Crossing the last mile: Cambodia’s journey towards malaria elimination

In 1997, Cambodia faced a daunting public health crisis, recording 170,387 malaria cases and more than 800 deaths. By 2025, that number had fallen to just 107 cases, marking a historic achievement and bringing the country to the brink of certification of malaria elimination.

For decades, the very landscapes that define Cambodia’s beauty – its dense forests and winding river systems – also formed the frontline of a deadly battle against malaria. The disease disproportionately affected those living and working closest to the forest. For many communities, entering forested areas carried real fear, as malaria was widely perceived as a life-threatening risk.

What was once one of the country’s most persistent and deadly public health threats is now being pushed to the edge of disappearance

On this year’s World Malaria Day, we reflect on the milestones that transformed Cambodia’s fight against malaria, a journey defined by scientific innovation, sustained government leadership, strong partnerships and the power of community-led action — and on the continued vigilance required to prevent its return.

From high burden to targeted response

As Cambodia rebuilt itself after decades of civil war, malaria remained a major public health challenge. In 1997 alone, the country reported 170,387 malaria cases and more than 800 deaths.

To address this burden, the National Malaria Control Programme integrated malaria diagnosis and treatment into the national essential drugs programme. By 2001, artemisinin-based combination therapies were introduced nationwide, alongside large-scale distribution of insecticide-treated mosquito nets. This marked a critical shift from hospital-based curative care toward a more proactive strategy focused on prevention, early diagnosis and prompt treatment at community level.

^{Thiem, a village malaria worker from Luon Thmey, a Kreung minority village in Stung Treng, provides malaria elimination services to 28 households in his community. He sometimes needs to travel by boat or on foot to remote areas to reach them. © WHO / A. Raab}

A transformative milestone followed in 2004 with the introduction of village malaria workers (VMW). The populations most at risk often lived in remote, forested and border areas, far from health facilities. These trained community volunteers became the frontline of the response. Living within the communities they serve, VMWs conduct rapid diagnostic tests, provide treatment, distribute mosquito nets and report confirmed cases within 24 hours. What began as a pilot initiative with just 34 workers expanded steadily over the years, becoming a cornerstone of Cambodia’s malaria programme.

The stakes increased further in 2008 when artemisinin resistance in Plasmodium falciparum was confirmed, placing Cambodia at the centre of global concern over multidrug-resistant malaria. In response, surveillance systems were intensified, treatment protocols were adapted and operational research expanded. Cambodia played a central role in global efforts to contain resistance and prevent its spread.

A key component of this strengthened response was the systematic and reinforced use of rapid diagnostic testing before treatment, ensuring accurate case management and preventing inappropriate use of antimalarial medicines.

^{Narin, a village malaria worker, performs a malaria rapid diagnostic test on a man from Luon Thmey, a Kreung minority village located in Stung Treng, Cambodia. © WHO / A. Raab}

In 2009, the programme evolved further with the introduction of Mobile Malaria Workers, deployed to reach migrant and forest-going populations. Travelling by motorbike, boat or on foot, they extended services to communities otherwise beyond the reach of routine health services.

Accelerating towards elimination

In 2011, Cambodia launched its National Strategy for Malaria Elimination 2011-2015, setting an ambitious goal to eliminate malaria nationwide by 2025. To advance this objective, diagnosis and treatment protocols were refined to curb P. falciparum resistance, and surveillance systems were strengthened to ensure rapid case detection, reporting and response, often in the most remote forested areas of the country.

The impact was substantial. Malaria cases declined from 113,255 in 2004 to 56,271 in 2014. Even more significant was the reduction in mortality: reported deaths fell from 382 to just 18 — a 95% decrease within a decade. This progress has been sustained, with Cambodia maintaining zero malaria deaths since 2018.

^{Demonstration of a malaria rapid diagnostic test (RDT). © WHO / Tytaart}

To conquer the "last mile," the 2020 Intensification Plan for Hard-to-Reach Populations focused on the five provinces where the disease remained most persistent. Outreach intensified among high-risk groups, particularly forest-goers and men aged 15-49. Through door-to-door services, proactive case detection and proactive weekly testing in deep-forest areas, the program successfully interrupted transmission.

By the end of 2023, Cambodia reported that no local P. falciparum cases were detected nationwide. While the country continues to manage a significant number of P. vivax cases, a form of malaria that requires more complex treatment to fully clear the parasite from the liver, the progress in reducing the deadliest species is historic. In 2025, the national program identified primarily imported cases, which were rapidly managed in line with national protocols to prevent the re-establishment of local transmission.

Prevention of re-establishment: safeguarding the gains

With the reported interruption of local falciparum malaria transmission, Cambodia has now entered a new and equally critical phase: Plasmodium vivax elimination and prevention of the re-establishment of malaria transmission. While the decline in cases is historic, significant challenges remain for the country to achieve WHO certification as malaria-free.

Vigilant surveillance and strong case management to ensure P. vivax clearance remain key to this effort. Every suspected case is tested, reported within 24 hours and investigated in line with national Prevention of Re-establishment Guidelines to prevent any onward transmission. Every P. vivax case is treated to clear the parasite from the liver.

To ensure long-term sustainability, village malaria workers are being integrated into village health support groups to maintain community-based detection and response capacities. Simultaneously, surveillance systems are being further strengthened to maintain rapid case investigations, entomological monitoring, and vital cross-border coordination.

This year’s World Malaria Day theme, "Driven to End Malaria: Now We Can. Now We Must," reflects Cambodia’s current momentum: the reported interruption of P. falciparum demonstrates that elimination is possible, and that the country must now address the remaining burden of P. vivax to achieve WHO certification.

Dr Huy Rekol, Director of the National Center for Parasitology, Entomology and Malaria Control emphasized: “Cambodia’s progress toward malaria elimination reflects decades of strong leadership, robust community engagement, and effective collaborations. As we transition towards preventing the resurgence of malaria, we acknowledge both the opportunities and responsibilities that lie ahead of us. We are eager to strengthen our successful strategies and remain dedicated to vigilant surveillance, ensuring that the advancements we have achieved endure and that malaria is effectively relegated to the past.”

Dr Marianna Trias, WHO Representative to Cambodia, added:“This achievement reflects the dedication of malaria workers on the ground and the collective efforts of the Ministry of Health and partners at every level. WHO is proud to have supported Cambodia through evidence-based guidelines, operational research and strengthened surveillance systems. Preventing the re-establishment of transmission will be essential to safeguard these gains and move towards certification.”

This phase requires sustained political commitment, continued investment and strong community engagement. Elimination is not the end of the journey; it marks the beginning of the long-term vigilance needed to ensure malaria remains a disease of the past.

Cambodia’s experience demonstrates that even in complex settings marked by forest transmission, mobile populations and drug resistance, elimination is possible — and that protecting those gains is just as important as achieving them.