I. EXECUTIVE SUMMARY
When it was launched in 2005, the goal of the President’s Malaria Initiative (PMI) was to reduce malaria-related mortality by 50% across 15 high-burden countries in sub-Saharan Africa through a rapid scale-up of four proven and highly effective malaria prevention and treatment measures: insecticide-treated mosquito nets (ITNs); indoor residual spraying (IRS); accurate diagnosis and prompt treatment with artemisinin-based combination therapies (ACTs); and intermittent preventive treatment of pregnant women (IPTp). With the passage of the Tom Lantos and Henry J. Hyde Global Leadership against HIV/AIDS, Tuberculosis, and Malaria Act in 2008, PMI developed a U.S.
Government Malaria Strategy for 2009–2014. This strategy included a long-term vision for malaria control in which sustained high coverage with malaria prevention and treatment interventions would progressively lead to malariafree zones in Africa, with the ultimate goal of worldwide malaria eradication by 2040-2050. Consistent with this strategy and the increase in annual appropriations supporting PMI, four new sub-Saharan African countries and one regional program in the Greater Mekong Sub-region (GMS) of Southeast Asia were added in 2011. The contributions of PMI, together with those of other partners, have led to dramatic improvements in the coverage of malaria control interventions in PMI-supported countries, and all 15 original countries have documented substantial declines in all-cause mortality rates among children less than five years of age.
In 2015, PMI launched the next six-year strategy, setting forth a bold and ambitious goal and objectives. The PMI Strategy for 2015-2020 takes into account the progress over the past decade and the new challenges that have arisen. Malaria prevention and control remains a major U.S. foreign assistance objective and PMI’s Strategy fully aligns with the U.S. Government’s vision of ending preventable child and maternal deaths and ending extreme poverty. It is also in line with the goals articulated in the Roll Back Malaria (RBM) Partnership’s second generation global malaria action plan, Action and Investment to defeat Malaria (AIM) 2016-2030: for a Malaria-Free World and the World Health Organization’s (WHO’s) updated Global Technical Strategy: 2016-2030. Under the PMI Strategy 2015-2020, the U.S. Government’s goal is to work with PMI-supported countries and partners to further reduce malaria deaths and substantially decrease malaria morbidity, towards the long-term goal of elimination.
Although considerable progress has been made in malaria control in Cambodia during the past 10 years, malaria remains a major concern for the international community, the Ministry of Health, and the people of the country. This is due primarily to the development and spread of resistance to artemisinin drugs, the principal component of the combination therapies for malaria that now are the first-line treatment for malaria throughout the GMS and the world. Plasmodium falciparum resistance to artemisinin drugs was first confirmed in western Cambodia; treatment failures to ACTs have been reported from multiple sites on the Thai-Cambodian border; and an early warning sign of artemisinin resistance — prolongation of parasite clearance times — has been reported throughout the region.
The U.S. Government has supported malaria control efforts in Cambodia since 2000, originally under the regional program funded by the United States Agency for International Development (USAID). These regional efforts have focused on antimalarial drug resistance monitoring and drug quality surveillance. Cambodia has received Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) support. Cambodia became a PMI focus country in 2012, as part of PMI’s GMS regional program. In 2015, support for PMI in Cambodia transitioned to direct bilateral support. The other major sources of funding for malaria in Cambodia include the Asian Development Bank, and the Bill & Melinda Gates Foundation.