Interview with Shreehari Acharya, Project Manager at ALIGHT Malaria Free Mekong project, a platform of communities and civil society organization based in Bangkok, Thailand.
1. You dedicate your work to fighting malaria. Why is this fight still important today?
If we go back to 2014, before the Regional Artemisinin-resistance Initiative (RAI) grant started in this region, there was no platform nor opportunities for communities to express their concern and share their best practices. I started coordinating the malaria CSO platform 8 years ago with a small group of people, and now we have more than 50 organizations working together as a platform. Our work is to document evidence of best practices and share our findings with other programmes and countries, and advocate on behalf of the communities. This role is crucial to engage communities and civil society partners for malaria elimination and must continue. Malaria Free Mekong is the only platform funded under the Global Fund in the Mekong region.
The fight is still important today because nearly half of the world lives in regions where there is a risk of malaria transmission. The 2021 WHO malaria report estimated 241 million clinical malaria cases and 627,000 deaths. This disease is not new like Covid-19, we have been fighting it for many decades. While there are fewer cases today in comparison with 10 years ago, the increase in the last two years shows concern and provides challenges for malaria. Today, tools exist to fight this disease but they need to be properly used, through the appropriate channels. The active role and engagement of community and civil society workers in malaria response was one of the reasons we managed to decrease malaria cases and deaths. With support and dedication from the communities, it is possible to eliminate malaria very soon.
This fight is also still important because unlike advocacy for other diseases, community and civil society voices in malaria are very weak and heavily technicalised. Indeed, significant portions of the Global Fund (GF) grants are managed by governments, which means less flexibility and less priority to community health workers. The Mekong region is the only one able to advocate and unite as a community because the Global Fund supports communities engagement and advocacy in the GF process through the Malaria Free Mekong platform. Funding communities and supporting them is crucial because they are the ones dealing with malaria on a day-to-day basis, they know the language and the culture of malaria risk people and they know the context. For example, when I go to any country in the Mekong, I have to rely on our partners from there to plan and implement the activities because they are the ones with the expertise. We should support communities and civil society partners’ needs rather than imposing our ideas.
2. How do you think the fight against malaria was impacted by the covid-19 pandemic?
It is difficult to answer because we have seen practical challenges, but in terms of numbers, not many analyses have been done yet in our region. One of the biggest practical challenges we faced was the shift of the community health system, which started focusing almost only on the Covid-19 response while the other diseases, including malaria, were forgotten. Tests and treatment were therefore difficult to access, people did not want to seek care because they were afraid of getting infected with Covid-19, and people also thought that if they had a fever, it was Covid-19 and not malaria.
Covid-19 has tied our hands since we are unable to travel and thus monitor the work and see the progress. Surveillance in malaria is key, but we were not able to implement it because of the travel restriction. Also, there were no more public health measures in the region for a while. For example, insecticide and mosquito nets were not distributed as planned in many places because the strategy of mass distribution had to be changed to door-to-door one, but with limited human resources, the distribution was jeopardized. Another negative impact of covid, still caused by travel restrictions, was the disruption on our supply chain for drugs and tests. In some areas, even when supply was available, partners were not able to move them from the warehouse to the villages and bring them to communities in need. Besides, malaria workers had no choice but to divert their effort to Covid-19.
3. In your view, what is the role of the Global Fund in eradicating malaria from the world and how is its new strategy going to help step up this fight?
Global Fund is the only donor that gives resources that go directly to communities in our region. In the 5 (Cambodia, Laos, Myanmar, Thailand and Vietnam) countries I work that are part of the RAI grant, most of the commodities related to malaria are paid by the Global Fund. The initiative highlights hard-to-reach areas and populations such as ethnic communities, migrants and illegal workers. The Global Funds provide free malaria services to these people and that is amazing work leading to elimination.
I work on a platform for the communities and civil society organizations, which is the only malaria community platform the Global Fund is funding as a sub-recipient. Because of this support, we are able to talk to community workers, listen to them and emphasize their voice in GF funding requests and development processes. The meaningful engagement with communities in the fight against malaria would be impossible without the support of the Global Fund.
Regarding the new strategy, it is more focused on resources for the communities (hard-to-reach population) compared to previous ones. In Country Coordinating Mechanism (CCM) which is a group of people, including communities and CSOs overseeing the work of the grant in a country, there is no meaningful participation from malaria communities right now, which is a mistake. In several countries, there are retired officers and doctors that represent malaria communities in CCM. This time, it seems that the Global Fund will focus more on the meaningful inclusion of communities. It is not crystal clear in the strategy, but it gives me hope that the Global Fund will focus on changing the way CCM works.
The RAI grant is a unique example, it has a regional CCM, with all five countries (Myanmar, Cambodia, Laos, Thailand, and Vietnam), governments, academia, private sector, donor and communities have an equal representation, which means that our voice is heard. This needs to be implemented in the next strategy. To do so, they need to learn from what is happening in our region and take it to different parts of the world. The learning experience should be transferred to Africa because thanks to the RAI grant, we were able to reduce malaria dramatically, especially with multidrug resistance. If we have a cross-border programme focusing on remote areas, we can respond to malaria quickly. Many countries in Africa are struggling because there are many malaria cases in remote and hard-to-reach border areas.
4. What more can be done to end malaria as a global health threat by 2030? What is your message to world leaders?
Malaria exists in a lot of places but when we talk about the elimination of malaria, it is in remote and hard-to-reach areas, inside the forests. In the Mekong region, for example, people rely on forestry activities to live, which is why our focus needs to be on hard-to-reach areas. Even though we have created a mechanism, we need to continue until malaria is eliminated. Besides, if we do not have relationships with communities and civil society, it is impossible to reach marginalized people such as illegal workers in those remote areas. In our region, malaria services are free and it must continue to be.
We need new commitment and vision from world leaders, especially since Covid-19 stepped back the progress made in the last 10 years. We were on track and now we need to make up for the gap generated by Covid-19.
The RAI grant focuses on 5 countries but two more countries, not part of the grant, report a significant number of malaria cases: India and Bangladesh. They should be included because these countries share a border with one another. We cannot eliminate malaria in Myanmar if we do not eliminate it in India, and vice versa.
I have two key messages for global leaders: first, do not give up. People are frustrated because of the disruption of progress caused by Covid-19 but we cannot give up the fight against malaria because we are almost there. If it is not done today, it can never be done. Second, it will only be possible if we have commitments from governments and partnerships with the communities. Willingness from community leaders and local CSOs is crucial but not enough: we need financial support and ambition from governments to eliminate malaria.