Expert Q&A: No one size fits all in the pursuit of the best pneumonia diagnostic aids

Malaria Consortium Senior Project Officer, Charlotte Ward, speaks about pneumonia as a global priority issue, how we are attempting to tackle the disease and explore the future of diagnostic devices.

Pneumonia is an acute respiratory infection that affects the lungs and is responsible for 16 percent[1] of deaths of all children under five. This proportion is much higher in low-resource countries where access to healthcare is limited, particularly in South Asia and sub-Saharan Africa.

Yet despite being the single largest infectious cause of death in children worldwide, pneumonia can be diagnosed and treated with low-cost and simple interventions and medication.

 

What are the current challenges in diagnosing and treating pneumonia?

Diagnosis of pneumonia by community health workers (CHWs) is commonly based on counting the number of breaths in 60 seconds in children under five to assess whether the respiratory rate (RR) is higher than the normal parameters for a child of that age. However, manually counting RR can be challenging due to the difficulties in observing and counting chest movements for a full minute and keeping the child calm during this period. Therefore, misclassification of observed rate is common, leading to incorrect diagnosis and consequently inappropriate antibiotic treatment, contributing to the spread of antibiotic resistance.

 What different types of devices are currently being used?

Non-automated devices, assisted RR counting devices and pulse oximeters are currently being used. Non-automated devices are the lowest cost and most commonly used tools. They support manual counting of chest movements by indicating when to start and stop counting. Assisted counting RR devices automate the counting process thus negating the need for manual counting. An example is a mobile RR smartphone app that works by counting the number of times the CHW taps the screen for each chest movement. Pulse oximeters work by measuring the blood oxygen saturation levels in the patient. Three types of pulse oximeters exist: handheld, mobile and finger-tip pulse oximeters.

How do we evaluate the best devices?

Formative research to understand the best class of devices is critical before designing and implementing a device field trial. An example of formative research is pile sorting and accompanying focus group discussions with key stakeholders. Pile sorting is when you ask key stakeholders to sort word, item or picture cards into piles that classify a range of opinions or categories of interest and then capture and explore participants’ decision-making rationale for their sorting using a focus group discussion. In this case, stakeholders including representatives of national and regional Ministry of Health (MoH), regional health bureaus, multilateral organisations such as UNICEF, and relevant NGO staff, would be demonstrated device types and asked to place cards with various device names into different piles according to their perceived usability, and again for their perceived scalability. Devices are then scored based on how they are sorted and those with the highest scores may be carried forward for field testing.

 What challenges will there be in designing appropriate diagnostic aids?

A major challenge is designing appropriate diagnostic aids that appeal to a wide range of stakeholders with differing views and priorities. CHWs and national and regional stakeholders prioritise different characteristics when rating the potential scalability of aids. For example, CHWs emphasise the importance of aids being acceptable to CHWs, parents and caregivers more than national stakeholders who prioritise the need for cost-effectiveness and sustainability. Practical usability is also heavily prioritised by CHWs whereas NGO and MoH stakeholders are strongly invested in ensuring the supply and distribution processes are uncomplicated and inexpensive. Further considerations are whether the device can be used in remote areas with unreliable electricity source, how much training is required to use the device and how durable the device is.

 What are future directions?

Device development is a complex process and the challenges in appealing to a wide range of stakeholders mean that a ‘one size fits all’ approach is unfeasible. However, there is global momentum towards developing automated devices that count RR without the need for human intervention. It is hoped that such devices will offer improved accuracy and effectiveness compared to current practice for classifying the symptoms of pneumonia, therefore improving the treatment of patients at community level. Furthermore, automated devices have the potential to increase caregiver and patient confidence in CHWs, thus strengthening programmes of integrated management of new-born and child health at community level in low-resource settings.

Projects that Malaria Consortium has undertaken on pneumonia

 Related resources:

Charlotte Ward is a Senior Project Officer here at Malaria Consortium. She is currently focussed on the ARIDA project, which is working to bring automated respiratory rate counting aids to wide-scale use by frontline health care workers in resource limited community settings.

