Tag Archives: Malaria

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

Voices for better health: Mozambique

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A large scale long lasting insecticide-treated net (LLIN) campaign was officially launched by President Filipe Jacinto Nyusi in November last year in an effort to reduce malaria in Mozambique. Many Mozambicans are still falling ill or dying of malaria. In 2014 alone, over five million cases of the disease were diagnosed, leading to over 3000 deaths.

The mass LLIN distribution campaign, supported by Malaria Consortium, is providing over 13 million nets across the country, with the first stage distribution taking place in Nampula and Niassa provinces. We spoke with some of the people involved in the first stage of the distribution to find out how the programme was being received by local communities.

Azelio Fulede MCD Ilha de Mocambique (4)Azélio Fulede, Chief Medical Officer

“The health situation in our district was critical because communities didn’t know how to use mosquito nets. Now, through social mobilisation activities run by community leaders, activists, volunteers, and community radio we are seeing behaviour change and the nets are being used properly.

In our regular visits to the communities, we see that families now hang the nets over their beds, on the porch or wherever they sleep. When we meet people who do not know how to hang the nets, we show them and help them. These are encouraging changes; fewer people are getting malaria and positive messages continue to spread within communities. We hope that fewer people will fall ill and that we will eventually eliminate the disease.”

Emília Corela, cEmiliaampaign supervisor

“I can already see changes in peoples’ behaviour. Everywhere you go you can see mosquito nets being aired in the shade, hanging on the balconies and in bedrooms. These are new scenes, really – you would not have seen this before. I believe that the efforts we made to educate the population about the importance of using nets to protect themselves and their families against malaria, such as advocacy events, lectures in schools, information sessions at community level, are beginning to bear fruit.

On a personal level my involvement in this undertaking has been very rewarding. I gained work experience, lost my shyness, learned more about interacting with people and meeting new people; these skills will also help improve my work.”

Nare Luis PF Erati (3)Naré Luis, focal point for malaria in the Eráti district

“This LLIN distribution campaign was a major challenge for us because it was the first time we covered the entire district, providing nets to over 95 percent of the population.

Malaria is a major health problem in the Eráti district, affecting as many as 60 percent of our people. However through this campaign we are already seeing that there is less malaria. We are now working together with the community health workers, local leaders and radios stations to ensure people know how to use and keep the nets in good condition.”

Francisco Eduardo APE (10)Francisco Eduardo, volunteer community health worker in Mucuegera

“Eighty percent of my work is devoted to community health promotion activities, including village health talks to ensure our community understands how to prevent diseases such as cholera, diarrhoea and malaria. The other 20 percent of my time I provide treatment services at either my patients’ homes or my own home.

The net distribution has been an excellent opportunity to show people the correct use of a mosquito net. I notice the difference in my daily home visits. People are hanging the nets and sleeping under them and I have already seen that malaria is reducing! Last year during the rainy season I diagnosed more than 100 malaria cases in only one month, but this year I recorded only 39.

Marcelino Joao MCD Nacala Porto (2)Marcelino Joao, Chief Medical Officer, Nacala Porto district

“Investing in mosquito nets is a guarantee for a long life! Before the distribution campaign, people often used nets for fishing and not for sleeping under. Malaria Consortium trained people from civil society associations and community structures, as well as community health workers, to help mobilise these communities, raise awareness and change behaviour in relation to malaria prevention and the appropriate use and care of mosquito nets. These messages have been reinforced by local radio and television channels which broadcasted the messages intensively during the campaign.

Through these efforts, we have already recorded a decrease in cases of malaria. We are very satisfied with the results and we believe quality of life will improve in the district. We will continue to hold regular meetings with local community leaders and to spread correct information about malaria prevention and the appropriate use of mosquito nets.”

Marcelino Melo PF DPSMarcelino de Melo, Provincial Health Directorate of Nampula province

“For the first time we have managed to distribute LLINs to all districts in the province – reaching a total of 1.3 million families with over 3.5 million mosquito nets. We are now focused on strengthening communication via radio, television, posters and leaflets so that people make good use of the nets we distributed.”

LLIN distributions are a key component in the Malaria Prevention and Control project, a country-wide initiative funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as primary partner, Malaria Consortium, Food for the Hungry (FH) and Foundation for Community Development (FDC).

