Cambodia’s ‘last mile’ to malaria elimination
Cambodia has made great progress in fighting malaria, with cases dropping by 76% from 2000 to 2022. The country is close to eliminating Plasmodium falciparum (Pf) malaria and has only around 1,300 cases of Plasmodium vivax (Pv). But there is a challenge: people moving around in forests and plantations are keeping malaria transmission going. Most remaining cases are in remote villages.
Under the guidance of Cambodia’s National Malaria Programme (CNM), Malaria Consortium is supporting a community network of 100 locally recruited and well-trained mobile malaria workers (MMWs) to offer quality malaria services to hard-to-reach populations across six northern provinces along the international border with Lao PDR, Thailand, and Viet Nam, including in Stung Treng province.
Starting in late 2020, Cambodia initiated foci-based innovative approaches, known as the ‘last mile’ to malaria elimination. The success of the last mile is contingent on villagers in high-risk areas agreeing to increased testing, regular fever screening, and in some cases, taking preventive antimalarial medication, supporting the MMWs to gain recognition as reliable sources of malaria care services in their communities.
Local solutions for lasting impact and keeping community at the core
San is one of the many MMWs in Cambodia. His journey embodies the power of community trust in healthcare in an indigenous village in Stung Treng, one of Cambodia’s northern provinces. In reaching mobile and migrant communities in remote and forested areas with conventional malaria approaches, MMWs like San are critical to bring essential malaria services to the doorstep of those in need.
San’s journey in this endeavour began in 2018, driven by a sense of pride and duty towards his community.
“In my village, all the people are indigenous population. Before I was asked to become a mobile malaria worker, I did not know at all that malaria was transmitted by mosquito bites. Also, nobody else in my village knew about this,” he said.
Initially unfamiliar with the intricacies of malaria transmission, San underwent rigorous training at the Siem Pang Health Center.
“This was not easy at all. I didn’t know anything about malaria and the nurse used so many difficult words – words I had never ever heard before. I asked them to speak a bit slower and explain to me again and again,” he recalled.
Central to this endeavour is the concept of community engagement and trust-building. MMWs like San are equipped not only with knowledge and essential tools but also with the cultural sensitivity and local insights vital for effective intervention. They are more than healthcare providers; they are respected members of the community, chosen by their peers to champion the cause of malaria elimination.
MMWs serve a wide range of people with different jobs and ways of life. They help everyone from those who work in forests and plantations to rangers, border guards, soldiers, and their families. Each group faces its own problems, like where they live and how they move around, which are influenced by what they do for a living, their culture, and their family connections.
MMWs are respected members of their communities, often from ethnic minorities or fluent in the local language. They are chosen by community leaders, Operational District staff, health center staff, and community members. Thus, the role of MMWs is pivotal within their respective communities.
The success of the tailored approach can be summarized in one word: community. Community-led initiatives do more than just improve healthcare; they make people feel like they own the responsibility together.
San proudly says that the decrease in malaria cases is not just a number – it shows how strong his village is. When communities are educated and empowered, they take charge of their health and are better able to fight against diseases like malaria. San’s story is a sign of hope, showing that with the right people and the right efforts, we can beat malaria and make the world a healthier place.
“Now I can smile. The tests of people in my community do not show malaria anymore as before. People have learned a lot and understand better about malaria. They also use the nets that we distribute to protect themselves,” he said.
