With concerns mounting over the increasing appearance of drug resistant strains of the disease along the Thai border, an ambitious five-year plan to eliminate the deadly Plasmodium Falciparium malaria parasite in Cambodia was presented yesterday by the Ministry of Health.
The Malaria Elimination Action Framework 2016-2020 (MEAF), with a proposed $141 million budget, aims to eliminate the parasite even in drug-resistant form by 2020 and reduce the incidence of malaria to less than one infection per 1,000 people.
MEAF’s analysis section notes that P Falciparium, which until 2011 was the predominant form of malaria in the Kingdom, is a particular threat, as certain forms have begun to develop resistance to artimisinin and other drugs that are taken in a combination treatment (referred to as ACT) that is considered to be the most widely tolerable and effective anti-malarial.
“There is a concern that multi-drug resistance could spread, given the high level of population mobility. If resistance were to spread to or emerge in India or sub-Saharan Africa, the public health consequences could be dire,” the plan reads.
Drug-resistant forms of malaria are nothing new to the Kingdom, indeed multiple studies show that the country has been an incubator for resistant parasites for over four decades. This is in part due to the Khmer Rouge regime and ensuing civil war disrupting national and international efforts to curb malaria, often resulting in partial and incomplete treatment regimes that allow resistant parasites to evolve.
Speaking on the sidelines of the event, Dr Luciano Tuseo, WHO Cambodia’s Malaria Program director, yesterday explained that anti-malarial drug resistance is caused by the inappropriate use of drugs, improper dosages, failing to complete a treatment, using a monotherapy (one drug instead of a combination) and using non-WHO-prequalified or fake drugs.
Health Minister Mam Bunheng, delivering off-script opening remarks at the Raffles Hotel in Phnom Penh, encouraged assembled donors to work together with the government to ensure the plan – which still has a funding gap of about $21 million – succeeded.
“If we fail, we are all to blame, including myself and you all as well,” he said, calling for speed and action.
According to the 66-page document disseminated at the meeting, MEAF’s implementation is based on fulfilling five objectives.
The first is streamlining management and resource deployment; the second is ensuring 100 per cent diagnostic coverage and effective case management; the third is protecting at-risk populations through “vector management” (i.e. deploying mosquito nets – which accounts for a third of the budget); the fourth is enhancing surveillance systems for rapid response and increased testing; and the fifth is deploying health education initiatives and media to boost community intervention.
“It’s the best plan in the region, and also compares well to plans in Africa,” said the WHO’s Dr Tuseo, noting the extensive consultation with international partners that went into the document’s formulation.
Listed as major financial partners to the plan are the Global Fund, USAID, the President’s Malaria Initiative, the Asian Development Bank and the Gates Foundation.
Perhaps most crucial, guests at yesterday’s presentation were told, are surveillance and case management. Under the new plan, thousands of additional “Village Malaria Workers” (VMWs), whose reporting and diagnosis of cases makes rapid response possible, will be deployed.
VMWs alone account for over $11 million or 7.9 per cent of the budget, which calls for their placement in every village in at-risk areas, scaling up from the current 2,539 villages to 4,528 over the course of implementation.
“The capacity of VMWs contributes to completeness of reporting,” said Huy Rekol, director of the National Malaria Centre. “I hope they [donors] are happy with the high quality of accountability and transparency.”
“They have it budgeted down to the tyres they need for the motorbikes,” Tuseo said.