Empowering village malaria workers in Cambodia: Prevention and control of malaria

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Standing under the shade of a cassava barn is Khem Bou, a 17-year-old mother of two from Kampong Cham province. Every day she sleeps with her children on a makeshift bed made of wooden planks, but this hasn’t driven them away from this temporary home.

“Since it became difficult to find work in my hometown, my husband and I relocated our family to find new opportunities in Pailin province. We found a job on this cassava farm and have been working here for a month. We heard that where we live now is a high risk malaria area, but we have no other choice. Although we do not know much about malaria, we know that if we get sick, there is one village malaria worker nearby who we can seek for advice. We also received these mosquito nets from the village malaria worker.”

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Khem Bou and her two children now live on a farm in Pailin province.

Khem Bou and her family are among the country’s poorest. Those living below the poverty line (about 17 percent of the population) are often forced to give up the chance of receiving basic education to work and supplement their families’ income. Many are living under poor hygienic conditions and have limited knowledge of disease and how to protect themselves. Khem Bou’s family is also at high risk of getting malaria and thereby spreading the drug resistant parasite. Like many other mobile and migrant families, their itinerant lifestyles make them difficult to reach with malaria control interventions.

In response to these challenges, Malaria Consortium has been working closely with the Cambodian National Malaria Control Program (CNM) and the Provincial Health Department to carry out malaria control activities with a specific focus on people at risk in Pailin province, where high levels of resistance to antimalarial drugs have been identified by CNM and the World Health Organization.

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Leap Sivmeng, a village malaria worker in Pailin, practices malaria diagnosis procedures during the refresher training with the Malaria Consortium team.

With funding from the UK government, the community health network in 68 villages in Pailin province will be strengthened and village malaria workers (VMW) will be trained to provide early diagnosis and treatment for malaria.

Leap Sivmeng, a VMW in Pailin, participated in the refresher training with Malaria Consortium.

“My father used to suffer from malaria. He almost died because we did not have enough money to see the doctor and treat him. So I volunteered to get the education necessary to help my family. It has been three years already since I started working as a VMW. I have been helping not only my family but also the villagers in the community.”

This training is part of the VMW project framework, which is designed to equip VMWs and enhance their education and technical skills to perform rapid diagnosis tests for malaria and provide treatment according to the national treatment guidelines. They are trained to detect and report any new cases found. Supportive supervision from Malaria Consortium’s field technical staff is provided on a regular basis to keep them motivated and reinforce what they learnt during the training.

So Sam Art, a 57 year old VMW from Pailin province, explained how what he learnt helped him make a better diagnosis.

“There was one new case of malaria I detected in April this year.  Normally, when a patient visits me, I ask about their symptoms and history and check their temperature. If I suspect they have malaria, I will do the blood test. If the patient has malaria, then I will give them the medicine.

Copyright Malaria Consortium
So Sam Art, a village malaria worker in Pailin, checks his medicine kit as part of his training with the Malaria Consortium team.

Leap Sivmeng and So Sam Art are among the frontline VMWs who can help provide primary health services directly to community members and connect with mobile populations in the area. Their work is an important part of malaria control efforts among the most vulnerable and high risk groups.

Cambodia aims to move towards pre-elimination of malaria across the country with special efforts to contain artemisininresistant p .falciparum malaria by the end of 2015, and achieve phased elimination of all forms by 2025.

Wanweena Tangsathianraphap is External Communications Officer for Asia



Agente Polivalente Elementar overcomes tragedy by helping her community

Caterina Cumbi, a community health worker or Agente Polivalente Elementar (APE) makes a check-up visit to three-year-old  Beldencio who  tested positive for malaria  three days ago; in Jogo, Inhambane (Photo by Ruth Ayisi).

Caterina Cumbi, a community health worker or Agente Polivalente Elementar (APE) as they are known in Mozambique, remembers how in the 1980s she lost three of her eight children to malaria. “There was no health centre nearby, no transport and no APE who could test and treat malaria.”

Today, Caterina, 46, supports her five surviving children, four of whom have gone on to further education. Not only has she been able to provide for her family by selling tangerines and avocados, but since 2010 she also has improved the health of her rural community in Jogo, in Mozambique’s southern province of Inhambane, after being elected by her community to work as an APE.

