The ARIDA ChARM acceptability sought to establish whether health extension workers (HEWs) in Ethiopia could correctly adhere to the integrated community case management (iCCM) algorithm for assessing and classifying under five children for fast breathing, as a symptom of pneumonia using the Children’s Respiration Monitor (ChARM) device, produced by Philips.
The infographic below provides a quick glance at the results of the study – full results and analysis are available in the research brief, available here.
Mozambique has been in the news recently following arrests of senior officials and bankers in London, New York and Jo’burg on their alleged involvement with fraud and loan scandals, that led to a financial crisis in the impoverished country.
The country already has some of the highest debt-to-GDP ratio in the world, ranks high on the corruption index and among the bottom ten on the global human development index — leading to increasing and justified calls for the scandalous debts to be written-off by the creditors.
Health challenges for Mozambique are immense –
Mozambique has the highest burden of malaria in southern Africa, with over 8.5 million cases reported in 2016 and all provinces of the country are prone to high malaria transmission.
Nearly half of the population lives below the poverty lineand those in rural communities lack access to basic healthcare services contributing to excess morbidity and mortality.
Each year, over 80,000 children lose their lives before their fifth birthday — this accounts to one young life lost needlessly every six minutes — the time it’d take one to read this post.
Malaria, pneumonia and diarrhoea are attributable to over one third of under five deaths — common childhood illnesses that are easily preventable and treatable in similar settings elsewhere.
Maternal malaria and malnutrition are widespread, coupled with insufficient health infrastructure and low coverage of preventative services such as IPTp and immunisation, low exclusive breastfeeding rates and high childhood malnutrition — the odds of losing young lives remains very high.
Since 2005, Malaria Consortium has worked closely with the national ministry of health and partners, to help strengthen systems and improve access to life-saving services for children and communities, in particular at the last mile.
Late last year, I visited the country to support colleagues and see for myself the impact we’re having on the lives of the most vulnerable across the country; and here’s what I found.
We are at the forefront of community and digital health work in the country — having developed and rolled-out with partners the mobile health app for community health workers (CHWs) over the past 10 years. The innovation enables CHWs, called the Agentes Polivalentes Elementares locally, to correctly diagnose and treat children with common childhood illnesses using the integrated community case management (iCCM) protocols.
Our flagship digital health interventionupSCALE consists of an interactive mobile phone app that guides CHWs through patient registration, routine health checks, diagnosis, treatment, referral and follow-up. The app automatically compiles CHW monthly reports for submission to supervisor online. A complementary CHW supervisor app supports two-way communication and feedback, while integration with the district health information system (DHIS2) enables easy visualisation of aggregated data.
Over the years, upSCALE has helped strengthen community service delivery in a low resource setting, significantly improved access to quality care at the last mile, improved availability of realtime data for monitoring, supervision and district planning. As a result, the government of Mozambique is planning to scale-up this evidence-based intervention across all CHWs and provinces over the next few years.
One of our local health heroes, Adelia, is a single mother and committed CHW in Marange, Homoine district. She has been providing community health services over the past 8 years and sees around 300 cases pm. She was one of the first CHWs trained on the upSCALE mobile app and said that she finds it‘really helpful for correct case management and sharing health messages during home visits’.
Working closely with the national CHW programme and provincial health departments, upSCALE started with just 10 CHWs in Inhambane in 2009. Since 2016, the innovation has been scaled-up to 650 CHWs in all districts of Inhambane and Cabo Delgado provinces, and expected to increase to 2250 later this year with the addition of CHWs in Zambezia province.
Similarly, we are working closely with the national malaria control programme and partners to strengthen malaria surveillance across the country, contextualising strategies and interventions for the lower and higher transmission areas in south and north of the country respectively.
We recently completed a national landscape analysis and brought stakeholders together to identify and address bottlenecks in the national malaria surveillance system, and support the collaborative development of a Data-to-Action (D2A) framework to support progress towards malaria elimination by strengthening surveillance in Mozambique.
Awareness of childhood illnesses and health-seeking practices are low across rural communities and only about half of the young children are taken to a health worker for treatment of common illnesses. Nampula province in northern Mozambique has the highest burden of neglected tropical diseases (NTDs) in the country, with high co-endemicity of schistosomiasis, lymphatic filariasis and soil transmitted helminths.
