Rutoke’s key influencer sets up a village health club and ‘ambulance fund’

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Ernest (left) informing Bagonza (right) about preventive measures for malaria

Ernest Masereka, a voluntary community health worker and key influencer from Rutoke village, Uganda, introduced his community to the idea of forming a village health club in December 2017. Village health clubs provide forums at which community members can disseminate messages and address different issues, such as sanitation, health and savings. Members of the club collectively come up with action plans and local solutions for the challenges their community faces.

Club members, Ernest suggested, could also contribute 1,000 Ugandan shillings every month for the community to use to address health issues when needed. The community welcomed this idea and in January 2018 a village health club was formed and members began contributing to what they referred to as the ‘ambulance fund’.

Since 2016, USAID’s Malaria Action Program for Districts (MAPD) has been working with the key influencers to reduce the malaria burden in Uganda. Their role is to sensitize their communities on the dangers of malaria, the importance of seeking early treatment within 24 hours of symptoms, and preventive practices. This is done through monthly home visits and, when they exist, through community dialogues via the village health club. In September 2017, MAPD, implemented by Malaria Consortium in partnership, identified and trained 32 key influencers in malaria prevention, treatment and interpersonal communication and one of their deliverables was to establish village health clubs.

Bagonza (left) attending a dialogue meeting hosted by the Rutoke Tweyambe Group chairperson

Thanks to Ernest’s encouragement, his community’s village health club is already proving a success. When Bagonza’s son got sick in May 2018, he took him to a nearby health centre where he was diagnosed with malaria and received treatment. However, his condition became worse after a week and he was referred to St Paul’s hospital 10 kilometers away from his home in Kasese town. Bagonza did not have enough money at the time, so he spoke with the chairman, treasurer and secretary of the village health club in his village and managed to borrow 40,000 Ugandan shillings. With this money, Bagonza took his son to hospital and bought a few other necessary items, such as sugar, soap and food. This was officially communicated to the village health club members at the next meeting and a repayment schedule was established for Bagonza to replenish the Ambulance fund.

“My child is very well now and is back at school,” said Bagonza. “Recently, the government gave us nets and we now sleep under a mosquito net. I also know even more nets are being distributed at the facilities to pregnant mothers. We are lucky that our village was chosen [for this project]. Please do not forget us in your future plans.”

MAPD plans to increase the number of key influencers in the Kasese district from four to 10 to extend its reach in promoting behavior change and reduce the malaria burden in the district. Since key influencers and community members are accountable for the success of village health clubs, this will ensure the sustainability of MAPD’s impact even after the project ends.

This success story is published as part of a series from the USAID’s Malaria Action Program for Districts project.

For more information, see www.malariaconsortium.org/resources/publications/977/ or contact: Dr Sam Gudoi, s.gudoi@malariaconsortium.org

USAID’s Malaria Action Program for Districts aims to improve the health status of the Ugandan population by reducing childhood and maternal morbidity and mortality due to malaria. The project will support the Government of Uganda for a period of five years, focusing in particular on children under five years of age and pregnant women. This project, made possible by the generous support from the American and British people, is implemented by Malaria Consortium in partnership with Jhpiego, Banyan Global, and Communication for Development Foundation Uganda (CDFU), Deloitte Uganda and Infectious Diseases Institute (IDI).

From the field: female community health volunteers in Nepal

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Nepal is one of only five countries that have reduced under-five mortality by 50% since 1990[1], however pneumonia remains one of the primary causes of death for Nepali children (15% of under five deaths in 2015[2]). In rural areas, the government relies on the country’s 50,000 Female Health Community Volunteers (FCHVs) to provide maternal and child health care. Although 42% of these women have never been to school[3] they have been trained to diagnose a number of illnesses, including pneumonia, and provide essential care to young children on a daily basis in the most remote areas where Health Posts are hard to reach.

Guta

As part of its Acute Respiratory Infection Diagnosis Aid (ARIDA) project/study, Malaria Consortium (MC) went on a scoping mission to Nepal end of January and visited an FCHV in a valley outside Kathmandu. Guta Kunwor is 38 years old and she has been an FCHV for 12 year. Her aunt was an FCHV before her and she used to accompany her to trainings at the local Health Centre. On average, she sees three children with cough or difficulty breathing every week. When children present with those symptoms she counts their respiratory rate (RR) for 60 seconds according to the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) guidelines and refers them to the nearest Health Post if she diagnoses fast breathing.