By Dorca Nhaca, Malaria Consortium, Nampula office, Mozambique

Seasonal malaria chemoprevention in Burkina Faso: Feedback from the field

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Malaria Consortium talks to Community Health Worker (CHW), Ipala Zidwemba, about his experience of administering SMC in the rural district of Boulsa, Burkina Faso.

“The CHWs are the people who bring the medication to the children. We are counting on them to ensure that fewer children fall ill with malaria this rainy season,” says Malaria Consortium’s Dr. Eleonore Fosso Seumo, Country Representative, Burkina Faso, as she explains that the role of the CHW is crucial to the successful implementation of the SMC campaign.

Making their way along the orange dusty tracks, Boulsa’s CHWs are easy to spot with their white tabards and kit bags. Their day begins at 6AM when they meet at the Community Health Centre to receive their supply of SP+AQ. By bike, they make their way in pairs through the fields, stopping to distribute the preventive SMC treatment to eligible children.

The role of the CHW is multifaceted: they must communicate effectively with parents, reassure the children and signal any problems and adverse reactions to their supervising health facility worker. All of the CHWs are volunteers who work four days each month over the course of the rainy season to ensure that all eligible children benefit from this preventive treatment with the aim of reducing malaria incidence.

25 year old Ipala Zidwemba is a CHW, working for the first time to bring SMC treatment to eligible children in the village of Gaouga, Boulsa. A maize farmer by trade, Ipala has always lived in Gaouga. He explains that participating in this campaign is very close to his heart having suffered, like the majority of Burkinabés, from malaria at several points in his in life. “We have all had malaria at one point or another, some are lucky but others are not and that is why it is important that we protect the most vulnerable who are the children under five years old,” says Ipala.

While Ipala is hopeful that the SMC campaign will have a positive impact on malaria incidence rates, he recognises that there are several obstacles to the successful delivery of this intervention.

Ipala explains that carrying out an SMC campaign is not easy like other campaigns, such as like the polio vaccination campaign. He explains that administering the polio vaccination consists of squeezing a couple of drops of a sweet tasting liquid into the children’s mouths and within a few seconds the medication has been administered. SMC is different. Before even giving the child the treatment, the CHW must first ask a number of questions in order to establish whether the child is healthy and eligible to receive the first dose of SP+AQ. Once the CHW has determined that the child can receive the treatment, a lengthy preparation process ensues, involving the crushing of drugs and mixing with sugar and water. Due to the bitter taste of the mixture, this is often rejected by the children, particularly by the younger children. In this instance, the CHWs must wait another 10 minutes before attempting to re-administer the mixture. “We really need medication that is adapted to be given to young children and in the conditions that we are working in,” says Ipala. He continues explaining that, once the children have been given the medication; each pair of CHWs must wait 30 minutes to observe whether there are any adverse reactions. Once everything is completed, the paperwork has been filled in and the parents have been shown how to give the remaining doses, they mark the house to show that the children have received the SMC treatment, finally staining each child’s finger nail with a permanent marker, to show that they have had their first dose of SP+AQ. “All of these things make the administration of SMC a lengthy and complicated process!” concludes Ipala.

In addition to problems of administration, the CHWs must also contend with the rains. The nature of the SMC campaign is that the treatment is given each month of the rainy season, as during this time there is an increased risk of malaria. However, with rains come floods which make the work of the CHWs even more complex.

“To ensure maximum coverage and successful roll out at scale of the SMC campaign, it is essential that we develop ways to overcome these obstacles,” Dr. Savadogo Yacouba, NMCP, Burkina Faso.

Malaria Consortium’s Edward Idenu receives best practice award

A child with severe malaria. Photo by William Daniels. 

In March, Malaria Consortium was invited to a meeting in Kampala, which brought together the partners of the Improving Severe Malaria Outcomes (ISMO) project. During this meeting I was delighted to receive an award for ‘Best Practice for Delivery’ in recognition of my work on the project.

A patient can make a complete recovery from severe malaria if it is caught in time and treated correctly. Unfortunately, however, of the estimated 216 million cases of malaria each year, approximately eight million of which are severe malaria cases, treatment is often too slow and makes use of incorrect drugs.