Since 2014, we have worked closely with communities and local authorities in Nampula province using our innovative Community Dialogues approach to improve awareness, prevention and control of NTDs.
Working through community champions and facilitators across 600communities in 4 districts of the province, we have contributed to strengthen community engagement, ownership and capacity to overcome socio-cultural barriers for improved acceptance and uptake of NTDs prevention and control services in target communities.
Over the years, Malaria Consortium has worked to promote partnerships at community, district, provincial and national levels in Mozambique, collaborating with development partners, international agencies and local researchers such as the health research institute at Manhiça, generating credible evidence and learning that has informed policies and practices of governments and partners, both locally and globally.
Despite the widespread development challenges, Mozambique is blessed with immense resources, not just the minerals and spectacular landscapes, but the rich culture, cuisine and diversity of her people.
I returned greatly impressed with the ingenuity and resilience of the Mozambican people, who are striving to make a difference every day with limited resources — there is no doubt the country has the potential to make significant progress towards malaria elimination, improving health coverage and saving lives, if the current pace of progress is maintained over the coming years.
And it may be on the other side of the world, but I cannot wait to return soon!
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.
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.
For more information, see www.malariaconsortium.org/resources/publications/977/ or contact: Dr Sam Gudoi, firstname.lastname@example.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).
Nepal is one of only five countries that have reduced under-five mortality by 50% since 1990, however pneumonia remains one of the primary causes of death for Nepali children (15% of under five deaths in 2015). 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 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.
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.
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.
 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
 Government of Nepal MoH. Annual Report, Department of Health Services, 2015–2016. 2016.
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.
História coletada por Dorca Nhaca e editada por Fernando Bambo, Novembro 2017
Ilha de Moçambique é uma ilha idílica, para visitantes; foi no passado a capital de Moçambique, e agora é um patrimônio mundial. Mas para a população local, bem como para os visitantes, há uma ameaça que escurece a imagem: o risco de contrair a malária, uma doença potencialmente mortal, que continua a ser a principal causa de problemas de saúde em Moçambique.
Castélio Muwasse, é oficial de campo da Malaria Consortium, trabalha no Distrito da Ilha de Moçambique, ele tem 31 anos de idade, é técnico de medicina preventiva e saneamento do meio. Castélio integrou a equipa do Projecto de Prevenção e Controlo da Malária, no ano de 2016, motivado pelo interesse de trabalhar com as comunidades e apreender novas experiências.
Como oficial de campo, as responsabilidades do Castélio, incluíam apoio ao Serviço Distrital de Saúde na implementação das actividades do projecto, treino de estruturas comunitárias e professores sobre a prevenção da malária, recolha e compilação de dados de monitoria das actividades e facilitação de encontros de coordenação entre as unidades sanitárias e as estruturas comunitárias, e entre os serviços distritais de educação e saúde.
Para além de mobilizar as estruturas comunitárias para a prevenção da malária, ele coordenava o treino de professores com o técnico de saúde escolar dos Serviços Distritais de Educação.
“Com as escolas, trabalhei bem sem grandes constrangimentos. Conseguimos treinar os professores e estes reportavam o trabalho feito mensalmente. Houve boa colaboração dos professores e os directores das escolas apesar da demora na entrega dos relatórios por parte de alguns professores”.
Castélio está baseado no escritório dos Serviços Distrital de Saúde, mas passa muito tempo circulando de mota, trabalhando com as várias comunidades e unidades sanitárias espalhadas em todo o distrito, atá as mais remotas. Com esse conhecimento do terreno, ele é capaz desenhar um mapa detalhado do distrito em apenas alguns minutos.
Para trabalhar efectivamente com as estruturas comunitárias, é essencial construir uma relação de confiança. Castélio juntou-se a MC para substituir um oficial de campo que trabalhou com essas comunidades por alguns anos. Castélio teve que usar todas as suas habilidades de comunicação interpessoal para se unir aos voluntários.
