Cross-Border Collaboration between India and Bhutan Towards Malaria Elimination

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Cross-Border Collaboration between India and Bhutan Towards Malaria Elimination

Investing in cross-border collaboration for a malaria-free South-East Asia Region

Challenges

The South-East Asia Region (SEAR) continues to record the largest decline in malaria globally. Within SEAR, India has shown tremendous progress, despite being the highest burden country outside of Africa. While India has focused on elimination of malaria by 2030, one of its bordering countries, -Bhutan, aims to have zero indigenous cases by 2020. In 2019, Bhutan reported only six indigenous cases but also 34 imported cases (most from India), and 14 introduced cases.

India and Bhutan share friendly international borders – 699 km with adjoining nine districts of four states on the India side and ten districts (Dzongkhags) on the Bhutan side – with almost unrestricted population movement. It is well recognized that malaria does not respect national boundaries, i.e. elimination cannot be achieved in isolation by any country, and Bhutan may possibly miss the set timelines without adequately addressing malaria along border areas. Border areas are mostly fraught with complex geographies and challenging settings; they are inhabited by ethnic, and mobile and migrant populations. Border malaria is therefore a socio-economic development issue and not only a technical one, which requires attention and investment.

Toward a Solution

To address the challenge above, Bhutan and India have requested that concerted efforts in cross-border activities, especially at local levels, be greatly accelerated facilitated and coordinated by the World Health Organization (WHO). This Cross-border collaboration initiative between Bhutan and India aims to contribute to the achievement of malaria elimination targets and Sustainable Development Goal (SDG) 3 (Good health and well-being) as well as other SDGs relating to ending poverty (SDG 1) and SDG targets on equity.

Preparing context-specific, cross-border action plans can mitigate the above-mentioned challenges. The initial steps towards these critical cross-border actions started with advocacy and planning meetings over several years in the SEAR. The countries showed strong commitment by signing the 2017 Ministerial Declaration on Accelerating and Sustaining Malaria Elimination and endorsing the Regional Action Plan 2017–2030. Cross-border collaboration was reinforced with the 2018 regional committee meeting with the launch of an operational framework for cross-border collaboration for malaria-free SEAR. The framework focuses on maximizing cross-border coordination mechanisms that provide an enabling environment for a context-appropriate harmonization and synchronization of policies, strategies, interventions and joint work plans, including joint capacity–building exercises.

The national strategic plans of India and Bhutan have a cross-border component, yet only a few episodic meetings were previously held with representation by high-level officials. In 2019, the WHO programme managers’ meeting discussed cross-border collaboration and arrived at a consensus on the way forward. Subsequently, intermittent discussions continued at the country level. A peer-to-peer exchange on prevention of the re-establishment of malaria transmission was convened by the Government of Bhutan and supported by the Global Fund and Asia Pacific Leaders Malaria Alliance (APLMA) in 2019 where the WHO provided technical inputs. This meeting discussed the malaria situation along border areas and emphasized, inter alia, rapid information sharing through informal coordination mechanisms and alignment of interventions. Another meeting was held in Bhutan to discuss the cross-border strategy and mechanism. As part of strengthening malaria elimination efforts in Bhutan, technical assistance was provided through the WHO for establishing a District Health Information Software?2– (DHIS2) based malaria module within the Health Management Information System (HMIS) in Bhutan in 2018, and a comprehensive assessment of progress in malaria elimination was carried out by the WHO, including surveillance assessment along the border, in 2019. Importantly, a meeting was organized with a key focus on local–level collaboration with WHO Country Office support in 2019. Participation included districts along the India and Bhutan border in addition to respective national programme managers and the WHO. The objectives were to review and share updates on malaria elimination, with special focus on districts sharing international borders, and to develop a roadmap for cross–border collaboration.

This India-Bhutan bilateral district-to-district meeting was a step forward in translating various recommendations from previous meetings/consultations and to operationalize 2017 Ministerial Declaration to mutually agreeable strategic ‘road map’ with special emphasis on border-relevant package of interventions for subnational (district) level. The priority areas were:

real–time data sharing, including case histories (on WhatsApp, Dropbox, e-mails, phone, etc.);
coordination meetings for joint review and planning.
synchronized implementation of interventions (long-lasting insecticidal nets, distribution, indoor residual spraying);
diagnosis and treatment, irrespective of nationality, and ensured treatment compliance;
strengthening of surveillance, and monitoring and evaluation adjusted to burden reduction and elimination settings;
epidemiological analysis and malaria risk stratification;
WHO facilitation and support for digital platforms for sharing malaria data, joint meetings and strengthening capacity at the subnational levels.

The initiation of bilateral district-to-district, real-time sharing of malaria information and periodic exposure visits for joint planning and action are innovative steps in the process of establishing a cross-border collaboration mechanism. This benefits both countries’ path to malaria elimination and ensures that the gains made are safeguarded. With a progressive evolution, this cross-border initiative is expected to be replicated in other countries of the region. An initial plan for India-Bhutan cross-border actions has been prepared. There will be further country–level consultations, especially at the district level, with special emphasis on: actions (what); and who, when, where, why and how the actions will translate into operationalization of commitments made by the countries and may be leveraged to develop an investment case for resource mobilization. This will also add to other examples of cross-border collaboration, such as the Timor-Leste and Indonesia and the Greater Mekong Subregion (GMS) platform. The WHO will continue to provide support in facilitating these efforts.

CONTACT INFORMATION
Dr Tjandra Aditama, Acting Director of Department of Communicable Diseases, World Health Organization (WHO) Regional Office for South-East Asia (SEARO)

SDG
03 - Good Health and Well-being

SUPPORTED BY
World Health Organization (WHO) Viet Nam

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