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

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

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

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

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

Myanmar MV
Malaria volunteer Ma May Thient Oo

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

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

Village malaria worker Thy Sambath (Photo: Luke Duggleby)

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

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

Village Health Team member Ali Karim Bagyanyi

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

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

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

Watch our video here: 

Good health for all: a crucial road to gender equality

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Voices for better health: Mozambique

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

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

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

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

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

Emília Corela, cEmiliaampaign supervisor

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Dorca Nhaca, Malaria Consortium, Nampula office, Mozambique

Top five moments of 2016

At Malaria Consortium we continued to work towards achieving our mission throughout 2016. With the support of our donors, partners and collaborators, we helped to improve lives in Africa and Asia through sustainable, evidence-based programmes that combat targeted diseases and promote child and maternal health. See below for a few of our highlights of 2016.

1) 6.4 million children receive seasonal malaria chemoprevention

Access smc

We continued to transform the malaria landscape in the Sahel through our ACCESS-SMC project that administers seasonal malaria chemoprevention. Funded by UNITAID, ACCESS-SMC treated approximately 6.4 million children during the 2016 campaign, including 88 percent of children under five years old.


2) Transforming Nigeria’s health sector 

Long lasting insecticide net demonstration
Long lasting insecticide net demonstration

The Department for International Development funded ‘Support to National Malaria Programme’ or SuNMaP concluded in 2016. This ground breaking eight-year project, led by Malaria Consortium, took an innovative approach to strengthening the country’s management of malaria at both state and federal level, harmonising intervention efforts and vastly improving demand for and access to malaria services. In addition, the project delivered millions of nets and has already saved an estimated 48,000 lives, which would have been lost to malaria.

3) Malaria Consortium placed as top GiveWell charity

GW_Logo_Standard_300ppi_CMYK (7) Malaria Consortium was selected as a GiveWell top recommended charity for our expertise in delivering seasonal malaria chemoprevention (SMC). GiveWell is a world-renowned meta-NGO that recommends charities by assessing them on four criteria: effectiveness, cost-effectiveness, transparency, and room for more funding.


4) New innovations in the fight against dengue and malaria 

Guppy fish eating mosquito larvae_During an experiment at the press chat
Guppy fish eating mosquito larvae during a presentation in Phnom Penh

We continued to develop and deliver innovative approaches to disease control in 2016. Most notably, our integrated vector management project, which uses larvae-eating guppy fish to reduce mosquito populations, was successful in reducing potentially dengue-carrying mosquito rates by 46 percent in Cambodia’s high risk areas. The project received wide spread recognition for being cost effective, sustainable and easy to implement, making it a suitable intervention for scale up.

In Myanmar, Malaria Consortium established an insecticide-treated clothing (ITC) project to determine the acceptability of ITC for malaria prevention among the key risk groups at the community level, such as rubber tappers. It was the first time this research had been conducted at the community level. Results showed that ITC was easy to use, durable, reduced mosquito bites and also has the potential for scale up.

5) 2016 World Malaria Report 

Secretary of State for International Development, Priti Patel, at the World Malaria Report launch

Malaria Consortium supported the launch of The World Health Organization’s annual World Malaria Report in the UK at an event co-organised with Malaria No More UK, the All-Party Parliamentary Group for Malaria and Neglected Tropical Diseases, and other leading malaria NGOs. The report contained a range of achievements and detailed the progress made towards achieving the 2030 Sustainable Development Goals. These included a five-fold increase in the recommended three or more doses of preventive treatment for pregnant women and an 80 percent increase in the use of long-lasting insecticidal mosquito nets for all populations at risk of malaria.

At the report launch, the UK’s International Development Secretary, Priti Patel, reiterated the UK’s commitment to end malaria and announced an additional £75 million investment to support the development of antimalarial drugs and insecticides.

We look forward to continuing to work with all of our partners and donors throughout 2017 to improve lives and progress towards achieving the 2030 Sustainable Development Goals. 