The ISMO project, comprising a consortium of partners: Medicines for Malaria Venture (MMV), Clinton Health Access Initiative and Malaria Consortium, aims to strengthen the market to accelerate access to, and uptake of, injectable artesunate – the World Health Organisation’s preferred treatment for severe malaria. However, market barriers have hampered its uptake. The treatment is expensive and buyers often have concerns due to there being only one World Health Organisation (WHO) already tested and trusted supplier.

Low uptake of injectable artesunate has affected its accelerated adoption, preventing potential new suppliers to delay in making major commitments to marketing the drug. The treatment has also not been readily accepted by providers and patients, due to a lack of advocacy, education and training at all levels.

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It is the role of the ISMO project to successfully create a stable and sustainable market for quality assured injectable artesunate with two or more suppliers, which will guarantee access to the treatment for severe malaria patients. This involves encouraging manufacturers to produce quality assured injectable artesunate and securing a commitment by donors to fund further production of the treatment.  The project is active in six countries, with Malaria Consortium focusing on implementation in Ethiopia, Nigeria and Uganda.

A major obstacle for countries implementing this project is the procurement, shipment, clearance and distribution of injectable artesunate. The process is often complicated by delays which lead to drug expiration, stock outs and subsequent poor uptake from clients. The duty of ensuring that these commodities are received and documented at the airport or sea ports is facilitated by the project with support from National Malaria Elimination programme (NMEP) – the government agency responsible for malaria interventions in Nigeria.

One of the key causes of delay is the time it takes for government documentation in support of the commodities to be issued by the Budget Office of the Federation, within the Federal Ministry of Finance, at the request of the Federal Ministry of Health. This cumbersome task normally takes between 8-12 weeks.

However, because of the strong partnership between NMEP, Malaria Consortium, and our partners in the Federal Ministry of Health, I managed to obtain a duty waiver for UNITAID injectable artesunate, to be used as part of the ISMO project, in just 14 days. It is for this that I received my award.

The timely receipt of the duty waiter ensured that the artesunate was cleared and distributed to all health facilities as planned. One of my main recommendations to partners working on this project is for all malaria commodities to be included in countries’ malaria strategic plans. This gives ownership to the government and ease of reference for commodities at the port of entry.

The award demonstrated the results that this project and its staff can achieve when they build networks and partnerships with government stakeholders. Going forward, the network established with key government partners will ensure speedy movement and delivery of commodities required for the next phase of the project.

Preventing malaria through drama and performance

“Our main purpose is to educate communities about malaria – its effects, how it is transmitted and how to avoid it.” Mugoya Muzamir is one of over two thousand community members in Mbale who has been trained as part of the Mbale Malaria Control project.

Malaria is the most common cause of illness and death in children in Mbale district and, in 2011, at the start of the Mbale Malaria Control Project, the district had the highest malaria burden in Uganda. Now that Mugoya has been trained in malaria case management, it is his responsibility to communicate how to prevent malaria transmission to the communities throughout Mbale. One of the most effective ways of doing this, he has found, is through performance and drama.

Mugoya, and 24 other village health workers (VHTs) trained as part of the project, now travel from community to community, performing dramas that teach how to avoid getting malaria. When I met Mugoya, he told me this was an effective way of communicating to a wide range of people: “When you do something funny, many people will come.”

The method has been successful in conveying messages to people throughout Mbale. Community members told me their families had learnt the importance of sleeping under a mosquito net and that they now clear any stagnant water near their villages. The dramas also include messages of when to contact a VHT, and how to recognise a case of severe malaria.

“When you move round the communities, you notice there has been a change. We have seen that the number of malaria cases has fallen. Last month there was one case of malaria, whereas three months ago there were 27 cases of malaria in that month, so people are picking up on our messages.”

You can check out photos of the drama performance below:

pThe drama group begins by playing songs all of them about preventing malaria in order to attract a crowdp
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Patrick Lee is Communications Assistant at Malaria Consortium in London.

Agente Polivalente Elementar overcomes tragedy by helping her community

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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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Helping to fight malaria with positive deviance volunteers

Wanweena Tangsathianraphap, External Communications Officer for the Asia region, visited Ratchaburi province in Thailand to report on Malaria Consortium’s Positive Deviance project.

At the community centre in Bor Wee village, Ratchaburi province in the western part of Thailand, a group of 14 positive deviance volunteers were conducting a role play on how to protect oneself from a mosquito bite. A mosquito net had been hung up and a volunteer acting as a mother was encouraging her children to sleep under it. It is simple thing to do, but can yield great results for malaria prevention if the behaviour is adopted by all villagers in the community.

The threat of malaria still exists in Bor Wee village. When Malaria Consortium’s team spoke to the children who participated in the latest positive deviance session, two thirds of them said they had contracted the disease more than once and thought that malaria was just a mild illness, similar to a common cold.

Dao Horla, one of the community health volunteers, shared her story with us: “My child once had a fever from malaria. I had to walk five kilometres to take her to see the doctor at the nearest clinic. At that time, I did not even know what had happened to my girl. She had very high fever and cried from pain. I was so afraid I might lose her.”

Dao and her youngest daughter

Dao and her youngest daughter

Dao’s house is located near a stream and is built in the typical hill-tribe style, on the side of a hill with an open door and window. “I did not realise that I have to use a mosquito net to protect my children. They love to play outside near the stream, and they did not always sleep under the mosquito net. But since I learnt about malaria, I make sure they sleep under the net every night. I do not want them to get malaria or any other mosquito-borne diseases again,” said Dao.  As a mother of five, she understood the pain and suffering children undergo because of malaria, and has now volunteered to learn more about the disease and to help raise awareness about malaria in her own community.

“My children no longer get malaria and I would like to tell my neighbours how to protect themselves and their families,” said Dao.  Her story is one of the several positive deviance tales that are being shared among the community members.

According to a report by the World Health Organization (WHO) and Department of Disease Control, Ministry of Public Health Thailand, the malaria incidence rates in parts of Thai-Myanmar borders are still high compared with the overall rates for Thailand. This high prevalence is due to the surrounding thick forest environment and the mobile population. With the natural borderline of Tanaosri mountain range, people in the area usually stay overnight in the forest either for work or to travel across the border to Myanmar. Over 80 percent of malaria patients live on this border. It is estimated that 70 percent of the patients diagnosed with malaria are adult males, who are likely to work in the forest.

Dao shares her story with the community

Dao shares her story with the community

Baan Huay Pak village is approximately 16 kilometres from the Thai-Myanmar border. Korwa Jorod, known by his community as Uncle Korwa, described his experiences of malaria to Malaria Consortium’s representatives.

“Most men in this area work in the forest and along the border. They usually come home late at night or during the next day. Sometimes they get sick. They are not careful about protecting themselves. I used to be the same,” said Korwa.

“I used to be careless and go to the forest without any protection from mosquitoes and, as a result, I kept getting malaria again and again. I didn’t think it was very serious until a local health organisation visited the village and told us about malaria. I then realised how dangerous the disease really is. My perception was drastically altered. So I joined the volunteer programme to learn more about malaria. I am so glad that I am now much better informed and also that I have a part in helping my community. Protecting people from mosquito bites is the best way to prevent malaria,” Korwa explained.

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Uncle Korwa shows a picture from the IEC material which demonstrates how to protect oneself in the forest.

Apart from being a community health volunteer, Korwa is also the religious leader in the village, and is a member of the community river committee. His roles give him many opportunities to interact with villagers on a regular basis.

“I talk to the villagers like I’m their relative,” Korwa told Malaria Consortium. “Of course, not everyone will listen to me, but I will do my best in my role. One volunteer may not control the disease, but together we may create some changes. Importantly, I know I have the support of the other volunteers and the staff from Malaria Consortium and the Pattanarak Foundation. This encourages me. I feel that every life is worth living and I will do my best to save them.”

Both Korwa and Dao are part of the pilot activity on community mobilisation through positive deviance volunteers. Six villages in a high-risk area of Ratchaburi province were selected to apply this innovative approach on behaviour and social change.

Uncle PD

Uncle Korwa shares his lessons with the community

Funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the community mobilisation through positive deviance project is conducted by Malaria Consortium in close collaboration with the Pattanarak Foundation, a local non-profit organisation, as an attempt to improve malaria prevention methods in hard to reach and vulnerable communities. Since the project was launched in April 2014, more than 20 community health volunteers have been recruited and trained. Their work is vital to help bridge the gap between the community and the health authorities. This pilot in Thailand will provide learning about this approach and evidence of impact and, if successful, can be scaled up across the country.