In 2012 Caterina attended a course supported by the Ministry of Health, in partnership with Malaria Consortium, to learn how to prevent, diagnose and treat malaria, diarrhoea and pneumonia, the three main killer diseases of children under the age of five in Mozambique.

Caterina’s working hours are from 9 am to 2 pm, Monday to Friday, which include consultations and home visits to carry out health promotion activities, including community dialogues around childhood illnesses, their prevention and management. “But sometimes when I return from my home visits I find mothers waiting for me,” says Caterina. “They also come during the night and over the weekends, and mothers from other communities who do not have an APE in their area also bring their children to me.”

Caterina works closely with the health committee, ensuring transparency and involvement of the community. “She always opens the monthly health kit [containing rapid diagnostic tests and medicines] in our presence,” says community leader Pedro Rafael. “We plan our health promotion activities together.” He adds, “Caterina has a lot of influence in our community. Before, most women used to give birth at home, but Caterina has sensitised them to make the journey to the health centre to give birth.”

Her supervisor, Hirondina Bernardo, a nurse at the health centre in Nhancoja, also speaks highly of Caterina and the other two APEs whom she supervises.  “People who did not like coming to the hospital, now come when the APEs refer them, as the APEs are from their own communities and are trusted.”  However, each month Caterina has to ride her bike for 18 kilometres along sandy tracks to collect supplies and deliver her record of consultations and health promotion activities. “The terrain is difficult”, comments nurse Hirondina, “so their bikes had to be replaced, and for a while some of the APEs had to walk each month to bring their records.” Despite the challenges, Caterina too says that she feels she makes a valuable contribution. “I keep the children in my community healthy,” she says.

Malaria Consortium is working with the Agente Polivalente Elementares in Inhambane through the inSCALE project. The inSCALE project is researching innovative ways to increase APE motivation and performance in order to increase the appropriate treatment of sick children.  Since 2013, the APEs in six districts in Inhambane have been using smart phones with an application called inSCALE APE CommCare, which features a multimedia job aid with images and audio to guide APEs through the consultation steps, a closed user group enabling free communication between peers and supervisors, and a data submission tool that enables the APEs to submit their records over the 3G network. To learn more about the work of APEs such as Caterina and the inSCALE project please join us at INSTIDOC – Ciclo do Documentário Institucional on Friday 24th April 19h00 at Centro Cultural Franco-Moçambicano in Maputo, Mozambique to watch our documentary focusing on two APEs “Caterina e Halima”. For further details about the event, please visit the website: https://instidoc.wordpress.com or for more information about the inSCALE project: www.malariaconsortium.org/inscale/.  

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Before, we had no way to prevent malaria. Now the nets protect the whole family

It’s the second week of August in Lichinga, Niassa Province in northern Mozambique – not far from the Malawi and Tanzania borders. It is a cold and wintery month with grey skies.

After about two months of preparation, our mosquito net distribution campaign using long lasting insecticide treated nets (LLINS) for universal coverage has finally reached the distribution stage. The teams who have been working to support and supervise the campaign will set out for the Ngaúma, Mandimba, Metarica, Nipepe, Marrupa and Majune districts – the six included in the first stage of distribution. Expectations are high for everyone involved. Finally, the campaign will start.

The main ceremonies of the campaign’s launch will take place in the Chimbunila district village of Lumbi, 15 km from the city of Lichinga. Here, in addition to the distribution of LLINs, a new health facility will be opened.

Alifa Rachide’s family was chosen by the community to receive the first LLINs to be distributed in this province. Alifa, 50, will bring his wife Atuege Jemuce, 43, and their seven children to the event. Their daughter attends fourth grade and another child is in year one. Alifa doesn’t know the exact age of his children, but he says the youngest is less than a year old.

The couple, originally from Lumbi, support themselves by cultivating cassava, groundnuts and beans, ensuring a supply of food for the family and generating some extra income. Alifa says this is the first time that his family will receive mosquito nets. “We never had mosquito nets, and so we had no way to prevent the mosquito bites and malaria,” he said. “At home, someone gets sick with malaria most years, but fortunately this year no one has got sick yet. I’m happy because the nets we receive will protect the family from malaria.”

