With a plastic case full of cheap medical supplies and only a few days’ training, Say Mu Phaw is on the verge of eliminating malaria from her village in south-eastern Myanmar’s Tanintharyi region.

Back in 2015, her first full year as a village health worker, 16 people came down with the disease in Mi Kyaung Hlaung, where roughly 600 residents live surrounded by mosquito-ridden tropical forests.

Last year, armed with latex gloves, lancets and a supply of disposable malaria testing kits, she diagnosed just one villager despite testing 250 people.

Before she started work, most of her neighbours had only a vague idea of what malaria was and how to prevent it. “Now, whenever they see symptoms, they’ll approach me first rather than the other way round,” she says.

Say Mu Phaw is one of thousands of volunteers across the country to have received training and supplies from foreign donors since political reforms began at the start of this decade, ushering in a flood of aid.

Their efforts have helped save thousands of lives, and are fast turning Myanmar from a malaria black spot into a world leader in the fight to eliminate the disease.

Across the country, almost 4,000 people died from malaria in 2010, according to World Health Organization (WHO) estimates. In 2017, the disease claimed just over 200 lives.

Dr Patricia Graves, a leading specialist on the transmission and control of malaria, is confident Myanmar is on track to be malaria-free by 2030. The country’s success with village-based health workers “is a huge thing that other countries can learn from,” she says.

Also key to the plummeting death rate is the distribution of mosquito nets treated with long-lasting insecticide, added Graves, who travelled to Myanmar as a consultant last year to assess US-funded malaria projects.

Say Mu Phaw is among thousands of volunteers in Myanmar who have helped to drive down malaria-related deaths.

Some fear the spread of drug-resistant forms of the disease might undo this progress, though scientists believe they have found a way to tackle these strains by treating large numbers of people in “hotspot” villages regardless of whether they showed symptoms. An experimental programme last year drastically reduced or eradicated malaria in 50 villages using this strategy.

As the number of cases reaches zero it is vital to remain vigilant, says Graves. “When you get towards elimination you need to mop up the cases much more quickly, because it can bounce back very fast.”

Dr Bo Bo Thet, the field director in Tanintharyi for University Research Co (URC), which manages USAid-funded malaria projects, says being close to elimination poses two problems.

“One is that community awareness becomes quite low, so if someone gets a fever they’re less likely to get tested for malaria. The second problem is that as malaria cases go down, immunity also goes down, so it’s easier to get malaria,” he says.

A lack of awareness is not just an issue for laypeople. Staff at government health clinics sometimes fail to recognise symptoms too, he added.

Farm labourer Pay Say has contracted malaria twice.

Pay Say, a 42-year-old farm labourer, went to the government clinic just outside Mi Kyaung Hlaung village as soon as he started having shivers and joint pain last month.

But staff there didn’t test him for malaria, instead giving him an unspecified injection and sending him home, he says. He had been hospitalised with malaria in 2006 and suspected he had it again, so he went to Say Mu Phaw for a second opinion.

She tested a drop of blood from his finger and found he was positive. Without her, he may well have remained untreated and become severely ill.

“In some rural health centres there aren’t enough staff, including doctors,” says Dr Thin Thin Chit, senior operations director at URC. “Infrastructure is really important for elimination.”

Myanmar’s badly underfunded health system is one of the reasons she and Bo Bo Thet are less optimistic than Graves about the chances of defeating the disease by 2030, when the WHO hopes to see at least a 90% reduction in cases globally compared with 2016.

“2030? I’m not so sure,” says Bo Bo Thet. “By that time some parts of Myanmar will achieve elimination, but not everywhere.”

When the number of cases reaches zero in areas where URC works, the volunteer health workers will be trained to diagnose and treat other diseases, such as tuberculosis and HIV, says Bo Bo Thet.

This will allow them to monitor their villages and act quickly if malaria returns, and is a better use of resources than focusing only on malaria in areas where people are no longer suffering from the disease.

Initiatives like this, which should stop donors losing interest once the battle appears to be all but won, are imperative. “I can’t imagine operating without outside funding,” says Bo Bo Thet.

With its dilapidated hospitals and clinics unable to meet the challenge, Myanmar will need major foreign donors like the US to remain committed until the very end.

Scot Marciel, the US ambassador to Myanmar, says that while anti-malaria funding has to be approved each year by Congress, he expects Myanmar to “remain a priority”.

“The biggest risk we face in this fight is complacency,” he says.

Additional reporting by Zaw Bo