In the north-east of Cambodia, near the border with Lao People’s Democratic Republic (Lao PDR), Mr Sython Makara, a 29-year-old primary care nurse, supports the health care needs of Cambodians living in 17 villages scattered across densely forested parts of Siem Pang district.
Based at the Siem Pang Health Centre in Phabang village, Mr Makara is working to reach isolated communities where difficult terrain and different ethnicities, languages and dialects remain as some of the barriers to eliminating malaria.
“[In my role] it is very important to be able to speak Lao and Kaveth, as over 85% of people over 30 years old only speak Lao or Kaveth, although around 80% of people under 30understand at least some Khmer. The main messages can be given in Khmer, but the non-technical discussions must happen in local languages and dialects,” explains Mr Makara.
Overcoming hurdles to reach marginalized populations is a key focus for WHO Cambodia this World Malaria Day, with the global theme Time to deliver zero malaria: invest, innovate, implement. Cambodia has shown inspiring progress in the fight to eliminate malaria, with a 91% decrease in confirmed cases between 2017 and 2022. It has been five years since malaria mortality was last recorded in 2017, achieving the 2020 target two years ahead of schedule.
Cambodia’s success in dramatically reducing malaria cases has been made possible through the strengthening of surveillance, case management and vector control, and has been intensified in the last two years by the roll-out of elimination acceleration strategies specifically targeted to the country’s context. Cambodia was the first country in the Greater Mekong Subregion to implement these acceleration strategies, which are being adapted by other countries in the region with the support of the WHO Mekong Malaria Elimination programme.
In Cambodia, remaining malaria cases occur almost exclusively in remote villages and communities and are managed by health workers at the local level. With this in mind, the national Center for Parasitology, Entomology and Malaria Control (CNM) developed recorded messages in the eight most common ethnic languages to encourage sustained behavioural changes. The messages are broadcast in all high-risk villages on loudspeakers, with the lyrics of popular songs replaced by new ones containing malaria messages that are also printed on pamphlets and distributed to villagers.
Health care workers in Cambodia often have to travel across difficult terrain to reach isolated communities in the battle to eliminate malaria.
© WHO/Sython Makara
In his role, Mr Makara supports other health workers to share the recorded messages and engage villagers in conversations and discussions. He also visits families to help them understand the urgency of protecting themselves against malaria and encourages them to sleep under long-lasting insecticidal nets; take chemoprophylaxis when travelling to high-risk areas; and ensure everyone with a fever is tested for malaria and receives treatment if positive.
Mr Makara’s involvement in the daily lives of the communities he works with has contributed to decreasing the malaria burden. Villages in the Siem Pang Health Centre catchment area have one of the highest rates of uptake of chemoprophylaxis in Cambodia, and Siem Pang Health Centre has recorded a 61% drop in malaria cases, from 1357 cases in 2019 to 532 cases in 2022.
"Community engagement is especially important in deep-forest minority villages to make sure that the government guidelines are added to the local customs and habits,” emphasizes Mr Makara. “Good community engagement brings together all the important partners who can influence the opinions of the villagers: if the influential people in the village want to include government guidelines in the village habits and beliefs, it will be accepted more naturally by the whole village."
WHO has worked with CNM to implement its intensification plan from 2018 to 2020 and ‘last mile’ activities since December 2020, now covering seven provinces reporting plasmodium falciparum malaria. In addition, WHO supported the country to roll out integrated drug efficacy surveillance in 10 provinces in 2022, and helped update national treatment guidelines, including the use of artesunate pyronaridine as second line treatment and primaquine over 7 days for the radical cure of Plasmodium vivax malaria patients, both of which will revolutionize malaria treatment.
“This World Malaria Day, we congratulate the Royal Government of Cambodia for its strong leadership in malaria elimination. WHO will continue to support Cambodia towards the goal of elimination, and beyond, to prevent the re-establishment of malaria transmission,” said Dr Ailan Li, WHO Representative to Cambodia.
Cambodia’s ‘last mile’ of malaria elimination is implemented by the Cambodia’s national Center for Parasitology, Entomology and Malaria Control at the Ministry of Health, in partnership with WHO, the United Nations Office for Project Services, Clinton Health Access Initiative, Catholic Relief Service, Cambodia Malaria Elimination Project 2 (University Research Co.), Malaria Consortium and civil society organizations.
The Mekong Malaria Elimination (MME) programme is an initiative that supports malaria elimination across 6 countries of the Greater Mekong Subregion – Cambodia, China (Yunnan Province), the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – that is made possible through the support of donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill & Melinda Gates Foundation, and the U.S. President’s Malaria Initiative (PMI).