Development partners making a difference: The European Union supports WHO in eight Asian countries prepare for the future

Communities across 8 countries in Southeast Asia gained better access to COVID-19 services, including vaccinations, and countries are now better prepared for future emerging diseases thanks to a dynamic 3-year project funded by the European Union (EU).

In 2021, the EU and the World Health Organization (WHO) agreed to strengthen pandemic response and preparedness in 8 countries from the Association of Southeast Asian Nations (ASEAN) region: Cambodia, Indonesia, Lao People’s Democratic Republic (PDR), Malaysia, Myanmar, the Philippines, Thailand, and Viet Nam.

From 2021-2023, the EU contributed EUR 20 million and adopted a flexible, highly responsive approach to how the funding is spent in view of rapidly changing conditions. This allowed WHO to work closely with national governments, and other partners such as civil society organizations, to identify and provide the services that people needed in real time.

WHO delivered essential equipment, trained health workers, supported outreach campaigns and mobilised over 600 additional volunteers, consultants and experts to strengthen response and preparedness for COVID-19 and future pandemics.

^{IPC nurse Ms Khalsy loads the medical equipment package into the EU-funded autoclave machines in the sterilization room at the Muang Khong hospital, Lao PDR, 2023. Photo credit: WHO/ Blink}

Responding to country needs as they arise

At first in 2021, the focus was on meeting the immediate demands of COVID-19, ensuring that people were aware of how to protect themselves, and knowing when and where to get vaccinated. By 2022 and 2023, work focused on research and innovative approaches to strengthen the ASEAN’s regional capabilities to prepare for, detect, and respond to future health emergencies and emerging diseases.

The EU understood how the context was changing and agreed for WHO to apply a dynamic approach to address fast evolving nature of pandemic, moving from one type of COVID-19 response stream to another – strengthening quarantine, surveillance, laboratory, vaccination services to respond the pandemic and combat future infectious diseases outbreaks.

Since 2021, WHO worked closely with ASEAN – sharing knowledge and experience in managing the pandemic to help the region build a better level of preparedness for the future, with improved regional and country collaboration. As a result, the eight ASEAN countries were stronger to navigate collectively the globally evolving nature of the pandemic, and regional collaboration flourished.

Longer-term benefits

The EU-funded, WHO-implemented project was designed to help ASEAN countries respond to COVID-19 and strengthen their pandemic preparedness capabilities. The project also provided assistance for countries to revive disrupted health services and, in the longer term, helped achieve progress towards universal health coverage by strengthening various components of health systems. Efforts focused on boosting quality assurance and genomic surveillance in laboratories; supporting risk communication and community engagement initiatives; strengthening disease surveillance systems; improving infection prevention and control measures and water, sanitation, and hygiene in health care facilities; and identifying ways to improve coverage of essential health services.

An Infection and Prevention Control nurse in the corridors of a hospital ^{Ms Khalsy, an IPC nurse in Lao PDR. Photo credit: WHO/ Blink}

Doctor checks blood pressure for patient ^{Dr Ses Vutha checks blood pressure for patient, Sorn Pun, at Sampov Loun Referral Hospital in Bamg in Battambang’s Sampov Loun district, Cambodia, 2023. Photo credit: WHO/ Blink}

Countries’ leadership decisive for success

Over the three-year project, each country focused on the areas of pandemic preparedness and response that most needed strengthening, responding to the evolving needs of their communities and health systems.

The project supported country-level coordination, planning, and monitoring for future. For example, Cambodia strengthened government coordination capacity in surveillance, laboratory, risk communication, clinical management, vaccination and infection prevention control, and there was high-level ministerial engagement with international health regulations, pandemic preparedness, and the strengthening of subnational health security systems.

