A bespoke, real-time surveillance system for malaria elimination in Cambodia: architecture, applications and impact.

Cambodia has developed and deployed a comprehensive, real-time, case-based Malaria Information System (MIS) to support national malaria elimination goals. This locally built, user-centred digital platform integrates surveillance, diagnostics, treatment, logistics, entomology and operational monitoring into a single system accessible at all levels of the health system. Mobile and web-based applications enable village malaria workers and health facility staff to report cases and interventions in real time, even in offline settings. The system promotes decentralized decision-making through intuitive dashboards and customizable analytics, enhancing local ownership, accountability and responsiveness. It supports key strategies such as the 1-3-7 surveillance model, integrated drug efficacy surveillance and incidence-based stratification. Operational functionality and system sustainability is supported by MIS modules for device management, stock management, geolocation, training and quality assurance. Real-time analytics drive timely interventions and adaptive planning, while interoperability with regional and global databases facilitates cross-border coordination and external reporting. Challenges remain, such as limited technical support capacity and a need for predictive tools. However, the Cambodia MIS demonstrates that locally developed digital health systems can transform disease surveillance and accelerate elimination efforts when effectively integrated with community-based networks and supported by strong governance. This model provides valuable evidence for other countries aiming to transition from malaria control to elimination, while complying with elimination certification requirements, and preparing for the prevention of re-establishment of transmission once malaria elimination has been achieved.