Malaria in the crossfire? Donor and provider attitudes across a momentous decade of peace, conflict and growth in Southeast Myanmar

Malaria outcomes are inextricably linked to armed conflict in southeast Myanmar. The most recent decade in Myanmar has been marked by multiple political transformations – from dictatorship to quasi-democracy and peace process back to military takeover in 2021. The study explores three key factors: 1) direct impacts of armed conflict on malaria epidemiology; 2) changing opportunities and constraints faced by funding agencies and malaria implementation partners; 3) major motivations for donors and the impacts of those motivations on implementation. Mixed methods were applied including a literature review, quantitative trend analysis using both publicly available data sources and Community Partners Internationals (CPI) in-house malaria data, and 15 semi-structured qualitative interviews. The policy triangle framework introduced by Walt and Gilson was used to analyse the way that policy can impact (or has impacted) malaria epidemiology and explore specific reforms with a focus on the actors that can make change happen. The study found a remarkable decline in both malaria morbidity and mortality over the past decade. Compared to 2010, a decline of 86 percent in cases and 99 percent in deaths was noted in 2018. There was a remarkable increase in donor investment and engagement, which, combined with (and partly caused by) the improved political stability, underpinned a significant malaria reduction. Proximate factors include the expansion of nationwide malaria volunteer programs, advances in malaria case findings and improved data sharing, all of which contributed to the overall reduction of malaria. However, since the recent military takeover in February 2021 there have already been increases in malaria cases as the operating environment has become much more challenging. This shows the potential for the reversal of malaria trends: without new approaches and continued funding, all of the gains of the last decade could be quickly lost. In conclusion, there is no doubt that sustained investment in malaria programming in Myanmar is required to avoid a reversal of gains made since 2011. To ensure this funding is effective, it is vital to work with those organizations that are still able to act on the ground: predominantly local, community and ethnic health organizations in border areas.