by 2015: 1. reduce malaria cases and deaths by 75 per cent from 2000 levels; and 2. contain artemisinin resistant strains of malaria.

APPROACH

The AQMTF will examine arrangements in the region for the regulation, production, procurement and distribution of medicines, diagnostics, mosquito nets, insecticides and other products used in the control and management of malaria (malaria control products) and develop options for: 1. ensuring the use of best-practice evidence-based therapies, consistent with international standards, and halting the use of oral mono-therapies and medicines that do not meet international standards; 2. strengthening national regulatory capacity in malaria-affected countries including through regional collaboration on standards and regulatory practices; 3. enhancing access to and affordability of quality medicines, diagnostics and other malaria control products, including options for increasing production, improving quality of manufacturing, possible incentives for private sector producers and/or improving distribution where appropriate; and 4. improving and/or increasing the use of preventive measures, including nets and insecticides. The AQMTF will collaborate with, and build on the work of, existing global and regional organisations and networks involved in malaria control and management to avoid duplication and accelerate progress.

MEMBERSHIP

The AQMTF will be co-chaired by the Secretary of the Department of Health and Ageing, Australia, and the Secretary of the Ministry of Health and Welfare, India. The AQMTF will comprise senior policy officials and experts from regional countries with influence and interest in improving access to high quality medicines, diagnostics and other products, together with representatives of international organisations and non-governmental organisations with interest and expertise in malaria control, including the World Health Organization (WHO). Membership will be by invitation issued by the co-chairs in consultation with the WHO Director-General and the UN Secretary Generals Special Envoy for Financing the Health MDGs and for Malaria. The AQMTF will consult with civil society and with malaria control product manufacturers, including in the private sector, as appropriate.

MEETINGS AND REPORTING

Meetings will be convened by the co-chairs, with Secretariat support to be provided by the Asian Development Bank. The AQMTF will present its findings to APLMA leaders by August 2014.

REGIONAL FINANCING FOR MALARIA TASKFORCE

TERMS OF REFERENCE
PURPOSE
The Regional Financing for Malaria Task Force (RFMTF) will advise the Asia Pacific Leaders Malaria Alliance (APLMA) on options for increasing financing for malaria and other communicable diseases in order to meet the following objectives by 2015, and sustain and improve upon these achievements beyond 2015: 1. reduce malaria cases and deaths by 75 per cent from 2000 levels; and 2. contain artemisinin resistant strains of malaria.

APPROACH
The RFMTF will review and update estimates of funding needs and gaps, review impacts of proposed changes in the global financing environment, assess the case for expanding existing or developing new financing mechanisms, and develop options and recommendations to mobilise and channel sustained financing for malaria in the Asia-Pacific region. The RFMTF may consider ensuring sustained financing for communicable diseases beyond malaria if appropriate given greater efficiency or leverage. The RFMTF will collaborate with, and build upon the work of existing global and regional organizations and networks involved in control of malaria and other communicable diseases to avoid duplication and accelerate progress.

MEMBERSHIP
The RFMTF will be chaired by eminent persons with regional expertise in finance and fund utilization. The RFMTF will comprise senior policy officials, experts and private sector members with interest and influence in improving regional financing for malaria and other communicable diseases, together with representatives of international and regional organizations and non-governmental organization with interest and expertise in financing for regional health initiatives, including the World Health Organization (WHO). The RFMTF will consult with governments, the private sector and civil society, as appropriate.

MEETINGS AND REPORTING

Meetings will be convened by the co-chairs, with Secretariat support to be provided by the Asian Development Bank. The RMFTF will present its finding to APLMA leaders in August 2014.

DELIVERABLES AND MONITORING FRAMEWORK (2014-2015)

Design Summary Impact Reduced malaria incidence in the GMS and other selected high-malaria burden member countries Performance Targets and Indicatorsa Malaria burden reduced by 75% by 2015 (2000 baseline) National artemisinin resistance containment/elimination targets met by 2015 Data Sources and Reporting Mechanisms World Malaria Report WHO Malaria Scorecard Assumptions and Risks Assumption Long-term government commitment to control or eliminate malaria Risks Continued evolution of malaria vector and virus Emergence and spread of drug resistance reduces effectiveness of malaria programs Outcome Financing, support and quality of drugs and technologies for malaria programs increased in the region APLMA mandate expanded beyond malaria to other communicable diseases relevant to the region by December 2015 Financing for malaria increased to fill 100% of the identified gap Withdrawal of marketing authorization for all oral artemisinin-based monotherapies from markets Decreased low-quality and counterfeit drugs in local markets of selected GMS countries (baseline to be established) Secretariat fully staffed, with results-based work plan in place by December 2013 Monthly progress reports against results work plan available from January 2014 to December 2015 Biannual (2 x per year) APLMA updates through 2015 Task force has membership and results-based work plan by November 2013 Task force delivers technical reports on options and proposed recommendations, including 2015 deliverables, for improved access to quality medicines to the APLMA by June 2014 APLMA communiqu WHO annual reports National malaria program assessments APLMA reports Assumption Leadership and advocacy impact international funding and national budgets Risk Other regional security and health priorities prevent leaders from focusing on malaria

Outputs 1. APLMA secretariat in place and delivering results

Project reports

Assumptions Countries remain committed to malaria reduction Risk Timely recruitment of qualified consultants is delayed

Malaria Scorecards and updates presented

2. Regional task force on access to quality malaria medicines and technologies (AQMTF) in place and delivering results

Technical reports Quarterly progress reports against work plan from January 2014 to December 2015

Design Summary 3. Regional financing for malaria task force in place and delivering results

Performance Targets and Indicatorsa Task force has membership and results-based work plan by November 2013 Task force delivers technical reports on options and proposed recommendations, including 2015 deliverables, for increasing financing for malaria and other health threats to the APLMA by June 2014

Data Sources and Reporting Mechanisms Technical reports Quarterly progress reports against work plan from January 2014 to December 2015

Assumptions and Risks

Activities with Milestones 1. APLMA secretariat in place and delivering results 1.1 Organize the APLMA secretariat; establish task forces, and develop results-based work plans for the secretariat and task forces (November 2013) 1.2 Hold meetings and workshops of the Champions Group (December 2013November 2015) 1.3 Organize third biannual APLMA meeting (October 2014) 1.4 Conduct review of APLMA and update objectives and targets (June 2015) 1.5 Prepare and submit TA final report (December 2015) 2. Regional financing for malaria task force in place and delivering results 2.1 Hold meetings and workshops of the task force (December 2013 November 2015) 2.2 Submit technical report on innovative financing mechanisms for long-term malaria control to the APLMA (June 2014)

Inputs APLMA Secretariat Staff and offices at ADB Manila WHO malaria scorecards Malaria content for senior level meetings Media and outreach on achieving malaria goals and objectives Progress on two work streams, including policy recommendations and plans for implementation of changes for (i) access to quality medicines and (ii) regional malaria financing

3. Regional task force on improving access to quality medicines in place and delivering results 3.1 Hold meetings and workshops of the task force (December 2013 November 2015) 3.2 Submit technical report on mechanisms for improving the availability of quality medicines for malaria to the APLMA (June 2014) APLMA = Asia-Pacific Leaders Malaria Alliance, GMS = Greater Mekong Subregion, MDG = Millennium Development Goal, TA = technical assistance, WHO = World Health Organization. a Performance indicators will be finalized after the APLMA Secretariat has been established and consultants are mobilized. Source: Asian Development Bank.