Alifa and his family received four LLINs – a sufficient number to cover the whole family, since two people can usually sleep under a single net. His wife Atuege lets out a smile because the community will have a closer health facility that will reduce the distance they have to walk – involving crossing a river and the risk of crocodile attacks. She says: “Our family was chosen by God – we have received mosquito nets, and we have a health facility. Community leaders visited our house and informed us that we would receive LLINs at a ceremony held by the Government. And here we are.”

The LLIN distribution campaign was implemented by Malaria Consortium, under a project funded by the Global Fund Round 9. The project is being carried out in nine provinces of Mozambique, partnering with World Vision and the Foundation for Community Development (FDC). Malaria Consortium supported the Provincial Health Directorates of Niassa and Nampula to distribute around 1,000,000 LLINs, benefiting more than 400,000 families. In addition to distributing LLINs, the project involves training volunteers and teachers to educate and engage their communities around malaria prevention and control strategies.

Fernando Bambo is Deputy Project Manager in Mozambique

Preventing the number one infectious cause of death in children

November 12th is World Pneumonia Day. To mark this occasion, Malaria Consortium interviewed Dr Phanuel Habimana, adviser on child and adolescent health for the World Health Organisation’s Africa region. 

What effect does pneumonia have in Africa economically and in terms of mortality? 

Pneumonia continues to be the biggest killer worldwide of children under five years of age. In 2013, it claimed the lives of close to one million children under five worldwide, 50 percent of them in the WHO African region.

Pneumonia is a disease of poverty. Poverty-related factors such as lack of access to safe water, poor access to health care and inadequate sanitation all increase the likelihood and amplify the effects of pneumonia. Children with deficiencies such as malnourishment, particularly those who are not breastfed or do not consume enough zinc, are at a higher risk of developing pneumonia.

Research has shown that prevention and proper treatment of pneumonia could avert one million deaths in children every year globally. With proper treatment alone, 600 000 deaths could be avoided.

The cost of treating all children with pneumonia in 42 of the world’s poorest countries is estimated at around US$600 million per year. Treating pneumonia in South Asia and sub-Saharan Africa – which account for 85 percent of deaths – would cost a third of this total, at around US$200 million. The price includes the antibiotics themselves, as well as the cost of training health workers, which strengthens the health systems as a whole.

What is the single biggest obstacle to reducing the burden of pneumonia?

The single most important obstacle to reducing the burden of pneumonia is low coverage of essential interventions for the prevention and control of pneumonia due to inadequate care seeking behaviour, access, availability and cost of diagnosis and treatment. Evidence shows that children are dying from pneumonia because effective interventions are not provided equitably across all communities.

Do you think that integrated community case management initiatives, such as those run by Malaria Consortium, are effective?

The integrated community case management initiatives have been very effective in training members of communities to identify treat and/or refer cases of pneumonia. With adequate training and supervision, community health workers can retain the skills and knowledge necessary to provide appropriate care for pneumonia, malaria and diarrhoea. For example:

  • In Malawi, 68 percent of classifications of common illnesses by health surveillance assistants were in agreement with assessments done by physicians, and 63 percent of children were prescribed appropriate medication.
  • In Zambia, a community case management (CCM) study on pneumonia and malaria found that 68 percent of children with pneumonia received early and appropriate treatment from community health workers.
  • In Ethiopia, the health extension workers (HEWs) performed better in terms of doing assessment tasks correctly – 84 percent compared to 70 percent by health facility health workers. HEWs treated the child with pneumonia correctly 72 percent of the time compared with 65 percent by facility health workers.

If pneumonia is an easy disease to both diagnose and treat, why does it cause so many deaths every year, especially among children? 

