Accelerating the last mile: A people-centred multidisease elimination approach for the WHO South-East Asia Region

The WHO South-East Asia Region has achieved more than 35 communicable disease elimination milestones between 2014 and 2025. Yet multiple WHO-mandated elimination targets for 2030 remain off-track across Member States. Furthermore, international financing is tightening, and the structural limitations of siloed, disease-specific programme delivery are increasingly apparent. A business-as-usual trajectory is insufficient to close remaining gaps within the time available.

This Working Paper proposes a multidisease elimination (MDE) approach as a strategic accelerator for the last mile to the 2030 goals: a people-centred, integrated framework that leverages shared health system platforms, cross-sectoral action, and community engagement to accelerate progress towards existing elimination targets, while strictly maintaining disease specific accountability for each target condition. MDE is not a merger of disease programmes; it is a coordinating framework that identifies and operationalizes evidence-based opportunities for synergy across existing initiatives.

The rationale rests on four converging pressures: fragmented delivery duplicating interventions and generating programme fatigue; common health system gaps affecting multiple programmes simultaneously; shared social and environmental determinants that no single programme can address alone; and declining donor financing that makes integrated, cost-effective delivery a programmatic necessity. MDE responds to these pressures at a moment when 16 simultaneous, time-bound WHO elimination targets and an increasing evidence base for integration make the approach both urgent and operationally achievable.

The SE Asia Region MDE Strategic Framework is organized around four pillars: integrating service delivery at community and facility levels; strengthening primary health care and shared health system building blocks; addressing social and environmental determinants through multi-sectoral coordination; and establishing formal governance and accountability architecture. Integration is applied selectively, guided by five evidence-based criteria — geographic co-endemicity, tool synergy, clinical overlap, logistical efficiency, and community acceptance — and calibrated to each Member State's burden profile and health system capacity.

The central country-level deliverable is the National MDE Roadmap: a costed, phased, evidence-based integration plan aligned with disease-specific elimination targets, piloted in hotspot districts before national scale-up. Regional support will be provided through a dedicated MDE Secretariat, an independent Regional Advisory Committee, and a real-time Regional Monitoring Dashboard.

The attached Working Paper was presented to the High-Level Preparatory (HLP) Meeting for its review and recommendations. The HLP reviewed the paper, deliberated in detail on the Agenda, and made the following recommendations for consideration by the Seventy-ninth Session of the Regional Committee:

Actions by Member States

1. Participate actively in the regionwide Member State Consultation and subsequent framework development, including Pathfinder countries where applicable, and collaborate with WHO-SEARO and partners to shape the SE Asia Regional MDE Framework and National MDE Roadmap template, and adopt integrated surveillance and monitoring tools as they become available.
2. Develop and implement a costed, phased, evidence-based National MDE Roadmap, piloted at district level before national scale-up, and validated against disease-specific elimination targets calibrated to each country's burden profile.
3. Strengthen whole-of-government multisectoral coordination (health, WASH, housing, education and agriculture) and community engagement or public-private partnerships to sustain elimination gains, address shared social and environmental determinants, and reduce programme fatigue.

Actions by WHO

1. Lead a structured, consultative process to develop the SE Asia Regional MDE Framework, including integration mapping across disease programmes (e.g. surveillance, community outreach, cross-border collaboration), cross-departmental alignment (HDC/HSD) with PHC and social-determinants platforms, and a standardized National MDE Roadmap template and operational guidance, with biannual reporting to the Regional Committee.
2. Establish the Regional Governance and Monitoring Architecture (SEA Regional MDE Secretariat, independent MDE Advisory Committee, and Regional MDE Monitoring Dashboard) and convene the Regionwide Member State Consultation, selecting a few Pathfinder countries to test the approach.
3. Provide technical guidance and a practical menu of evidence-based integration options tailored to country burden profiles, support redeployment of post-elimination workforce/surveillance capacity, and develop an MDE investment case to mobilize flexible, cross-programme financing.

The Working Paper along with the HLP Meeting recommendations are placed before the Seventy-ninth Session of the WHO Regional Committee for South-East Asia for its consideration, as appropriate.