Table 5.

Provider level and migrant level perceived barriers and suggested solutions to increase timely malaria testing among migrants in regional artemisinin-resistance initiative (RAI) areas of Myanmar (Dec 2017–Jan 2018)

Categories	Theme	Verbatim quotes
Migrant level	Inappropriate health care seeking	“He [Quack] is specialized in malaria. We usually go to him when face with sickness [fever]” (28 year old female stone mine worker)
	Self-medication	“We will go for health care provider if we cannot stand because of fever. [We take] some traditional medicines for mild fever” (49 year male fisherman)
	Not giving importance to fever	“I have no idea to say for timely testing of every fever cases. Actually we sleep when having fever and when feel recovered, go to work.” (36 year male construction worker) “We will not go for health care and will go when not recovering from sickness” (24 year male charcoal maker)
	Transportation difficulty	“Going to the bottom of this mountain [to rural health centre or village health volunteer] is mainly difficult, especially in rainy season, the only possible way is walking.” (52 year male oil digger)
	Not affordable	“Even the blood testing is free of charges but needed to pay for the treatment for the fever.” (30 year female charcoal maker)
	Previous experiences of no timely testing	“The health care providers, here is midwives from public clinics, asking previous history of experiencing malaria and what medication taking when we go with fever. No experiences on malaria blood testing” (45 year male fisherman)
	Uninformed about VHV or activities of VHV	“Firstly, it [malaria blood test] can be done at Pauk Taw [sub centre] then also possible at Inn Din [private clinic] and finally we can go Kalay [hospital or private clinic].” (28 year male oil digger) “We didn’t know and not heard about malaria volunteer [VHV]”. (39 year female oil digger, 36 year male oil digger and 51 year male oil digger)
	Lack of symptomatic treatment from a VHV	“Only malaria diagnosis is not sufficient. There should be treatment for other symptoms as well” (33 year male fisherman)
Provider level	Lack of practices for malaria testing	“If the symptoms is as malaria, then giving blood test and not undergo blood test for the simple sickness [fever].” (34 year male BHS)
	Afraid of paper workload	“Because VHV afraid to fill in the needed forms, some are not trying to do blood testing” (39 year male vector borne disease control staff)
	Waste of test kits in no burden area	“They [BHS and VHV] not try to do blood testing because of low burden in the area and also worrying about stock out of malaria test kits [rapid diagnostic tests kits].” (39 year male vector borne disease control staff)
Suggestion to improve timely blood testing among migrants
Providing needed health message  Provider acceptance for malaria testing		“Everybody will do blood testing timely when the clinics or services available in easily accessible places for example the Dam Gate and needed such kind of health message for timely malaria testing.”(33 year male charcoal maker) “However, I would like to suggest the health care providers or volunteer also need to be patient and accept for coming request to do blood testing in every fever cases.” (33 year male charcoal maker)
Providing peer volunteer with supervision		“They have [Migrants] need to have the information about timely testing within 24 h of fever. Also providing volunteer in their working site because they will not coming if available sources are far away even they know the information” (60 year male vector borne disease control staff)
		“After providing the person who knows well and well trained for malaria in our working places, we suggest community to do timely testing even the fever seems to be malaria or not.” (51 year male oil digger) “It is the best to provide Working site leader or other one volunteer from village near work site or in our work site for the purpose of training on blood testing” (29 year male bamboo cutter)
		“Peer volunteer is the best and they are always closest one for them. But needs supervision for not becoming quack.” (56 year male BHS)