 

[1] http://www.who.int/mediacentre/factsheets/fs331/en/

Distribution of LLINs in Niassa Province: mission accomplished

After a year of intensive work, Niassa Province in Mozambique, an area with a high malaria incidence rate, has successfully completed its mass long-lasting insecticidal net (LLIN) distribution campaign in its 16 districts.

The Malaria Prevention and Control Project is part of the Universal Coverage Campaign (UCC),  a national initiative led by the Ministry of Health.  It is funded by the Global Fund, and implemented by World Vision as the recipient partner, with Malaria Consortium, Food for the Hungry and Community Development Foundation as secondary recipients.

The UCC aims to ensure that every Mozambican has access to a LLIN to protect themselves from malaria. In Niassa Province, the campaign has reached approximately 415,000 households in the 16 target districts, amounting to a total of 1,058,750 LLINs. Niassa Province covers an extensive area of ​​approximately 123,000 km², with around nine inhabitants per km² in some of the more remote areas.  Access roads are lacking and most are not tarred, which renders the UCC implementation a complex process.

To overcome these challenges and to meet the high demand, the campaign was cascaded down from the central level, on to the provincial level, and finally expanded to the districts, towns and villages. In a combined effort of thousands of people involved.  The local government, the Provincial Health Directorate, District Directorates, support teams, trainers, distributors, registrators and different service providers were all critical to the success of the mass distribution.

According to Dr. Inês Juleca, focal point of the National Malaria Control Programme of the Ministry of Health of Mozambique for the province of Niassa, “The distribution of LLINs is an activity that includes several steps and high-quality coordination, from the consultation of guiding documents, planning, procurement, transportation and packaging, to communication, engagement, mobilisation, training, population registration and distribution itself.”

In this process, the National Malaria Control Programme is responsible for the acquisition of LLINs and led overall planning and implementation through the decentralised structures of the health system. Malaria Consortium is responsible for operational support, which includes financial management, transport, logistics, training, management of service providers, efficient use of resources and effective coordination at provincial, district and field levels.

On the challenges encountered on the ground, Joaquim Chau, Interim Coordinator of the Malaria Consortium in Niassa province, says: “The challenge of coordinating processes is largely to achieve the commitment of all those involved, even with different procedures or practices, sensitivities and institutional hierarchies, to bring together an understanding of the common vision of what is to be achieved. This makes a difference in the process, and in the professional and individual expectations of all the actors involved.”

With the successful completion of the distribution, the team is planning a post-distribution campaign that will focus on effective messaging about the correct use of LLINs. Highlighting the importance of the post-distribution campaign, Dr. Juleca stated: “Malaria prevention does not end with distribution of mosquito nets. We are ensuring that, after the distribution phase, our beneficiaries are knowledgeable about the use of nets and that this process is effectively translated into behaviour change.”

By Xavier Machiana

Mozambique’s unrecognised malaria heroes

Throughout Mozambique’s Niassa Province thousands of unassuming community members have given up their time to improve community health by volunteering in the distribution of long lasting insecticidal nets (LLINs).

 

The campaign, which is distributing over one million LLINs to 480,000 families in April and May is being organised by the Provincial Health Directorate, District and Community Leadership, civil society organisations, World Vision and Malaria Consortium under the leadership of the Provincial Government of Niassa.

So far, over 3,500 men and women from different ages and backgrounds have volunteered in the campaign, which has been crucial to the organisers efforts to reach all families in the province.

 

These malaria heroes have overcome many hurdles including inaccessibility due to lack of roads. They have walked on foot with bundles of nets on their heads and backs where their vehicles could no longer go. They took boats and canoes to reach remote villages on the islands of Lake Niassa. They have used motorcycles, tractors and all possible means to carry out their work, including crossing dangerous areas, such as Niassa Reserve, which is inhabited by many wild animals.

Community volunteers are essential to the success of many health campaigns. See our #MalariaHeroes webpage and support community health volunteers around the world.

