Leaving No One Behind: Indigenous People and the Fight Against Malaria

Each year, August 9th commemorates the InternationalDay of the World’s Indigenous Peoples. Celebrated around the world, itmarks the date of the inaugural session of the Working Group on IndigenousPopulations at the United Nations in 1982. The Working Group represents aglobal commitment to  Human Rights and serves a platform for indigenous peoples to share their experiences and raise theirconcerns at the UN.

Indigenous peoples are the original stewards of theenvironment, holding the land of their ancestors in trust for futuregenerations. Determined to preserve their unique culture, language, traditions,languages, and knowledge system including health practices, Asia Pacific ishome to 70% of the total indigenous population in the world (FAO). India, Indonesia and PNG alone have roughly more than2300 minority ethnic groups belonging to this community (UN 2019).Not only are they the most marginalized but they are also the most vulnerableto  “diseases of the poor”. With starkdifferences in health and poverty indicators, national policies often fail to integratethem into socioeconomic programs. Poor access to health services, limitedawareness, and social-cultural differences between providers and patients aresome of the most extreme challenges that many health systems across the region face toensure a healthy lifestyle for the indigenous community.

Malaria is increasingly a disease of poverty andinequity, with the most vulnerable communities, at the greatest risk of dyingfrom malaria. In Asia Pacific, malaria still strikes hardest in vulnerable populationsliving in remote and rural areas, particularly in high burden countries -India, Indonesia, Papua New Guinea, Pakistan and Afghanistan. Theseimpoverished rural areas are often home to indigenous communities who are outof reach of routine medical care and where malaria control and surveillancesystems are either non-existent or neglected.

As evidence:  

• India malaria is a major public health problem in rural and tribal communities and accounts for 30% of all cases and 50%of Malaria mortality in the country (GoI2018).
•   Papua province in Indonesia accounts for an overwhelming 86% of all cases nationally (MoH) )  
  

• In Papua New Guinea, a country that is home to 2/5th'sof the world’s active languages with over 800 unique languages and culturalgroups, is facing the highest malaria infection burden in the region.

In most if not all of these countries, however, sub-nationallevel data on malaria cases based on ethnicity and geography is not available,which hinders effective elimination strategies and solutions. Factors such asround the year presence of mosquitoes, ideal climates and geographies formosquitoes to breed, higher mosquito-human contact, malnutrition, low awareness,and poor access to care are just a few of the conditions and challenges thatmake the tribal and indigenous most vulnerable and susceptible to malaria.Despite this, current malaria interventions are often based on the assumptionthat the tribal and indigenous share the same health problems as the generalrural population. There is vast heterogeneity.

Several epidemiological studies are working towardstailoring the intervention based on the socio-demographic characteristics ofthe indigenous population in the region. The Mandla Malaria EliminationDemonstration Project in India for example combined a rapid detection (approach(Track fever, Test patient, Treat malaria and Track patient), and treatmentwith tailored community level solutions, including routine entomologicalinvestigations,  behavioral educationcampaigns and capacity building for community health workers to reduce the indigenousmalaria cases by 91% (Bharti, P.K., Rajvanshi,H., Nisar, S. et al. 2020), suited to the needs of that particular community. Similarly,Odisha, state with highest malaria burden in India, employed innovative folk troupes'performance and health alerts in local languages which supported the cases dropby 50% in 2017 (WHO 2018).The project is proof that malaria can be managed within these communities. Itis therefore critical that we endeavor to work towards a whole-of-societyapproach; one that considers and integrates the unique cultural andenvironmental needs of indigenous communities in malaria elimination strategies.The indigenous community need to be actively involved in every process of theelimination strategy including key decision making to maximize impact. It allstarts with ensuring they have a voice and a seat at the table.

This International Day of the World’s Indigenous Peoples,the UN have called for the building of a new social contract. One that expressesgenuine cooperation and partnership for the common good to ensure “no one isleft behind” and put a stop to the age-old legacy of exclusion andmarginalization. The Covid-19 pandemic has further exposed the inequalities andis a prime opportunity for us to come together as a health community toactively advocate for recommendations from Indigenous people, integrate their unique needs within malaria eliminationstrategies and interventions but also highlight where more research is required.Disaggregated data for decision making, strengthened supply chains, sustainablefinancing support, and whole-of-society partnerships will play a key role inthe path to malaria elimination and help strengthen the health system inindigenous communities to prepare against current and future outbreaks.

As long as malaria exists, it will be anengine of inequality, burdening the poorest and most vulnerable communities,and will always have the potential to resurge in times of crisis.  Ridding Asia and the world of malaria willlead to healthier, more resilient communities that are better able to thrive,prosper and confront new health challenges as they arise.