Health care starts at home

A community dialogue led by a community health worker takes place under a tree in central Uganda

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.”

Meet the health workers at the frontlines of disease control: Q&A with a rural health worker

Dorothy Ibrahim – rural health worker in Guaraka Nigeria

Dorothy Ibrahim is a rural health worker of many years’ standing. She is a proud contributor to the fight against malaria in the rural settlement of Gauraka, just outside Abuja in Niger State. Nigeria is one of the world’s most malaria endemic countries, accounting for approximately a quarter of all deaths from the disease worldwide. Kolo Yakubu, Senior Technical Malaria Officer at Malaria Consortium in Nigeria, spoke to Dorothy about her role as a rural health worker and the impact that SuNMaP – Support to National Malaria Control Programme – a partnership programme led by Malaria Consortium, has had on her role.

You’ve been working for many years in this area. What changes have you seen during that time?

When I first started working here, many years ago, I would do all that the books demanded but still lose the baby. Severe malaria claimed the lives of one in 15 children under-five in my area. The traditional healer would prescribe herbal concoctions and tell parents that their baby would get well before morning. But the baby would die of worsened fever that same night.

Years went by and the local health centre was upgraded to a model primary healthcare centre. There was more modern equipment and training from SuNMaP, as well as long-lasting insecticidal nets (LLINs) and intermittent malaria preventive therapies for pregnant women (IPTp). All these have changed the course of service provision. Nowadays, I never see severe cases of malaria in babies at all.

How would you describe your role in malaria control in Gauraka?

I support the home management of malaria by working with community volunteers that we call community care givers. They work with local people to identify fevers and give drug treatment as necessary. I tell them to refer persistent fever cases to me. I also give talks about how to hang the LLINs properly and take care of them, and encourage environmental sanitation and hygiene.

Since the LLINs and IPTp support to first time mothers started, cases of anaemia and severe malaria have declined. There have been none at all in the three years since SuNMaP began.

Support to National Malaria Control Programme

These positive changes have been facilitated by SuNMaP – Support to National Malaria Programme – and other agencies in collaboration with the State Malaria Control Programme (SMCP). SuNMaP provides support to the Nigerian government and people in tackling the massive burden of malaria in the country. It is implemented by international and local partners, funded by UKAid and managed by Malaria Consortium. SuNMaP works in close co-operation with Nigeria’s National Malaria Control Programme (NMCP), in selected states and Local Government Areas (LGAs) across the country.

In addition to mosquito nets and drugs for malaria treatment, SuNMaP has provided training to senior management staff at the LGA level, which has been cascaded down through the LGA to staff, like Dorothy, in health facilities across Nigeria.

A very simple guide to the MDGs, global health and what comes next

Photo: Jenn Warren/Malaria Consortium. In South Sudan, Malaria Consortium Community Drug Distributor Simon Nguany Madit gives preventative antibiotics for trachoma to a young girl with the help of her mother.

It is not clear how the post-2015 goals will be framed, but health will undoubtedly play a crucial role

The Millennium Development Goals (MDGs) will expire in 2015. As we approach the deadline, it is clear that the next development framework needs to be in place to take over. Discussions at the highest level have begun. British prime minister David Cameron is an important player of the process being led by the United Nations. Development agencies and civil society groups are already jostling for position and trying to ensure what they think what should come next is included and the issue of global health is proving to be a particularly fraught one.

With this as the context, it is expected that global news coverage of the future of the global development agenda will increase as the deadline gets closer and decisions are made. This article therefore aims to provide the basics that everyone should know if they want to understand what is at stake.

What are the Millennium Development Goals?

In 2000, world leaders came together at United Nations Headquarters in New York to develop a blueprint agreed by all the world’s countries and all the world’s leading development institutions. This blueprint committed their nations to a new global partnership to reduce extreme poverty and set out a series of eight time-bound targets, otherwise known as the MDGs.

By 2015, the eight MDGs aim to:

MDG 1: eradicate extreme poverty and hunger

MDG 2: achieve universal primary education

MDG 3: promote gender equality and empower women

MDG 4: reduce child mortality

MDG 5: improve maternal health

MDG 6: combat HIV/AIDS, malaria and other diseases

MDG 7: ensure environmental sustainability

MDG 8: develop a global partnership for development

Have they been a success?

