Transforming relations between service providers and at-risk communities to accelerate malaria elimination in the Greater Mekong Subregion

Background/Objectives

To achieve malaria elimination by 2030 in the GMS, effectively reaching those most at risk of malaria with early diagnosis and quality treatment is critical. Forest-goers are considered to be the most at-risk group, however their remoteness, diversity, mobility and dynamism have made it challenging to reach and engage them. PSI's objectives were to develop insights into forest-goers' (i) perceptions of malaria risk and importance); (ii) access to and use of malaria-related services, and (iii) barriers/facilitators of treatment adherence. PSI also engaged forest-goers as active participants rather than passive recipients of, the new strategy.

Description Of Intervention And/or Methods/Design

The EIP approach was adapted for the Cambodia, Vietnam, and Myanmar contexts. PSI program and research teams engaged in a field-based process, collecting data from remote forest-going communities. Data were collected from 18 forest-goers in Cambodia, 12 in Vietnam, and 30 in Myanmar. The three tools employed to build empathy and understanding were: Day in the life, to recognize barriers and opportunities in a typical day; Circles of Trust, to map influencers and understand the basis of trust; and Empathy map, to explore perceptions and behaviors around malaria. PSI and community representatives synthesized these data in an insights workshop and design sprint, which produced three prototypes of solutions to the key problems identified. These prototypes were taken to the community for feedback and discussion. The inputs received from the community were then incorporated into the next model of the prototype, which was taken to pilot stage.

Results/Lessons Learned

While the EIP studies conducted in Cambodia, Vietnam and Myanmar between August 2018 and September 2019 produced nuanced results, some common themes emerged. Key findings included: (i) malaria elimination is not a priority in low burden settings amongst financially vulnerable populations; (ii) prioritizing economic activities causes delays in seeking treatment for suspected malaria; (iii) knowledge is necessary but not sufficient to change behavior because perceived severity, convenience and cost are powerful influencers of care seeking; (iv) malaria prevention and case management knowledge gaps exist because forest-goers spend the most time with those that they trust the least for malaria information; (v) forest-goers trust providers based on previous experience, hierarchy and reputation. Communities appreciated processes that involved them as advisors rather than recipients, and responded well to new strategies that gave them control over who their providers would be, facilitating engagement between patients and providers.

Discussion/Implications For The Field

In Cambodia, Myanmar and Vietnam, EIP generated rapid context specific insights and new designs for malaria elimination strategies that directly engage the most at-risk communities. It has transformed the relationship between the program provider and the community from one of giver and receiver, to a more equal one of partnership. While this early empathy proved relatively quick to build, it will require a more time and resource intensive approach to maintain high levels of community engagement, which demands a change in the way many international organizations and donors operate.

Abstract submitted by:

Kemi Tesfazghi - PSI

Lorina  McAdam - PSI

Mathias Pollock - PSI