Private Sector Contributions to National Malaria Surveillance Systems in Elimination Settings: Lessons Learned from Cambodia, Lao PDR, Myanmar, and Vietnam

Abstract

Comprehensive malaria case surveillance is necessary to achieve and sustain malaria elimination. In the Greater Mekong Subregion (GMS), the private sector plays a substantial role in malaria treatment. Yet, none of the six GMS countries collects complete case data from private sector points-of-care. Between 2016 and 2019, the GMS Elimination of Malaria through Surveillance program supported national malaria programs in Cambodia, Lao PDR, Myanmar, and Vietnam to execute elimination strategies by engaging the private sector in malaria case management, generating private sector case data, and integrating these data into national surveillance systems. The project enrolled 21,903 private sector outlets, covering between 52% and 80% of the private sector in targeted geographies, which were trained and equipped to perform rapid diagnostic tests (RDTs) and report malaria case data. By 2019, the private providers enrolled in the program reported a total of 3,521,586 suspected cases and 96,400 confirmed malaria cases into national surveillance systems, representing 16% of the total reported caseload by these countries (Cambodia, 25%; Lao PDR, 5%; Myanmar, 12%; Vietnam, 8%). Results demonstrated that with comprehensive support, such as training, provision of free or subsidized RDTs, first-line treatments, and routine supportive supervision, private providers can provide quality malaria case management and achieve high reporting rates.

Malaria epidemiology, surveillance and response for elimination in Lao PDR

“…Addressing these challenges requires a multi-sectoral and integrated approach, with strong leadership and coordination among various stakeholders, including the government, non-governmental organizations, development partners, and local communities [ 30 , 31 ]. It is essential to invest in strengthening health systems, improving access to quality healthcare services, and promoting community engagement to overcome the barriers to malaria elimination in Laos [ 32 , 33 ].…”

Bangladesh should engage the private sector for malaria elimination by 2030

“…We recommend this stepwise but multimodal model due to the strength of evidence supporting multifaceted PSE programs. 8,9,29,45,66,75 In one systematic review of strategies oriented towards informal PHPs, Shah et al 2011 note that the average percentage of positive outcome measures rises steadily as the number of strategies employed by a program increases, doubling from 44% for interventions that used only a singular strategy to 88% for interventions that use 4. 18 A multimodal model is also necessitated by the heterogeneity of motivation amongst PHPs in Bangladesh, all of which are targeted under our model.…”

“…So-called private sector engagement (PSE) has in recent years become a point of emphasis within both regional and global malaria elimination programs due to the large proportion of patients who seek care from private healthcare providers (PHPs). 8,9 This high utilization of the private healthcare sector holds true also in Bangladesh, where in some endemic regions private healthcare providers represent over 97% of all healthcare available. 10 Global trends in the epidemiology of malaria and other diseases near or at elimination, such as draculaniasis and smallpox, suggest that as malaria elimination in Bangladesh advances, an increasing fraction of disease cases will begin to localize amongst difficult to reach subpopulations; as PHPs oftentimes have greater reach than public entities, it will be essential to find ways to include them in the broader movement towards malaria elimination within the country.…”

Surveillance for Action: Operationalizing Private Sector Surveillance and Service Delivery across the Malaria Transmission Continuum

“…A lesson from this mapping exercise is to start early in collaboration with key government stakeholders and recognize that dedicated time and resources may impede other activities. 3 Developing databases of private healthcare providers. Once a list of private providers who treat malaria has been established or updated, the private provider list should be added to the country's Common Geo-Registry if one exists or to the hierarchy of the Health Management Information System (HMIS).…”

“…Then, midway through implementation, mobile case reporting was introduced in three of the countries, using DHIS2 to capture, store, and validate data before they were submitted to the NMCPs. 3 When considering private sector integration with government systems, a key challenge can be building enough confidence in the quality of the data such that public sector leaders are willing to integrate. In GEMS, routine data quality assessments helped build NMCP confidence over time and eventually showed that accuracy of malaria case data reported from the private sector was greater than 95% and that data were generally complete.…”