PSI /CAMBODIA
Interventions in Private Plantations in Cambodia:
Bringing malaria services - prevention, diagnosis, treatment and referral to communities at risk
APMEN VII
Hoi An, Vietnam
25-27 March 2015
1. NATIONAL PLANTATION SURVEY
2. TRAINING & EMBEDDING OF HEALTH WORKERS
3. OPERATIONAL RESEARCH: PREVALENCE
4. TAILORED RESPONSES & INTERVENTIONS
5. INTEGRATED DELIVERY OF HEALTH SERVICES
PLANTATION P R O G R A M
PSI – C A M B O D I A
2013 National Survey to map private and family run plantations
1. Location of the three key types of enterprise employing MMP
2. Peak number of workers by season/month
3. Availability and accessibility of health services on site
Findings
o Private Plantations – Strong
MMP magnets with workforce
spikes (June – rubber)
o High malaria incidence overlaps
with high density of plantations
o The lifecycle of rubber
plantations and malaria risk
o On-site health services scarce
o Families on site - wider
healthcare needs
o Prioritize Net Coverage
PLANTATION P R O G R A M
PSI – C A M B O D I A
Malaria Incidence – Covered by Plantation Program
Plantation Malaria Program
•
•
•
•
•
Signed MOUs with 45 private plantations in 5 provinces
77 Plantation Malaria Workers trained on Early Diagnosis and Treatment,
stocked with QAACTs/ RDTs, and reporting monthly
Passive Case Detection – 30% test positivity rate
Quality Assurance assessments conducted
Data collected and entered into national system at OD level
1,192 cases tested
351 cases treated
PLANTATION P R O G R A M
PSI – C A M B O D I A
2014 Gates Operational Research
•
Develop a demographic and anthropological evidence base on MMP
•
Develop an epidemiological evidence base on MMP’s infection status.
•
Test different ‘screen and treat’ models in selected plantations.
Prevalence
How many workers are infected?
Type of Malaria
How many workers have P. falciparum vs.
P. vivax?
Resistance
What is the level of known resistant P.
falciparum genotypes?
PLANTATION P R O G R A M
By transmission
season (high and
low i.e. 2 surveys)
By occupation
type (rubber
workers).
By worker
classification
(migrant, mobile or
local).
PSI – C A M B O D I A
PLANTATION P R O G R A M
PSI – C A M B O D I A
Research Findings
• In both dry and wet seasons, 41 people were found to be positive by PCR
• Prevalence was low: 0.85% in dry season and 1.09% in the wet season
• Higher prevalence of P. falciparum; no resistance detected
Next Steps
• Screen and Treat Modeling & Roll Out
• Transition from Paper-based to
Electronic Reporting – Direct links to
DHIS2
• Linking PMW Data with Private
Outlets, Health Facilities, and VMWs
• Coverage of 100 Plantations across 8
Provinces
• Engagement at Corporate Level
• Replication and Links across the GMS
• Integration with other Health
Services
PLANTATION P R O G R A M
PSI – C A M B O D I A
Lessons Learned
• Improved coordination with CNM – at
all Administrative Levels
• Importance of Quality Assurance
• Relationship Building with Plantation
Owners
• Importance of the Feedback Loop to
Maintain Engagement and Coverage
• Understanding the significant
investments of Time and Resources
• Empowering Teams to Make Decisions
PLANTATION P R O G R A M
PSI – C A M B O D I A
Thank you!
Thank you!
PLANTATION P R O G R A M
PSI – C A M B O D I A