The campaign is part of a national initiative led by the Ministry of Health with the support of the Malaria Prevention and Control Project, a project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as the main partner,  Food for the Hungry, Community Development Foundation and Malaria Consortium.

Strengthening partnerships at the Institutionalising Community Health Conference

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Malaria Consortium Senior Research Advisor Karin Kallander

In March, Malaria Consortium participated in the Institutionalising Community Health Conference (ICHC) in Johannesburg, South Africa. The conference was held to build partnerships and support country-led initiatives to strengthen health systems and community partnerships so that future generations not only survive, but thrive. It also focused on the development of country-specific action plans to address priority issues and challenges.

The global agenda for community health is moving beyond child survival to include the thriving of children so that they can contribute to transformation in their own communities. WHO is in the process of developing guidelines to assist national governments and national and international partners to improve the design, implementation, performance and evaluation of community health worker (CHW) programmes.

Throughout the conference, countries presented their own experiences and lessons learnt on different aspects of implementing community health programmes. Main themes included community engagement, supervision systems, financing of community health programmes, partnerships and engagement with private sector, equity and accountability, and research and innovation including community health information systems.

Malaria Consortium’s Senior Research Advisor, Dr Karin Kallander, contributed to the programme with a presentation on the upSCALE project which uses mobile phone technology (mHealth) to support CHWs in Mozambique. Our Nigeria Country Technical Coordinator, Dr Olusola Oresanya, also presented a poster on the seasonal malaria chemoprevention pilot project in Nigeria.

There was a strong focus on community empowerment throughout the conference and Dr Anthony Costello, WHO Director of Department of Maternal, Newborn, Child and Adolescent Health, outlined the four principles of effective community empowerment during a plenary session. These principles are that it should be country led; scientific (impact at scale is attenuated); have the participation of communities; and include district systems for community empowerment for health – leadership action.

It was acknowledged that participation is not the same as empowerment; participation is to do with outcome yet empowerment is to do with process; empowerment has to do with creating opportunity for people to make options and choices and empowerment is not given but taken.

Equity and gender recommendations included integrating a gender analysis of CHW systems to align policies and programmes to empower CHWs. This included supporting recognition, remuneration and training of CHWs, especially females, to achieve greater gender equity within the CHW system and wider society; and identifying alternative pathways to professionalising CHWs.

The Institutionalising Community Health Conference was hosted by USAID and UNICEF in collaboration with USAID’s flagship Maternal and Child Survival Programme, WHO, and the Bill & Melinda Gates Foundation

Communities embrace new health technology

View in: English | Portuguese

moz blog picJosé Petane and Rafael Timóteo Nhone are community health workers from the Cachane community of Inhassoro district, Inhambane province, Mozambique. They provide basic health services to their community of 1,200 people. This includes diagnosing and treating malaria, managing simple cases of pneumonia and diarrhoea, following up with patients seeking care for reproductive health, HIV/AIDS and tuberculosis, and educating the community about health practices.

Last August, José and Rafael received training and began using CommCare, a mobile phone application designed to support community health workers and improve the quality of their services. The system enables community health workers to be in regular contact with their supervisors and the programme’s management.

The CommCare application is not entirely new to Inhambane province. It was developed and tested in a few districts under Malaria Consortium’s inSCALE project (funded by the Bill & Melinda Gates Foundation and UK Aid), which showed positive results in improving the performance and motivation of community health workers.

The roll-out of the project has not been without difficulties however, as José and Rafael explained. “When we first started using phones in our consultations, people did not accept them,” said Rafael. “Many people thought we were doing this only to collect personal data. To overcome this challenge, we called for support from community leaders and organised a community meeting or ‘community dialogue’ to explain the purpose of the phone and answer questions and concerns.”

“After our meetings people realised the value mobile phones have in our services, but this then lead to people only accepting health services if we had a mobile phone,” José added.  “This caused problems when we could not use a phone because of low battery or poor reception, especially on rainy or cloudy days when we can’t recharge the battery on the solar panel. Many people did not understand why we were not using the phone and thought we did not want to treat them or their children. Because of this we now work with both our paper-based registry and a telephone at all times. This shows that what we record on the phone also goes to the book and that we can access information regardless of the situation.”

In this project titled upSCALE, Malaria Consortium, in partnership with Dimagi, UNICEF and the Ministry of Health, with funding from UK Aid, is training all community health workers in Inhambane province to use an improved version of the CommCare system. Community health workers’ have also been equipped with smartphones with bigger and higher quality screens. The project is being supported by the community health committees and community leaders who coordinate community dialogues and help solve problems when they arise. This support and coordination are crucial for the community health workers to be able to provide high quality health services to their communities.

By Dietério Magul

World Malaria Day 2017: Mozambique’s Niassa province launches mass net distribution

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World Malaria Day ceremony, Metangula Village

To mark World Malaria Day on April 25, Niassa province Mozambique held an official launch ceremony for a campaign to distribute long lasting insecticidal nets across the provinces 15 districts. The ceremony was held at the distribution headquarters in Metangula and was attended by district leaders, provincial leaders, civil society organisations and community members.

Activities included the laying of flowers at Heroes’ Square and a march with different civil society players, delivering speeches to spread the message of malaria prevention.

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District administrator Sara Mustafa

The formal distribution of the mosquito nets was initiated by the district administrator, Sara Mustafa, who stressed the importance of using them correctly to a large audience of community members.

Her statements were echoed by Dr. Inês Juleca from the National Malaria Programme of the Ministry of Health, who said, “The distribution campaign needs to be complemented by ongoing mobilisation and awareness raising activities at the local level so it is effective and reduces malaria among the communities the campaign was created to reach.”

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Monica Saíde, mother of five, collecting her mosquito net

Malaria is a major public health issue in Niassa Province, with over 700,000 registered malaria cases in 2016 giving an incidence rate of 407 cases per 1,000 people. The campaign, run by the Ministry of Health and Malaria Consortium, is part of an effort to reduce this burden through wide spread national and local level programmes.

 

The campaign is part of a national initiative led by the Ministry of Health with the support of the Malaria Prevention and Control Project, a project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as the main partner,  Food for the Hungry, Community Development Foundation and Malaria Consortium.

Text and photos: Xavier Machiana

New drugs could save 25 million children from malaria

smc 4This World Malaria Day is a chance to shine a spotlight on a highly effective intervention that prevents malaria in children under five in the Sahel region of Sub-Saharan Africa – seasonal malaria chemoprevention or SMC. It is an intervention that is about to become even more successful with the introduction of a much more palatable version of the drug that is easier to give to children.

SMC – a World Health Organization recommended intervention – is an antimalarial medicine given to children each month for up to four months of the rainy season, when malaria incidence increases. It provides a high degree of protection, with about 90 percent efficacy and has the potential to reduce cases of malaria by 75 percent when used with other interventions, such as mosquito nets. Unfortunately, however, in its earlier form, hard SMC tablets had to be crushed and mixed with water, while the bitter taste was very unpleasant.

For the first time, during the most recent distribution of the drug, a new sweetened, dispersible formulation of SMC was used. Administering SMC, which used to take close to five minutes, now takes less than 30 seconds and caregivers can easily give children the sweetened medicine at home.

smc 1In 2012, only 3.4 percent of the 25 million children eligible for SMC were covered. After concentrated efforts from the UNITAID funded ACCESS-SMC project, led by Malaria Consortium in partnership with Catholic Relief Services, and other implementing partners and countries, more than 11.4 million children received SMC in 2016, close to 50 percent of the total number of those eligible.

At a joint consultation meeting in Burkina Faso in February this year the feasibility, safety and effectiveness of SMC delivered at scale was proven through the evidence presented. National Malaria Control Programmes (NMCPs) from 12 different SMC eligible countries, key implementing partners, research institutions and others invested in SMC, discussed its future implementation.

