Center for Malariology, Parasitology, and Entomology, Ministry of Health, Vientiane, Lao PDR.
World Health Organization, Bangkok, Thailand.
Malar J. 2017 Nov 13;16(1):460. doi: 10.1186/s12936-017-2104-5.
As in other countries of the Greater Mekong Sub-region (GMS), the private health sector constitutes a significant avenue where malaria services are provided and presents a unique opportunity for public-private collaboration. In September 2008, a public-private mix (PPM) strategy was launched initially in four northern and southern provinces in Lao PDR to increase access to rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT), improve quality of care, and collect routine malaria data from the private sector. Throughout the process, key stakeholders were involved in the planning, monitoring and supervision of project sites. Following an initial assessment in 2009, the PPM initiative expanded to an additional 14 district sites to a total of 245 private pharmacies and 16 clinics covering 8 provinces and 22 districts. By June 2016, a total of 317 pharmacies, 30 clinics in 32 districts of the 8 provinces were participating in the PPM network and reported monthly malaria case data.
This descriptive study documented the process of initiating and maintaining the PPM network in Lao PDR. Epidemiological data reported through the routine surveillance system from January 2009 to June 2016 were analyzed to illustrate the contribution of case reporting from the private sector.
A total of 2,301,676 malaria tests were performed in the PPM districts, which included all the PPM pharmacies and clinics (176,224, 7.7%), proportion of patients tested from 14,102 (4.6%) in 2009 to 29,554 (10.4%) in 2015. Over the same period of 90 months, a total of 246,091 positive cases (10.7%) were detected in PPM pharmacies and clinics (33,565; 13.6%), in the same districts as the PPM sites. The results suggest that the PPM sites contributed to a significant increasing proportion of patients positive for malaria from 1687 (7.4%) in 2009 to 5697 (15.8%) in 2015.
Ensuring adequate and timely supplies of RDTs and ACT to PPM sites is critical. Frequent refresher training is necessary to maintain data quality, motivation and feedback. In the context of malaria elimination, the PPM initiative should be expanded further to ensure that all febrile cases seen through the private sector in malaria transmission areas are tested for malaria and treated appropriately. Results from the PPM must be integrated into a centralized registry of malaria cases that should prompt required case and foci investigations and responses to be conducted as part of elimination efforts.
与大湄公河次区域（GMS）其他国家一样，私营医疗部门提供了疟疾服务的重要途径，为公私合作提供了独特的机会。2008 年 9 月，老挝人民民主共和国在北部和南部的四个省最初启动了公私混合（PPM）战略，以增加对快速诊断检测（RDT）和青蒿素为基础的联合疗法（ACT）的获取、改善护理质量，并从私营部门收集常规疟疾数据。整个过程中，利益攸关方都参与了项目地点的规划、监测和监督。2009 年进行初步评估后，该倡议扩展到另外 14 个区，共有 245 家私营药店和 16 家诊所，覆盖 8 个省的 22 个区。截至 2016 年 6 月，8 个省的 32 个区的 317 家药店和 30 家诊所参与了 PPM 网络，并每月报告疟疾病例数据。
本描述性研究记录了老挝人民民主共和国启动和维持 PPM 网络的过程。对 2009 年 1 月至 2016 年 6 月通过常规监测系统报告的流行病学数据进行了分析，以说明私营部门病例报告的贡献。
在 PPM 区进行了 2301676 次疟疾检测，包括所有 PPM 药店和诊所（176224，7.7%），患者检测比例从 2009 年的 14102 人（4.6%）增加到 2015 年的 29554 人（10.4%）。同期 90 个月内，PPM 药店和诊所共发现 246091 例阳性病例（10.7%）（33565 例，13.6%），与 PPM 点所在的区相同。结果表明，PPM 点有助于显著增加疟疾阳性患者的比例，从 2009 年的 1687 例（7.4%）增加到 2015 年的 5697 例（15.8%）。
确保向 PPM 点提供充足和及时的 RDT 和 ACT 供应至关重要。需要经常进行复习培训，以保持数据质量、积极性和反馈。在消除疟疾的背景下，应进一步扩大 PPM 倡议，以确保在疟疾传播地区通过私营部门看到的所有发热病例都接受疟疾检测并得到适当治疗。PPM 的结果必须纳入疟疾病例的中央登记册，这应促使开展所需的病例和焦点调查，并作为消除努力的一部分作出反应。
