Shrinking the Malaria Map

UCSF Global Health Group’s Malaria Elimination Initiative (MEI)

The Asia Pacific’s drive towards malaria elimination by 2030: The role of frontline health workers in the Philippines and beyond

19 May 2016
By Sara Rossi and Erika Larson

 

Clemente takes pride in contributing to the decline of malaria in his remote, mountainous community of indigenous people. He describes his tribal community as extremely geographically isolated – the distance to the nearest rural health unit is over an hour on foot, which creates a large physical barrier to access basic social services. As a trusted elder of his community and as one of the only adults in the village who can read and write, Clemente was nominated by his fellow villagers to providemalaria diagnosis, treatment, case management, and community education. He is an especially effective vehicle for malaria prevention, diagnosis, and response, his supervisor Aileen added, because of his deep understanding of the local culture and environment.

Clemente Col is a volunteer malaria rapid diagnostic test (RDT) specialist in Palawan, Philippines. Of more than 7,100 islands in the Philippines, Palawan has the highest burden of malaria in the country, though the malaria map is quickly shrinking. Palawan’s progress is, in part, due to the vision of the Department of Health and strong Global Fund support through the Pilipinas Shell Foundation, Inc., and its Movement Against Malaria program. Success is also driven by boots on the ground—community health workers like Clemente who can tackle malaria where it occurs, and where their services are most needed.

Lately, Clemente estimates that he sees just a couple of cases of malaria in a given month and in some months none at all. Cases tend to cluster among men who travel for temporary agricultural work in the forests. This type of labor migration is common among indigenous populations of the Philippines and puts them at higher risk of malaria transmission.

Shown below are malaria cases by Philippine province in 2003 and 2014, revealing dramatic reductions over time. Despite this trend, malaria remains highly endemic in the Palawan province (circled below).

 

These hard-to-reach communities will likely be the last to eliminate malaria in the Philippines and in the Asia Pacific region. Supporting efforts in these ‘hot spots’ was one of the topics discussed last week when malaria experts, researchers, implementers, civil society, donors, and high-level leaders met in Bangkok during the first annual regional Malaria Week (link is external). Rallying behind the Asia Pacific Leaders Malaria Alliance (APLMA) Malaria Elimination Roadmap (link is external), stakeholders are aligning to tackle some of the biggest threats to success, including drug and insecticide resistance.

Capacity to identify, reach, and treat every malaria case will be required to eliminate malaria and prevent reintroduction in the Asia Pacific. This demands investment in health workers and robust, sustainable health systems. However, efforts to strengthen surveillance and health system infrastructure will extend beyond malaria—they will contribute to universal health coverage and, importantly, will be critical to preparedness for future infectious disease threats. An investment in malaria elimination is an investment in health security.

Solutions are within reach. A strong research and development pipeline will provide new tools to tackle these threats and accelerate progress towards elimination. Clemente’s effectiveness at educating and treating his own community is proof, however, that many solutions are already in our hands. Frontline health workers like Clemente remind us that strong surveillance and health systems are at the core of malaria elimination success.