Malaria elimination by 2025
Cambodia has achieved significant levels of malaria reduction, aiming to eliminate all species of malaria by 2025. Despite this progress, populations living in the most remote and forested areas in the north, including ethnic minorities and mobile and migrant populations, still lack equitable access to malaria services.
In Cambodia, forest-goers and migrant populations contribute to sustained malaria transmission because their high mobility and seasonal cross-border migration limits their opportunity to access healthcare services. Forest-goers also have a greater malaria infection risk, as their movements in and around forested areas tend to coincide with Anopheles mosquitoes’ active biting times.
In response to these issues, Malaria Consortium is collaborating with the Cambodian Government – the Ministry of Health’s National Centre for Parasitology, Entomology and Malaria Control (CNM) and the provincial health departments – through the Regional Artemisinin Initiative 3 Elimination (RAI3E), contributing towards the country’s goal of eliminating P. falciparum by 2023 and P. vivax by 2025.
Provision of malaria services in remote locations through mobile malaria workers
Mobile malaria workers (MMWs) are locally recruited volunteers, trained by health centre staff to provide quality, free malaria services. Malaria Consortium enables MMWs to deliver early malaria detection and treatment interventions in hard-to-reach locations through a flexible, culturally tailored approach that provides appropriate infrastructure, human resources and supplies where they are needed.
A network of 95 MMWs operate across six provinces along Cambodia’s international border, travelling to remote, forested areas in the north of the country. MMWs directly reach those at risk of malaria by actively delivering free malaria testing, providing treatment, organizing health education sessions and distributing preventive tools.
Those living in these hard-to-reach locations typically live in plantations and new settlements in the deep forest. Loy (pictured) lives at her family plantation inside the Vireak Chey forest. Like many other people who work in the forest, Loy and her family live at their plantation site. The MMW went an extra mile to make sure that Loy has access to the healthcare she needs.
“My husband had to go to the forest to collect resin. I felt so sick and stayed alone with our three children. I was so happy when the MMW came to my house to do malaria tests and give us mosquito nets. I was so far from my village and the road was so muddy to visit my family. I know the MMW very well. After treatment, I had no malaria,” Loy said.
Malaria posts have also been set up strategically at entry/exit points of forest areas, providing malaria services to passers-by who live and work nearby. At these posts, MMWs provide malaria case detection services to at-risk individuals using malaria rapid diagnostic tests (mRDTs). They are also equipped to conduct health promotion activities to raise community awareness on malaria transmission and use of effective personal protection, such as long-lasting insecticidal nets (LLINs) and treatment.
Community dialogues at malaria hotspots: inclusive approach
Local authorities, the MMWs and health centre staff regularly lead community dialogue meetings at remote settlements or sub-villages where malaria transmission has been recently detected. Through these, participants can raise their health concerns, receive malaria prevention messages and discuss how to engage their community in the countrywide malaria elimination objectives. The local population can also explore ways to ensure that all members with fever are immediately tested by the MMW and, if P. vivax-positive, referred to the health centre for radical cure treatment.
Some MMWs belong to prominent ethnic groups along the international border. They each speak the local language of the forest-goers and their families. The MMWs know the populations’ movements, local traditions, activities and locations with high activity in forests and forested areas.
Mr Hill, who belongs to the Jarai ethnic tribe in Ratanakiri Province, is a well-known and much respected person within his community. He is helping to improve easy access to quality malaria services for everyone in the community. Speaking the local language, he is also sharing knowledge on how to prevent malaria and the importance of treatment compliance.
“I facilitate community dialogue meetings both in villages and family plantations close to the forests. Using the local language is so important for them, for better understanding and to have good dialogue on health issues,” he said.
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Bringing services to communities is the best way to reach as many people as possible. By providing essential malaria services in remote regions – overcoming geographic, physical, financial, administrative or cultural barriers that could impede people’s access to healthcare – the RAI3E project is supporting community and health system resilience. MMWs are better equipped to diagnose and treat communities, who, in turn, have a stronger understanding of the services available to them and the importance of seeking treatment.
