The Malaysian case study was developed during the third annual APMEN meeting (APMEN III) in Kota Kinabalu in 2011. During this meeting, APMEN held a study tour focusing on the history and current work of the community-based health worker (volunteers) program in Sabah. The organisation of the study tour was facilitated by Dr. Moh Seng Chang, now the Chair of the APMEN Vector Control Working Group, who also provided dissemination of a report and data on the program. Additionally, innovative intersectoral collaborations between the Vector Borne Disease Control program and private palm oil and rubber plantations were presented as part of the overview of Malaysia’s program for meeting participants. The study tour subsequently spurred discussions between APMEN meeting participants, Dr. Christina Rundi of the National Disease Control Division, Malaysia as well as the Sabah Health Department team, in particular Dr. Jenarun Jelip, around the potential to develop a case study on Malaysia for APMEN. All parties agreed that Sabah State would be an interesting place to conduct a comprehensive overview of progress and challenges related to malaria elimination, in order to gather as much information as possible on the national context and the private public partnerships.
Through the close collaboration between Dr Rundi and the UCSF Global Health Group, which leads the case study work, the case study partners were brought together to craft the objectives, topics of focus and the timeline for a case study on Malaysia. Ms. Kelly Sanders, MSc., was recruited through the UCSF Global Health Group to conduct the in country data collection. Ms Sanders arrived in Malaysia in mid February and began immediately collecting aggregate epidemiologic data at the National Vector Borne Disease Control office with Dr. Rundi and her staff. The next two and a half months were spent in Sabah with the state level malaria control program officers, collecting additional data (see Chart 1for sample results), making site visits, observing meetings and learning about the program. The Sabah Vector Borne Disease office, lead by Dr. Jenarun Jelip and supported by Mr. Yusof Rashman, provided Kelly with technical information, program details and logistical support. During this time, Kelly was also able to meet with other APMEN collaborators, Dr. Noor Rain Abdullah and Dr. Moh Seng Chang, who provided additional perspectives on the malaria situation in Malaysia, and offered technical support throughout the study. Upon approval for the qualitative component of the study, Kelly conducted comprehensive interviews on the malaria program with key personnel in the National office, the Sabah and Sarawak (East Malaysia) and the Malacca, Negeri Sembilan and Selangor states in West Malaysia. These comprehensive interviews focused on key programmatic information, detailing both program activities and malaria epidemiology over the past two decades.
[Data collected at the Sabah state Vector Borne Disease Office, 2012]
In addition to the program interviews, Kelly interviewed District Health Officers and plantation management from throughout the Sabah state, about the intersectoral relationship between private palm oil, rubber and acacia plantations and the government malaria program. The collaboration of the state and district offices was crucial, and the district malaria officers contributed significantly to the success of the project by participating in interviews and providing logistical and technical support for Kelly.
Preliminary findings from the 34 key informant interviews with over 55 participants show a wide variety of collaborative efforts between the Vector Borne Disease offices and plantation management and staff. These include privately subsidized and/or subcontracted IRS, government malaria sub-sector offices on private land, and a number of varying financial, programmatic and logistical support inputs from both groups. These relationships were often developed in response to outbreaks, and discussions regarding collaborative efforts were usually initiated by government health offices. In light of the substantial number of migrant workers employed by plantations in Sabah, collaborative efforts between the private sector and the government will continue to be key in identifying and working with migrant populations. Additionally, the information gathered regarding these private-public partnerships may act as a blueprint for other APMEN countries facing similar challenges. The case study will launched in 2013 as part of the WHO Global Malaria Programme – UCSF Global Health Group case study series on malaria elimination, in collaboration with APMEN.