Malaria Consortium, with continued funding from UNITAID, will resume its efforts to help NMCPs in Burkina Faso, Nigeria and Chad to administer SMC to four million children.

Studies have demonstrated that the average recurrent cost for a child to receive SMC each year is US $4.27, making this an inexpensive intervention. Although Sahelian governments are committed to eliminating malaria, financial support is still required from development partners.

Strong political will and financial commitment by donors, governments, the pharmaceutical industry and NGOs are essential to avoid the advancements made with SMC – both in health and in subsequent economic improvements – being lost and to ensure that all 25 million eligible children can be reached.

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Malaria volunteer makes health care in “Elephant” village count

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Malaria volunteer, Ma May Theint Oo

Ma May Theint Oo, mother of a four-year old boy called My Myo Thit Naing, has been working as a malaria volunteer in Sin village – which means elephant in Burmese – for six years now. At the weekends she attends Kalay University to finish her degree in history before she turns 25 next year.

To mark World Health Worker Week, this article takes a look at the lifesaving role that health workers such as Ma play in their communities.

riverMa’s village is located 24 miles from Kalay, in western Myanmar’s Sagaing region. To reach the nearest health centre, members of her community must travel seven miles, crossing a river by boat and travelling the rest of the way in often extremely high temperatures. In remote rural villages where road conditions are extremely bad, this lack of access to vital health services can prove fatal for children under five, as receiving care in the first 24 hours after onset of symptoms is crucial. Even if they survive, the recovery may be significantly longer, leading to more time for the child out of school and the parent off from work. Malaria Consortium has been piloting an approach called iCCM, or integrated community case management. This approach combines diagnosis and treatment of three common childhood illnesses malaria, diarrhoea, pneumonia, while adding diagnosis for malnutrition, and brings health care to the villagers’ doorsteps.

Malaria volunteers such as Ma can bring prevention, diagnosis and treatments services into the heart of remote communities such as Sin, and thereby act as a link between their village and the official health system.

The network of malaria volunteers in remote rural communities was established by the Ministry of health and Sports to help to prevent, track, diagnose and treat malaria cases. By building on this existing network and adding new iCCM responsibilities to the volunteer’s work, Ma can now treat more illnesses besides malaria, which is becoming less prevalent, and thereby remain  useful to her community.

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Midwife Daw Yi Yi Aung

Providing iCCM training for the volunteers and their supervisors – health assistants and midwives – is crucial for the success of the project. The training for the volunteers focuses on how to diagnose malaria, diarrhoea, pneumonia and malnutrition, how to administer treatments, and in severe cases, how to refer patients to health centres for acute care.

“I learnt how to treat common illnesses such as diarrhoea and fever and I can now give the right treatment. I also know how to accurately count the child’s breathing rate and to organise a follow-up visit. If the illness is severe, I can refer to the hospital,” Ma explains.

Midwife Daw Yi Yi Aung from the nearest rural health centre supervises Ma and helps her to correct any mistakes. “I truly believe Ma can be successful in her work. One of the mothers told me that she’s very satisfied because her child can get immediate treatment and she doesn’t need to cross the river anymore.”

The supervision is of great help to Ma. “At first I didn’t understand the medicines and their use, but now I am confident I can use them correctly.”

Thanks to her additional iCCM responsibilities, Ma’s status within Sin village has been given a boost. “The parents trust and rely on me and come to me for quick treatment so they are very grateful,” she smiles.

The project is a pilot to demonstrate the feasibility of re-training malaria volunteers to deliver iCCM, and initial results are promising. The project has been successful in improving the health of vulnerable and children under five, and reducing the time spent travelling to seek health services.

familySpeaking of the project, Ma said, “Now parents don’t need to travel as often to the hospital. This is very expensive for people with financial problems. I can give care and medicines to the villagers at no cost thanks to the project.”

When asked about her own future she replies, “I would like to find government work as a teacher, alongside my volunteer’s responsibilities, to continue sorting the difficulties of my community members and provide them with health services.”

