Health Impact Assessment of the Malaria Elimination Area Management Policy for a Sustainable Safety Province, Nakhon Si Thammarat Province

Abstract

This study aimed to assess the health impacts of the malaria elimination area management policy in Nakhon Si Thammarat Province using the Health Impact Assessment (HIA) framework through a mixed-methods approach. A mixed methods researchapproach witha concurrent triangulation design wasemployed, collecting quantitative and qualitative data simultaneously and integrating the results. Data were obtained from three sources: (1) document review of official policy and implementation records, (2) quantitative surveys with 450 residents from malaria-risk areas A1, A2, and B1 and 475 primary school students (totaling 925 individuals), and (3) qualitative interviews with 91 frontline practitioners. Descriptive statistics were used to analyze knowledge, perception, and practices (KPP) levels of both groups. Findings revealed that residents demonstrated high levels in knowledge, perception, and preventive behaviors, while students were predominantly at an intermediate level, particularly among those with previous malaria infection or engagement in community-based disease control (e.g., village health volunteers). The strengths of the management system included timely disease surveillance, the use of GIS and digital tools (e.g., Malaria Online), and cross-sectoral proactive engagement. However, barriers remained, including budget limitations, insufficient neutral monitoring systems, and inconsistent involvement of local administrative organizations. Resource disparities across sub-districts also hindered equity in disease control. Policy recommendations include integrating health curricula into schools, devolving planning authority to local governments, supporting sustainable financing mechanisms, and coupling HIA with cost-effectiveness analysis in policymaking. Strengthening communityownership and creating participatory, transparent monitoring frameworks are also essential. Future studies should explore the long-term behavioral impact of malaria education on children and adolescents, and assess the role of decentralized governance in sustaining malaria-free zones.These findings provide valuable baseline evidence for strategic provincial health planning and contribute to broader public health policy development for infectious disease elimination in similar endemic regions.