The Menoreh Hills region is one of the few remaining foci of persistent endemic malaria in Java, Indonesia. These hills border three districts of Yogyakarta and Central Java Provinces. Despite commitment from all three districts to build a partnership to eliminate cross-border malaria, there is a lack of understanding of how this partnership might be translated into an implementable strategic plan.
We did a participatory action research involving participants from different levels of the health system (village, district, provincial, and national). Focus group discussions (FGDs) and joint consultation with malaria stakeholders at the primary health centre (PHC) and district health office (DHO) were done to identify priority problems and formulate interventions. A costing study was performed with representatives from villages, PHCs and DHO, followed by joint consultations with national and provincial stakeholders to develop and finalize a joint strategic and operational plan for malaria elimination in the Menoreh Hills.
Problems identified by stakeholders were low community awareness and participation in malaria prevention, the high mobility across three districts, lack of financial, human resources, lack of inter-district coordination between PHCs and DHOs, and poor implementation of migration surveillance. Cross-border strategies identified to address malaria were improving cross-border migration surveillance, strengthening the network, governance, and advocacy of malaria control implementation across borders, and development of malaria information system in Menoreh Hills area. Stakeholders also agreed to create a working group, composed of the three districts representatives authorized to make decisions for cross-border issues.
Participatory approach was applicable in cross-border malaria planning for within-country settings. and useful in enhancing stakeholders’ capacities as implementer. While done in a participatory way, the joint plan crafted was a non-binding agreement; stakeholders should advocate to ensure adequate funds are poured to mobilize the plan. Further studies to identify bottlenecks of implementation are needed.