Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications that may result in death.
According to the World Health Organization (WHO), malaria mortality rates dropped by about half during the implementation of the Millennium Development Goals (MDGs), meaning millions of malaria deaths were averted – mostly in children under five. In 2014 there were 214 million cases of malaria and an estimated 438,000 deaths, 10% of which in South East Asia.
Over the past 15 years malaria incidence has fallen by 37% globally and mortality rates have also decreased by over 60% during that same period. The Malaria Consortium note that the increasingly effective nature of the malaria response has led many countries to now focus on the elimination of the disease but there is still significant work that remains to be done.
The 2030 Sustainable Development Agenda facilitates two strategies that will guide malaria control and elimination efforts – the Global Technical Strategy for Malaria (GTS) and the Action and Investment to Defeat Malaria (AIM). The GTS provides a comprehensive framework intended to enable countries to develop tailored programmes for accelerating towards elimination. The AIM is the successor of the Global Malaria Action Plan (GMAP), advocating for investment in malaria as a ‘best buy’ for development. It highlights how reducing and eliminating malaria creates healthier, more equitable and prosperous societies.
In the Asia-Pacific, the Great Mekong Sub-region (GMS) countries are at the center of the malaria response, covering Cambodia, Lao PDR, Myanmar, Thailand and Viet Nam, with a combined population of 326 million people. Artemisinin-resistance is significant in the GMS, considered by many to have reached emergency status, and given its cross boarder nature, requiring a regional response. A regional US$ 100 million programme, the ‘Global Fund Regional Artemisinin Resistance Initiative’ (RAI), for Lao PDR, Vietnam, Myanmar, Cambodia and Thailand has been split between country components (US$ 85m) and the inter-country component (US$ 15m) for the period of 2014-2016 to improve the regional response to malaria.
There have been a number of effective aspects of the response in the GMS:
- Several cross-border malaria diagnosis and treatment posts have been established;
- Countries have developed clear national strategies (e.g Lao PDR);
- Community-based malaria programmes have been developed, including community-based testing (e.g. Myanmar), as well as education (including behavioural change education – e.g. Thailand), treatment and follow-up (e.g. Cambodia);
- Regular coordination between government and other sectors involved in the response has increased (e.g. Myanmar, Cambodia);
- Pilot mobile app / smart phone treatment regime have been developed (e.g. Myanmar);
- Mobile clinics – integrating malaria and other health priority services have been introduced (e.g. Myanmar);
- Public-private partnerships are being advanced (e.g. Cambodia);
- Distribution of long-lasting insecticide nets (LLIN) has become more expansive (e.g. Cambodia);
- Training of mobile malaria workers has occurred in key sectors of forestry and mining (e.g. Cambodia);
- Engagement of migrant health volunteers to target high risk groups (e.g. Thailand);
- Translating education materials into various migrant languages has been scaled up (e.g. Thailand);
- Strong network and health care at the village level has been utilised in the malaria response (e.g. Lao PDR); and
- National monitoring and evaluating (M&E) systems have been developed (e.g. Lao PDR).
But the response in the sub-region still faces many challenges:
- Cross border collaboration must be improved – networking must be through all levels of the response;
- Health centres need to become sensitised to the needs of mobile and migrant populations: this included consideration of language and cultural norms being facilitated in the delivery of health services and initiatives to remove stigma and discrimination from health centres being implemented;
- Consistency is required in treatment regimes across the GMS;
- There is no regional malaria platform to coordinate civil society and at risk communities, both for malaria and across other health development priorities such as HIV, TB and dengue fever;
- There is a need to strengthen civil society involvement in regional and national governance mechanisms;
- Improving health and treatment literacy is needed and will be a critical step in enhancing the civil society response to malaria;
- Limited access to remote locations, particularly during rainy season remains a concern (e.g. Myanmar);
- Bureaucratic barriers in some locations, whereby approvals requirements from regional and local level, for mobile health services integration hinder the response (e.g. Myanmar);
- Identifying and maintaining qualified volunteers (e.g. Myanmar);
- Use of expired drugs in the region requires attention (e.g. Myanmar);
- Difficulties integrating across different health priorities must be acknowledged (e.g. Cambodia);
- Funding for testing needs to be scaled up (e.g. Cambodia);
- Difficulties following-up with patients over course of treatment is a concern given the drug resistant nature of the epidemic in the region (e.g. Cambodia);
- Incentives under national programme differ to those offered under international programmes (e.g. Cambodia);
- Limitations on role of civil society to mobilising communities and behavioural change education (e.g. Thailand)
- Migrant volunteers are given less responsibility than government appointed village health workers;
- Quality of behavioural change education (e.g. Lao PDR);
- Delayed M&E reporting (e.g. Lao PDR);
- Limited civil society organisations with skills and experience working in the malaria response (e.g. only one organisation in Lao PDR);
- Need for mobile clinics, specifically focusing on malaria to reach remote and high-risk populations (e.g. Lao PDR);
- Volunteers are under utilised, they are only paid for directly observed treatment (DOT) and not for diagnosing cases;
- High workload of volunteers prevent them getting to forests and reaching high risk populations (Lao PDR)
It is crucial to sustain the civil society-focused response to malaria. At this juncture, one important priority is the establishment and sustainability of a GMS civil society working group on malaria, which can design and implement a regional community and civil society platform. This platform will allow civil society stakeholders to engage national governments and donors effectively to ensure that malaria programs take into account the inclusion of communities and civil society, in particular mobile populations. The platform will also serve as a venue for advocacy and cross-border collaboration among civil society groups within and outside the sub-region, linking the local response to global processes. It will also provide a mechanism to strengthen knowledge and understanding of crucial human rights and gender-related aspects of the malaria response.
Please see the following resources for further information: