November 2023
“When I got malaria, my body felt warm from the inside out. At first, I thought it was something else but when, after five days, I found myself shivering with a high fever, that is when I went to see the community collaborator who was able to test and treat me,” Señora Emelida, a 52-year old, Indigenous woman from Rio Cañas, said.
Rio Cañas is one of many remote villages in Ngäbe-Buglé, an area of Panama that stretches from the Caribbean Sea in the north, to the provinces of Chiriquí and Veraguas to the south, and where the population is 97.9% Indigenous and 2.1% afro-descendant.
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To reach Emelida’s village, which is not connected to mains electricity or telephone networks health care workers must travel along precarious mountain roads from their base in San Felix for five hours by car, followed by two-hours by boat. The nearest health center is a 40-minute speed-boat ride away.
This is why the community collaborators, or colcoms as they are known locally, are such a crucial part of Panama’s malaria elimination strategy.
Over the past couple of years, the country has found itself in the midst of a malaria epidemic, with cases spiking by 65% - from 4181 in 2021 to 7083 in 2022. As of October 2023, reported cases have already reached 8301, more than 90% of which have occurred among hard-to-reach Indigenous communities.
In February 2023, the Ministry of Health published a health alert in response to the outbreak and issued a resolution to step-up malaria response in the four areas of the country with the highest number of cases, including Ngäbe-Buglé. This enabled local health systems to strengthen community networks to diagnose and treat malaria with more laboratory professionals and vector technicians, as well as additional diagnostic supplies and treatment. The 43 colcoms are a vital part of this network.
Colcoms are individuals, recruited from within the Indigenous communities themselves. They are then trained to carry out malaria diagnosis and treatment by the Ministry of Health, in collaboration with the Pan American Health Organization (PAHO) and the Regional Malaria Elimination Initiative (RMEI). This training is also supported by the Inter-American Development Bank and the Clinton Health Access Initiative.
“Vector control technicians visit the area for 20 days, followed by ten days off, so during those ten days, we are the ones in charge of malaria response in the community,” Ostenia Palacio Valdes, a community collaborator from Rio Cañas said.
When we find out that someone in the village is experiencing malaria symptoms, we visit their home, carry out testing and provide treatment, not just for positive cases but for everyone living in the house,” she added.
Not only do the colcoms facilitate the expansion of malaria surveillance in Ngäbe-Buglé by proactively seeking out those with symptoms and carrying out rapid tests, but they also ensure that cases are treated quickly before they can spread. In exchange for these services, they receive a US$100 monthly stipend from the Ministry of Health.
“Community collaborators are a fundamental part of Panama’s malaria elimination strategy because they are immersed in the community, speak the language, are trusted and can empathize with the local people,” Gloria Henao, International Consultant on Malaria at PAHO said.
“PAHO supports the training of these workers and provides them with the tools they need to perform diagnostic tests and record cases in a timely manner.” The Organization also facilitated the donation of antimalarial medicines and rapid diagnostic tests during a stock-out of these items in 2022.
“Thanks to their skills and leadership, colcoms are able to provide diagnosis and treatment to their community in places where we lack a physical health center,” Dr. Carmen Perez, Head of the Ministry of Health of Panama’s Vectors Department said. “But it is vital that we sustain this initiative beyond the current malaria outbreak.”
Malaria is a disease caused by parasites of the genus Plasmodium, which are transmitted to humans through the bite of infected Anopheles mosquitoes. The disease is prevalent in tropical regions, and symptoms can range from mild, such as fever and headache, to severe forms with a risk of death.
The PAHO Elimination Initiative, which seeks to put an end to more than 30 communicable diseases, including malaria, calls on countries to reinforce surveillance, and to implement innovative solutions to tackle and prevent outbreaks, including the use of rapid tests in the community.
“One of the challenges we face when working towards elimination is to address communities in a more organic way – working with them and making them an integral part of diagnosis and response. In Panama, the colcoms are a key part of this,” Dr. Ana Riviere-Cinnamond, PAHO/WHO Representative in Panama said.
In the Region of the Americas, thanks to evidence-based interventions, Argentina, Belize, El Salvador and Paraguay, have successfully eliminated the autochthonous transmission of malaria in their countries.
“If we continue to move forward like countries that have eliminated malaria, it will not only be a win for Panama but for the Region as a whole,” Dr. Ivette Berrio, Vice Minister of Health of Panama added.
“Involving the communities themselves is a crucial part of this.”
