Fighting malaria amongst high-risk communities: Myanmar rubber plantations workers receive malaria diagnosis and treatment

U Tin Naing Soe prepares to conduct a Malaria Rapid Diagnostic Test (RDT) in Kwali Camp rubber plantation, Mon State, Myanmar. Photo: F. Maurizio/WHO

 In the seemingly uninhabited jungles of Myanmar’s Mon State, hundreds of people work every night collecting rubber, making their way through acres of dense forests. As they go on with their heavy work, they need to be wary of small but dangerous threat: the bites of malaria-carrying mosquitoes.

Rubber plantations are an important part of Myanmar’s economy. Found mostly in the South-Eastern part of the country and along the border with Thailand, they need to be constantly manned to keep rubber production going. Migrant and seasonal workers from around the country set camps in the middle of the plantations, having to work through the night and early morning across hundreds of acres of land. As such, their chances of falling ill with malaria soar.

U Tin Naing Soe is a migrant worker in the Kwali Camp of Kyat Hto Township. However, he now has an additional role in his community: “I am the Rapid Diagnostic Test provider of the camp” he says proudly. “I have been trained to conduct malaria testing for everyone in the community who feels sick or has a fever, and if the result is positive for malaria I can administer treatment. I also report any malaria cases to the Township Community Project Assistant from the International Organization for Migration (IOM), so they can share malaria case data accordingly with health authorities”.

IOM’s project for detecting and treating malaria in high-risk communities is funded through the Global Fund to Fight AIDS, Tuberculosis and Malaria; they are one of the implementing agencies working across the country on malaria-related projects. The National Malaria Control Programme (NMCP), WHO and other partners are instrumental in ensuring that malaria funds and quality-assured drugs and diagnostics are secured and distributed efficiently, to achieve the objective of a “Malaria-free Myanmar” by 2030.

WHO has been supporting the NMCP of the Myanmar’s Ministry of Health and Sports to plan, develop and fund the implementation of malaria control and elimination strategies in the country. In recent years, Myanmar has achieved impressive results in the fight against the disease. In the past decade the number of malaria deaths has dropped steadily year by year from 1,707 in 2005 to just 37 in 2015 (over 98% reduction over 10 years) reflecting major improvements in access to early diagnosis and appropriate treatment, also thanks to the network of Village Health Volunteers. Still, pockets of ‘high-risk areas’ remain.

“Migrant and Mobile Population (MMP) are one among some of the high-risk population groups for malaria in Myanmar. Since the country is moving towards elimination, strategies focused on MMPs and interventions to early detect and treat malaria among these groups of people are all the more important. The surveillance system should also be tailored to make it more MMP sensitive”, says Dr Badri Thapa, Malaria Scientist in WHO Country office, Myanmar.

In order to bring the number of cases down to zero, effective coordination amongst all partners is required. WHO is working as the secretariat of the Malaria Technical and Strategy Groups in Myanmar, which bring together 31 implementing partners, donors and government counterparts to strengthen collaboration and to optimize the malaria strategies and interventions. The new Myanmar Malaria National Strategic Plan for 2016-2020, developed by the NMCP with technical assistance from WHO, will be the master plan guiding all malaria activities across the country for the next five years.

NMCP and partners provide comprehensive packages of services to the MMP by establishing malaria screening border posts, malaria clinics, and migrant work site interventions. Dr Aung Thi, Programme Manager for NMCP says: “MMPs have language barrier, they are stigmatized and discriminated; most of them move due to socio-economic reasons and are engaged in informal work or in various sized industries and development projects. We should not be waiting for them to access prevention, diagnosis and treatment services in public health facilities. Instead, we should be proactive in finding these groups in their worksites, through suitable malaria interventions in partnership with the sectors employing them. Otherwise, these people are at risk of being infected and of reintroducing malaria in areas which are already working towards prevention of re-establishment.”

For U Tin Naing Soe and his fellow camp-dwellers, good Malaria programming and strategies mean being able to get accurate information, diagnostic opportunities and treatment for malaria as soon as they are needed. As he goes on to deliver his health information session on the risks and prevention of malaria across the plantation camps, there is a concrete hope that soon the threats of malaria infection will only be a memory in all areas across Myanmar.