Uncovering Asian tropical medicine – JITMM 2016

By Kyaw Thura Tun

jitmmThe Joint International Tropical Medicine Meeting 2016 (JITMM) took place this December with the theme ‘Uncover Asian tropical medicine’. The event was a great success, attracting over 800 regional and international participants, the highest attendance in over a decade.

During the conference Malaria Consortium staff presented the organisation’s expertise in innovative research, dengue and surveillance, outlined current regional projects and chaired group sessions.

Notable events included Malaria Consortium Asia Director Siddhi Aryal chairing the session ‘Meeting the challenge of outdoor transmission of malaria’. The session was extremely informative and featured presentations from World Health Organization (WHO) Emergency Response to Artemisinin Resistance Hub, Institute of Tropical Medicine of Antwerp Belgium and Infakara Health Institute of Tanzania. The WHO Emergency Response to Artemisinin Resistance Hub presentation by Michael MacDonald was a particular standout as he explained new paradigms for outdoor malaria transmission control, which showed options and opportunities moving from concept to programme implementation in the contexts of the Greater Mekong Sub-region. 

jitmm-2Other Malaria Consortium presentations included Vanney Keo and Dyna Doum’s dengue related presentations about the situation in Cambodia and Shafique Muhammad’s session entitled ‘Malaria elimination: Mobile populations and behaviour changes’. This session – with presentations from Malaria Consortium, Bureau of Vector Borne Disease of Thailand and Raks Thai Foundation – attracted an array of stakeholders and partners with an interest in more effective and regional behaviour changes among mobile populations.

On the final day of the conference, I presented ‘Improved surveillance towards malaria elimination in Myanmar’. The presentation detailed how the National Malaria Control Programme project, supported by Malaria Consortium, filled gaps in capacity and surveillance, and how data gathering and data accessibility has improved greatly. In particular, I explained why our approach and the consolidation of data at all levels, including townships, states and regional levels, is so appropriate to Myanmar.

jitmm-3JITMM is the most notable annual event for the tropical medicine community in Asia, bringing a wide range of researchers, scientists, lecturers, programme managers, implementers, students, donors and policy makers from around the world. This meeting was one of the opportunities for Malaria Consortium to present our work to the region and the world. I was glad to see such a great turn out and high quality presentations, not just from Malaria Consortium staff, but the whole community. I look forward to returning in 2017.

Meet the recipients of Mozambique’s largest ever mosquito net distribution

By Dorca Nhaca

On 3rd November 2016 the Ministry of Health, Mozambique, launched the largest ever distribution of mosquito nets. In total over 13 million long lasting insecticide-treated nets (LLIN) will be distributed throughout the country – an important step to reducing the burden of malaria.

Malaria Consortium has supported the roll out of this mass distribution in the most populous province of the country, Nampula, located in the north of the country, delivering LLINs to protect over five million people.

As a consultant on the project, I travelled the Nampula province monitoring and supporting distribution efforts. The importance of this project was clear during my visits to various districts. Everywhere I went people converged en masse to the distribution points and were eager to get mosquito nets to protect their families.

I managed to speak with some of the recipients about the project and what it means for their families. This is what they told me:


Mrs Gracinda Francisco, Monapo district

“Today I received two mosquito nets and I am very happy because my family will be protected from mosquito bites. The mosquito causes malaria which is a disease that makes us very weak. Before receiving these nets, the situation was very complicated in our home because we only had one old net to share with our son. The net was old and damaged and the mosquitos could easily enter through the holes. We had a terrible time because our home is close to the Monapo River which brings a lot of mosquitoes. People are constantly sick. Last month, my son fell ill and had to be admitted in hospital for treatment. I was worried because he is still very small. He is doing better now and these nets will help a lot to prevent malaria in my family.”