A child wearing the ChARM device

So far, Guta has been using the ARI Timer, a device which works like a stopwatch whilst she is counting the child’s breaths by watching their stomach moving with each inhalation and exhalation. The ARIDA study is focused on testing an automated device which is strapped to the child’s belly and automatically counts the child’s breaths. It also reduces the assessment time from five minutes to merely a couple of minutes. When we told Guta about this new device, she spontaneously thought of an analogy which rang very true: she said that using the ARI Timer was a little like touching a child’s forehead and yours at the same time to check for fever, whilst using the ChARM device was more like using a thermometer to get a reliable diagnosis.

This stage of the ARIDA study is looking at the acceptability of this new automated device under a number of specific themes: affective attitude, burden, intervention coherence, perceived effectiveness and self-efficacy. The results should show whether FCHVs and health facility workers (HFWs) using an Acute Respiratory Infection Diagnostic Aid (ARIDA) can adhere to the IMNCI algorithm, and should help us better understand FCHVs’ and HFWs’ perceptions on the benefits of and barriers to using this new device.

Alice Maurel is Senior Programme Officer at Malaria Consortium. Alice visited Nepal in January 2018.

Find out more about the ARIDA study in our project brief here.

The ARIDA study is funded by the La Caixa Foundation and UNICEF in collaboration with the Federal Ministry of Health Ethiopia, Federal Ministry of Health Nepal and Ministry of Health Mozambique.

[1] P Dawson YP, R Houston, S Karki, D Poudel, S Hodgins. From research to national expansion: 20 years’ experience of community-based management of childhood pneumonia in Nepal. Bulletin of the World Health Organization, 2008

[2] Government of Nepal MoH. Annual Report, Department of Health Services, 2015–2016. 2016.

[3] Ibid.

Mozambique: A field officer developing community capacity in malaria prevention

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Field officer Castélio Muwasse

Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Ilha de Moçambique is an idyllic island for visitors; it was once the capital of Mozambique and is now a world heritage site. But for the local population as well as for visitors, there is a threat that darkens the picture: the risk of getting malaria, a potentially deadly disease that remains the main cause of health problems in Mozambique.

Castélio Muwasse, a Field Officer for Malaria Consortium, works in the District of Ilha de Moçambique. This 31-year old technician in preventive medicine and environmental sanitation joined the Malaria Prevention and Control Project team in 2016, motivated by the desire to work with communities and learn new experiences.

As a field officer, the responsibilities of Castélio included support for the District Health Services in the implementation of project activities, training of community structures and teachers on malaria prevention, collection and compilation of activity monitoring data, and coordination between health facilities and community structures, such as health committees and local organisations, and between district education and health services.

In addition to mobilising community structures for malaria prevention, he coordinated the training of teachers with the school health technician of the District Education Services.

“With the schools, I worked well without major constraints. We managed to train the teachers and they reported the work done monthly. There was good collaboration from teachers and school directors.”

Castelio is based at the District Health Services office, but actually spends a lot of time traveling on his motorcycle to reach the various communities and health facilities scattered throughout the district, even the most remote ones. With this knowledge of the terrain, he is able to draw a detailed map of the district in just a few minutes.

In order to work effectively with community structures, it is essential to build a trusting relationship. Castélio joined Malaria Consortium to replace a field officer who had worked with these communities for a few years so he had to use all his interpersonal communication skills to gain the trust of the volunteers.

”Throughout the project I have had good moments. One of these was when I was accepted by the communities and received a warm welcome. This was crucial as they were open to listening to the messages and to making use of them. ”

Castélio says that the communication activities for behaviour change carried out by community structures volunteers, teachers and students have contributed to the reduction of malaria cases, partly as a result of their collaboration.

“We have noted that there is a reduction in the number of malaria cases, a reduction in the misuse of mosquito nets, an improvement in environmental sanitation and a better uptake of the use of mosquito nets, Previously, families would take the nets to go fishing or cover their gardens.”

This is certainly the most rewarding part of being a field officer on the ground. This type of work also offers many learning opportunities for young professionals, such as Castélio, to grow.

