Commentary by Dr. Nenette Motus, Director, Regional Office for Asia and the Pacific, International Organization for Migration (IOM).
Bangkok - The International Organization for Migration (IOM) has joined the World Health Organization (WHO), The Global Fund (for AIDS, TB and Malaria), the Roll Back Malaria Partnership and other partners on World Malaria Day (25 April) to call for renewed efforts to prevent and eliminate the disease, which continues to kill over 400,000 people every year.
Children are particularly vulnerable – in 2015, almost 70 percent of all malaria deaths were children under five. The theme of World Malaria Day 2017 is “End Malaria for Good.”
Advances in malaria prevention, including new methods of testing, the widespread distribution of insecticide-treated nets and the introduction of artemisinin-based combination therapies (ACTs) have contributed significantly to major reductions in malaria cases and deaths in the Greater Mekong Sub-region (GMS) - Cambodia, Laos, Myanmar, Thailand, Vietnam and China’s Yunnan province.
There has been a major decline in cases and deaths across the GMS over the last three years, according to the WHO. The six GMS countries cut their malaria case incidence by an estimated 54% between 2012 and 2015. Malaria death rates fell by 84% over the same period.
But despite these achievements, the emergence of drug resistance in many areas across the region, particularly in border areas, has required a change in strategy to completely eliminate disease in the Asia Pacific region, or “end malaria for good.”
Migrant and mobile populations (MMPs) are considered as highly vulnerable to malaria for a variety of reasons. The GMS region, which is home to some 300 million people, hosts an estimated 4 million cross-border migrants, mainly in Thailand. Many others migrate internally in search of work.
Migrants’ vulnerability to the disease is linked to the fact that they often live and work in forest-related industries, agriculture or construction in remote rural areas, where the anophleles mosquito that carries the malaria parasite still exists.
In addition, due to their lack of official status and their exclusion from public health services, they may be less aware of malaria and have less access to health services than host communities.
Their biological immunity may also be lower if they come from non-forest areas where there is no malaria. And they often live in poor housing with few mosquito screens or bed nets.
While malaria elimination efforts need to target all at risk populations, IOM believes the vulnerability of MMPs in the region could be dramatically reduced through better outreach, education, protection, service provision and surveillance by national health systems and their implementing partners.
IOM is working across the GMS with migrants, host communities, worksites, employers and governments to improve access for MMPs to malaria diagnosis and prevention services. But more needs to be done.
Governments and society as a whole needs to rethink a commonly held view that MMPs are “a problem that needs to be addressed.” In fact, they are a group that is sometimes excluded because we often fail to fully understand their situation and don’t always know where, when or how they can best be reached. The problem which needs to be addressed is therefore the failure of our health systems to always reach migrants.
The WHO recognized this challenge in 2008, when it called on its member states and partners to advance migrant-friendly practices and policies to achieve universal health coverage - on the grounds that healthy migrants are necessary for healthy societies.
IOM believes that in order to move forward we now need to rapidly improve the tools, methodologies and practices for assessing and understanding local mobility dynamics and how they affect transmission of malaria.
We also need to link malaria prevention, treatment and surveillance data and initiatives across migration routes and borders. Cross-border cooperation will show us where MMPs are currently being missed.
In addition, we need to strengthen multi-sectoral engagement to combat malaria beyond health to include relevant public sector bodies like immigration, labor ministries and private sector players, notably forest product companies.
Finally we must promote and encourage migrant inclusion in national/state/provincial health service planning and all malaria services in all six GMS countries.
These initiatives reflect the four-pillar approach that IOM recommends for combating malaria worldwide.
They include: the introduction of migrant-Inclusive policies and legal frameworks; the creation of migrant-sensitive health systems and programmes; the establishment of partnerships, networks and multi-country frameworks; and better monitoring of migrants’ health.