Strengthening field-informed for-profit private sector engagement strategy in malaria elimination: insights from a single-group quasi-experimental pilot study in Bangladesh.

backgroundDespite the dramatic achievements in malaria control, Bangladesh continues to face persistent transmission in high-endemic regions such as Bandarban in the Chittagong Hill Tracts. One important strategy to close surveillance and case management gaps is to involve the for-profit private sector that serves marginalized populations including high-risk occupational groups and communities facing geographical obstacles. The objectives of this study were to determine the practicality and the effects of involving the private healthcare providers in the national malaria surveillance system in Alikadam Upazila, Bandarban.

methodsA One-month pilot study was conducted in March 2023 in 10 for-profit private healthcare facilities in Alikadam Upazila, Bandarban. The providers were trained to do rapid diagnostic tests on suspected malaria patients and to refer positive cases to government or partner NGO facilities. Data on adherence to diagnostic protocols, the detection of malaria cases, the reporting, the referral and patient satisfaction were collected using standard registers, reporting forms and supervision checklists. These data were entered into an electronic database and analysed descriptively. Quality assurance was taken care of by monitoring and evaluation mechanisms, including regular supervisory visits.

resultsRapid diagnostic tests were done on 440 patients in the pilot, and 1.8% were positive of malaria (Plasmodium falciparum and P. vivax were equally distributed). The study period has shown that the private sector has a share of 20% in all the reported cases of malaria in Alikadam. Most of the participants were males (54.6%), and 4.0 percent of the women were pregnant. The level of patient satisfaction was also good as 100 percent of the people who were surveyed claimed that they were confident in the private providers and the referral process. The accuracy of data recording rose as the providers performed better over time with a rate of 37.5 in week one but in the fifth week, it was 87.5. Although these successes have been achieved, referral gaps and lack of financial incentives to the private providers were a challenge.

conclusionsThe research highlighted private healthcare providers' potential in malaria surveillance and case detection in remote, vulnerable populations. Integrating them into national programs could strengthen health systems and eradication efforts, but scaling requires addressing challenges like sustained training, financial incentives, and adequate service coverage.