Many of the reasons, which are associated with poverty conditions, are:

  • Delayed care-seeking: Recognising the symptoms of pneumonia and seeking appropriate care from a health care facility is the first step in reducing deaths from pneumonia. However, sub-Saharan Africa has the lowest care-seeking for pneumonia – 48 percent. Nearly half of early childhood pneumonia is estimated to result from lack of or delay in appropriate diagnosis and treatment.
  • Lack of access to health facilities with well trained staff and essential medicines:  Most vulnerable communities do not have access to health facilities with well-trained health workers and essential medicines to get lifesaving interventions in time. Currently in the African region, only 24 percent children with suspected pneumonia are given proper antibiotic treatment. Stock out of essential antibiotics to treat pneumonia is a major problem.
  • Low coverage of vaccines:  Many countries have not yet introduced pneumococcal vaccines to prevent pneumococcal pneumonia.
  • Low exclusive breastfeeding rate:  Exclusive breastfeeding and continued breastfeeding with complementary feeding reduces pneumonia illness and death in children. However, only 35 percent of infants less than six months are exclusively breastfed.
  • Lack of simple and standardised guidelines in every health facility: The World Health Organisation (WHO) and UNICEF have developed guidelines for the integrated management of childhood illness to improve the quality of care provided to under-five children. However, the training in the use of these guidelines has not been scaled up to reach every health worker managing sick children under five in every health facility in most of the countries in Africa. Therefore, millions of children are still dying because those most at risk are not reached and services are provided piecemeal.

What does the WHO recommend in order to reduce the prevalence of pneumonia in rural and low-resource communities?

WHO and UNICEF, in collaboration with other partners, have developed an integrated plan entitled Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025: The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea.  This plan emphasises that the prevention and control of pneumonia and diarrhoea should not be dealt with separately but must be addressed together. Both are caused by a range of pathogens, and no single intervention alone will be adequate to prevent, treat or control either disease. Further, they share several common causes and risk factors, common prevention strategies and interventions, and similar delivery platforms in health facilities and communities.

What can be done at community level to help limit pneumonia?

In most high-mortality countries, facility-based services alone do not provide adequate access to treatment within the crucial window of 24 hours after onset of symptoms. If child mortality is to be adequately dealt with, the challenge of access must be addressed.  Community health workers – appropriately trained, supervised and provided with an uninterrupted supply of medicines and equipment – can identify and correctly treat most children who have pneumonia. A recent review by the Child Health Epidemiology Reference Group estimated that community management of all cases of childhood pneumonia could result in a 70 percent reduction in mortality from pneumonia in children less than five years old. Furthermore, community health workers can empower families and communities to improve care seeking practices and care for the child at home during sickness and wellness.

How has technology contributed to reducing the burden of pneumonia?

The use of vaccines against streptococcus pneumonia and haemophilus influenzae type b, the two most common bacterial causes of childhood pneumonia plus vaccinations against measles and pertussis, substantially reduces the disease burden and deaths caused by pneumonia.  Furthermore, the development of evidence-based simplified Integrated Management of Childhood Illnesses’ (IMCI) guidelines for the identification and treatment of pneumonia at facility and community levels has greatly contributed to the reduction of the burden of pneumonia. At hospital level, the availability and use of pulse oximetry has been a great technological advance to assess the saturation of oxygen in the blood. Oxygen concentrators have been very critical in providing care to very sick children. All those technological advances have enabled health workers to give appropriate lifesaving interventions.

Malaria Consortium’s RAcE project: Implementing iCCM in Nigeria

Dr Jonathan Jiya is the programme manager of Malaria Consortium’s RAcE project in Nigeria. He recently met with senior leaders of communities in Niger state to discuss the implementation of a project which aims to provide healthcare for 150,000 children under five by 2016.

Malaria Consortium’s Rapid Access Expansion (RAcE) project, funded by the World Health Organization (WHO) and the Canadian Department of Foreign Affairs, Trade & Development (DFATD) aims to improve the community-level management of childhood malaria, pneumonia and diarrhoea in Niger state, Nigeria. In rural areas of Niger state, there is a lack of healthcare services required to treat these conditions, which are the biggest killers of children under five.

The project builds upon existing community-based health interventions, such as integrated community case management (iCCM), and involves working with a number of Nigerian organisations, including the Centre for Communications Programs Nigeria (CCPN) and the Federation of Muslim Women Association Nigeria (FOMWAN).  Malaria Consortium is supporting the Ministry of Health in Niger state to implement iCCM activities in six local government areas (LGAs).

As the project leader for RAcE, I recently met with influential leaders, including senior community leaders and other stakeholders across the six LGAs, in order to mobilise resources and begin implementing iCCM activities. The LGA representatives welcomed the proposed meetings – there were never fewer than 40 people at each one. Discussions focused on the value of iCCM, on reasons why a programme like RAcE is necessary and on how best to select members of each community to take part in the project.

