While there are substantial resources being deployed to fight malaria on a global level, it remains a terrible problem. Health agencies have great difficulty delivering services to remote communities. Effective anti-malarial drugs supplied by The Global Fund sit in boxes at the regional hospital in Sumbawa while just over the mountain pregnant mothers and their children needlessly suffer repeated bouts of malaria during the rainy season. In such communities some 20% of children either die from malaria or are permanently disabled by it before reaching the age of 10. As a result, economic and social development are stunted while thousands of villagers suffer from treatable or preventable diseases. Health Access Sumbawa has been addressing this unmet need since 2015.
Malaria is an infectious disease caused by Plasmodium parasites which are spread by the bite of infected female Anopheles mosquitos. There are four main types of Plasmodium (P) species that infect humans, two of which, P. vivax and P. falciparum, are endemic to Eastern Indonesia. Severe malaria, primarily caused by P. falciparum, is life-threatening.
Currently, there is no vaccine available for malaria, though research is underway. Despite that, all developed countries and a growing number of developing countries have eliminated malaria by implementing prevention measures (insecticide spraying, insecticide –treated bed nets, screens on windows and doors), rigorous protocols for monitoring every incident of infection, and universal access to malaria diagnosis - treatment.
70% of Indonesian’s already live in low infection areas, primarily on the densely populated islands of Java and Bali. Indonesia has made a commitment to be malaria-free by 2030. Most of eastern Indonesia is still endemic with malaria. The 2030 goal will not be achieved without a stepped –up effort to reach remote, under-served communities.
Diagnosis of malaria involves examining blood smear slides under a microscope to identify the parasite. These tests are currently the "gold standard" for malaria detection and identification. They require examination by a trained analyst. When microscopy is not available, rapid diagnostic tests (RDT) are commonly used. These tests detect malaria antigens in a sample of a person's blood and indicate a positive result by a color change on the testing strip. They deliver a reading quicker, require less training, but are more expensive and less reliable than microscopy. They are not suitable for mass-screening of populations due to the high cost and lack of availability of bulk quantities.
There was no malaria control program on the north coast of Cempi bay when HAS began its work in 2015. Our first step is to meet with community leaders to gain support and organize volunteers. We take a complete village census and affix metal numbers to the outside of every home so patients can be tracked. A team of community volunteers then goes house -to-house, delivering and hanging treated bednets. We provide enough so 100% of the population has protection from mosquitoes while they sleep. The bednets, as with all our programs, are provided to the public at no cost.
In 2016 HAS built a laboratory and health clinic in Sili village so medical staff could competently diagnose & treat malaria. HAS sent two health department staff for training at The Sumba Foundation Malaria School . They became the first-ever WHO certified malaria microscopists in Sumbawa.
The HAS malaria control technique focuses on elimination of the parasite from the human population through a program of universal screening and effective treatment, thereby rendering the vector mosquito harmless. This eliminates the requirement for insecticide spray, with obvious environmental, health, and cost reduction benefits.
Our clinic currently employs three part time nurses and an administrator. The goal of controlling malaria in three off-the-grid hamlets within three years was accomplished in November 2017, protecting 1,000 people.
In September 2019 we expanded our malaria program to include the village of Mata, with 1,500 residents. 350 homes will be numbered, 900 treated bed nets will be placed in homes, and local nurses will be sent for malaria microscopy training. Working with the Sumbawa Health Department, HAS will give the Mata health center a face-lift, provide running water, and remodel a back room to become a malaria laboratory.
Our next step is to expand our service area to include adjoining communities. We run our own programs In our primary service area. This covers an area within 1 hour from our clinic. Dark blue on the map below, Expanding malaria coverage to Mata and Tolo-oi will be cost effective because our lab in Sili is under-utilized. HAS could process 5 times more malaria blood slides with a modest budget increase.
HAS helps the health department boost the effectiveness of it's existing health infrastructure. We can make a big impact on malaria infection rates throughout central Sumbawa long term by sending nurses to The Sumba Foundation Malaria School, setting up simple diagnostic laboratories within existing hospitals / health centers, subsidizing the cost of insecticide treated bed nets and making sure they are widely available to the public. The area to be served is the bright green area on the map.