Malaria cases in Laos have decreased from an estimated 462,000 cases in 1997 to 2305 in 2022, thanks to new ‘accelerator’ strategies that were put in place to eliminate the disease.
The Ministry of Health and partners have recently achieved enormous strides, and Laos now hopes to eradicate Plasmodium falciparum, the deadliest of the five malaria parasites, by the end of 2023.
“Malaria now only affects a small proportion of the population,” said the Ministry of Health’s Dr. Rattanaxay Phetsouvanh, Director General, of the Department of Communicable Diseases Control. “Cases are found in just 10 percent of the country’s health facilities, across five of the country’s 18 provinces.”
“However, these remaining pockets are almost entirely remote, extremely hard-to-reach communities. Communities that are now most impacted by malaria in Laos are ethnic minority groups,” he added.
Mostly, these groups live and work in heavily forested locations that are ideal habitats for malaria mosquitos and difficult for health services to access – posing challenges for the “final push”.
The health sector has continued to provide and enhance routine responses with a focus on quick and early diagnosis and treatment, but the situation has changed and a new strategy is now necessary.
Increased outreach efforts by volunteer village malaria workers and “accelerator” strategies—more creative, aggressive tactics that concentrate on the proactive elimination of the disease—have been crucial to recent results.
Ms. Khounmy is one of several village malaria workers supporting the increased efforts across 60 villages in the five at-risk provinces. She is a mother of two and a part-time farmer.
Taking education, testing, treatment, malaria surveillance, and supplies like bed nets to isolated groups of people, particularly farmers and those working in forests, is a key component of Khounmy’s efforts to assist in the acceleration of malaria elimination.
“I want to protect the community,” she said during a village visit in rural Attapeu Province.
“My dream is to not have any cases in the village. I will keep working until it is eliminated.”
Khounmy enjoyed her rural upbringing but suffered from severe malaria, as did her family. She also vowed not to let her family suffer the same fate.
“I can do this by testing the people around me, giving them medicines, sending them to the health center, and explaining how they can be protected from malaria – this makes me very proud.”
Malaria workers go beyond villages as part of elimination efforts, visiting informal settlements to provide preventative treatment to people living in forests or fields. The government provides training for workers and the community, and WHO’s provincial-based experts assist with a variety of ongoing activities.
WHO has deployed staff in the two highest-risk provinces to support these efforts. They profile and map high-risk, difficult-to-reach groups and behaviors in order to tailor responses, analyze data and impact, and modify approaches as needed.
While progress has been made and continues to be made, a number of significant challenges remain – significant enough to jeopardize the progress made so far.
Village malaria workers in Laos now collect and report data digitally using mobile phones and a dedicated web platform. This information is fed into the national malaria surveillance and health information systems, which aids in informing responses.
This system is also driving a final step toward elimination by preparing for the World Health Organization’s malaria elimination certification process.
Taking this a step further, the Ministry of Health and WHO have developed a provincial-level verification process that allows parts of the country to be declared malaria-free while efforts in other parts of the country continue.