Community leaders and other key stakeholders were briefed on proposed iCCM strategies. As part of the project, Malaria Consortium will train over 1,700 community oriented resource persons (CORPs) and will consequently help to provide basic healthcare by 2016 to over 150,000 children in hard to reach areas of the six selected LGAs. CORPs will be trained to identify and treat the diseases, and will serve as both an access point and a form of continuity of care to existing healthcare systems.

The community leaders I met were asked to select responsible and well-respected members of their communities to be nominated as CORP volunteers. As one objective of the project is to build trust and cooperation between health systems and community members, the input of leaders in selecting role-models from the community is essential. Respected members of the community are in a strong position to influence others and to encourage behaviour changes which can prevent the spread of illnesses.

The second in command to the Emir in Lapai emirate, The Shaba Lapai, welcomed the opportunity to be consulted, saying, “This is the type of project we want. It will save the lives of our children and because the participation of community leaders has been recognised, we will support the project in any way we can for it to succeed”. He went on to say that the community will “support CORPs training and ensure that the community health committees function optimally for progress and abide by the given criteria for selection of CORPs”.

Hajiya Hauwa Usman, a participant at one of the forums, said: “Pneumonia, diarrhoea and malaria bring so much pain to mothers and families each year, especially during the rainy season. Malaria Consortium’s RAcE project will reduce this suffering and help children in their communities.” Mallam Garba Hussaini, an Islamic cleric agreed, stating, “We are appreciative of the effort of the state government and RAcE in selecting our communities to benefit from this project”.

The community forums also provided a chance to clear up logistical issues, such as the problem of a lack of storage facilities for the drugs that are being provided. In this instance, the concerns were addressed by promising the provision of portable storage facilities for each CORP. The most positive outcome of the meetings, however, was seeing that community leaders were appreciative of the opportunity to be included in the planning and implementation of RAcE.


Connecting healthcare workers in rural Uganda with mobile technology

Malaria Consortium has encouraged the creation of parish coordinator roles as part of the integrated community case management (iCCM) programme in support of the Ugandan Ministry of Health’s village health team structure and as part of the inSCALE project in Uganda, which seeks to increase coverage of community health services. Acting as the link between village health team members (VHTs) and supervisors, the role of the parish coordinator facilitates the reporting, supervision and mobilisation processes, often through the use of mobile technology.

Bulega Abdul was elected as the coordinator for his parish of Kibugubya in Hoima district, Western Uganda. “Three VHTs were nominated for each parish, from which we elected the coordinator” said Abdul.  “I think they elected me because of the way I do my work. I was happy to be elected. I like it. I don’t mind that I don’t get paid.”

Abdul’s main responsibilities include collecting monthly reports from the 28 VHTs in his parish. “I make monthly home visits to all the VHTs to make sure they’re doing okay. We go through the register together; if I find any mistakes in how they give out drugs, or if there is a discrepancy in drug use and patients seen, we find and correct the mistakes together so that the next time, they can do it right.”

Traveling on his bicycle across the 18km wide parish, Abdul visits at least one VHT most days. “I call a day in advance to let them know I am coming. I used to have to spend my own money – maybe 5,000 shillings per month – making these calls. But now, I make them for free on the inSCALE CUG.” The CUG – or Closed User Group – is part of the inSCALE technology intervention where selected VHTs receive phones allowing free calls between VHTs and their supervisors, as well as functions for mobile submission of reports.

“The CUG really helps me,” Abdul said. “Before, when I was sacrificing my own money, it would be very tiresome. To limit the time on the phone I would call one VHT and ask him to notify his partner, and the calls would be so short – just a few words,” Abdul laughed, mimicking a clipped, abrupt conversation. “There would be misunderstandings and sometimes you would not find that person in the correct meeting place and would have to go back again later. And there would never be time for asking and answering questions on the phone. Now, it’s so much better. We can talk longer and the VHTs can call me if they have any problems with drugs or with their register and I can explain it properly. It really helps the VHTs in their performance.”

