Far from the capital’s roads and police, in Cambodia’s remote and often inaccessible regions – where the terrain is rugged and difficult to navigate, and road networks are scarce – mobile malaria workers cover long distances and traverse deep slashes in the landscape. As mobile teams operating across the geography, they play a critical role in Cambodia’s effort to reach those in remote communities with hard-to-reach health services. With malaria still among the country’s top five diseases, these mobile malaria workers cover vast areas and physically deliver tools for diagnosing, treating, and preventing malaria. This commentary highlights some of the stories of mobile malaria workers in Cambodia.
The Role of Mobile Malaria Workers
Mobile malaria workers play an important role in the delivery of malaria control efforts, especially in hard-to-reach areas lacking health services, where they:
- Diagnosis and Treatment: Using rapid diagnostic tests (RDTs), they diagnose cases and treat those with antimalarial drugs.
- Education and Prevention: Workers teach communities how to reduce malaria with bed nets impregnated with insecticide, and how to seek prompt treatment when sick.
- Surveillance and collection of data on malaria cases and vector distribution to help guide public health strategies and resource allocation.
Challenges Faced by Mobile Malaria Workers
Despite their critical role, mobile malaria workers face numerous challenges in their day-to-day activities:
1. Geographic and Logistical Barriers
Story from Sokha, a Mobile Malaria Worker
Sokha, a mobile malaria worker in the Ratanakiri province tells me: ‘If the team is going by foot it’s very hard to reach the people. The road is very bad, or no road, and it’s mountainous with big forests. It can take two or three days to travel from one point to another.’ The road during the rainy season. Photo by the authorThis can stretch out the time between regularly scheduled malaria distributed most days of the year. Some villages don’t become easier to reach in the dry season when the water table is high on the roads.
Challenge: Many of these communities are geographically isolated, which poses real logistical obstacles. Workers may have to walk, ride a motorbike, or take a boat for miles to reach the boatyard, and a long day’s work can turn into a multi-day event.
2. Resource Constraints
Story from Vannak, a Mobile Malaria Worker
Vannak, who works in the Preah Vihear province, says: Our RDT [rapid diagnostic test] kits and medicines sometimes run short, so we can’t work, or, not for long, and can’t give treatment to patients who probably need it. We need more money to maintain our machines and equipment, and we don’t have enough.
Limitation: Constraint: Often there would be challenges with time in meeting with medical officers and accountability officers because I was out of town at times. The supply chain issues with diagnosis firms impact service delivery. We have to ensure that we can continue to provide service at the same quality level by ensuring that we always have working and enough supplies of our diagnostic tools, medication, and materiel.
3. Community Engagement and Trust
Story from Sreyneang, a Mobile Malaria Worker
‘It is difficult for us to gain communities’ confidence here in Kampong Thom province,’ says Sreyneang. ‘Some people are scared to come in for care or do not believe in the antimalarial drugs or prevention methods we promote. We have to go around and build relationships and explain our work.
Challenge: Building community trust and engaging with communities are difficult because few people believe they can and should take drugs regularly to prevent infection or because scary stories of traditional health systems (drug pushers, etc) exist. Local leadership needs to be mobilized, and messages need to be culturally relevant.
4. Health Worker Safety
Story from Chenda, a Mobile Malaria Worker
Chenda, working for the Oddar Meanchey province, explains: ‘Public safety is a major issue. We can sometimes work in places where there isn’t adequate access to medical assistance with the ability to call 119 [an equivalent to 999] quickly or an ability to provide evacuation or safety [in the event of] a person with arms.’ She adds: ‘We never know when a situation might turn difficult or even dangerous when we are working on a complaint.’
Challenge: Mobile malaria workers work in high-risk settings, where personal safety can be hard to guarantee. The safety of workers is essential for their well-being and the ability of the service to continue.
Triumphs and Success Stories
However, with some important successes in Cambodia, the mobile malaria workers plodded on: Last year, Cambodia’s mobile malaria workers tested 1.3 million people in 1.1 million households, identified 58,424 malaria cases, and treated 218,131 people.
1. Successful Malaria Case Reduction
Story from Pheaktra, a Mobile Malaria Worker
Pheaktra, based in the province of Stung Treng adds: ‘For three years in a row, we have come down with fewer and fewer malaria cases in the areas where we work. That is likely because we have identified the cases quickly and given them treatment, while also educating communities on how they can prevent the disease.’
Victory: With remarkable dedication and the right interventions, mobile malaria workers have helped to reduce malaria cases by enormous amounts in many parts of Cambodia. As a result, the program has helped to bring countries one step closer to the goal of elimination. Furthermore, these efforts not only improve public health but also foster community engagement and resilience against future outbreaks
2. Improved Community Health Outcomes
Story from Narin, a Mobile Malaria Worker
Narin, who works in Banteay Meanchey province, says that his team has reduced malaria by working with communities to raise awareness: ‘We talk to the people how to avoid malaria and this has made people more healthy. When they recognize the disease, they can go earlier to the clinic for treatment.’
Victory: Community awareness and education have increased, and that is good for health Outreach workers are now better able to educate communities. This is having a positive effect, by dispersing knowledge about malaria avoidance and the use of bed nets and early treatment.
3. Innovative Approaches and Partnerships
Story from Dara, a Mobile Malaria Worker
‘Now in Kandal province, I have used vehicles to go with mobile clinics, trained community health workers, and partnered with various local organizations,’ says Dara. ‘These innovative approaches have greatly increased the reach and impact of our work.’
Victory: Innovation and increased collaboration have also helped tackle some of the challenges facing mobile malaria workers. Both mobile health clinics and partnerships with local and international organizations have augmented the provision of malaria services and outreach.
4. Strengthened Local Capacity
Story from Rachana, a Mobile Malaria Worker
Rachana, located in Takeo province, says, “We provided training and capacity-building support to the village health workers, enabling them to take on a larger share of the work. In doing so, we empowered them to be more effective in their roles and enhance the overall health services in the community.” It not only enabled us to reduce our workload but also improved the entire health system by making it better equipped to serve the people.
Success: Capacity-building has strengthened local health systems and empowered community health workers so that malaria interventions are more effective and malaria control is more sustainable.
The narratives of mobile malaria workers in Cambodia illustrate how progress in the war against malaria is a seesawing balance of struggle and fortuity. The forces frustrating progress remain as strong as ever – geographical isolation persists, supplies run out, and community liaison is thwarted – but despite these obstacles, mobile malaria workers are saving lives and reducing malaria.
These successes highlight the importance of mobile malaria workers reaching remote, underserved populations and delivering vital services to support the broader agenda of malaria elimination. Moreover, as the Cambodia malaria story continues to unfold, the resilience, ingenuity, and determination of these workers are likely to remain a vital ingredient in achieving that malaria-free future. Thus, their ongoing efforts will be crucial not only for immediate health impacts but also for the long-term sustainability of malaria elimination initiatives.