“Personally, with the project, I learnt a lot, gained a lot of knowledge and experience. I learnt to be a more open person. One of the lessons I take with me is that working with communities is not an easy task, but humility, love, care and patience are key to success and to overcoming certain difficulties.”

The Malaria Prevention and Control Project has been implemented in nine of the 11 provinces of Mozambique by a consortium of civil society organisations  led by World Vision, with Malaria Consortium, Community Development Foundation and Food for The Hungry. Malaria Consortium carried out interventions in 17 districts of the province of Nampula and six districts in Niassa. Castélio Muwasse is one of the 23 field officers who worked with Malaria Consortium to implement communication activities to change behaviours at the community level.

Mozambique: The behaviour changing power of radio

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Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Ismael Janato is a presenter and technician at Ngauma community radio, Niassa Province, and Jonas Ali Mussa, director of the community radio on the Island of Mozambique. The Ngauma district, located in the midwest of Niassa Province, near the border with Malawi, has an estimated population of 86,000. The Island of Mozambique is part of Nampula Province with a population of about 53,000 inhabitants.

Despite the enormous distance separating Ismael and Jonas – over 700km – both have the same mission: to discuss the prevention of malaria on their community radio programmes.

Radio is recognised as the ‘African media’ for its broad accessibility and its ability to transcend cost barriers, geographical barriers and low levels of literacy, supporting listeners as they negotiate the challenges of everyday life. The Malaria Prevention and Control Project in Mozambique, implemented by Malaria Consortium in the provinces of Nampula and Niassa, has established partnerships with community radio networks to develop and transmit quality messages and programmes in local languages, promoting essential malaria prevention and treatment behaviours.

Ismael Janato from the Ngauma community radio talks about his experience with the activities:

“For the past three years, I have been managing the project activities. We received audio announcements on malaria, its transmission, signs and symptoms, the use of mosquito nets and the importance of seeking treatment. As a presenter, my job was to translate the spots into the local language, to broadcast the messages every 15 minutes, and to animate public debates live in the communities.”

Often malaria symptoms are not recognised, yet rapid and appropriate diagnosis and treatment of malaria are extremely important for reducing morbidity and mortality. Ensuring population access to essential information can substantially increase the effectiveness of existing interventions for malaria prevention.

Ismael explains that he gained knowledge about malaria through his participation in the training provided by Malaria Consortium, and thus developed the ability to discuss these issues properly. Besides broadcasting the spots, Ngauma’s community radio produces interactive programmes with the public through phone-in discussions on malaria issues and interviews with health technicians. Ismael continues, “With the work we do we have noticed changes in people’s behaviour regarding the use of mosquito nets, better hygiene at home, and there are more people who, when ill, go to the health centre and do not go to traditional practitioners anymore.”

Jonas Ali from the community radio of Mozambique Island also reports an improvement in the correct use of mosquito nets and reduction of malaria cases in the communities.

“With the work we have done, we have been able to see that there is a reduction in the use of mosquito nets for fishing and that fishing communities use the nets more responsibly. People are using the mosquito net correctly, malaria cases are also decreasing thanks to better knowledge of the consequences of malaria.”

Indeed, monitoring data and testimonies indicate an increase in knowledge about malaria and some behavioural changes in the project areas. These developments are likely to be the result of a number of complex factors and combined interventions of the Ministry of Health and its partners. The results of the Malaria Prevention and Control Project indicate that the significant expansion of intensive awareness raising, education and mobilisation activities combined with the mass distribution of long-lasting insecticidal nets may have contributed to this positive development.

Goncalves Bacar, Training Officer at Malaria Consortium Niassa, underlines that “the use of a combination of reliable sources of information – community structures, schools and radios – to disseminate harmonised messages at community level was certainly key.”

This story is part of a broader project documentation exercise; to read more and other lessons learnt, click here.

Leadership makes the difference in defeating malaria

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Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Nacala-Porto, on the northern coast of Mozambique, is the deepest natural harbour on the east coast of Africa. It serves as a terminal for the rail link to landlocked Malawi. Many goods transit through this district on their way to Malawi and other parts of southern Africa. The town is also known for its beaches and diving; this may be the district’s best known feature. What is less well known is the strong leadership within the District Health Service where there is an exceptional team dedicated to defeating malaria and saving lives.