calima-primeiro-1Calima Primeiro, Rapale district
“I am very happy to have received these nets. It will greatly improve malaria care at home. The people in my neighborhood have suffered a lot from malaria and we have also suffered from this disease in our home. We had not used mosquito nets for a long time. A few weeks ago, I myself got malaria and I was very resentful because I was very weak and could not walk or work on the farm. We are currently in the agricultural season where we sow corn, peanuts and other crops, so my sickness caused a difficult situation. The children who live with me could not go to the farm because they had to take care of me. I had to stay home and could not do anything for about eight days. After this, my daughter and grand-daughter became sick with malaria and I had to take them to the hospital for treatment. This was a big learning experience for me: we got sick because we did not protect ourselves.

The government came at the right time to help us fight this disease. I know that malaria is dangerous and a killer disease. Now, if we use the mosquito net we can not only avoid getting sick, but also avoid spending money for the medicines and use this money for other things. So, I and my family will use the mosquito nets so we don’t get bitten by mosquitoes.”

valentim-antonio-cidade-nampula-2Valentim Daniel António, Nampula City
“I started using a mosquito net in 2010 when my wife became sick with malaria. At the time, she was pregnant. Besides not having the financial means to buy a mosquito net, we did not realise the importance of nets, because we thought that if we got sick we could just go to the hospital and get treated. But this time it was different. My wife was so sick that she had to be admitted to hospital while she was pregnant; she became very weak and had to take intravenous drugs. Luckily my wife got better and when she left the hospital, the nurse who cared for her asked us if we had a net at home and we said no. She gave a net to my wife and advised us to always use the net because malaria can be deadly. When we got home, we started using the net, but my kids did not because we had only one.

I bought two more nets for my children and nephews but after several years they developed holes and I could not replace them, but today, I received three new nets, and I want to thank the government.

I say with great pride that I use the mosquito net to protect my family’s health against malaria. If this net gets spoiled, then I will buy replacements. I am pleased to be a part of those benefiting from mosquito nets and I have been mobilising my family, friends and neighbors to use the mosquito net because it protects us from the mosquito bite that causes malaria – it is really worth it.”

pTrucks loaded with nets are sent to distribution centres around Nampulap
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Dorca Nhaca is a consultant to Malaria Consortium in its Nampula Office, Mozambique

This undertaking is part of a nation-wide initiative lead by the Ministry of Health with support from the Malaria Prevention and Control project, a country-wide initiative funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as primary partner, Malaria Consortium, Food for the Hungry (FH) and Foundation for Community Development (FDC).

Exciting times for new pneumonia diagnostic tools

kevin-photo2This year’s ASTMH saw a number of key sessions and presentations that highlighted the exciting work being done to evaluate the performance of new pneumonia diagnostic aids at the community level.

Day one included a presentation by Dr. Michael Hawkes from the University of Alberta titled: ‘Solar powered oxygen delivery: a randomized controlled non-inferiority trial’. The presentation provided evidence for to show solar powered oxygen delivery can be an effective intervention in resource poor settings. The study was conducted in Jinja, Uganda and based on the results the project team is now planning to expand the work to another 85 health facilities in Uganda.

This was followed by Save the Children’s evaluation of the Philips ChARM device (Children’s Automated Respiratory Monitor) – an innovative and easy to use pneumonia-screening tool for low resource settings. The evaluation showed that the ChARM device is an acceptable alternate diagnostic tool for identifying fast breathing among children under five. 

On day two, Malaria Consortium’s US Representative, Madeleine Marasciulo, moderated a symposium titled ‘Key elements for improving management of pneumonia in children in resource poor settings’. The symposium was attended by over 200 people.

The event featured a presentation from Malaria Consortium’s African Technical Advisor, Dr Ebenezer Baba, ‘Progress towards universal access to pneumonia treatment’, as well as results from the pneumonia diagnostics study, presented by Pneumonia Diagnostics Programme Coordinator, Kevin Baker. The results highlighted the difficulty health workers face when counting respiratory rates and the need for better tools to support them to better detect the symptoms of pneumonia.