The iCCM project is funded by UK aid from the UK Government and Vitol Foundation.

Recognising community health workers this World Health Day and World Health Worker Week

Mobile malaria worker, Dom Sophat, teaches people at risk of malaria about the disease in O’svay by the Laos/Cambodia border (Photo: Luke Duggleby)

To mark the fourth annual World Health Worker Week as well as World Health Day on Friday 7, this article reflects on global health care and recognises the important work community health workers (CHWs) are doing around the globe.

CHWs play a vital role in extending healthcare to rural communities around the world and are often the first point of call for rural communities who lack access to formal healthcare facilities.

Their responsibilities often include educating people about preventive health measures, caring for pregnant women and new born babies and children under five, as well as diagnosing and treating common infectious diseases and childhood illnesses, such as diarrhoea, pneumonia and malaria.

By providing basic health services at the community level, CHWs also act as a vital link between remote communities and the formal healthcare system. This allows the referral of serious cases to health facilities, ongoing supervision from formal health workers, and improved health reporting.

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Malaria volunteer Ma May Thient Oo

Myanmar: In Sin ‘Elephant’ village, Myanmar, mother of four, Ma May Thient Oo has also been serving her community as a malaria volunteer for the past six years. For the people in Ma’s community, this is an important service. To reach the nearest health centre, they must travel for miles, crossing a river by boat and walking the rest of the way in often extremely high temperatures, which is both expensive and difficult.

To improve health in her community, Ma received training and expanded her services to provide education, diagnoses and treatment, not just for malaria, but also malnutrition, pneumonia and diarrhoea. She can count breathing rates and identify symptoms of common illnesses in her community and only refers people to the health centres when she identifies severe illnesses that she cannot treat.

Village malaria worker Thy Sambath (Photo: Luke Duggleby)

Cambodia:  In Tun Village in northern Cambodia, village malaria worker, Thy Sambath, provides free malaria education, testing and treatment to people in his community. He is a volunteer that wants to improve the health of his people, particularly those who live, work or travel in forest areas and have the highest risk of malaria.

Thy visited the Sreynoeunn family after learning both daughters, aged four and 11, had developed strong fevers. He conducted malaria tests on the girls which both turned out to be positive. Thy then provided the girls with treatment and educated the family about the importance of using mosquito nets while sleeping. Thanks to Thy both girls made full recoveries.

Village Health Team member Ali Karim Bagyanyi

Uganda:  Ali Karim Bagyanyi is a Village Health Team member in Kitengule village in Uganda. In this role he provides education as well as free testing for malaria and pneumonia.

In a recent visit, Ali tested a 17 month old girl and four year old boy who had been brought there after developing diarrhoea, fevers and a cough. Both children tested negative for malaria and pneumonia and received appropriate referrals to be treated for their diarrhoea.

It is estimated that half of the nine million children who died in 2015 had illnesses that could have been easily prevented, or diagnosed and treated if they had access to health care services. However, there is currently a global shortage of over seven million health workers and that shortage is set to rise to almost 13 million by 2035. If we are to achieve universal health coverage we must increase investment in community health workers. This World Health Worker Week and World Health Day, join us in supporting health workers around the world.

Watch our video here: 

Good health for all: a crucial road to gender equality

By 2030, we will ‘achieve gender equality and empower all women and girls’: these are the words used by global leaders to coin Goal 5 of the Global Goals for Sustainable Development.  Today, 8th March 2017, Malaria Consortium is celebrating International Women’s Day together with the global community to show our support for a gender equal world.
Empowering women on a global scale requires a cross-cutting approach, tackling areas that we may not always consider as exerting a direct influence on gender inequality. One issue that has been frequently overlooked as an empowerment mechanism is improvement in global health systems.

The inadequacies of health infrastructure in the world’s most underdeveloped regions has an overwhelmingly and disproportionately high impact on women [1],[2]. Poor or lacking health services lie at the beginning of a long chain of problems contributing to gender inequality.

