The number of new cases of malaria in Myanmar has been dropping for the past twelve years. The Malaria National Strategic Plan shows that in 2005, there were more than 1,700 deaths from the disease, down to just 37 deaths in 2015. This is a 98 percent reduction, which is great news for the country – but it means the volunteers who have been trained to find and treat cases have less and less work to do.
To make full use of their skills, the Malaria Consortium – a 3MDG implementing partner – is piloting a new project called Integrated Community Case Management (iCCM) in Sagaing Region. The aim is to broaden the knowledge of community-based health volunteers so they can identify, treat and refer children under five who are unwell, as well as malaria patients.
“When sick patients visit me, I check them and provide the treatment they need. If they haven’t improved in three days, or if they get worse, I refer them to the closest rural health centre, 3.2 miles away. My main focus is children under five,” says Ko Nwet Linn, an iCCM volunteer working in Kyan Thar village, in Kalay Township.
Children under five are particularly vulnerable because their health can deteriorate rapidly. This is especially true in hard-to-reach areas, where access to care may be limited. The good news is that the major causes of death, pneumonia and diarrhea, can be diagnosed and treated by community volunteers after a short training and continuous supervision. The signs and symptoms of these diseases can be easily taught, meaning that community-based volunteers can make an enormous difference to health in these underserved locations and ultimately save many lives.
“I have been able to diagnose 85 children so far. Many of them needed treatment for pneumonia and diarrhea, which can be very dangerous if left untreated in the village. I referred another five to Kalay hospital,” says Ko Nwet Linn. In the end, all the children were cured.
Ko Nwet Linn is in a unique position to help: “I have close ties to my community, and I know them well. That makes it easier to improve their health and well-being. They trust me,” he says.
The village, with a population of more than 1,500 people, has no other health providers, and the nearest hospital is 35 miles away. “Now,” Ko Nwet Linn says, “thanks to the training, I have learned about common diseases, and I can help out by treating and referring people.”
The pilot follows a community-based approach which has proven effective in developing countries in Africa and Asia. Nepal has had a long-running approach of community-based management of child illnesses. The proportion of severe pneumonia and acute diarrhea has decreased significantly in the country over the last 20 years.
To provide the right services, the volunteers attend an eight-day training course on the leading causes of death for children, and receive supervision from basic health staff and the Malaria Consortium.
“One of the health assistants from the closest rural health center comes to the village once a week to supervise me. They teach me more about how to diagnose and treat, and help me to not make mistakes.”
Even with the focus on child health, Ko Nwet Linn is still finding and treating malaria cases. Recently, he identified and treated two positive malaria cases coming from the Htan Thee Mine site. Those patients were both cured too.
To make sure the community knows about the services he offers, he asked the village council to organize a meeting. Ko Nwet Linn says, “I taught them good health practices, and told them how I could help them. I am so proud to be able to help my community.”
The pilot programme aims to assess how feasible and acceptable it is to use malaria volunteers to diagnose, treat and refer childhood illnesses. It is run by Malaria Consortium in partnership with the Ministry of Health and Sports, and financed by 3MDG and DFID-PPA grant and Vitol. Results from the pilot programme will be disseminated in July 2017, and will be used to provide evidence-based information for future programming.