‘’Ao longo do projecto tive bons momentos de trabalho. Um dos momentos foi quando fui aceite pelas comunidades e tive um bom acolhimento. Isto foi determinante para que elas pudessem receber as mensagens e fizessem o uso das mesmas”.
O Castélio diz que as actividades de comunicação para a mudança de comportamento realizadas pelas estruturas comunitárias, professores e alunos contribuíram para a redução dos casos de malária, em parte resultado da sua colaboração:
“Nota-se que há redução do número de casos de malária, redução do uso da rede mosquiteira para outros fins que não sejam para a prevenção da malária, melhoria das condições de saneamento do meio, aceitação do uso das redes mosquiteiras e melhoria no uso correcto das mesmas, consciencialização sobre a importância do uso da rede, o que antes não acontecia. As famílias levavam as redes para a pesca, cobertura das hortas entre outras formas não adequadas”.
Esta é certamente a parte mais gratificante do trabalho árduo de um Oficial de Campo no terreno. Este tipo de trabalho também oferece muitas oportunidades de aprendizagem para que jovens, como o Castelio, cresçam.
“Pessoalmente, com o projecto, aprendi muito, ganhei muitos conhecimentos e muita experiência. Aprendi a ser uma pessoa mais aberta no que diz respeito ao meu jeito de ser. Uma das lições que levo comigo é que trabalhar com comunidades não é tarefa fácil, mas a humildade, o amor, o carinho, a paciência trazem consigo muito sucesso e superação de certas dificuldades”.
O Projecto de Prevenção e Controlo da Malária é implementado em 9 províncias das 11 do país, tendo como parceiros, a Visão Mundial, Principal Recipiente, a Malaria Consortium, Fundação para o Desenvolvimento da Comunidade e Food for The Hunger, Sub – Recipientes. A Malaria Consortium interveio em 17 distritos da província de Nampula e 6 da província do Niassa. Castélio Muwasse é um dos 23 oficiais de campo contractados pela Malaria Consortium para a implementação das actividades de comunicação para a mudança de comportamento ao nível das comunidades.
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.
História coletada por Dorca Nhaca e editada por Fernando Bambo
Ismael Janato, é locutor e técnico da rádio comunitária de Ngauma, Província do Niassa, e Jonas Ali Mussa, administrador da rádio comunitária da Ilha de Moçambique. O distrito de Ngauma, está localizado no Centro Oeste da Província do Niassa, junto à fronteira com a República do Malawi, a sua população é estimada em 86,000 habitantes. A Ilha de Moçambique é uma cidade insular, situada na Província de Nampula com uma população de cerca de 53,000 habitantes.
Apesar da enorme distância que separa o Ismael e o Jonas, acima de 700Km, ambos tem a mesma missão: comunicar para a prevenção da malária através das suas rádios comunitárias. Ismael Janato, da rádio comunitária de Ngauma, fala da sua experiência com as actividades:
“A três anos que acompanho as actividades do projecto. Recebemos spots sobre a malária, transmissão, sinais e sintomas, uso de redes mosquiteiras e importância de procura de tratamento. Como locutor, a minha função era de traduzir os spots para a língua local, difundir as mensagens de 15 em 15 minutos, e também fazer debates públicos em directo nas comunidades”.
Muitas vezes, os sintomas da malária não são reconhecidos. O diagnóstico e o tratamento rápidos e adequados da malária são extremamente importantes para a redução da morbidade e mortalidade. Assegurar acesso da população a informações essenciais pode ampliar substancialmente a eficácia das intervenções existentes para a prevenção da malária.
A rádio é reconhecida como o “média africano”, por sua ampla acessibilidade e sua capacidade de transcender as barreiras de custo, barreiras geográficas e baixos níveis de alfabetização, apoiando os ouvintes enquanto negociam os desafios da vida quotidiana. O projeto Prevenção e Controlo da Malaria em Moçambique, implementado pela Malaria Consortium nas províncias de Nampula e Niassa, criou parcerias com redes de rádios comunitárias para desenvolver e transmitir mensagens e programas de qualidade em línguas locais, promovendo comportamentos essenciais de prevenção e tratamento de malária.