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Tania Morais, Monitoring and Evaluation Officer at Malaria Consortium, Mozambique, with women members of a community-based organisation

The absence of health infrastructure reinforces poor health; poor health reinforces poverty; poverty reinforces gender inequality. For example, poor health often causes additional economic pressure on a family which can result in girls being taken out of school, or to women staying home to care for sick children rather than work. It can also lead to lasting disability due to pregnancy and childbirth.  These are just some of the ways in which poor health among the poorest and most vulnerable impacts on women in particular, resulting in women being less educated, less economically independent and less empowered than their male counterparts.

And this develops into a cycle, with gender inequality also reinforcing poor health.  Women are, in many regions, not permitted responsibility for decision-making and must seek permission to receive healthcare for their children and themselves from their male counterparts.  In many regions, where men only allow their female family members to seek treatment from women health workers who may be few and far between, this has serious consequences on women’s health and empowerment.

So how has Malaria Consortium worked to combat this gap? In our programmes to tackle malaria and other communicable diseases, we ensure women are both consulted and represented as a critical element of our targeted beneficiaries.  One particularly effective intervention that we use is integrated community case management (iCCM) for common childhood illnesses – pneumonia, diarrhoea and malaria, and nutrition.  iCCM involves working with and training people within the community to diagnose and treat these diseases, thereby addressing the challenges of access to quality healthcare. Malaria Consortium has supported ministries of health to train and equip community health workers in iCCM in Mozambique, Nigeria, South Sudan, Zambia and Uganda to diagnose and treat or refer sick newborns and severe cases to the nearest health facility.  Through iCCM, we also help to raise the social status of women by training female community health workers, a positive step recognised by WHO [3], which also increases access to health services for many more women and their children.

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Community health worker visits a mother, concerned that her child may have pneumonia, Buliisa District, Uganda

Women make up 69 percent of the community health workers trained through our projects in South Sudan, and around half of our community health workers in Uganda, who are known as ‘true village heroes’ in their communities. Around 30 percent of health workers in Mozambique treating and diagnosing sick children are women, as well as many of our project staff.

By including women health workers in our iCCM training, we have helped to increase significantly their confidence and status among their fellow community members. These women have set an example for their peers. Their work in treating and diagnosing diseases brings life-saving health services closer to people’s homes, freeing mothers from burdens they would otherwise face, such as going to distant health centres, missing out on work, or taking care of sick children.

In recognition of the fact that poverty is one of the primary causes of disease, Malaria Consortium works to bring change to systems that maintain or exacerbate inequality. We are eliminating various barriers to healthcare, including setting up care at community level, involving women in our projects or facilitating access to appropriate healthcare for women at higher level health centres. We bring together all stakeholders, including ministries of health, local leaders and remote communities, to strengthen health systems that are appropriate for the needs of those we aim to serve, so that communities can extract themselves from the cycle of poverty caused by poor health and, in so doing, tackle the associated elements of gender inequality.

As global health priorities falling under Goal 3 of the Global Goals, malaria, communicable diseases and neglected tropical diseases (NTDs) cross-cut with Goal 5. Most communicable diseases, NTDs and malaria, are treatable and/or preventable, yet prevail in underdeveloped regions and force economic turmoil on households affected by them. Reducing these diseases is cost-effective and relatively straightforward with sufficient and sustained investment, so Goal 3 should be an easy target to meet, particularly with the support of interventions such as iCCM. This is also highly cost-effective way of empowering women in the long-term.

Certainly, the road to women’s empowerment is more complex than simply reducing disease and providing good healthcare. But it is only with a global understanding of women’s health needs, combined with health infrastructures relevant to their cultural context, that the journey to women’s empowerment will be accelerated.

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[1] p.16-17, The global strategy for women’s, children’s and adolescent’s health (2016-2030)

[2] p.54, The global strategy for women’s, children’s and adolescent’s health (2016-2030)

[3] p.1, WHO guidelines on health policy and system support to optimize community health worker programmes