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From the Regional Director 
Dear Friends,
 
The World Health Organization strives to be more responsive to the fast changing public health arena in the South-East Asia Region. Our efforts are now focused on four strategic areas - addressing the persisting and emerging epidemiological and demographic challenges; advancing universal health coverage and robust health systems; strengthening emergency risk management for sustainable development; and articulating a strong regional voice in the global health agenda.
 
This edition of our newsletter highlights the advances and gains made in some of our strategic areas. Efforts that are being made to finish the task of eliminating neglected tropical diseases such as kala azar, leprosy and yaws; and vaccine preventable measles which continues to be a major childhood killer.  
 
All countries in the Region are making concerted national efforts to improve the health of their people. As a result, we are seeing substantial progress in some areas. The Region has halted and reversed the HIV and AIDS epidemic. Impressive efforts are being made in the fight against malaria. The lessons from polio eradication programme are now being applied to reach the vulnerable children with other lifesaving vaccines. Some countries have rolled out unique interventions to engage and reach communities with immunization and other health programmes.

This edition features efforts by some of the member countries. The ensuing editions will feature more. We hope to continue to engage and interest you with our newsletter.



Dr Poonam Khetrapal Singh
Regional Director
KALA-AZAR: Striving for elimination


Spread by the bite of infected female sandflies, Visceral Leishmaniasis, also known as Kala-azar, is a neglected tropical disease. Over 147 million people in the World Health Organization’s (WHO) South-East Asia Region are at risk of contracting this life-threatening disease, mainly in Bangladesh, India and Nepal, with recent, sporadic cases being reported from Bhutan and Thailand. Of the total 109 districts in these three countries where Kala-azar is endemic, 52 are in India, 45 in Bangladesh, and 12 in Nepal. 

Characterised by high fever, loss of weight, anaemia and swelling of the liver and spleen, Kala-azar is debilitating, and without treatment, it is fatal in almost all cases. Defeating the disease involves early detection of all Kala-azar and post-Kala-azar dermal Leishmaniasis cases, improved treatment for post-Kala-azar dermal Leishmaniasis cases, and compliance with treatment along with effective vector control. Full story
Renewed focus in the fight against LEPROSY
 
Vagavathali Narsappa, 47, is a hero not only to people affected by leprosy in his home city of Hyderabad, in central India, famous for microchips and minarets, but also to tens of thousands of people across the country.

Narsappa has been living with leprosy since he was eight. His fingers were affected and had to be amputated.

“I only have my two thumbs and little fingers.” The disability meant that he could not work. There was a time when he begged on the streets. But the rejection, humiliation and discrimination did not crush his spirit or his love for life. Full story
Halting and reversing the HIV epidemic in the South-East Asia Region – Getting it right
 
One of the most heartening trends in the South-East Asia Region has been the active participation of civil society groups in the consultative process that has gone into the formulation of the World Health Organization’s recent guidelines for treatment of HIV and AIDS. “The consultations helped strengthen our relationship with WHO. We made a regional submission to WHO with examples of good practices from our partners. We are helping with the roll-out of the guidelines. This will eventually help in improving the quality, coverage and equity of services and interventions for key populations such as men who have sex with men (MSM),” says Midnight Poonkasetwattana, Executive Director of the Bangkok-based Asia-Pacific Coalition on Male Sexual Health (APCOM).

WHO’s consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations are a prime example of this collaboration. The recommendations focusing on earlier treatment saves lives and also prevents new infections – these guidelines were developed with inputs from affected communities living with HIV. Full story
Battle against MALARIA: Sri Lanka and Bhutan show the way
 
Every year, around World Malaria Day (April 25), we hear about how malaria, a mosquitoborne infectious disease, mowed down thousands of adults and children. In 2011, more than 1.3 billion people in the World Health Organization’s South East Asia Region (SEAR) lived in areas at risk of malaria. Ten of the eleven Member States are endemic for the disease. Despite that, the picture is not uniformly bleak because countries are fighting back with success.

New tools and tactics being used to counter the spread of the disease and to reduce its huge economic and human costs are producing results. Maldives has been malaria-free since 1984. Many countries in the Region are making progress. Two countries which provide inspiring examples in the battle against malaria in recent years are Sri Lanka and Bhutan. Sri Lanka, an island nation, once among Asia’s worst affected nations for malaria, has since October 2012, reported zero local cases of malaria. The country’s Anti-Malaria Campaign is now working hard to prevent reintroduction of the disease and towards obtaining the Malaria-Free Certification from the WHO. Full story
Community clinics in Bangladesh: Bringing health care to the doorsteps of rural people
 
Dokhaiya Para, a ward (smallest local government administrative unit) in Bangladesh’s Rangamati district in the Chittagong Hill Tracts (CHT), is a picturesque place surrounded by hills and a lake. But Munni Chakma and Lima Sree Chakma, who commute every day by boat from the Rangamati town, have little time to enjoy the scenic beauty.

