USAID (Under the AERA Program) / The Thailand Ministry of Public Health (2009-2012)
Starting in 2009, Kenan, with funding from USAID, supported systematic efforts by the Phuket Provincial Health Office to build its capacity to eliminate local malaria transmission. A malaria prevention and control unit was established and highly experienced retired malaria workers were employed to lead the development of a model for the elimination of malaria transmission, the first of its kind in the Greater Mekong Subregion. A situation analysis revealed that Burmese migrant laborers and Thai rubber tappers, comprising nearly 6,000 people, were the most at-risk populations. Key actions included the establishment of a task force, training health officials and migrant volunteers, entomological surveys of mosquitoes, surveys of migrant worker camps, mapping of high-risk sites, mosquito control through house spraying, prevention by providing long-lasting, insecticide-treated bed nets to migrants, and proactively seeking cases in newly-arrived or returned Burmese migrants. The elimination model overcame the language barrier for migrants by developing and using health education media in Burmese and Mon languages. Infected migrants, regardless of their legal statuses, were given directly- observed treatment, with a 28-day follow-up to ensure a complete cure and re-treatment.
Kenan’s establishment of a malaria unit in the Phuket Provincial Health Office and implementation of the pilot elimination project resulted in the interruption of malaria transmission in the province. Investigations of the 166 malaria cases in 2009-2011 show that transmission was interrupted in all three districts. Only five locally acquired malaria cases occurred during that period–one in five different villages. Due to the improved local capacity for active surveillance and rapid response, no cases due to sustained community transmission occurred. The team was able to extinguish each of these potential outbreaks after the occurrence of only one case. The Phuket Provincial Health Office built its capacity to identify imported cases, detect locally-acquired infections, and respond rapidly to prevent outbreaks. According to criteria set by the World Health Organization, the province of Phuket qualifies as a malaria transmission-free area due to the technical and financial assistance provided by Kenan and USAID.