The Nacala-Porto District Health Services were among the pioneers in the implementation of the Malaria Prevention and Control Project in 2011.  Malaria Consortium’s role, as one of the implementing partners for the project, was to support 17 districts of Nampula Province until 2017.

The main objective of the project was to contribute to the reduction of malaria through a combination of interventions aimed at improving malaria knowledge among the population and promoting the adoption of good practices in relation to malaria prevention and treatment at community level.

Successful implementation of this project required strong coordination between the district government and Malaria Consortium, health facilities and communities, as well as with schools and community radios. The excellent leadership of the Nacala-Porto District Health Services represented best practice in managing the partnership, including integrating the Project Field Officer into the district team, in line with the collaboration and coordination approach sought by the project implementers.

Janete Chau is the District Health Director at Nacala Porto. She is as charming and friendly as she is professionally demanding and rigorous, and she has embraced the project and managed to develop an effective partnership approach. It is for these qualities that she was awarded the title of ‘best district director of the province’ by the Nampula Provincial Health Directorate in October 2017.

“The Malaria Consortium Field Officer was actually working under our responsibility. He had to share his work plans and get involved in all the activities, and we had regular review meetings to look at the malaria situation here in the district. …My main role was to monitor and control project activities, see what was being done at district level, know where the activities were being done and what impact the project was having. ”

Janete Chau, District Health Director in Nacala Porto, Mozambique

The District Health Services’ team and Malaria Consortium worked together to map out community structure such as community health committees and local organisations, select and train them, and implement communication interventions towards behaviour change at community level. According to Ms Chau, malaria prevention activities carried out by community volunteers have contributed to increasing knowledge about malaria, care seeking and reducing malaria deaths in the area.

“People have gained knowledge about malaria, they now know how to describe it. They realise that malaria comes from the mosquito and that they breed in stagnant water. They now know they should go to the health centre if they present any malaria signs and symptoms and this has helped us to reduce malaria deaths.”

These efforts to promote good malaria prevention and treatment practices at the population level have also been accompanied by improved diagnosis and treatment of malaria patients at the health facilities level, as Ms Chau explains. “As an institution, through this project we became more aware that malaria is a serious problem and that we must keep it under control. It must be discussed. Our clinicians are more aware that they should not simply attribute malaria based on symptoms, but that we need to test for confirmation of malaria.”

These efforts are already starting to pay off but need to be maintained to achieve long-term impact. Nacala Porto’s team remains committed and motivated: “Every health professional is psychologically prepared to continue doing everything the project was doing so that one day malaria will be out of Mozambique.”

This story is part of a broader project documentation exercise; to read more and other lessons learned, click here.

Children who learn about malaria contribute to disease control in their communities

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Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Fátima Mário, 12 years old, Dinala Muhamudo Aid, 18 years old, Cristina Muanhar, 18 years old, and Carlitos Gabriel Tolembeta, 16 years old, are seventh grade pupils at Undi Primary School. The school is in Chimbonila District, Niassa Province, 30km from the province capital  Lichinga. At school, in addition to learning how to read, write and count, students benefit from educational activities on malaria prevention.

Fátima explains, “Everything we know, we learn at school with our teachers. During the lectures, we pay attention to the teacher’s explanation because in the end she asks us questions and we need to respond. We have learnt many good things. We learnt how to use and take good care of the mosquito net, not to wash the mosquito net in the river, not to accumulate water in the yard, and that when we get malaria we have to go to the hospital.”

In Africa, malaria accounts for up to 50 percent of all school-age deaths. Ensuring that children learn about malaria prevention practices will not only reduce malaria but also contribute to disease control in their communities.

Under the Malaria Prevention and Control Project, implemented in nine of the eleven provinces of Mozambique by a consortium of civil society organisations (2011-2017), one of the innovative interventions was to strengthen malaria education for students in the classroom. Undi Primary School is part of the schools reached by malaria prevention education activities implemented by Malaria Consortium under this project, in Niassa province.

At Undi Primary School, three teachers were trained on basic concepts of malaria, its transmission, signs and symptoms, prevention methods, and importance of early care seeking. In the classroom, teachers conduct interactive educational sessions using a flipchart that contains illustrations, questions and key messages about malaria prevention. Students are expected to share the knowledge they have gained with their families, friends and community.