The boat journey takes more than an hour. It is not comfortable. The work they do, however, is quietly revolutionizing the health scenario across Bangladesh – from inaccessible, hilly terrain to storm and tidal bore-prone areas. Full story
Mission Indradhanush: Leveraging lessons from the polio success story
 
Was the routine immunization session held at site on time? Did the ANM (auxiliary nurse and midwife) have the list of all the children eligible to be vaccinated in the area? Were the cold-chain logistics maintained? Did the ANM inform parents that the child may develop mild fever after the vaccination? Were the banners and posters displayed properly?

Vandana Singh’s work is like that of a military general precisionplanning every detail of a campaign. Every morning, she starts out early, with a check-list. “We go to the site earmarked in our monitoring plan. And then start ticking off each of the items, one by one,” says the World Health Organization Surveillance Medical Officer posted at Barabanki in Uttar Pradesh, India, a high-focus district in a state trailing in routine immunization. There are over twenty questions in Singh’s check-list. Full story
Defeating MEASLES and RUBELLA in Myanmar
 
Myanmar has been witnessing unprecedented large-scale immunization campaigns this year. The country, with a population of over 62.3 million, has targeted 17.4 million children, the entire cohort of 9 months to 15 year-old children in the country, with the measles and rubella (MR) vaccine. The Government of Myanmar embarked on a grand mission to achieve the World Health Organization’s South-East Asia Regional goal of measles elimination and rubella control by 2020.

Expectations were high, and to accelerate progress towards this goal, Myanmar’s Ministry of Health, with support from WHO and other partners like UNICEF and GAVI, the Vaccine Alliance, launched a national Measles Rubella Vaccine campaign in January-February 2015 targeting all children in the age group of 9 months to 15 years irrespective of their previous immunization status. Full story  
Appreciative inquiry: Nepal uses new approach to achieve full immunization for children
 
Forty-one-year-old Nara Bahadur Karki was luckier than many in Kathmandu. The recent earthquake damaged his house. He slept out in the open for eight days. But no one died or was injured in his family. Now, he is back home, and has come to terms with the reality that he has lost many friends in the quake that devastated large parts of Nepal.

Now is the time for “healing and restoration,” says Mr Karki, a public health professional, who is a well-known appreciative inquiry practitioner and coach, and has conducted over 40 AI workshops in districts across Nepal. Perhaps it is the transformational nature of AI that lies behind his optimism. Full story
Timor-Leste: Strong malaria control programme cuts cases
 
A few months ago, when 45-year-old Rita Soares, who lives far from a health post, developed a fever, she felt drained and wondered how she would get treated. In fact, help arrived in the shape of a community health worker who came to her and tested her for malaria.

“When it turned out that I had malaria, he gave me the medicine I needed and I was soon feeling better. I am really grateful as I didn’t need to go to a city hospital for either tests or for treatment.” Full story
YAWS elimination: India’s success story leads the way for global eradication
There is a famous saying in public health – where the road ends, yaws begins.

Dr Rajendra Panda, an Indian doctor, now retired, vividly recalls the time when he led a government medical team deep into the forested areas of Dantewada in Central India in what is now Chattisgarh state. “It was the summer of 1995. We were hearing reports of cases of yaws in Dantewada. But no doctor had actually seen anyone with yaws. Local health workers were unaware of its existence. So we set out to collect evidence. There were three of us – all medical doctors. We had to cross a river to get to the areas where yaws cases were suspected. There was no boatman; we rowed ourselves. We walked 10 kms in the forest before we saw the first yaws case – a boy of about ten with heavy lesions on both his hands. He was roaming around, scantily clad, and seemed totally unaware that there was anything wrong.”

“We moved around the forest and found 12 more cases – mostly young children, some adults. We brought them to the nearest health sub-centre at Nelasnar in Dantewada and took a blood test. They were diagnosed with yaws and each given a shot of penicillin,” says Dr Panda, a former Joint Director, National Centre for Disease Control at Bastar in Chhattisgarh. Full story
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