O Ismael relata que adquiriu mais conhecimentos sobre a malária através da sua participação na formação dada pelo Malaria Consortium, e assim desenvolveu a capacidade de debater questões com mais propriedade. Para além da emissão de spots, a rádio comunitária de Ngauma realiza programas interativos com o público através de chamadas telefónicas, apresentação de questões sobre a malária e resposta dos técnicos de saúde. O locutor reporta notar mudança de comportamento como resultado das intervenções comunitárias, em particular, a rádio.
“Com o trabalho que fazemos temos notado mudança de comportamento das pessoas em relação ao uso da rede mosquiteira, mais higiene nas casas, há mais pessoas que quando estão doentes vão a unidade sanitária e não aderem ao tratamento tradicional”.
Jonas Ali da rádio comunitária da Ilha de Moçambique, também reporta o uso correcto das redes mosquiteiras e redução de casos de malária nas comunidades.
“Com o trabalho que temos feito, conseguimos ver que há redução do uso da rede mosquiteira na pesca e responsabilização dos comités de pesca. As pessoas estão a usar a rede mosquiteira de forma correcta, os casos de malária estão também a reduzir e devido ao conhecimento das consequências da malária.
De facto, dados de monitoria e testemunhos indicam um aumento de conhecimentos sobre a malária e algumas mudanças de comportamentos nas áreas do projecto. Esses progressos provavelmente resultam de uma série de factores complexos e intervenções combinadas do Ministério da Saúde e seus parceiros. Os resultados do projecto de Prevenção e Controlo da Malária indicam que a expansão significativa de actividades intensivas de conscientização, educação e mobilização, combinadas com a distribuição massiva de REMILD, podem ter contribuído para este desenvolvimento positivo.
O uso de uma combinação de fontes confiáveis de informação – estruturas comunitárias, escolas e rádios – para disseminar mensagens harmonizadas a nível comunitário foi certamente chave.
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. ”
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.
História coletada por Dorca Nhaca e editada por Fernando Bambo
Nacala-Porto, na costa norte de Moçambique, é o porto natural mais profundo da costa leste da África. Ele serve de terminal para a ligação ferroviária ao Malavi sem litoral. Muitas mercadorias transitam por este distrito em seu caminho para o Malawi e outras partes da África Austral da região. A cidade também é conhecida por suas praias e mergulho. Esta pode ser a característica mais conhecida do distrito; O que é menos conhecido é que existe uma liderança forte no Serviço Distrital de Saúde, uma equipe excecional dedicada a derrotar a malária e salvar vidas.
Os Serviços Distritais de Saúde Mulher e Acção Social (SDSMAS) de Nacala – Porto foram entre os pioneiros na implantação, em 2011, do Projecto de Prevenção e Controlo da Malária que a Malaria Consortium apoiou em 17 distritos da Província de Nampula, até 2017.
O projecto teve como objectivo principal contribuir para a redução da malária, através de uma combinação de intervenções visando melhorar os conhecimentos da população sobre malária e promover a adopção de boas práticas em relação a prevenção e tratamento da malária a nível comunitário.
A implementação bem-sucedida deste projecto requeria coordenação entre o governo distrital e a Malaria Consortium, as unidades sanitárias e comunidades, escolas e também rádios comunitárias. A gestão da parceria sob a liderança dos SDSMAS de Nacala-Porto e a integração do Oficial de Campo do projecto na equipa distrital representou por excelência a abordagem de colaboração e coordenação pretendida entre as intuições do governo e os parceiros da sociedade civil:
A Janete Chau é directora distrital de saúde em Nacala Porto. E uma honra conversar e trabalhar com essa pessoa; ela é dócil e amigável, mas ao mesmo tempo exigente e rigorosa. É por essas qualidades que ela foi premiada pela Direção Provincial de Saúde de Nampula em Outubro de 2017 como melhor directora distrital da província; ela abraçou o projeto em tudo e consegue desenvolver uma abordagem de parcerias eficaz.
‘’Este Oficial de Campo da Malaria Consortium era mais controlado por nós mesmos, ele tinha que apresentar os seus planos de trabalho e nos envolver em todas as actividades que realizava e tínhamos os nossos encontros em que fazíamos balanços sobre a malária aqui no Distrito. (….) O meu principal papel era de fazer a monitoria e controlo das actividades, ver o que estava sendo feito ao nível do distrito, conhecer os locais onde estavam sendo feitas as actividades e o impacto que o projecto estava a causar”.
