Malaria control in the Greater Mekong Subregion: an overview of the current response and its limitations.

The malaria burden in the Greater Mekong Subregion has been dramatically reduced over the last 20 years but the disease remains an important public health issue in all six countries. This chapter introduces the standard tools for malaria control (long lasting insecticidal nets; indoor residual spraying; early diagnosis and appropriate treatment; epidemic surveillance and response; and, communication) and presents the evidence base supporting the use of each of these tools in the Subregion. Targeting approaches and delivery mechanisms for these tools are presented and discussed country by country. The technical limitations of these standard tools and delivery mechanisms are then discussed in the context of local variations in the epidemiology of the disease. The challenges presented by the feeding and resting habits of local vectors, by the characteristics and behavior of different human population groups, and by particular species and drug resistant strains of malaria parasites are considered. A range of innovative tools and delivery mechanism that have been developed to address these problems are presented and moves to bring these various innovations together to provide a comprehensive package of malaria control services for each risk group are discussed. Implementation arrangements are introduced and an overview of the stakeholder landscape at regional and country level is provided. Finally, remaining programmatic gaps (which include limited coverage, declining funds, drug resistance, weak surveillance and weak health systems) are highlighted and areas in need of further action (including the need for continued innovation) are discussed.