Approaches for mobile and migrant populations in the context of malaria multi-drug resistance and malaria elimination in the Greater Mekong Subregion

Abstract

The emergence of multifrug-resistant malaria in the Greater Mekong Subregion (‎GMS)‎ has been identified as an emergency issue that may have catastrophic consequences on the future of malaria elimination in the GMS as well as globally. In recognition of the need for a cohesive regional response, GMS countries have committed to a shared goal of eliminating malaria from the GMS by 2030 working within the framework of the Strategy for Malaria Elimination in the Greater Mekong Subregion 2015-2030. Population mobility has been identified as a key concern in the context of multidrug-resistant malaria; and in a region of highly porous borders where the majority of intra-Mekong migration occurs through informal channels, addressing the health needs of migrant populations has never been more critical. Migration in the GMS is strongly associated with shifting land use, including large-scale rural infrastructure projects and agricultural industries that attract migrant labour and influence human-vector contact. Migrant workers are highly likely to be exposed to high-risk work in forests or on construction sites but are frequently unable to access quality health-care services and may resort to self-treatment with substandard antimalarial drugs with potentially serious consequences for their own health and for drug resistance. Governments and development partners are now called upon to recognize that containing multidrug resistance and eliminating malaria in the GMS will require a future-oriented and multisectoral approach including non-health ministers, private sector and development partners. In addition, it will require programmes that include targeted activities to reach out to mobile and migrant populations; interventions that are timed with seasonal mobility; development and scale-up of migrant-friendly health services; and strengthening of programme activities to engage mobile populations. Ultimately, addressing health in other public policies as part of a ‘health in all policies’ (‎HiAP)‎ approach would be crucial to achieving successful health outcomes where multiple stakeholders from non-health fields must be engaged to systematically incorporate health issues into relevant national security, labour, migration and economic development policies.