VHT performance is partly monitored through the weekly reports submitted on the inSCALE phones. “The reports are very good, because they are short,” Abdul said. “Before, with the written monthly reports, they were long and you could lose information or notes, so there would be more mistakes. The VHTs would often be reluctant to complete them because it would take so long. Now, with the weekly ones, they are quicker and more accurate. To me it is very important that we report exactly what is happening on the ground; it is very important when you deal with medicine that you can account for it.”

The phone software is designed to increase the VHTs level of motivation through regular messages of recognition and appreciation that, according to Abdul, are very important. “The reminders and the messages of thanks are very popular. It is really important to feel that you are working for someone, and to have regular contact with Malaria Consortium as our donors. I really appreciate that; I feel I am part of Malaria Consortium now because the phones have brought us closer.”

And, as Abdul noted, this benefit is mutual. “I think it also helps Malaria Consortium. If they need something urgent, they can just call the VHTs directly. I think it positively affects the success of the programme because they know what is going on at ground level. Surely, these phones are cheaper than the fuel they would need to see us all?”

Just as the phones are helping to connect the VHTs with each other and with Malaria Consortium, they have also improved relations with supervisors and health workers. “Before, many of us VHTs had an inferiority complex with our supervisors and the health workers; there would be a big gap between us. But now that feeling is no longer there. Because of the frequent communication we are more familiar with them. We feel equal; that we are all health workers and all have the same goal. These phones have really done so much good.”

Malaria Consortium has been implementing iCCM projects in Mozambique, South Sudan, Uganda, and Zambia since 2009. To date, over 14,000 community health workers have been trained, providing close to three million treatments for over 2.4 million cases.

South Sudan: a network of volunteers tackling malnutrition and malaria

South Sudan ranks 15th highest in the world in mortality rates for children under five. Malaria and malnutrition are amongst the leading health threats in the country. As a result, Malaria Consortium has been working to provide an integrated response to malnutrition and common childhood diseases in the country. This is the story of Paul Malong, a community health worker, trained by Malaria Consortium and partners, in Gueng Village, South Sudan.

Pual Malong is a community nutrition worker in Gueng Village in Mariem East Payam, Aweil West County. He has been a community nutrition worker since 2011 when he was first trained by Malaria Consortium. Previously he had been a supervisor for 133 community drug distributors.

“When the nutrition programme was introduced to treat severe malnutrition cases, the community again selected me to be the community nutrition worker. I was then trained again by Malaria Consortium, after I had received the initial ICCM programme training. So far I have received two ICCM and three nutrition trainings and I have got all the skills for carrying out ICCM and as a community nutrition worker.”

Malong’s training has meant he is able to not only help his community with ICCM care, but he is also able to help tackle malnutrition, which is a common problem for children in the area, increasing the risk of disease and mortality. Malong screens children brought to his outpatient therapeutic feeding (OTP) site, where he provides general health education. He screens the children for severe acute malnutrition and provides nutritional supplements (Plumpy’nut) to those who need it and refers more complex cases to the nearest health facility or Aweil Hospital. He has enrolled 32 children in the malnutrition and ICCM programme at his OTP site. Malong’s work has been well received by his community, especially by community leaders and caregivers, who are now able to access malaria and malnutrition treatment, recognise common disease symptoms and seek appropriate healthcare for their children.

“The caregivers like the programme and they use the service, especially now they are able to recognise some danger signs in their children and immediately go to health facility or to the OTPs. The treatment they receive at the OTP site and the daily Plumpy’nut supply for malnourished children helps so much.”

Malong was concerned, however about delays in the supply of Plumpy’nut and some of the drugs used for ICCM. He also commented that the lack of storage facilities for the supplies needed to be improved as they are currently stores at his house. A simple shelter for OTP days in the rainy season would also be good, he added hopefully. His usual location is under a tree.

But despite these concerns, he is generally very pleased with how his work is going. “The nutrition and ICCM programmes work well based on my experience as an ICCM supervisor and community nutrition worker. We refer most of the cases that might be beyond the capacity of the ICCM and nutrition programmes, based on the danger signs.”

“The programme is liked by all in the community and the leaders appreciate it and encourage the programme’s continuity in the community to serve their children.”

You can read more about the programme in South Sudan by viewing or downloading the full learning paper here.