A laboratory techniciam inspects patients' blood samples in a hospital's laboratory room ^{A laboratory technician, Them Chhun, inspects patients’ blood samples in the laboratory room in Sampov Loun Referral Hospital in Battambong’s Sampov Loun district, Cambodia, 2023. Photo credit: WHO/ Blink}

Health official writes down patient information ^{Health official, Ouk Savath, writes down patient information at Sampov Loun referral hospital in the Battambang district in Cambodia, April 2023. Photo credit: WHO/ Blink Media}

Surveillance, risk assessment, and contract tracing capabilities were strengthened in Cambodia, Lao PDR, Malaysia, Myanmar, the Philippines, Viet Nam and Thailand. For example, Lao PDR strengthened its surveillance systems, conducted investigations, contact tracing, risk assessment and response to disease outbreaks, integrated COVID-19 into existing influenza surveillance, and conducted 64 risk assessments in total, using multisource surveillance.

Malaysia strengthened surveillance data management and analysis, and collaborated and coordinated national, regional, and provincial action on public health emergencies and emerging infectious diseases between the Ministry of Health and WHO.National laboratories were strengthened in Cambodia, Indonesia, Lao PDR, Malaysia, the Philippines, and Viet Nam. For example, Indonesia established external quality assessment of COVID-19 laboratories to ensure quality testing of COVID-19, providing 1034 testing panels to 989 laboratories in 34 provinces.

^{A laboratory officer conducting external quality assessment on whole genome sequencing. Indonesia, 2022. Photo Credit: WHO/ Arie Ardiansyah & Hartanti Dian Ikawati}

Risk communications and community engagement was a strong feature of the project in Cambodia, Lao PDR, Malaysia, Myanmar, the Philippines, Viet Nam and Thailand. For example, Myanmar printed 10 000 posters, and distributed 5400 information kits to flood- and conflict-affected populations. WHO’s open course on Risk communications essentials was translated into the local languages to mobilize community volunteers and local service providers. In Myanmar, activities were conducted through civil society organizations, and WHO worked with World Vision to train a team of migrant health volunteers who provided important health services to over 5,800 members of Thailand’s migrant communities.

In Malaysia, the project helped vaccinate 7882 individuals in 483 localities by conducting outreach COVID-19 vaccination campaigns for hard-to-reach areas in Sabah State. In Viet Nam, the project collaborated with the Tay Nguyen Institute of Hygiene and Epidemiology to develop routine immunization programmes for those who missed their routine vaccines due to the COVID-19 pandemic.

Vaccinations at outreach point ^{Vaccination at outreach point in Dak Nong, Viet Nam, 2023, Photo credit: WHO Viet Nam/ Loan Tran}

Supporting those who are hard to reach

As the project’s goal was to ensure health for all, work benefited those populations that are hardest to reach with community campaigns, outreach events, and awareness raising.

Migrants and refugees in Thailand access COVID-19

When Thailand’s second wave of COVID-19 emerged in a major residential area of migrant workers, it became clear migrants and refugees needed to be the focus of additional attention. Thailand has many migrant workers arriving across the borders of neighbouring countries, many of whom were not automatically entitled to free health services.

Migrant health volunteers give an ATK (Antigen Testing Kit) demonstration at a beneficiary home ^{At a migrant beneficiary home, Migrant Health Volunteer Sung Seo Sang (right) gives an ATK (Antigen Testing Kit) demonstration with fellow volunteer Wanna Tun (left). Migrant Health Volunteers are trained through the World Vision organization with support from partners, including WHO and EU. Bangkok, Thailand, 2023. Photo credit: WHO/ Blink}

The project team built customised COVID-19 services for migrants, including setting up telephone hotlines in four languages, helping all migrants get vaccinated, and strengthening coordination and partnership with health authorities, the Migrant Working Group, WHO, and other key stakeholders.

In 2022 for example, the project supported active COVID-19 case finding and facilitating access to vaccination for over 3000 migrants in 45 districts across Thailand. The project also trained and supported migrant health workers to operate the hotlines, so that migrants could feel confident and comfortable calling and talking.

