Oral Presentation First Malaria World Congress 2018

Meeting the needs of ethnic populations: Health as a bridge to peace (#188)

Thet Myo Tun 1
  1. American Refugee Committee, Hlaing Township, YANGON, Myanmar

American Refugee Committee’s (ARC) is an international non-governmental organization with over 30 years of relief and development experience in complex operational contexts in Africa, Asia and Eastern Europe. 

ARC is implementing Regional Artemisinin Resistance Initiative (RAI) project in Myanmar from 2014 to 2017 with collaborative activity with the Myanmar Ministry of Health and Sports, the National Malaria Control Programme (NMCP), ARC, and the Ethnic Health Organizations (EHOs), Karen Department of Health and Welfare (KDHW) and the Mon National Health Committee (MNHC).

This project aim to contribute to the elimination of P. falciparum Malaria in Myanmar and the Greater Mekhong Sub region (GMS), and to the prevention of the emergence or spread of Artemisinin resistance to new areas. ARC focus on hard-to-reach and transient populations in Southeast (SE) Myanmar of Mon, Karen, Tanintharyi and Bago East, including ethnic minority and mobile migrant populations. Priority was given to areas most at-risk of Artemisinin resistance in identified Tier 1 areas with credible evidence of Artemisinin resistance and Tier 2 areas with significant inflow of people from Tier 1 areas, including those immediately bordering Tier 1. The programmatic context in cease fire areas of SE Myanmar is particularly unique KDHW, MNHC played a critical role in accessing difficult to reach populations. 

ARC’s RAI project was designed to strengthen community base health system through partnership with ethnic health partners. The joint programme implementation was delicate and need trust, however; this could be bridge for peace and could avoid misunderstanding between state and non-state actors. In this approach, ARC is bridging EHP, government and donor in coordinated response to Malaria through community volunteer to the ultimate goal of access to the sustainable health system for the hard to reach population. With the support from RAI programme, ARC developed capacity of community Malaria volunteer for case management and prevention as well as reporting and monitoring of Malaria data and trend. Furthermore, ARC supported health facility with equipment, training for Malaria National Treatment Guideline, infrastructure for health facility and Lab, and microscopist training. 

There are total 337 community malaria volunteers, 43 health facilities, 19 border malaria posts which covered 335 villages and worksites, 19 border crossing points along Thai-Myanmar border, 18,880 household, 110,940 population.

More than 90% achievement for all performance indicator from 2014 to 2017. With the effort of ARC RAI Malaria programme, the number of Malaria cases in the project area reduced significantly. Malaria prevalence is decreasing in the project villages and overall decrease in Malaria Positivity Rate (MPR) from 20% in 2014 (test total -13,250, positive total - 2,690) to consistently below 3% in 2016 (test total - 53,754, positive total - 1,460) and 2017 (test total - 56,290 , positive total - 1,148) . From 2014 to 2017, 91.69% of total positive cases (7,017 cases out of 7,653 cases) received the treatment accordingly with National treatment guideline. There will be opportunity for ARC and NMCP to go forward to “Malaria Elimination” in the near future.

The effectiveness and efficiency of project through community base volunteer has huge impact upon the prevention and control of Malaria in EHP area. However, project modification recommended for decreasing Malaria prevalence as a result of four year project and continued efficient use of volunteer resources such as training provided, high motivation, and experiences for health volunteering—multi-service health volunteer (integrated Malaria services and basic and some emergency health) together with more advance training for quality of health service provided and necessary support to volunteer such as material (medicines, health equipment, health IEC and promotional materials), and supervision and reporting.