Following this, Kristoffer Gandrup-Marino, Chief ofInnovation at UNICEF Supply Division presented plans for the ARIDA project and the important factors to consider when developing pneumonia diagnostic trials at the community level in resource poor settings.
If the pneumonia diagnostics project showed us anything, it is the urgent need for user-friendly devices and for technological innovators to continue developing diagnostic tools for the millions of health workers who use them to count respiratory rates every day. The ARIDA trial is taking this forward, Kevin Baker said.

Finally, Dr Grant Aaron, Global Health Director at Masimo, presented ‘Scaling up Medical Oxygen and Pulse Oximetry – the case of Ethiopia’. Dr. Aaron highlighted the work being done to scale up oxygen management in Ethiopia as well as a new respiratory rate device being developed by Masimo.

On Tuesday evening an important session was held on the Pneumonia Etiology Research for Child Health Study (PERCH). PERCH is a multi-country, comprehensive evaluation of the etiologic agents causing severe and very severe pneumonia among children 28 days to 59 months with data collected between August 2011 and January 2014, with over 9,500 cases enrolled.

It was great to see such high quality sessions on pneumonia at ASTMH this year with several of the sessions presenting important findings for the first time. Community health delivery in remote or low resource settings will surely benefit from the new diagnostic tools and study results.

By Kevin Baker

pPanel photo from the pneumonia symposiump
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Malaria is one of the ‘best buys’ in Global Health

Op-ed by Dr James Tibenderana, Malaria Consortium Development Director, on the launch of two new malaria strategies

At this week’s 3rd International Financing for Development meeting in Addis Ababa, the World Health Organization (WHO), along with the Roll Back Malaria (RBM) partnership present their 2015-2030 strategies during a financing for malaria side meeting.

Both strategies – WHO’s Global Technical Strategy for Malaria 2016-2030 (GTS) and RBM’s Action and Investment to defeat Malaria 2016-2030 (AIM) – for a malaria free world – will be shaping the future of health development by saving more than 10 million lives and averting nearly 3 billion cases worldwide. Together, these documents chart the investment and collective actions needed to reach the 2030 malaria goals and reach a malaria-free world.

Malaria Consortium, UK’s leading malaria NGO and a partner of RBM, made a significant contribution to the development of the GTS: through the WHO Malaria Policy Advisory Committee of which our Technical Director Dr Sylvia Meek is a member, by sharing its technical expertise into online consultations and by translating evidence and learning of our work into practical advice for the strategy.

I am delighted to see both strategies highlight the huge health and economic benefits that result from investing in eliminating malaria while demonstrating malaria is one of the ‘best buys’ in Global Health. Meeting the 2030 malaria targets will generate more than US $4 trillion of additional economic output across the 2016-2030 timeframe.

Though the world has made dramatic progress – malaria mortality rates have decreased by 54 percent in Africa, much remains to be done. Nearly 300 million people in sub-Saharan Africa still lack access to a protective insecticide-treated net, and at least 15 million pregnant women do not receive the protective treatment they need to keep themselves and their unborn child healthy. Each year, malaria costs the African continent an estimated minimum of US $12 billion in lost productivity.

History demonstrates that maintaining gains made fighting malaria are dependant on sufficient and sustained investment. Since the 1930s, there have been 75 documented resurgences of malaria reported in 61 countries, the majority linked to reduced or suspended funding for malaria programmes.

We therefore call on governments, donors and partners to continue to work together – within and between sectors and across borders.

I am proud to see today’s event marks a milestone in global health history and the start of a new era in development.

Dr James Tibenderana, Malaria Consortium Development Director

Preventing malaria through drama and performance

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

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

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

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

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

You can check out photos of the drama performance below:

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

My first week with Malaria Consortium: Positive Deviance in the Suan Phueng district of Thailand.