To date the answer to this can be yes and no, depending on whom you ask. However, for the most part they can be viewed in a positive light. They have undoubtedly focussed international attention towards achieving a set of tangible results, backed by the UN system, and opened the development sector up to the general public and increased their interest. They have also made donor countries more ambitious in tackling development issues and allowed for greater coherence amongst donors.

In malaria specifically the UN estimates that the global incidence rate of malaria has decreased by 17% since 2000, and malaria-specific mortality rates by 25%. In addition, countries with improved access to malaria control interventions have seen child mortality rates fall by about 20%.

What lessons have we learnt from them?

Despite these impressive outcomes, there are still lessons that can be learned, particularly as some of the goals will not be achieved by 2015. Inevitably when progress has been made in the areas targeted by the MDGs, some issues that were excluded from the process did suffer in terms of attention and funding, with neglected tropical diseases a notable example from the health sector. There has also been a tendency to focus on easy targets which offered the best chance of success, such as immediate results, rather than maximum impact on poverty reduction. This has led to inequity where the goals fail to measure and thus disregard outcomes for vulnerable and marginalized groups. These lessons can help articulate the future goals to be more balanced and context specific.

What will replace the MDGs in 2015?

This is the key question currently being discussed within the development sector and, although new thematic areas are emerging, there is widespread consensus that the future goals should focus on the poorest and most vulnerable people, not nation states. It is also agreed that these discussions must include Southern as well as Northern voices to give the process a global consensus. The post-2015 agenda is likely, therefore, to include new areas of focus such as governance, water, population dynamics, energy and economic growth.

How many goals will there be?

It is widely agreed that the number of goals should be limited to a maximum of ten, maintaining their simplicity. The UK government recently said that they “strongly support a framework with no more than ten goals, all with quantifiable targets”. Any new goals are also likely to follow the current 15 year pattern and so will set the development agenda until 2030.

How does health fit into this new framework?

With the emerging development areas noted above, which are expected to be included in the new framework, the likelihood of health having more than one goal as it does now is small. Instead there is likely to be one overarching health goal that will then be broken down into specific targets.

What will the health goal be?

As the recent WHO and Unicef led health consultation highlighted, three main health goal options have emerged:

Universal health coverage: Simply put, achieving UHC means that all people, including vulnerable, marginalised and stigmatised populations, have access to health information and services of sufficient quality to cover and fulfil the variety of their needs while protecting against the risk of financial hardship from accessing health services.

If this option is taken up then UHC must be articulated with precision and incorporate achievable targets. It also needs to be recognised that the aim of UHC should not be just coverage, but universal access to healthcare.

Healthy life expectancy: The World Health Organisation defines healthy life expectancy as the “average number of years that a person can expect to live in ‘full health’ by taking into account years lived in less than full health due to disease and/or injury”. If incorporated into the post-2015 framework, this goal will address the need for action on the determinants of health and on the root causes of ill-health, preventable disability, and premature death.

MDGs alternative: Another option is for more specific goals that resemble the current MDGs. Proponents of this option believe that the post-2015 development agenda should maintain the priorities of the MDG framework and not be designed to encapsulate everything that development seeks to achieve. The MDG framework generated resonance and buy-in because of the focus on clear, targeted, measurable outcomes that were meaningful to both the general public and policy-makers. With the broader themes offered by the alternatives, this might be lost.

When will these decisions be made?

We are currently in the midst of a number of high level consultations and conferences to discuss the post 2015 agenda. In January 2012, the UN Secretary-General established the UN System Task Team on the Post-2015 UN Development Agenda of which David Cameron is a Co-Chair, to coordinate the development of a new framework in consultation with all stakeholders on each thematic area.

The High Level Dialogue on Health in the Post-2015 Development Agenda took place in Gaborone, Botswana, from 4-6 March, 2013 and produced a report following months of consultations with civil society. This report will feed into the more general post-2015 consultative meeting in Bali, Indonesia on 25 – 27 March 2013. The findings from all the thematic consultations will be presented in a report to the UN General Assembly in September 2013 where the recommendations will be ratified.

Alex Hulme is advocacy officer at Malaria Consortium