Bill & Melinda Gates Foundation

Private Sector Innovates to Eliminate Malaria in Cambodia

April 20, 2015

On this World Malaria Day, it’s important to reflect on the major ground we’ve gained. For example, in the last decade, Cambodia has achieved impressive results in its fight against the disease — so much so that it is now one of the 17 countries in South East Asia aiming to eliminate malaria by 2025. But the largest gains can often be madeby closing the smallest gaps.

Cambodia’s National Strategy for Malaria Elimination stresses the need for early diagnosis to detect all malaria cases, lest the problem once again grow to previous proportions. The strategy relies on public and private sector providers offering access to reliable diagnostics and high quality malaria treatment, while simultaneously preventing the use of substandard drugs and monotherapies. These steps are vital to ensuring that artemisinin-resistant parasites, which threaten control and elimination gains with the prospect of untreatable malaria, are not allowed to spread.

Indeed, the spread of artemisinin-resistant parasites heightens the sense of urgency in the fight against malaria and amplifies the need to detect and treat every single case promptly and appropriately.  To do this, it’s critical to reach remote, high-risk populations with limited access to health services and inconsistent treatment seeking behaviours.  This means creatively pressing the private sector — where 60% of antimalarial drugs are distributed in Cambodia — into service.

Increasing demand for malaria case management services

Mobile migrant workers in Cambodia run a greater risk of malaria infection than other populations. Their work brings them to endemic forested areas – and they often do not have access to preventive measures, such as insecticide-treated nets or repellents. In addition, because of the overall decline in malaria cases in the country, they rarely link their symptoms to malaria and forego treatment. When treatment is sought, it is often among informal providers who often prescribe a mix of drugs of unknown origin and efficacy.

In order to reach the remote populations of mobile workers and their families, Population Services International-Cambodia (PSI-Cambodia) is implementing an innovative project in partnership with the corporate private sector and the Gates Foundation. Working with rubber plantation owners in northeast Cambodia, PSI-Cambodia is operating across five provinces on 45 of the largest plantations (with a plan to expand to 100 plantations in 8 provinces this year) through a network of community health workers or Plantation Malaria Workers (PMWs). Data collected in these plantations show that almost a third of tested fever cases are malaria, highlighting the need to reach workers and their families to ensure they are given a rapid diagnostic test and receive quality treatment if positive.

To increase treatment-seeking behaviour, PSI-Cambodia is launching an integrated delivery of health services through PMWs, which offers the workers and their families free deworming and diarrhea treatment, as well as condom distribution — all in addition to malaria prevention, diagnosis and treatment. By offering a range of highly sought-after health interventions, the project generates consumer demand, increases workers’ trust in PMWs and improves perceptions of the PMWs added value.

Strengthening public-private partnerships

Effective collaboration between the private and public health sectors is an essential component of Cambodia’s malaria elimination strategy. This project uses a range of technology solutions to assess the quality of care administered by PMWs, to track actual malaria cases among high-risk populations in rubber plantations, and ultimately share information with both regional and national authorities.

Teams using tablet-based programming for supportive supervision have conducted over 130 quality assurance assessments to date. PMWs will soon use mobile phones to upload caseload data to an integrated information system linked to the national malaria reporting system. The newest programming will enable real-time data sharing and options for analysis across decision-making tiers. Programs like these are often the only option available to the public sector for integration of private sector data into its own registry.

On the path to eliminate malaria, no innovation can be left untested.  But it’s likely that no single innovation alone will turn the tide either. By integrating the right partnerships, technologies and most important, an understanding of the population we aim to treat, elimination can, indeed, be in our grasp.

To learn more about PSI’s malaria programs, go to


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