Key findings and recommendations from assessment of Cambodia's national malaria surveillance system

Cambodia is approaching the final stages of malaria elimination, reporting only 1,384 cases in 2023 and aiming to eliminate all species of human malaria by 2025. Given the importance of surveillance in control and elimination efforts, the National Center for Parasitology, Entomology, and Malaria Control (CNM) elected to assess its malaria surveillance system to identify strengths and gaps and make recommendations. The WHO Malaria Surveillance Assessment Toolkit was utilized to evaluate 68 indicators across four primary objectives: Performance, Context and Infrastructure, Technical and Process, and Behavior. Data from 2021-2023 and activities which took place in 2023 under the 2021 edition of Cambodia's Surveillance for Malaria Elimination Guidelines were utilized. Indicators were evaluated through a survey completed by subnational staff, a field data quality assessment (DQA) at the service delivery level, a national-level DQA, and a national-level desk review including interviews with CNM staff. The assessment demonstrated strong performance of Cambodia's surveillance system. Of the core indicators assessed, 82% of Performance (14/19), 77% of Context and Infrastructure (8/13), 79% of Technical and Process (4/7), and 100% of Behavior indicators (3/3) were met. Notable successes included the improved completeness and timeliness of reporting and case investigation in the previous three years. Key areas for improvement include revising case investigation and updating case classifications, enhancing data cleaning and verification processes to improve data quality, and upgrading the national malaria information system to include unique patient identifiers and enable interoperability with other national information systems. Cambodia's surveillance system is strong overall and CNM is committed to addressing identified areas of improvement. Lessons learned from this assessment informed revisions to the national Surveillance for Malaria Elimination Guidelines, implemented in May 2024. Additionally, the results will be used to guide the design of surveillance and response-related objectives for Cambodia's 2026-2035 National Strategic Plan for malaria.