Information is key to effective malaria control
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Version 0 of 1. A recent US audit of malaria prevention in Benin (pdf) aptly summarises the shortfalls of a commodities-driven approach: "USAid had delivered 705,000 nets — worth $4.1m — to 800 health centres across the country, where they had been sitting in storage for nearly eight months ... At [one health centre] the director said she did not understand why the mission continued to deliver bed nets if she and her staff could not distribute them to beneficiaries." Such top-down approaches are fast being replaced by bottom-up, community-driven initiatives. Becky Weir, senior child health programmes adviser at World Vision agrees. "NGOs are trying to do a lot more in terms of behaviour change within communities. You can't just hand out nets and hope that it will all be OK ... I have seen areas myself that have supposed to have had mass-distribution of nets, but you visit households and they are not in use. Most of the time that is because there has been limited communication about the real value of them." Stories circulate of bed nets being used as fishing nets, even wedding dresses. Such uses are entirely understandable if distribution is not backed by education and awareness campaigns; or worse, as in the Benin, community distribution systems have not been set-up. "There's a growing acknowledgement that really effective malaria control happens at the local level," says Scott Filler, senior technical adviser, Malaria, at the Global Fund to Fight Aids, Tuberculosis and Malaria (the Global Fund). "Bed nets are only good if people use them; spraying is only effective if people allow the spray teams into their homes. There has to be a grass-roots approach to malaria control, communities have to own it. And in order to own it, they have to be provided with the information and education to make an informed choice." Simple messages such as how malaria is transmitted, or how it can be prevented, are yet to reach some communities. Increasingly the approach of World Vision and others, says Weir, is to work with community health workers who are from the community themselves, and ideally linked in with the ministry of health. "Because those individuals are known by communities but have the training from the ministry of health, or from NGOs, gives them the trust from the community and credibility. It's also important that there is clear messaging ... [from] community leaders, faith leaders and other who are respected within the community." At the Global Fund, Filler gives a similar example. "The Ethiopia Health Extension Programme was an acknowledgement that basic primary health services need to happen at a community level. Ethiopia came to terms with the fact that their health infrastructure was not accessible to the population, and a dramatic paradigm shift took place whereby they built small health posts populated by a cadre of 30,000 new health workers, to get them out into the community because that's where you need to do malaria control ... crucially they recruited them from communities, trained them and paid them." Such healthcare workers need not be viewed as exclusive to the public sector, but equally can be funded and trained by NGOs, Filler says. Mass media also has a role to play. United Against Malaria (UAM) are using Africa's obsession with football to convey malaria awareness. In the upcoming African Cup of Nations, where it is one of the official social causes, during half time in every game a UAM advert will show malaria prevention messages delivered by Africa's biggest soccer stars, including Didier Drogba, Samuel Eto'o, and Steven Pienaar. One will include Drogba showing viewers how to correctly set up a bed net. Campaign manager David Kyne said after its first campaign during the South Africa World Cup in 2010, polling showed 6.6 million Tanzanians reported taking action to ensure that their family slept under a net ... and ads in Ghana reached 70% of the population. "Even in a remote village there's one TV and when a game is on everyone crowds around it." But clarity for donors remains the stumbling block for behavioural change programmes. It is easier to allocate X amount of funds for X amount of drugs. "It can be quite difficult to get beyond those numbers," says Weir. "You can speak to some individuals who work for donor agencies who completely agree about the need to look at broader indicators, and share our frustrations with the fact that donors tend to focus on these narrower results." The Global Fund are by far the biggest donor in malaria prevention, accounting for between 50-80% of global malaria financing in any given year. "Behavioural change is a 'riskier' investment in the sense that it is less tangible, sometimes harder to put your finger on what the exact outputs of these interventions should be. Are communities strengthened, are people changing their behaviour – these are very hard things to measure. So sometimes I think there is a tendency to gear towards the easiest things to count," Filler says. However, it just means we have to go into it with an eyes-open approach, that these things can be slightly harder to evaluate, he adds. Harder, but by no means impossible. Outputs can be just as tangible as inputs. "Ultimately that comes down to counting cases and infections, so that you can show that the money coming in is not simply resulting in more stuff being packed out but is actually resulting in changes or decreases in the malaria burden," says John Miller, senior malaria technical advisor at the NGO PATH. That's what sells, he says, "and what will keep selling until there's no malaria left." <strong>This content is brought to you by </strong><strong>Guardian Professional</strong><strong>. To get more articles like this direct to your inbox, sign up free to become a member of the Global Development Professionals Network </strong> |