Malaria Elimination Challenges and Barriers in High, Middle, and Low Endemic Areas: A Qualitative Study in Western Indonesia

¹ Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jl. Raya Jakarta-Bogor KM 46, Cibinong, West Java, Indonesia
² Doctoral Program in Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
³ Pangandaran Health Laboratory Center, Ministry of Health, Republic of Indonesia

^* Corresponding triwahono1983@gmail.com

Abstract

Malaria remains a major public health challenge in Indonesia, particularly in regions with varying levels of endemicity. This qualitative study explores the challenges and barriers to malaria elimination in high-, middle-, and low-endemic areas of western Indonesia. In-depth interviews were conducted with 140 key stakeholders across three provinces, including health officials, cross-sector representatives, and community members. Data were analyzed thematically using Braun and Clarke’s six-step approach to ensure validity through triangulation and member checking. Thematic analysis identified four overarching themes: policy implementation, resource allocation, cross-sector collaboration, and community knowledge/practices. The results showed variations in the implementation of malaria elimination policies across endemic levels, with resource limitations, cross-sector gaps, and community misconceptions as recurring barriers. This study underscores the importance of context-specific strategies tailored to the local epidemiological and socioeconomic landscape. Strengthening cross-sector coordination, ensuring sustainable funding, and enhancing community engagement are essential for advancing malaria elimination in western Indonesia. These findings offer valuable insights for policymakers and public health practitioners aiming to refine malaria control strategies and accelerate progress toward the national elimination goals.