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| Commune Health Worker Vang Thi Hac at her health station in Pa Ve |
Towards a malaria-free Viet Nam
As Viet Nam approaches elimination, malaria has become rare or non-existent in settled, ethnic majority villages but persists in geographically remote areas inhabited by ethnic minorities. Malaria control is facing a lot of difficulties because of uncontrollable mobilized populations such as forest goers and border crossers. Behavior change of minority groups - to alert populations to need to seek prompt diagnosis and treatment from available services, and to comply with full course of treatment - is challenging and requires persistent efforts using multiple channels with involvement of Commune Health Workers and Community Malaria Action Team members. Here are two typical examples of such engagement in two malaria hotpots of Viet Nam - Lai Chau and Gia Lai.Commune Health Worker Vang Thi Hac: "It's my duty to take care of them" Lai Chau, a mountainous province in northwestern Vietnam bordering China, faces significant challenges in combating malaria, particularly in Moung Te District, where the Lahu hill tribe resides. Since 2019, malaria cases, especially those caused by Plasmodium vivax, have surged in three communes within the district. Despite these challenges, Vang Thi Hac, a 34-year-old health worker at Pa Ve' Su' Commune Health Centre, remains optimistic about eliminating malaria. She has served as the malaria focal person and health worker for over five years, responsible for combating 12 communicable and noncommunicable diseases. Her commitment to her community is evident as she continues to provide care and promote malaria prevention. Pa Ve' Su' Commune Health Centre serves 748 households across 12 villages, many of which are located in high-risk malaria areas like woodlands, mines, and plantations. Although Vietnam has made significant strides in malaria control, reducing cases by 98.1% and deaths by 99.3% between 2000 and 2020, the fight is far from over. Malaria remains a threat, especially in hard-to-reach areas and among mobile populations. In 2021 and the first half of 2022, Pa Ve' Su' Commune reported the highest number of malaria cases, with 32 and 21 cases, respectively. With support from the Global Fund, comprehensive malaria prevention and control measures are being implemented by various stakeholders, including the National Institute of Malariology, Parasitology, and Entomology (NIMPE), the Provincial Health Department, the World Health Organization (WHO), and civil society organizations. Dr. Faisal Mansoor, Head of the UNOPS Asia Regional Health Cluster, praised Vietnam's progress in malaria control, attributing success to strong government commitment and effective partnerships. Measures such as distributing long-lasting insecticidal bed nets, mass drug administration, and increased malaria testing are helping to control and eventually eliminate the disease.  Commune Health Worker Vang Thi Hac conducting malaria microscopy at her health station in Pa Ve' Su', Lai Chau Province, Viet Nam. Photo: ARHC Malaria testing has accelerated through active case detection, with approximately 90% of cases identified this way. Mass drug administration has also been conducted in affected villages, with around 70% of the population covered in the first round of antimalarial treatment. Long-lasting insecticidal nets are distributed to every household, and health education sessions are conducted to reduce infection risk. Health workers like Vang Thi Hac play a crucial role in these efforts, often going the extra mile to reach remote populations. Despite facing challenges such as difficult road conditions and personal health issues, Vang remains dedicated to her mission. She regularly visits patients to ensure treatment adherence and provide necessary care, such as in the case of Giang Ga Nu, an 11-year-old boy who contracted malaria after accompanying his father to the woodlands. "We really rely on the Commune Health Centre. We go directly to the Centre whenever our family member is sick. I was so worried about my son when I found out he had malaria. But the health worker provided comprehensive care and my son's condition is getting better. Now, he is on day 11 and will be fully recovered soon," said Ly Mul Huy, mother of the child. "I am hopeful for a future without malaria in our area," Vang said. 
Pa Ve' Su' Village in Moung Te District under Lai Chau Province in Viet Nam. Photo: ARHC
From Malaria Patient to Malaria Fighter: Hiao Khanh's Dedication
Hiao Khanh, 29, a member of the Community Malaria Action Team in Ch? Rc?m commune, Krông Pa district, Gia Lai province, has become a key figure in malaria prevention after surviving the disease himself in 2019. The district has one of the highest malaria case rates in Vietnam, with over 200 cases reported in 2020. Hiao Khanh oversees malaria control in two villages, working tirelessly to reduce malaria cases in his community. His motivation to fight malaria stems from his own near-death experience with the disease. The community relies heavily on woodlands for their livelihood, making them particularly vulnerable to malaria. Reaching these remote woodland settlements, especially during the rainy season, is challenging due to flooded dirt tracks and slippery terrain. Despite these obstacles, Hiao Khanh and his team use motorbikes to access the community, providing mosquito nets, raising awareness about malaria prevention, and ensuring treatment adherence. "It was a near-death experience," said Hiao Khanh. "I had high fever before getting access to health care support. After that, I was motivated to help reduce sickness and deaths from malaria in my commune."
Community Malaria Action Team member Hiao Khanh after a meeting with members of the community. Source: WHO/Viet Nam The team's main activities are to raise awareness about malaria prevention, provide protective items such as mosquito nets, identify people who might have malaria and then transport them to health care facilities for testing, and support adherence to treatment for forest goers. The positive news is that with proper treatment, patients can now recover in a shorter time frame. WHO previously advised a 14-day regimen of antimalarial drugs to prevent a relapse of P. vivax malaria. However, new evidence has led WHO to suggest a shorter, 7-day treatment course. Despite this improvement, keeping individuals committed to their treatment regimen remains a challenge. For instance, forest workers often choose to return to work as soon as their fever decreases. Hiao Khanh's role includes locating and convincing patients to continue their treatment. Effective communication is key for his team; they listen to concerns, address questions, and stress the importance of completing the entire course of treatment. This approach ensures that patients can fully recover and return to work without further complications or interruptions caused by malaria. "I hope to make people aware of malaria so that they are able to access health care services when they have symptoms," said Hiao Khanh. "Just a 'thank you' from my people is enough to give me strength to continue this job to eliminate malaria from my homeland."
 During a community meeting in Gia Lai province, Viet Nam, a member of CMAT provides information about malaria prevention and control. Source: WHO/Viet Nam Viet Nam is highly motivated to reach the goal of eliminating malaria for a healthy future, an aim shared by many countries in the Greater Mekong Subregion. However, Viet Nam still has malaria transmission in some remote or dangerous locations, such as forests, and in some mobile labor-intensive industries, like mines and plantations. "We must really all work hard in the next few years to reach the last mile, ensuring we keep our focus on reaching the remotest communities. By doing this together, we can win this historic fight and achieve zero malaria in Viet Nam", said WHO's Representative in Viet Nam Dr Angela Pratt.
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