Sustaining community-based malaria services through stakeholder engagement: lessons from co-creation in northeastern Thailand

Abstract Introduction In remote communities in the Greater Mekong Subregion, maintaining community-based malaria care is vital to achieving the goal of malaria elimination. This project aimed to collaborate with the community members and implementers of malaria and health programmes, our key stakeholders, to co-create engagement activities that promote the integration of community-based malaria activities that best fit the local context. This article describes the design, implementation and results of this co-creation process, and highlights key learnings and insights, enabling factors and challenges. Method In Buntharik district, Ubon Ratchathani province bordering Laos in northeastern Thailand, we adopted a co-creation framework to design and develop iterative and responsive engagement activities, and used a theory of change framework to outline the necessary steps and conditions to achieve the desired co-creation outcomes. Data were recorded in engagement logs, meeting minutes, observation notes, and participant evaluation to measure the results of engagement and extract key learnings from implementation. Findings Between April 2023 and June 2024, 36 in-person engagement activities were conducted with approximately 550 participants, to co-create and evaluate locally-owned health education materials—the 2024 Buntharik health calendar—that integrates malaria information with priority local health issues. The co-created calendar offered one potential entry point to maintain malaria awareness in low transmission areas, but future initiatives ideally should secure additional funding sources to maintain the capacity of local health workers. We found that responding to local health concerns and expectations of the communities and stakeholders is the key enabler to co-creation. However, in the context of changing policy, careful thought about the range of scenarios in which co-creation is applied is crucial to plan for sustainability of the integration. Learning from the context of this engagement, new champions could emerge from involving additional stakeholders beyond those involved in malaria service implementation. Conclusion Drawing from this stakeholder engagement work, the co-creation process showed strong potential for ensuring the sustainability of community-based health care in the context of declining awareness and advocacy, such as in the case of malaria elimination. The process and its learning can be adopted to any ongoing local collaborative partnership and future participatory action research and community-informed policy considerations.