The burden of malaria in the Asia-Pacific region, being much lower than that of Africa, has led to some neglect in the past when it comes to rolling back the disease. Two news reports today show why neglect is not an option is global country-by-country elimination os the disease is to be achieved.
Hope was expressed clearly by national Department of Health authorities in the Philippines who exclaimed that “THE Philippines could be malaria-free by 2020 as the number of cases declined by 80 percent in the recent years, the Department of Health (DOH) said on Friday.” The article in the Manila Sun-Star quoted Health Secretary Enrique Ona who said “The government has recorded 9,642 malaria cases in 2011 as compared to 43,441 in 2003.”
A close accounting of the 58 provinces that are considered endemic in the Philippines found that nine have had no cases in the past three years, and forty have been reporting less than 1 case per 1000. While definitely being optimistic about the prospects of overall elimination from the country, the Health Secretary is realistic as quoted by the Sun-Times: “The journey towards elimination status is more difficult than working for a reduction in cases and we will need more commitments and resolutions of the different sectors to be consolidated into a singular, comprehensive initiative so that the whole country, not just the 58 endemic provinces, will be declared malaria-free by 2020.”
The situation in another regional partner is more dire. VOA reports that the problem of malaria drug resistance is “more severe in Cambodia than anywhere else in the world.” The National malaria Center in Cambodia found that, “About 17 percent of all cases in the Cambodian-Thai border area of Pailin were drug-resistant in 2011, up from 10 percent the year before.”
On the positive side, even though the proportion of drug-resistant cases in increasing, the total number of cases continues to decrease. Still, there is concern about ramification of the situation “beyond borders.” Travel and migration among the Mekong region countries means that resistance may not stay put in Pailin. A comprehensive control program, not just reliance on treatment, needs to be in place throughout the region.
Fortunately there are groups like the Asia Pacific Malaria Elimination Network (APMEN) that brings countries in the region together to address common and cross-border challenges. APMEN recognizes that, “Elimination requires a different strategy than sustained control,” and is thus, in am important position to help the rest of the world learn innovative approaches to put paid to malaria.
Gawrie Galappaththy guided a session at the Asia Pacific Malaria Elimination Networkâ€™s Community Engagement for Malaria Elimination Workshop that helped participants summarize their group work on training and research to support community participation in malaria elimination.Â Her report follows:
All the participants were agreed and thought that following training areas are necessary for effective community engagement for malaria elimination.Â Thoughts about training included key topics and target groups as seen below.
- Advocacy â€“ AdvocacyÂ is needed for all level including central, district, village level for all the category of staff
- Partnership with other sectors- specially with the public sector as more than 50% of patients in most of the countries seek treatment from the public sector
- Skills on communication methods â€“ As most of the health personnel is not very much familiar with communication, methods it is important to train all the trainers on communication methods eg -COMBI, materials, participatory approach)
- Resource mobilization- funds as well as personals
- Integration with other diseases â€“ community engagement as an integral part of the health (health package)
- Training for community – training of community on every aspects of malaria
- Strategy developments â€“ most of the malaria programmes in their strategic plans not mentions the involvement of community in malaria elimination. It is important to include this aspect along with key activities
- Skills on Monitoring & Evaluation â€“ most of the countries engaged community for malaria control but lack M&E component. It is important to include M&E as an integral part of the elimination statergy
- Empowerment of community for sustainability of community engagement in malaria elimination
Many research areas were identified by the participants, but need to priority areas depending on funds availability.Â Examples of priority research issues included …
- Cost effectiveness of engagement of community in malaria elimination
- Improvement of drug compliance specially among migrant workers
- Case studies or documentation of success stories
- Promote treatment seeking behaviour specially inÂ Â malaria elimination countries
- KAP studies on malaria especially since perceptions may change as we progress toward elimination
- Role of community in malaria elimination
- Effectiveness of village malaria posts/brigade in malaria elimination
- Role of NGOs/FBOs in malaria using community engagement
- Development and testing of Training modules
- Research on new mechanisms of communityÂ engagement for mobile population
- Understand community structure and to identify the mechanism to sustain motivationAchieving synchronous cross boarder community engagement for malaria elimination
Of particular interest in the region are the training and research needs to identify and test strategies for community engagement between countries – cross-border areas present a special challenge in terms of mobile populations and malaria medicine resistance. APMEN therefore, has to play a major role in advocacy as it is important to increase awareness among politicians, decision makers regarding cross border problems between countries. APMEN can raise a voice in international bodies such as SAARC, ASEAN, BIMSTEC etc.
Regular meetings in cross-border areas are essential at district/state level between countries egÂ Bhutan and ASSAM, Bhutan and West Bengal.Â There is need to address the issue of communication methods between countries taking into consideration ethnicity, language, cultural background etc
Priority Research and training needs for cross-border areas include descriptive studies to understand the migrant pattern, behavior, and risk groups. We also require needs assessment studies including assessments of existing facilities among border populations.
On the final day of the workshop, participants refined and prioritized these research and training topics for follow-up action back home.