LocationsHow Indonesia is safeguarding its forest workers from the threat of Malaria
Health is wealth
April 22, 2025
With support from UNDP, the Government of Indonesia is building robust systems to diagnose and treat malaria, even in the most remote areas.
Photo: UNDP Indonesia/Maya Tamara
Samsol has been mining gold near the rainforests of Aceh, Indonesia for over a decade. Every morning, he navigates through thick mud on his motorbike, heading to a site 30 metres below ground to extract the precious metal.
“It’s risky and exhausting, but it puts food on the table,” said the father of two. Samsol’s livelihood and family depend on the forested land.
About half of Aceh is covered by dense forest, a vital resource and breeding ground for malaria, a mosquito-borne disease. Sometimes fatal, malaria is a constant threat for workers like Samsol.
Even milder cases can be debilitating, causing absent workers to lose their wages.
“The last malaria attack hit me hard. Fever. Chills. I couldn’t even walk,” he recalled. “At the mine, when someone gets sick, the whole operation slows.”
About half of Indonesia's Aceh Province is covered by dense forest. This vital resource is also a breeding ground for malaria, which is spread by mosquitos.
Photo: UNDP Indonesia/Maya Tamara
Despite Indonesia nearly eliminating malaria in Aceh, a new challenge has emerged: Plasmodium knowlesi. This malaria parasite primarily infects monkeys, but can jump to humans through mosquito bites.
As Indonesia faces P. falciparum and P. vivax, two other malaria strains, P. knowlesi has surged—from just five cases in 2021 to 170 in 2023.
While it accounted for a small fraction of the country’s 418,000 confirmed malaria cases that year, P. knowlesi cases could climb as demand for lumber, crops and minerals pushes workers into forests, heightening contact with monkeys. About 40 million Indonesians rely on forests for their livelihoods.
To overcome these challenges, which impede Indonesia’s race to end malaria by 2027, UNDP partners with Indonesia’s Ministry of Health to stop malaria in remote communities. The partners are scaling systems for effective diagnosis and treatment with financing from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
A new malaria strain is hampering efforts to eliminate the disease in Indonesia by 2027.
Photo: UNDP Indonesia/Maya Tamara
Evi Susiana supports artisanal miners like Samsol from a puskesmas, a community health clinic. Traversing steep muddy hills, she helped establish a posko, a weekly malaria screening and treatment post, and trains community members to deliver health education.
“This consistent presence built trust and ensured that even isolated communities receive timely care,” she explained.
"It starts here, in the field, one worker at a time.”– Evi Susiana, Malaria Prevention Lead, Puskesmas Krueng Sabee
Timely treatment prevents complications, but only with accurate diagnosis.
Sri Wulandari, a microscopist at Krueng Sabee, carefully examines blood samples under a microscope to identify malaria parasites.
“Misdiagnosis can lead to delayed or inappropriate treatment,” she said. It also contributes to wasted medicines and drug resistance.
It gets tricky when she receives poorly prepared samples, a challenge improved by better diagnostic tools and training. When in doubt, she turns to the district laboratory and standard slides for identifying malaria parasites.
Once the malaria type is confirmed, appropriate treatment begins.
Microscopists at Krueng Sabee carefully examine blood samples to identify malaria parasites. Accurate diagnosis is critical for appropriate treatment and to prevent complications.
Photos: UNDP Indonesia/Maya Tamara
Microscopists’ data feeds into the System for Malaria Surveillance (SISMAL), Indonesia’s national malaria monitoring platform.
“SISMAL has improved early detection and response,” observed Dadang Supriyadi, a SISMAL analyst and programmer in Jakarta.
“In remote areas, local health offices can identify an increase in malaria cases and quickly deploy additional supplies or conduct community outreach,” he added.
Diagnostic data feeds into Indonesia’s national malaria surveillance platform, supporting early detection and response to case increases.
Photos: UNDP Indonesia/Maya Tamara
SISMAL now synchronizes with SMILE, the health supply chain management system that monitors over 900 million vaccines and 129 million doses of HIV, tuberculosis and malaria medicines countrywide.
If clinics report low stocks, authorities draw on SISMAL data to decide where to send supplies. This system also helps prevent overstock, reducing waste from expired products.
“Having real-time data means we’re not totally in the dark. There have been times when the system flagged low inventory before the facility even contacted us, which helped us avoid delays,” recalled Raige Akmal, a pharmacist in Aceh Jaya.
The malaria surveillance platform synchronizes with SMILE, the health supply chain management system that monitors the supply and distribution of HIV, tuberculosis and malaria medicines.
Photos: UNDP Indonesia/Maya Tamara
Malaria response is complicated by forest workers travelling between worksites, making follow-up challenging. Incomplete treatment and human mobility can cause P. vivax malaria relapse and re-establish transmission. The potential spread of P. knowlesi from workers returning to their families is not well-understood.
“We’re isolated. If we don’t stay alert, someone could fall seriously ill with no help in sight,” said Samsol.
Evi Susiana and workplace supervisors coordinate treatment as workers move between sites. She encourages employees to share their recovery stories, emphasizing the importance of early treatment. During home visits, she also advises families to use mosquito nets and eliminate breeding sites.
Effective supply chain management ensures medicines are available when and where needed. The system also prevents overstock, reducing waste from expired products.
Photo: UNDP Indonesia/Maya Tamara
UNDP supports the Migrant Mobile Population module, a new SISMAL feature designed to help authorities better understand malaria among migrant groups.
“These populations may fall outside the coverage of routine surveillance due to their mobility or remote locations,” explained Supriyadi. “A dedicated module ensures their health data is not overlooked.”
In 2023, 95 percent of reported malaria cases in Indonesia were laboratory confirmed, up from 85 percent in 2018. Closing data gaps helps health authorities ensure equitable access to health services for mobile populations and is crucial for staying ahead of P. knowlesi transmission.
Health workers coordinate with workplace supervisors to ensure continuity of treatment for workers who move between sites.
Photo: UNDP Indonesia/Maya Tamara
Back at the mine, Samsol reflects on his strenuous work.
“After days away, I just want to be home with my family. We eat together, talk and try to enjoy quiet moments,” he revealed.
“I hope my kids can get a proper education and not have to take the same path I did.”
Global efforts to end malaria have saved nearly 13 million lives since 2000. But progress has stalled, and funding to complete the job is insufficient.
Photo: UNDP Indonesia/Maya Tamara
Global efforts to curb malaria have averted an estimated 2.2 billion cases and saved nearly 13 million lives since 2000. Yet malaria claimed close to 600,000 lives worldwide in 2023. Progress has stalled, and funding remains insufficient to reverse current trends.
UNDP and the Government of Indonesia are building robust systems to diagnose and treat malaria, even in the most remote areas, while improving livelihoods for forest-dependent communities. Stopping malaria and emerging threats like P. knowlesi requires sustained investment, including in the Global Fund’s Eighth Replenishment.
UNDP and its partners are committed to tracking, testing and treating malaria to ensure no one is left behind and to end malaria as a public health threat by 2030.
Ending malaria as a public health threat is critical to achieving Sustainable Development Goal 3 on good health and well-being.
Photo: UNDP Indonesia/Maya Tamara
Related
content
content
