Cambodia Malaria Elimination Project 2 (CMEP2)

The Challenge

Previous USAID/PMI Cambodia projects implemented by URC contributed to a 100% decline in malaria deaths and an 80% reduction in malaria cases nationwide between 2000 and 2021. Cambodia is on track to eliminate Plasmodium falciparum (Pf) malaria by 2023, and all species of malaria, including Plasmodium vivax (Pv), by 2025.

Challenges remain in preventing malaria re-introduction in elimination areas and scaling up elimination efforts nationally and within specific high-risk populations, such as forest workers and mobile and migrant populations. While significant progress has been made, local capacity in malaria prevention, diagnosis, and management, as well as surveillance and reporting need to be strengthened to reach elimination targets.

Overview and Objectives

The Cambodia Malaria Elimination Project 2 (CMEP2) builds on URC’s 20-year legacy of working with Cambodia’s National Center for Parasitology, Entomology, and Malaria Control to eliminate malaria and control the development and spread of drug-resistant malaria in the Greater Mekong Subregion.

The goal of CMEP2 is to eliminate malaria and prevent its re-introduction in target provinces, contributing to nationwide elimination and achievement of the Cambodia Malaria Elimination Action Framework 2: A Malaria-Free Cambodia and leading efforts towards self-reliance and sustained, self-financed malaria programming.

CMEP2 works to:

• Detect, effectively and safely treat, and follow up on all malaria cases and provide personal protection to high-risk populations;
• Strengthen national malaria surveillance and monitoring and evaluation systems appropriate for malaria elimination and control activities as well as prevention of re-introduction; and
• Build Cambodian health staff capacity to manage, intensify, and sustain malaria control and elimination efforts, especially at the provincial and operational district levels.

The activity works in six provinces: Pailin, Batambang, Pursat, Kep, Kampot, and Koh Kong – which are supported by PMI malaria elimination activities.

Achievements

CMEP2 successfully continued to contribute to the reduction of malaria cases and containment of multidrug-resistant Pf malaria. Project achievements during its first year include:

• According to the national malaria information system, the malaria incidence rate was 0.26/1,000 in 2021 compared to 0.56/1,000 in 2020. No malaria deaths are reported in Cambodia since 2018. This is despite an estimated 9.3 million people (58% of the total population) living in malaria-endemic areas in 55 operational districts within 21 provinces.
• For Pf malaria, the incidence was 0.02/1,000 in 2021, compared to 0.05/1,000 in 2020. The 2021 Pv incidence was 0.24/1,000 people, compared to 0.51/1,000 in 2020.
• CMEP2 focuses on transition of ownership and responsibility for service delivery from the project to government counterparts. Operational districts increasingly plan, implement, and monitor activities, with the project providing technical assistance and capacity building.
• An unusual increase in Pf cases in Pursat triggered an immediate response by the project in close consultation with Cambodia’s national malaria program and other stakeholders. Among other project interventions in Pursat, CMEP2 introduced intermittent preventive treatment for forest goers (IPTf), implemented with an encouraging success rate on both coverage and adherence.
• The project initiated monitoring of the distribution of insecticide-treated nets (ITNs) at all levels of the health system. This work will expand with periodic assessments of ITN use.
• Every confirmed malaria case was treated according to national treatment guidelines and 95% of the cases were handled by the 1-3-7 approach: case notification on day one, case investigation/classification and response by day three, and foci investigation and management by day seven.