A equipa dos SDSMAS e a Malaria Consortium trabalharam juntos para conduzir o mapeamento das estruturas das estruturas comunitárias, selecção e treino das mesmas, e implementação de intervenções de comunicação para a mudança de comportamento a nível das comunidades. Segundo a Directora, as actividades de prevenção da malária realizadas pelos voluntários tem contribuído
para o aumento de conhecimentos sobre a malária, procura de cuidados e redução de óbitos no seu distrito:
“As pessoas ganharam conhecimento sobre a malária, já sabem descrever a malária e sabem que vem do mosquito e que este provém da acumulação das águas paradas que se multiplicam, já sabem se dirigir á unidade sanitária em caso apresentarem alguns destes sinais e sintomas e isto nos tem ajudado a diminuir os casos de óbitos por malária nas unidades sanitária”.
Esses esforços para promover boas práticas ao nível da população em relação a malária, foram também acompanhados com melhoria do diagnóstico e tratamento dos pacientes com malária ao nível das unidades sanitárias. A Directora explica:
“Como instituição ficamos mais consciencializados de que a malária é um problema sério e que devemos tomar atenção, deve ser discutida, os nossos clínicos estão mais conscientes de que não devem atribuir malária simplesmente pelos sinais e sintomas, mas é preciso ter o auxílio dos testes para a confirmação da malária”.
Estes esforços já estão começando a trazer resultados, mas precisam de ser mantidos para conseguir impacto a longo prazo. A equipa de Nacala Porto mantém-se engajada e motivada: “Todo profissional de saúde está psicologicamente preparado para continuar a fazer tudo o que o projecto vinha fazendo para que um dia a malária esteja fora de Moçambique”.
Este documento de aprendizagem faz parte de um exercício de documentação do projeto; para ler mais e outras lições aprendidas, visita: http://www.malariaconsortium.org/projects/malaria-prevention-and-control-project
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.
História recolhida por Dorca Nhaca e editada por Fernando Bambo
Fátima Mário, 12 anos, Dinala Muhamudo Aid, 18 anos, Cristina Muanhar, 18 anos, e Carlitos Gabriel Tolembeta, 16 anos são alunos de sétima classe da Escola Primária Completa (EPC) de Undi, Distrito de Chimbunila, Província de Niassa, a 30km da cidade capital, Lichinga. Na escola, para além de apreenderem a ler, escrever, contar, corte e costura para serem futuros empreendedores, os alunos beneficiam de actividades de educação sobre a prevenção da malária.
A Fatima explica: “Tudo quanto sabemos, aprendemos na escola com os nossos professores. Durante as palestras, procuramos ficar atentos á explicação da professora porque no fim nos faz perguntas e nós respondemos. Aprendemos muitas coisas boas. Aprendemos que devemos usar e cuidar bem da rede mosquiteira conservando-a bem, que não devemos lavar a rede mosquiteira no rio, não devemos acumular as águas no quintal, que devemos limpar a casa capinando a volta que quando apanhamos a malária devemos ir ao hospital”
Em Africa, a malária é responsável por até 50% de todas as mortes entre crianças em idade escolar. Assegurar que as crianças aprendam sobre práticas de prevenção da malária não só irá reduzir a malária, mas também contribuirá para o controlo da doença nas suas comunidades.
No âmbito do Projecto de Prevenção e Controlo da Malária, implementado em 9 das 11 províncias de Moçambique pelo consórcio da sociedade civil (2011 – 2017), uma das intervenções inovadoras foi de reforçar a educação sobre a malária para os alunos dentro da sala de aulas.
A EPC de Undi faz parte das escolas abrangidas pelas actividades de educação sobre a prevenção da malária implementadas pela Malaria Consortium no âmbito deste projecto, na província do Niassa.