“When we get home, we talk to our parents, they listen and follow the things we explain to them if they do not know already.” …Everyone likes to use the mosquito net now and last night everyone slept underneath because they know the net serves as protection against mosquito bites and malaria.”, says Carlitos

Helena Samuel, Undi Primary School natural sciences teacher acknowledges the project’s contribution to increasing knowledge about malaria, reducing school absenteeism and drop out.

“It was great to be a part of this project, because I learnt a lot, gained more knowledge about malaria and dispelled many myths that were in my mind. As a natural science teacher I transmit the concepts to the communities. …The project also brought advantages to the school and the students; now we have a low dropout rate because the students are healthier.”

Between 2011 and 2017, Malaria Consortium supported the provincial and district education directorates to train 1,682 teachers in 700 schools in the provinces of Niassa and Nampula reaching approximately 31,289 students on a quarterly basis with key messages on malaria, prevention methods and the importance of care seeking.

Project monitoring data show that school malaria education activities have contributed to increased knowledge of both teachers and students and better adherence to good malaria prevention practices in their homes and communities.

This story is part of a broader project documentation exercise; to read more and other lessons learned, click here.

The time to invest is now: fighting malaria in the Sahel

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Children in sub-Saharan Africa are 14 times more likely to die before the age of five than those living elsewhere in the world. Preventable and treatable diseases, such as malaria, claim hundreds of thousands of lives each year.

Since 2014, leading players in malaria prevention have come together to deliver seasonal malaria chemoprevention (SMC) to children under five in the Sahel. 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 60 percent of malaria cases occur. It provides a high degree of protection, with about 90 percent efficacy and has the potential to reduce cases of malaria by 75 percent.

After concentrated efforts from the UNITAID funded ACCESS-SMC project, led by Malaria Consortium in partnership with Catholic Relief Services, and other organisations’ SMC programmes, roughly 12 million children received SMC in 2016. Over 6.4 million of those children were reached through ACCESS-SMC across seven countries[1].

Many children will still miss out on receiving SMC in 2017 though, due to lack of funding and production capacity for quality assured medicines used in SMC (SP+AQ). Nine million children in Nigeria alone, will remain unprotected this rainy season.

With areas in the Sahel having the highest incidence of malaria in the world, it is time to look towards reaching all 25 million eligible children. For less than $5, one child is protected with SMC each year. To support our continued efforts as a GiveWell Top Charity protecting all 25 million children in the Sahel from malaria visit http://www.givewell.org/charities/malaria-consortium.

 

[1] Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, The Gambia

Delivering nets at the last mile: success through promoting a culture of net use

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In February and March 2017, USAID’s Malaria Action Program for Districts distributed one million long-lasting insecticidal nets to 1,978,114 people in three districts in Uganda. A focus on promoting positive behavior change on net use led to the successful delivery of the campaign.

Background

In the three districts of Arua, Koboko and Nebbi in West Nile region, malaria, like in most parts of Uganda, is a serious public health problem. In these three disctrict, which has a population of over 1.5 million, over 700,000 confirmed or suspected malaria cases were reported to public health facilities in 2016.  
USAID’s Malaria Action Program for Districts conducted a long-lasting insecticidal net (LLIN) distribution campaign in February and March 2017 as part of its objectives to increase the impact and reach of malaria prevention services. The project took a four-step approach in conducting the LLIN distribution campaign: 1) community sensitization 2) a community-led registration of households, 3) data-entry and verification, and 4) community-led distribution. During community sensitization, emphasis was placed on social behavior change communication (SBCC) to reach all targeted communities with relevant and effective messages on use of LLINs.

Promoting a Culture of Net Use

Prior to household registration, the project team convened a regional advocacy meeting in Arua district with local leaders from the three districts. These included district health officers, resident district commissioners, district health team, chief administrative officers and local council V chairpersons. Local leaders’ understanding of malaria prevention and their engagement in promoting positive behavior towards malaria prevention was key to the campaign’s success.
During this meeting, the project team shared malaria prevention strategies and messages to the local leaders who would then share these with their own communities.
The leaders committed to promoting a culture of net use, highlighting that a significant change in mindset and behavior towards prevention can lead to a ‘malaria-free world’. They shared a vision of a malaria-free district – where communities would have higher levels of productivity, due to less money lost on treating malaria and more time spent on income-generating activities. Leaders also raised the need for adequate community-led mobilization for household registration and subsequent LLINs collection, as well as working with the local wanaichi to create a net use culture.

