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There
are a number of issues and challenges responsible for the persistence of the
problem of malaria in the countries of the Region.
These include the following;
 Health System
Advocacy and partnerships
Technical
Management
Socioeconomics condition
Health
System
Poor capacity of the health system with poor
access to diagnosis and treatment. A lot of malaria cases are out of reach by
health services
Decentralization inspired by political changes
has caused confusion at implementation level and weakened the health services
including malaria control.
The diagnostic services and drugs are short in
supplies and these shortages are acute in underserved areas. Consequently, a
large proportion of suspected cases are treated by the private sector or the
NGOs which is not cover by existing information system
Even
though the health systems are established, the responsiveness of the health
system is poor
Advocacy
and partnerships
Community
participation and mobilization are poor. The technical know how has not been
demystified to bring the program to the communities
Community
participation in vector control is unsatisfactory. The ITNs although having
proven efficacy are not adopted on a large scale because of numerous
constraints. The coverage with Indoor residual spraying (IRS) is less than 7%
and the coverage with Insecticide treated materials low. Bioenvironmental
control measures are restricted to a few projects only.
Partnerships,
coordination and intersectoral collaboration are poor
Technical
The surveillance systems are poorly developed
and therefore epidemics are missed in the early stages
The diagnosis and treatment are often
inappropriate. There is little regulation of practices and poor coordination
Spurious, counterfeit and substandard drugs
are common. This problem is exaggerated in the border areas. The manner in
which drugs are packaged and dispensed leads to poor compliance.
Even though multi drug resistance is emerging
as a major concern in SE Asian countries, and monitoring of therapeutic
efficacy of antimalarials has been established, the information is not used
to review the national drug policies. Mapping of areas has been initiated but
needs to be extended to cover high risk malaria areas.
Development of resistance to insecticides
combined with high costs of insecticides is a problem. The operational
problems in indoor residual spraying limit the efficacy of this approach
Management
Unplanned developmental projects and
unprecedented unplanned urban growth migration, and cross border spread are
common.
Natural disasters and emergencies with break
down of health infrastructure are common. The staff presence is
unsatisfactory and there are "missing health workers’. Those who are
available to provide the services have poor capacity
Socioeconomics
condition
The proportion of poor people in the region is
estimated to be about 30%. Since the economic crisis the problem has
worsened. Malaria is a disease of poverty and its poor control is retarding
development.
The impact of the economic crisis in the
Region adversely affected malaria control activities and this resulted in
focal outbreaks, especially in Thailand
and Indonesia
are the countries most affected by the crisis.
Conflict and civil unrest has exacerbated
malaria in many countries of the Region. Health services are scarce for
people in need, particularly those who live in remote and border areas.
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