Health care starts at home

Effective health care starts at home and in the community. Leila Noisette, Malaria Consortium’s Advocacy Officer in Uganda, explains how Malaria Consortium works with communities, providing training and tools that they can use to improve their own health and that of their children

Though close to Kampala – the capital city of Uganda – and close to a major highway, Kiboga District is essentially rural and the main means of income are from crops and livestock. Most of the local residents rely on subsistence agriculture. Malaria has been a major cause of child mortality here and has affected the productivity of adults working in the fields.

Adera Nakato, a young grandmother explained that falling sick from malaria used to be common in the area: “I could hardly work for money and had limited food for my children. I used to buy nets but they were not effective because they were not treated; it gave us false confidence and we continued to suffer from malaria.”

Three years ago, Malaria Consortium distributed long-lasting insecticidal nets in the area. Adera received nets through the distribution for her family:

“Ever since we started using them, none of us here has suffered from malaria fever,” she told us.

Every household in four districts of mid-western Uganda benefited from the net distribution, a universal coverage campaign undertaken by Malaria Consortium through the Pioneer project funded by Comic Relief.

Tumusiime Mildred, a 32 year old mother of five children also benefited from the distribution of nets: “What can I say about the nets? It is just evident when you look at my children playing. They look happy and healthy.”

Mildred’s husband is a teacher but she had to stop work after a complication during the birth of her youngest child. She explains that nets have helped to reduce the amount of money her family have to spend on health care: “Treating the whole family was costly. Now, we no longer frequent hospitals due to malaria. My last born is two years old and she has never suffered from malaria yet. When the older ones get sick, they are taken to Ssunna, the village health team member, and they get better in a few days,” Mildred adds.

Ssunna is one of a number of community members who have been trained by Malaria Consortium to act as village health team members (VHTs), providing basic health care to young children in the community. He learnt to diagnose and treat malaria, as well as other leading causes of child death including pneumonia and diarrhoea in children under the age of five.

“I am glad that I am here to serve my community as a VHT,” Ssunna explains.

As well as diagnosis and treatment, VHTs also actively work with communities to share information about disease prevention and basic sanitary measures that families can follow to stay healthy. Ssunna received training to conduct community dialogues. The dialogues, part of a community outreach initiative supported by Malaria Consortium and the District Health Authorities, encourage communities to express their views and share experiences related to health, sanitation and hygiene. “With the village chairperson, we organise community dialogues every month where we discuss prevention of diseases such as malaria. These dialogues have yielded good results. In fact I can now spend a whole month without seeing a child suffering from malaria, diarrhoea or pneumonia.”

Catherine Nassiwa, a senior nursing officer, is the Malaria Focal Person in Kiboga District Health Team. A lot has improved as a result of the partnership between the district health team and Malaria Consortium, she explains: “Awareness of malaria has increased… sanitation, hygiene and care-seeking behaviour have improved, which, combined with the use of nets has reduced the morbidity in the district. Thanks to reduced expenditure for treatment, families can invest their money elsewhere. The relationship between community members and health workers has also improved. This has built health workers confidence and increased community members trust in the public health services.”

As the Pioneer project draws to a close, Ssunna talks about the lasting impact the project will have on the area. He hopes that, with support from active residents like himself, the community will continue taking care of their health without relying on support from partners.

“I am looking at a strategy to continue working with the community without waiting for support form Malaria Consortium.”

A new cross-border approach in the move to malaria elimination

The booth with its big banner catches your eye as you approach Phsar Prum, on the Cambodia border with Thailand. There are people there, clustered under the multi-language message about malaria and the colorful logos representing Malaria Consortium and our project partners. Once you pass through the checkpoint, a Malaria Consortium field assistant in a bright green jersey approaches, asking permission to talk with you about malaria, offering you a chance to be tested.

The team is good at what they do. The village chiefs, local health workers and the ‘Village and Mobile Malaria Workers’ are actively engaged and, though it’s only two weeks since the project launched, over 500 people have already been screened at checkpoints in Steung Treng, Rattanakiri and Pailin provinces.

“We explain very clearly what we are doing and why first, before they are asked to join,” says Malaria Consortium field assistant, Sokhoeun Chum. “At first some are scared about the finger prick, but when we explain, most agree to the test and are not worried about what we are going to do.”