Successes and Impact

The high turnout of community members can be attributed to effective community-led mobilization and the malaria messages that promoted positive prevention behaviors such as net use. In Nebbi district, for example, leaders indicated that sensitizing the community before the distribution was key to its success:

“… you will realise on the day of distribution that there is going to be high turnout of community members […] this has been shown in registration after the community’s sensitisation by political leaders and other stakeholders. When you look at the registration, you feel very happy that these people have been sensitised. The registration was 100 percent. Everybody registered because they understood why the nets are being distributed to them. So this has been a very big achievement.”
– Olweku Fred Jibril, Secretary for Social Services, Nebbi district

The campaign in the three districts reached 98 percent of households registered during the pre-campaign registration. At the wave one review meeting, district supervisors in the three West Nile districts reported that 91 percent of the population was sleeping under a net.

The net distribution campaign was welcomed by the community members and health workers alike:

“…On behalf of my people, we are very happy for this service, in fact, we have been having problems of malaria [for a long time], and case numbers had become so high that we could not manage with the current drugs in the hospitals. So I think with this, it is going to improve our health.”
– Achong Emmanuel, area LCI Oufa Village, Aiivu sub county

“The reason I have come for the net is because we have so many mosquitoes and there is a high rate of malaria, as we are along the river. The mosquitoes are very many. Without nets, there is no sleep here…”
– Net recipient, Rhino Camp

Lessons and Next Steps

Community involvement is instrumental in ensuring a well-supported distribution and to achieve a high proportion of immediate net uptake and sustained use of nets. An SBCC approach before the net distribution campaign allowed community leaders and members to be engaged in education around malaria prevention.
Building on these successes, USAID’s Malaria Action Program for Districts will continue to run an SBCC campaign to create a culture of net use through a community-led approach for promoting the correct and consistent use of nets which is supported by local council leaders.

Download the Success Story in PDF format here.

Chimbonila: A district committed to fighting malaria

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The district of Chimbonila in Niassa province has a high malaria burden, which can be difficult to manage for a number of reasons.

The district itself is very large. It is located about 30 km from the city of Lichinga and covers an area of ​​8,075 km² with a population of about 87,000 inhabitants. Despite its proximity to the capital city, however, Chimbonila has the typical challenges of the other districts of Niassa: poor roads and high poverty rates, as well as a remote, mostly rural population which relies on an economy based on agriculture (population density of 15.8 inhabitants per km²).

Since 2014, the National Malaria Control Programme of the Ministry of Health and its partners (World Vision and Malaria Consortium) with funding from the Global Fund, has been implementing the Malaria Prevention and Control Project within local communities.

The project in Chimbonila District involves 22 community structures, 428 volunteers, 23 schools, 72 teachers, 14 health facilities and one community radio in a continuous effort coordinated by Health, Women and Social District Services to ensure the prevention and treatment of malaria.

Since 2014, Gabriela Nazaré has been the Malaria Consortium Field Officer assigned to this district. Her role is to coordinate the activities of all project stakeholders, ranging from health facilities to community volunteers.

Every day Gabriela visits the villages by motorcycle, ensuring that all project’s participants have the necessary tools for mobilisation work and that they have a correct understanding about how to prevent malaria and that they know what to do in the occurrence of malaria symptoms.

After three years as Field Officer, Gabriela feels integrated in the community: “I was born and raised in Lichinga. I moved to Chimbonila to work and today I feel at home. Despite the complexity of the job, knowing that I am contributing to the improvement of people’s living conditions is rewarding.”

Rain or shine, her activities don’t stop. Owing to the large number of beneficiaries, her schedule is very busy. “I try to spend as much time as possible in each community. My routine in each village is to visit schools, health facilities and work with community structures.

“Over the years we have been establishing work mechanisms and today it is amazing how communities are engaged in the project in such a way that they now bring in their own initiatives and suggestions for new approaches.”

 

Text and photos: Xavier Machiana

Distribution of LLINs in Niassa Province: mission accomplished

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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