Pathways to sustaining malaria care at the community level: lessons from Thailand

Abstract

Sustaining the roles of community health workers (CHWs) and community-based malaria services along the Thailand-Myanmar border is critical to maintain access to malaria prevention and care among mobile and migrant populations. As countries in the Greater Mekong Subregion (GMS) advance towards malaria elimination, there is an ideal policy window to integrate CHWs into the primary healthcare system and to identify innovative pathways for sustaining community-based malaria services. Participatory stakeholder engagement activities were conducted to document practical evidence and case studies of malaria service integration and sustained community-based malaria care in Kanchanaburi province, Thailand, along the border with Myanmar. Two multi-stakeholder workshops were conducted with 49 participants representing national, provincial, and community-level malaria actors. The activities were designed to identify gaps in access to malaria services among at-risk populations and in implementation of surveillance and control activities, as well as to inform changes that align with the health and wellbeing needs in border communities. Enabling factors and potential entry points for sustaining CHWs were identified. Stakeholders highlighted three core requirements for sustaining community-based malaria services: (1) comprehensive training with appropriate incentives for CHWs, (2) active community participation in malaria prevention and care, and (3) reliable policy and financial support. In high burden areas, immediate priorities included scaling up training for migrant health workers, while longer-term goals emphasized cross-border collaboration and integration of malaria surveillance into local health systems. The case studies illustrated diverse approaches to integrate community-based malaria care through financing mechanisms, harmonized training, public–private partnerships, and policy advocacy, each offering potential entry points for embedding malaria care within broader community health services. Findings from the Thailand-Myanmar border demonstrate that sustaining CHWs requires coordinated investment in skills, incentives, and system-level support, combined with approaches that reflect local priorities. By engaging stakeholders and documenting integration pathways, this study provides actionable strategies for programme implementers and partners to strengthen community-based malaria care, safeguard access for vulnerable populations, and co-create sustainable models aligned with broader health system strengthening. This collaborative approach offers valuable lessons for informing national strategies in the GMS ensuring they are well-suited to the communities they serve.