BACKGROUND: SHARED CHALLENGE

The United States has successfully worked with the Thai Ministry of Public Health for decades to control malaria in Thailand and the Greater Mekong region. With U.S. financial and technical inputs, Thailand has dramatically reduced malaria cases. U.S. assistance greatly expanded the Thai Malaria Division by training technical staff, organizing and managing field operations, conducting insecticide spraying programs and establishing a nationwide network of malaria clinics. Recent assistance has focused on the introduction of advanced diagnosis and treatment regimens, and promotion of mosquito bed nets – these proven interventions have dramatically reduced infection rates and the lethality of the disease in most areas of Thailand.

Now Thailand and the U.S. are bringing their expertise and resources to collaborate with the Burma Ministry of Public Health to tackle the challenge of drug resistant strains of malaria along the shared border regions of Thailand and Burma. Malaria is a serious problem for the approximately 850,000 inhabitants and migrant workers living along the border and the lack of quality malaria services has long been identified as a gap in malaria control efforts in these difficult to access areas. Recent data shows that these people often travel across the border to seek malaria services, delaying treatment and burdening health systems.

REGIONAL APPROACH: TWIN CITIES

The U.S. President’s Malaria Initiative (PMI), led by USAID in partnership with the Centers for Disease Control and Prevention, implements malaria surveillance, research, commodity distribution and prevention activities in every country in the Greater Mekong Sub-region (GMS). The objective of the PMI GMS Program is to prevent the spread of drug resistant malaria, usually found in cross-border regions. The PMI GMS Program is joining forces with Thailand’s International Development Cooperation Agency (TICA) to provide targeted support to the Burma Ministry of Public Health to scale up complementary malaria control efforts on the Burma side of the border.

Malaria control will be strengthened through capacity building of Burma’s Malaria Control Program staff on diagnosis, treatment, mosquito vector control and support for operational costs for delivering services in targeted areas. A special focus area is the construction workforce at the Dawei deep sea port construction project in Burma. The employer, the Italian-Thai Development Company, is providing additional support for malaria prevention, screening, and treatment services at its work site.

A key element of the cooperation strategy will be the focus on five sets of “twin cities” on the Burma–Thailand border. The twin cities model will provide a platform to synchronize malaria control activities in both countries.

The twin cities are:

• Tarchileik, Burma and Maesai, Thailand
• Myawaddy, Burma and Tak (Mae Sot), Thailand
• Phayathongzu, Burma and Kanchanaburi, Thailand
• Dawei, Burma and Kanchanaburi, Thailand
• Kawthaung, Burma and Ranong, Thailand

Minority ethnic groups residing in remote areas along the border and migrant workers in forestry, mining, farming and construction are particularly vulnerable to malaria. Drug resistant malaria can develop from patients who are undiagnosed or fail to complete treatment. Cross-border screening efforts are vitally important to prevent drug-resistant malaria spreading globally.

ACTIVITIES AND EXPECTED IMPACT

This four-year project is expected to train 1,500 Burma malaria technicians on field entomology, vector control, case identification and treatment and community control activities. Some trainees will study at the Vector-Borne Disease Training Center in Saraburi, Thailand, built with U.S. funding in 1982.

The Thai and Burmese Malaria Control Programs and TICA will collaborate with PMI’s Control and Prevention of Malaria program (CAP-Malaria) to establish malaria screening points at each twin city. Volunteer malaria workers will distribute bed nets and will be trained to use rapid diagnostic test kits to screen potential cases among the mobile and migrant population crossing the border. The volunteers will be stocked with treatment for positive cases in accordance with national malaria treatment guidelines. The volunteers will also coordinate with antenatal clinics to ensure every pregnant woman has a bed net and information to protect her from malaria infection. Information from the intervention areas will be collected and analyzed to improve program efficiencies.

The program will diagnose an estimated 5,000 at-risk individuals, and treat (if tested positive) at the twin city malaria screening points every year.

TRILATERAL PARTNERS

• Burma Ministry of Public Health
• Thailand International Development Cooperation Agency (TICA)
• Thailand Ministry of Public Health
• USAID Regional Development Mission for Asia
• USAID Control and Prevention (CAP) Malaria Program