A participatory approach to address within-country cross-border Malaria: the case of Menoreh Hills in Java, Indonesia

Abstract

Background Malaria remains Indonesia's significant public health issue. Most of the endemic areas are in the eastern parts of Indonesia. However, there are a few remaining foci of persistent endemic malaria in Java, particularly in Menoreh Hill, a region bordering three districts of two provinces on this island. Despite a commitment to build a partnership to eliminate cross-border malaria, there is a lack of understanding of how this partnership might be translated into an implementable strategic plan. The study aims to provide evidence of how a participatory approach was used to strengthen the cross-border collaboration and stakeholders' capacity to develop a joint strategic, operational, and costing plan for cross-border malaria elimination. Methods We performed participatory action research from January to August 2017, involving participants from the village, district, provincial, and national levels. This study was conducted in seven phases, including document review, focus group discussions (FGDs), planning and costing workshops, and a dissemination meeting. A total of 44 participants from primary health centers (PHC) and 27 representatives of affected villages in three districts, 16 participants from the district and provincial malaria programs and planning bureaus, and 11 participants from the national level were involved in the processes. Data on priority issues, costing, program coverage, and administration were collected. We use thematic coding and feedback for analysis. Results Problems identified by stakeholders included low community awareness and participation in malaria prevention, high mobility across three districts, lack of financial and human resources, lack of inter-district coordination, and poor implementation of migration surveillance. Cross-border strategies identified to address malaria were improving cross-border migration surveillance, strengthening the network, governance, and advocacy of malaria control implementation across borders, and developing the malaria information system. A working group composed of the three districts' representatives authorized to decide on cross-border issues will be created. Conclusion The participatory approach was applicable in cross-border malaria planning for within-country settings and useful in enhancing stakeholders' capacities as implementers. While done in a participatory way, the joint plan crafted was a non-binding agreement; stakeholders should advocate to ensure adequate funds are poured into mobilizing the program.

A framework for evaluating health system surveillance sensitivity to support public health decision-making for malaria elimination: a case study from Indonesia

“…Magelang District in the Central Java Province was certified malaria-free in 2014, though with an epidemic in 2015, there is a need for continued surveillance to prevent reintroduction. Kulon Progo District in Yogyakarta Province is nearing elimination [ 10 ], with an increasing number of subdistricts becoming malaria-free since 2000 [ 11 ]. Central Java Province has a malaria elimination target of 2023, and malaria cases have shown a downward trend between 2014 and 2016 [ 12 ].…”

Clusters of malaria cases at sub-district level in endemic area in Java Island, Indonesia

“…The problems related to malaria that have currently occurred in Indonesia include low awareness and low community participation in malaria prevention and lack of resources, especially with respect to financing (Ahmad et al, 2021). Various efforts have been made to achieve the elimination target set, including the use of mosquito nets, indoor residual spraying (IRS) and mass testing, but the results are still not optimal .…”

A Framework for Evaluating Health System Surveillance Sensitivity to Support Public Health Decision-Making for Malaria Elimination: A Case Study from Indonesia

“…Magelang District in the Central Java Province was certified malaria-free in 2014, though with an epidemic in 2015, there is a need for continued surveillance to prevent reintroduction. Kulon Progo District in Yogyakarta Province is nearing elimination [10], with an increasing number of subdistricts becoming Keywords: Care seeking, Malaria elimination, Freedom from infection, Global health, Public health, Decision-making, Surveillance sensitivity malaria-free since 2000 [11]. Central Java Province has a malaria elimination target of 2023, and malaria cases have shown a downward trend between 2014 and 2016 [12].…”