Hospitals and health centers are most likely to receive patients with emerging infectious diseases, but IPC practices in health facilities are substandard. Hospital sanitation and hygiene facilities are lacking. Hospital medical waste management is often unsatisfactory. The general public has almost unrestricted access to infectious patients wards, and such practices may result in ineffective treatment, the spread of emerging infectious diseases from health facilities to the general public, increased hospital-acquired infections, and development of drug resistance.

Weaknesses in CLMV’s health systems are a threat to health security in the GMS, one of the targets of the UN sustainable development goals for the health sector. The governments have demonstrated strong commitment and leadership towards the control of emerging infectious diseases and other diseases of regional importance. National policies and plans are in place to deal with these major health threats. CLMV countries have stepped up domestic financing and mobilization of external assistance to improve cross-border cooperation and put in place comprehensive national health security systems. CLMV are committed to achieve standards based on the International Health Regulations, 2005 in line with the strategic framework of the Asia Pacific Strategy for Emerging Diseases (APSED), 2010, both of the World Health Organization (WHO). The APSED, 2010 includes eight focus areas: (1) regional preparedness, alert, and response; (2) surveillance, risk assessment, and response; (3) monitoring and evaluation; (4) risk communication; (5) laboratories; (6) IPC; (7) zoonoses; and (8) public health emergency preparedness. CLMV governments have developed or are developing national strategies to increase quality of laboratories and IPC, based on WHO guidelines.

The midterm review of Strategy 2020 of the Asian Development Bank (ADB) recommends expanding operations in the health sector to 3%–5% of ADB’s annual approvals. The project is in line with ADB’s Operational Plan for Health, 2015–2020. The project is included in the current country operation business plans of CLMV and in the GMS Regional Investment Framework Implementation Plan, 2014–2018; and is aligned with the CLMV country partnership strategies. The project addresses regional public goods as described in ADB’s regional cooperation and integration strategy. ADB financing in the GMS health sector includes engagement in supporting regional cooperation, infrastructure development projects, human resources development, and a health sector governance reform program. ADB has supported several loans and grants focusing on CDC; multiple loans, grants, and technical assistance projects focusing on HIV/AIDS; and a number of grants and technical assistance projects focusing on malaria financed under ADB’s Regional Malaria and Other Communicable Disease Threats Trust Fund under the Health Financing Partnership Facility.

Earlier ADB GMS projects on CDC have supported regional cooperation, equipped provincial health facilities, and focused on addressing single diseases (malaria, HIV/AIDS, and neglected tropical diseases). Building on the lessons learned from previous interventions, the project will focus on (i) overall health system strengthening, rather than concentrating on a single disease; (ii) streamlining support for regional cooperation with existing regional frameworks such as the APSED; (iii) supporting district health facilities close to remote populations rather than provincial health facilities; (iv) combining equipment investments with improvement of the quality of laboratory diagnostic and health services in the district hospitals; (v) focusing on MEVs; and (vi) uniting separate CDC health interventions on single diseases into one investment focusing on preventing and mitigating the risk of adverse public health events that endanger collective health.

Other development partners that play an important role in CDC are the United States Agency for International Development, which is rolling out the Global Health Security Agenda; the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria; the Three Millennium Development Goal Fund in Myanmar; WHO for CDC and health system technical support; the Global Alliance for Vaccines and Immunization and the United Nations Children’s Fund (UNICEF) for immunization; and the World Bank for hospital infection control in Viet Nam. So long as funding concentrates on HIV, malaria, and tuberculosis, it remains inadequate. As CLMV’s national income per capita increases, future financing by the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria, and bilateral development partners is uncertain. Aid coordination mechanisms are improving at the central level, across subsectors, and increasingly also at the provincial level.

CLMV governments have requested ADB support for the GMS Health Security Project. The project will expand surveillance and outbreak response systems, improve data management, shift from expanding laboratory services to improving laboratory quality and biosafety, and add support for rolling out IPC to all hospitals in the target provinces.