Malaria is often associated with Africa, but the disease is rampant in the Asia Pacific region too. In countries such as India, Indonesia, Bangladesh and Papua New Guinea, almost 30m cases are reported every year, resulting in an estimated 42,000 deaths.
The region’s national governments would do well to look at the experience of Sabah on the island of Borneo. Cases of malaria in the Malaysian province have dropped from a high of 49,192 in 1994 to 2,032 in 2011.
At the root of the rapid decline lies an informal, yet highly effective, partnership between the state-led Malaysian Malaria Control Programme (MCP) and companies operating in palm oil and rubber sectors. Since 1991, MCP has been building links with many of the state’s 1,074 plantation estates, leading to joint cooperation around key interventions such as indoor residual spraying and the distribution of insecticide-treated nets.
“In large districts with remote populations, malaria control officers struggle to meet deadlines for bi-annual IRS (indoor residual spraying) coverage because of the time required to travel to rural areas,” states a recent research paper in the Malaria Journal.
Resource commitments and divisions of labour between MCP’s district offices and plantations differ hugely. The most engaged plantations go as far as to construct office buildings and living quarters for MCP’s rural outposts, as well as providing equipment, electricity and help with transport. All participating plantations, whatever their level of involvement, cover the costs of spraying and net distribution as a minimum.
In return, MCP provides training on malarial prevention, as well as assistance with screening new workers and advising on appropriate treatment if and when a worker should become infected.
“Most communications between partners are informal and ad-hoc, occurring on a daily or weekly basis,” the researchers note, adding that MCP’s programme officers aim to physically visit most participating plantations on a weekly basis where possible.
The motivations for the private sector to engage with the government’s malarial programme range from the ethical (ie worker care) to the economic (ie avoiding lost productivity). Very often, the partnership strikes up after a plantation has experienced a malarial outbreak. Risk of infection is comparatively high as up to 45% of the sector’s workers come from neighbouring Indonesia and the Philippines, where malaria is endemic.
Managing a cross-sector relationship is not without its difficulties. The most frequent source of tension occurs around the allocation of scarce resources. Government officers state that educating plantation management on the importance and benefits of malaria control is a time-consuming business, while estate owners complain that logistical support can be tricky during peak production periods.
Still, the results are impressive. In 2011, only 107 cases were reported across all Subah’s plantation estates. Among the “best practices” identified by the researchers are the importance of frequent communication between the two partner entities, the engagement of top-level management, and the formal recognition of plantations’ achievements.
“Partnering with the commercial sector has been an essential operational strategy to support malaria elimination in Sabah,” the independent analysis of the partnership concludes. “Private industry is an untapped resource for malaria control programmes regionally.”
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