At least half of the world’s population lacks access to quality essential healthcare. Meanwhile, for the first time this century, malaria is on the rise. Global progress against malaria has stalled since 2016, bringing a renewed urgency to expand access to core malaria interventions, particularly in high-burden countries. Population Services International (PSI) supports national malaria control and elimination programs across 25 countries to deliver next-generation malaria vector control and the latest in antimalarial treatment, move quality malaria care closer to patients and caregivers, and create response-driven surveillance systems. We view our malaria interventions as a critical entry point for strengthening health systems, not only through public and community networks but also the integration of the private sector where most people first seek fever treatment.
Through the Greater Mekong Subregion Elimination of Malaria through Surveillance (GEMS) project, led by PSI with funding support from the Bill & Melinda Gates Foundation, we sought to engage private healthcare providers in malaria elimination efforts across Cambodia, the Lao People’s Democratic Republic (PDR), Myanmar, and Vietnam. Over the course of eight years, the project operated in two phases — GEMS and GEMS+ — with the primary goal of achieving sustainable malaria elimination by leveraging private sector resources and data.
Throughout the life of the project, we’ve:
- Improved the quality of malaria diagnostics, treatment, and referral services among private providers.
- Successfully integrated private sector malaria surveillance data into national health systems.
- Increased availability of quality-assured rapid diagnostic tests (RDTs) and antimalarials.
Here’s how we did it and what we’ve learned along the way.
Creating Conditions for Greater Private Sector Participation
The GEMS project aimed to enhance the quality of care provided by private healthcare providers for malaria elimination. The project found that ongoing support and training of private healthcare providers improved adherence to national guidelines and successfully restricted banned or ineffective drugs and increased usage of quality assured antimalarials. Understanding private providers’ motivations also played a critical role in increasing engagement in elimination activities. We discovered that government acceptance and recognition of private providers were primary factors of success for overall compliance to guidelines, data sharing, and contribution to a well-functioning mixed health system.
Catalyzing Private Sector Data
PSI ensured high-quality malaria data from private providers were made available in national surveillance systems through a balanced approach between data needs and reporting burden, leveraging technology, and providing tailored incentives. A challenging process, integrating private sector data into national surveillance systems required building trust, recognition of the value of private sector data, and rigorous verification. Ultimately, electronic reporting emerged as a cost-effective and sustainable solution for surveillance. This experience showed the potential to apply similar cost-effective and adaptable data integration solutions to other disease and health areas.
Engaging At-Risk Communities
While GEMS initially focused on private providers, it was recognized that at-risk communities – particularly those who were remote or marginalized in some way – needed to be better engaged in order to (a) better tailor services to improve access and use of high-quality care and (b) understand and address existing behaviors that were impeding malaria elimination. Understanding and engaging at-risk communities was required to design appropriate and responsive service delivery mechanisms. PSI’s experience highlights the significance of community engagement, user-centered design, and tailored interventions for effective malaria elimination strategies.
Leveraging Insights for Effective Interventions
Insights from research and learning activities led to important project adaptations throughout GEMS and GEMS+. For example, ethnographic studies conducted in Cambodia, Lao PDR, and Vietnam emphasized the importance of tailored messaging to at-risk communities and patients, engagement with local health providers, and continuous support for effective public health initiatives.
Building Sustainability and Transitioning to Government Management
While the first phase of GEMS contributed to strengthening and demonstrating private provider quality of care and linking quality-assured data into national information systems, GEMS+ aimed to ensure that this quality and linkage was sustainable. Demonstrating the value and quality of private sector data, refining engagement approaches, optimizing healthcare provider networks, and leveraging lessons learned were key to successful and sustainable integration into national health systems. Private sector linkages also proved beneficial for emergency response and surveillance in other health areas.
GEMS proved to be a transformative learning journey, emphasizing the significance of private sector engagement in health systems. By fostering collaborations between public and private sectors, leveraging technology, and focusing on people-centered approaches, the program provided lessons for advancing universal health coverage and promoting a more resilient and equitable healthcare landscape, extending beyond malaria elimination efforts. Achievements in malaria surveillance under GEMS have laid the foundation for expanded disease surveillance strengthening, digital innovations, and private sector involvement in public health emergencies in the Greater Mekong Subregion and beyond.
Dive deeper into the learning legacy of the Greater Mekong Subregion Elimination of Malaria through Surveillance project! Explore the Legacy Report.