Laos and Cambodia
Health Poverty Action
Crossborder Response for Overlooked, Stigmatized Sub-populations in Laos & Cambodia (CROSS)
Overview
People who live and work in the forest areas of the Cambodia-Laos border are at high risk of malaria. The forest terrain is ideal for the spread of malaria, and the nature of how people earn a living (such as farming, night-time work or hunting) makes it hard to protect themselves.
This project built on previous work that took place with support from the Global Fund to Fight Aids, TB and Malaria. The project worked to improve health seeking behavior and uptake of malaria / febrile illness services amongst the local and migrant people in the forest areas. The project sought to promote cross border collaboration to tackle the spread of malaria and other febrile illnesses, strengthening the health systems at the border through improved cross-border data collection, case detection, reporting, coordination, and stock control.
The project faced an array of challenges including the Attapeu dam disaster, low level military conflict between Laos and Cambodia, extensive flooding, droughts, and torrential rains that made roads impassable, multiple dengue outbreaks, and the COVID-19 pandemic. However, the staff and health systems supported by the funding from the Comic Relief-GSK partnership remained resilient and were able to make significant progress. The project dramatically increased the demand for services and improved health seeking behaviour through raising awareness via community workshops, radio shows, videos, and provision of awareness-raising products. Significant improvements were also noted in the systems of reporting and surveillance in Laos. HPA will continue to advocate for improvements to disaggregation in Laos’ government data. HPA will also continue to support Laos’ surveillance by trialling and deploying the 1-3-7 system of case tracking and reporting.
Key learnings
Continually speak to communities about what is and isn’t working
Issues such as the bed nets distributed by the national malaria programme not being used because the insecticide is so strong that it irritates the skin and damages clothing are details that simply are not picked up by projects that are too large and bureaucratic. It requires regular informal contact with communities (rather than obtrusive or conspicuously formal contact), building key relationships and talking to learn what is actually going on behind the formalised metrics of malaria work.
Build into project schedules time for unexpected events
HPA had worked in both Laos and Cambodia for many years, but rarely had they faced so many unexpected issues heavily affecting their project.
Key statistics
In Cambodia, the percentage of the population at risk of malaria living in the targeted villages who sought the correct healthcare at first sign of fever increased from 8.8% at baseline to 37% at endline.
Over the course of the project, the number of suspected malaria cases that received a parasitological test in the community increased from 640 to 213,152 in Cambodia, and from 31,473 to 187,965 in Laos.
The proportion of health facilities reporting at least one episode of ACT stock-outs reduced from 30% to 5% in Laos.
In Laos, the proportion of the 11 District Health Offices who reported utilising derived malaria data to inform planning, monitoring, implementation of activities or reporting increased from 0 to 100%.