All this activity is part of an innovative new study Malaria Consortium is leading focused on the special challenge Cambodia faces in identifying and treating migrants and other travelers, difficult-to-reach populations who may be at risk for malaria and transmission of drug-resistant parasites.

“It is the right thing to do in a right time for mobile and migrant people, and it is very important as a new approach for active case detection to do the screening at the cross borders,” adds Sophal Uth, field office coordinator, Malaria Consortium Pailin Field Office.

The goal? To develop a screening strategy that will help reduce the number of malaria parasites crossing Cambodia’s borders. Doing so could make a big contribution towards elimination of malaria and containment of drug resistance, goals of both Cambodia and the Greater Mekong Sub-Region. By locating check points in three different border provinces, this study presents a unique opportunity to compare and contrast their findings, enriching the strength of the recommendations that will be shared with the Cambodian National Programme for Parasitology, Entomology and Malaria Control (CNM) and others across the region next spring.

These early successes reflect careful planning, coordination and positive working relationships among individuals and organizations across Cambodia: the Ministry of Health and CNM; provincial government and health officials; police and immigration officers, village chiefs, village malaria workers, mobile malaria workers and local health workers; partner NGOs, like FHI360, Institut Pasteur du Cambodge and the London School of Hygiene & Tropical Medicine, as well as the project’s funder, the UK Department for International Development (UKaid).

Mafalda’s commitment to her community

Fernando Bambo, Malaria Consortium’s Training Manager in Mozambique, recounts meeting Mafalda José Ngonhamo, one of almost 800 community health workers who received training in case management of childhood diseases from Malaria Consortium and partners in Mozambique in July and August 2013

The weather forecast said that the southern part of Mozambique would be hit by a heat wave, with temperatures reaching around 36 degrees celsius. True to the forecast, the temperature is scorching. It is our “spring” here in Mozambique, we are still transitioning from winter to summer and it will be cool again tonight.

We arrive at the Eduardo Mondlane Resource Center for Inclusive Education, a centre in southern Mozambique providing day care and access to education for children with disabilities. We are here to conduct a refresher training course for local community health workers. We will be reviewing prior training that the health workers have had in health promotion and the case management of malaria and other simple childhood diseases in the community.

The children at the center welcome us with curiosity. Interacting with them, I realise my relative illiteracy. They are using sign language to communicate with us but we are unable to understand.

Mafalda José Ngonhamo, 37 years old, is one of the community health workers participating in the training. She lives in Bilene District in Gaza province. She has four children: two girls and two boys, the oldest 15 years old. She is pregnant and expecting her fifth child soon.

The coordinator responsible for community health workers in the district had informed Mafalda about the training and suggested that because of the advanced stage of her pregnancy, she need not participate.

But Mafalda did not agree. She felt she should do her best to participate in the training and uphold her responsibility to her community.

She takes short breaks often but actively participates in the training, always raising her hand to answer questions. She is clearly motivated and determined to be on an equal footing with the other trainees. When I asked her why she decided to come she replied:

“When I heard about the training and that I was not expected to participate, I really felt very sad. Then I gathered forces, I gained courage and communicated that I was willing to participate because I love the work I do as community health worker. I committed to help my community and could not miss this opportunity to learn.”

As we are chatting, Mafalda shows me a poster on the danger signs during pregnancy. It is a new communication material that district authorities have distributed to community health workers to support them in their efforts to improve maternal health.

“This is very useful to me now as I am pregnant, but I will use it in my work to educate other pregnant women about danger signs and the importance of seeking immediate care at the nearest health unit…”

As part of the Project for the Prevention and Control of Malaria funded by the Global Fund to fight AIDS, Tuberculosis and Malaria, Malaria Consortium and partners including World Vision, International Relief for Development and Fundação para o Desenvolvimento da Comunidade, held a series of training sessions in disease prevention, health promotion, proper management of cases at the community level, monitoring and evaluation and proper medicines management.

Mafalda José Ngonhamo, is one of the 785 community health workers who were trained between the months of July and August of 2013. Training was given to both district trainers and community health workers and took place in the provinces Inhambane, Sofala, Manica, Tete, Zambézia, Gaza and Maputo.

Find out more about Malaria Consortium in Mozambique here.