Cambodian health officer checks the temperature on Cambodian migrant workers as a health check for COVID-19 ^{Cambodian health officer, Srae Loet, checks the temperatures on Cambodian migrant workers as a health check for COVID-19 at the Phnom Dey International border checkpoint in Cambodia’s Battambang’s Sampov Loun district, 2023. Photo credit: WHO/ Blink}

Grassroots heroes in Cambodia

In Cambodia, village chiefs stepped up to create a healthier future for their communities. In villages across 25 provinces, 2000 village chiefs and nearly 5400 village health support groups received trainings, organised by the Ministry of Heath with support from WHO and the EU. This equipped the chiefs with knowledge and skills necessary to control transmission of COVID-19, influenza, and other respiratory diseases, and collaborate with authorities more closely on health issues facing their communities.

“I want to see all the people in my village healthy, free from diseases and leading prosperous lives,” said village chief Kuon Visoth.

Nurse consults with local patients about symptoms concerning their baby son ^{Ms Soun Sokly, a nurse (right), consults with local patients, parents Chem Bun Thorn (left) and Srey Ream (centre), about symptoms concerning their son. Serey Meanchey Health Center in Battambang’s Sampov Loun district, 2023. Photo credit: WHO/ Blink}

The chiefs then shared their newfound knowledge during community dialogues, which then transformed how community members adopted healthier practices. Empowered with accurate information, communities embraced protective measures during times of high COVID-19 transmission. “We are delighted that village chiefs have become champions to increase their own and villagers’ health literacy, and sustainably use local capacity to advocate and raise the awareness of families to protect and improve their health and well-being,” said Dr Nargiza Khodjaeva, Acting WHO Representative to Cambodia (July 2023).

Grassroot heroes – how village chiefs in Cambodia are stepping up to create a healthier future

“This WHO-EU partnership was sparked by the urgent need to respond to the COVID-19 pandemic. However, the crisis provided an opportunity to accelerate the strengthening of (Cambodia’s) health security for the future. COVID-19 has been a powerful reminder that when health is at risk, everything is at risk. We must invest in resilient health systems and ensure (Cambodian) communities are well prepared for future health threats and emergencies,” explains Dr Khodjaeva.

Reaching remote populations in the Philippines

People on the remote Manicani Island in Eastern Samar province of the Philippines experienced a transformation in access to COVID-19 services, thanks to the work of a local organization, People in Need Philippines, supported by WHO and the EU.

It was hard for the 3000 residents to separate sound advice on COVID-19 vaccinations from misinformation. Even if they wanted to be vaccinated, they faced the cost and hassle of a 45-minute boat ride to the nearest vaccination centre. Not surprisingly, vaccine uptake was low.

In collaboration with village health workers, local leaders, and the Philippines’ Department of Health, the project focused on strong community engagement activities, house-to-house visits, and easy to access vaccination services.

“We had meetings with the barangay health workers and the barangay health emergency response teams on how we can convince people to get vaccinated,” said Benilda Codoy, the barangay captain in Hamorawon village.

The results were impressive. Every resident on Manicani island was reached with information. Vaccination rates almost tripled, with 79% of people on the island being vaccinated. In one part of the island, barangay (village) Banaag, 100% of eligible adults were vaccinated by March 2022.

Philippines: Local health workers champion COVID-19 safety on remote islands

WHO staff and civil society organization (People in Need) walk by village for COVID-19 vaccination uptake increase amongst vulnerable groups ^{Manicani is an island in the Eastern Samar province of the Philippines. WHO Philippines worked closely with civil society organization People in Need (PIN) to increase COVID-19 vaccination uptake among vulnerable groups in the island, 2022. Photo credit: WHO/ Blink Media}

Building resilient health systems

The EU-funded, WHO-implemented project also helped achieve progress towards universal health coverage by strengthening various components of health systems and assisting countries to revive disrupted health services.

^{Migrant workers walk from the Cambodia border to Thailand at the Phnom Dey International border checkpoint in Cambodia’s Battambang Sampov Loun district, 2023. Photo credit: WHO/ Blink Media}