Pavan Singh works as an external communications volunteer at Malaria Consortium’s Bangkok office. As part of his six month placement, he visited a remote village in Thailand to get a first-hand account of Malaria Consortium’s Positive Deviance project.

As a GlaxoSmithKline (GSK) Pulse Volunteer, I joined Malaria Consortium’s Bangkok team at the start of July for a six month work placement. The PULSE Volunteer Partnership is GSK’s skills-based volunteering initiative. Through PULSE, selected employees are matched to a non-profit organisation for three or six months full-time, contributing their skills to help meet healthcare challenges.

Following orientation and training, I undertook a two-day field visit to learn more about Malaria Consortium’s Positive Deviance project being implemented in a small village in the Suan Phueng district of Ratchabury province in Thailand, close to the border with Myanmar. There is growing evidence of the emergence of artemisinin resistance along the Myanmar-Thailand border and significant efforts have been underway for a number of years to contain its spread. The transmission of a malaria parasite which is immune to the artemisinin vaccine could have catastrophic consequences in the fight against malaria.

Many migrant workers in this area of Thailand look for work during planting or harvesting seasons, and frequently cross borders with their families and stay for several months. For these communities, malaria is one of the most common diseases, and there is a risk of spreading a drug resistant parasite across borders.

Positive deviance involves identifying people who, despite sharing similar living conditions and resources with the rest of their community, are already demonstrating positive preventive and care-seeking behaviours. These individuals are encouraged to share those behaviours with the rest of their community. The strategy has been implemented in a number of countries to identify positive behaviours associated with newborn health, family planning, female genital mutilation and HIV/AIDS. Malaria Consortium is the first to implement the strategy for malaria control.

The pilot villages were identified based on the presence of mobile and migrant populations in high risk areas for malaria throughout Thailand. The men work in the rice fields until late, and the village is surrounded by forests. The risk of being infected by a malaria parasite-carrying mosquito is high, and there is a chance that an infected person could then spread the parasite.

I attended a community meeting which began at in the early evening and was attended by 25-30 villagers. Five positive deviance volunteers spoke and shared best practices to avoid being bitten by a mosquito, including advising to always sleep under a mosquito net, to always wear long-sleeved shirts and long trousers when working in a field, and to immediately go to the health centre for a blood test if suffering from malaria symptoms.

Villagers who work in the fields are particularly at risk of contracting malaria.
Villagers who work in the fields are particularly at risk of contracting malaria.

It was clear to me that the simple practices and solutions being shared by trusted members of a community made a big impact on the villagers. After each volunteer spoke, behaviour change specialists and project staff reinforced the key messages around malaria prevention and control. The meeting was conducted in English, then translated into Thai, and further translated into Karen, the local language, by Anusha from the Pattanarak Foundation, Malaria Consortium’s implementation partner on this project. This process was exhilarating to watch, and it was very rewarding to see life-saving messages being translated and successfully conveyed to people in the community.

Worth mentioning is that the language barrier is just one difficulty to be overcome when organising and implementing positive deviance activities. It is challenging to organise and motivate people to attend, especially in remote villages. Positive deviance volunteers have to conduct sessions sometimes at the convenience of the community, matching timings for as many members of the community as possible, organising a location, and making sure that the methods taught in seminars by volunteers are fully understood.

Community members attending the positive deviance meeting.
Community members attending the positive deviance meeting.

The following day we returned to the village for a feedback session. The objective was to consider further interactive tools for communication and to improve the quality of the meetings. As a result, we decided to provide further training to the positive deviance volunteers.

I have now been working with Malaria Consortium for just over a month, and my colleagues have returned to the village in Suan Phueng to provide further training to volunteers and improve integrated community healthcare and prevention techniques. It has been very interesting to see how Malaria Consortium projects work at community level and the challenges associated with disease prevention and control.