Na EPC de Undi, três professores foram treinados em conceitos básicos da malária, transmissão, sinais e sintomas, métodos de prevenção e importância de procura precoce de cuidados. Na sala de aulas, os professores realizam sessões interactivas de educação com recurso ao álbum flexível que apresenta ilustrações, perguntas e mensagens chave sobre a prevenção da malária. A expectativa é de os alunos partilharem os conhecimentos adquiridos com as suas famílias, amigos e comunidade.
“Quando chegamos em casa, conversamos com os nossos pais, eles aceitam e fazem as coisas que lhes explicamos quando não sabem.’’(…) Todos gostam de usar a rede e na noite passada, todos dormiram debaixo porque eles sabem que a rede serve de protecção contra picada do mosquito e da malária”, conta o Carlitos.
A Helena Samuel, professora de ciências naturais da EPC de Undi reconhece a contribuição do projecto para o aumento de conhecimentos sobre a malária, redução de absentismos e desistência escolar:
“Foi muito bom fazer parte deste projecto, pois aprendi muito, ganhei mais conhecimentos sobre a malária, tirei muitos mitos que estavam na minha mente. Como professora de ciências naturais relaciono os conceitos e transmito as comunidades (….) O projecto também trouxe vantagens para a escola e para os alunos, agora temos um baixo índice de desistência dos alunos porque os alunos estão mais saudáveis”
Entre 2011 e 2017, a Malaria Consortium apoiou as direcções provinciais e distritais de educação de Nampula e Niassa no treino de 1,682 professores em cerca de 700 escolas nas províncias de Niassa e Nampula, atingindo cerca de 31,289 alunos trimestralmente com mensagens chave sobre a malária, métodos de prevenção e a importância de procura de cuidados.
Os dados de monitoria do projecto mostram que as actividades escolares de educação sobre a malária tem contribuído para o aumento dos conhecimentos, ambos dos professores e dos alunos, e melhor adesão as boas práticas para prevenção da malária nas suas casas e comunidades.
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.
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.
 Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, The Gambia
Pour les enfants d’Afrique sub-saharienne le risque de mourir avant d’avoir atteint l’âge de cinq ans est 14 fois plus élevé que pour les autres enfants à travers le monde. Chaque année, des maladies qu’il est possible de prévenir et de guérir, telles que le paludisme, emportent des centaines de milliers de vies.
Depuis 2014, les principaux acteurs de la prévention du paludisme se sont unis pour que les enfants de moins de cinq ans vivant dans le Sahel puissent bénéficier de la chimioprévention du paludisme saisonnier (CPS). La CPS – une intervention recommandée par l’Organisation Mondiale de la Santé – est un traitement antipaludéen donné aux enfants chaque mois, pendant un maximum de quatre mois consécutifs au cours de la saison des pluies, période à laquelle 60 pourcent des cas de paludisme se déclarent. Ce traitement offre un haut niveau de protection, avec une efficacité de 90 pourcent environ, et la capacité à réduire les cas de paludisme de 75 pourcent.
Grâce aux efforts soutenus du projet ACCESS-SMC, financé par UNITAID et géré par Malaria Consortium en partenariat avec Catholic Relief Services, ainsi que d’autres programmes de CPS de diverses organisations, près de 12 millions d’enfants on bénéficié de la CPS, en 2016. Plus de 6,4 millions d’entre eux en ont bénéficié par le biais d’ACCESS-SMC, déployé à travers sept pays.
Cependant, de nombreux enfants n’auront encore pas accès à la CPS en 2017, à cause du manque de financements et de capacités à produire les médicaments de qualité certifiée nécessaires à la CPS (SP+AQ). Rien qu’au Nigeria, neuf millions d’enfants resteront sans protection durant cette saison des pluies.
Certaines zones du Sahel présentent la plus forte incidence de paludisme au monde, il est grand temps de tout mettre en œuvre pour traiter les 25 millions d’enfants éligibles. Avec moins de 5$, un enfant peut être protégé chaque année, grâce à la CPS. Pour soutenir nos efforts sans relâche, en tant qu’œuvre caritative parmi les mieux classées de GiveWell, et protéger ensemble les 25 millions d’enfants du Sahel contre le paludisme, rendez-vous sur http://www.givewell.org/charities/malaria-consortium.
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.
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.