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Background Among 13 endemic districts, the Chittagong Hill Tracts bear more than 90% of Bangladesh’s malaria burden. Despite the private sector’s prominence in rural healthcare, its role in malaria management remains underutilized. This study aimed to strategize leveraging the for-profit private sector, such as diagnostic and treatment centers, to bolster national malaria surveillance and control, advancing Bangladesh toward malaria elimination by 2030. Methods This mixed-method study commenced with a questionnaire-based cross-sectional survey followed by selected focused group discussions (FGDs) among the participants. Three FGDs were held with the for-profit service providers so that further insights and qualitative viewpoints of them can be utilized in situation analysis. Based on the endemicity and strategic priorities, a comprehensive mapping of private for-profit facilities from the regions comprising 15 sub-districts across 8 chosen districts (7 malaria endemic districts and the rest non-endemic districts) was created. For the non-endemic zone, the sub-districts were selected based on their proximity to an area with high malaria transmission. Results Among the 104 representative participants, majority were male ( n  = 92, 88.5%), had a diploma in their respective fields ( n  = 53, 51%) and were involved either in laboratory work ( n  = 49, 47.1%) or as owners/managers of health centers ( n  = 41, 39.4%). The selected health facilities were close to the corresponding Upazila Health Complexes (mean distance 2.8 km), but were distantly located from the designated district hospitals (mean distance 48.9 km). The main sources of RDT kits (62.3%) and anti-malarial drugs (63.2%) were local wholesale markets. A large share of the corresponding facilities neither provided malaria treatment services (81.7%) nor worked with the NMEP (93.3%). Conclusions This study highlights challenges and recommendations for engaging private for-profit health facilities in Bangladesh’s malaria elimination efforts. The identified challenges include low-quality RDTs, staff shortages, and inadequate capacity building. Recommendations emphasize effective training, stakeholder interaction, and enhanced oversight for successful malaria control efforts.

Background Malaria transmission in the Chittagong Hill Tracts (CHT) districts in Bangladesh is characterized by considerable heterogeneity in incidence and the frequent mixing and importation of parasites across districts. Thus, elimination efforts must account for human mobility between endemic and non-endemic locations, and the relative importance of local transmission and parasite importation domestically. Methods We construct a metapopulation malaria model, parameterized by human mobility data and fit to epidemiological data, to guide elimination efforts in the region. Results We find substantial heterogeneity in the transmission intensity across the CHT, with the estimated basic reproduction number varying greatly across places with similar levels of observed incidence. When vector control interventions are applied locally, the greatest impact in reducing overall incidence are in places with both high transmission intensity and high connectivity with more populated districts in the western part of the CHT. Conclusions Local elimination in several areas with low or intermediate incidence has a moderate impact in reducing overall incidence, indicating that only focusing on high incidence areas is not sufficient for malaria elimination. More generally, our modeling framework can be used to prioritize resource allocation and identify the conditions necessary for malaria elimination in the region. Plain Language Summary Malaria can be hard to eliminate because people move between regions. This movement can carry parasites from areas with high transmission (“source” regions) into areas with lower transmission (“sink” regions). We built a mathematical model of malaria in Bangladesh that combines human movement patterns with disease data. We found that elimination works best when control efforts target areas that have both high malaria transmission and strong connections to larger, more populated districts. Focusing only on areas with high numbers of cases is not enough to achieve elimination. Our model can facilitate public health decisions on where to focus resources and what conditions are needed to achieve malaria elimination in Bangladesh. Mahmud, Chang et al., model malaria transmission encompassing human mobility and epidemiological data in Bangladesh to guide elimination efforts. Local vector control efforts have the greatest impact when targeted to places with both high transmission intensity and high connectivity.