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Community dialogues for the prevention and control of neglected tropical diseases (14 photos)


Published:17 January 2019

Malaria Consortium has been working since 2014 with the Nampula Health Directorate in northern Mozambique to implement a community dialogue approach that aims to improve communities’ understanding of schistosomiasis, lymphatic filariasis and soil transmitted helminths (intestinal worms) – and improve the uptake of protective behaviours in highly endemic areas.

In the second phase (April 2017 – March 2019), Malaria Consortium has conducted research around the local population’s perception of these diseases, and developed visual tools, adapted to the literacy level and local context, to promote protective practices. Sensitisation meetings were conducted in each of the four target districts to orient and engage the heads of all health facilities in the districts – and their respective community representatives – on the objectives and activities of the project, and selection criteria of the facilitators. Here you can see the participants in Mogovolas district. In March 2018, in Nampula city, Malaria Consortium trained a group of 12 district health staff on the community dialogue approach applied to NTDs, so that they can roll out the training in their respective districts to volunteer community members. 228 volunteers were trained across the four target districts using adult learning techniques adapted for low-literacy audiences. Most of these people were traders, farmers, health activists and health committee members who volunteered to organise dialogues in their own villages. The training methodology used a lot of practical and group work exercises to familiarise the trainees with the visual materials. This picture shows group work in Murrupula district. The training sessions were very lively, and participants also developed their own songs and dances to illustrate participatory facilitation techniques for successful community dialogues. At the end of the training, community dialogue facilitators received individual badges and branded t-shirts for identification within their community, together with the visual flipcharts and the Community Dialogue Guidebook as their key study materials. These are the community dialogue facilitators from phase two, trained in three NTDs in Erati District. When they returned from training, facilitators met with their community leaders to start planning the community dialogues. All of them started enthusiastically: an average of two dialogues per month were held. They focused the dialogues on lymphatic filariasis and intestinal worms, to try and raise demand and participation in June’s mass treatment campaign. A facilitator from Erati district can be seen here engaged in a Q&A session with community dialogue participants. Community dialogues provide an interactive platform for village residents to explore and better understand diseases that are very prevalent but often not well understood and dealt with. They are encouraged to discuss the diseases and share their concerns – which this man is doing in Erati district. Erati district, Canaruma community: the community dialogue facilitator talks to participants about the images showing signs of intestinal worm infection. Community dialogues provide a community-owned platform to bring basic information closer to people’s homes and correct misconceptions about the diseases, their transmission route and control mechanisms. Fátima Daniel, from the community of Mequita, Namapa Sede, District of Eráti, never missed a dialogue in her community; she remembers she already attended two dialogues that discussed lymphatic filariasis. During these dialogues, she learned about the signs and symptoms of the disease and where to seek care. She explains: "I suspect that I have elephantiasis, my leg hurts, and my father has this disease too. But now that I have learned how to treat I will follow what they said in the dialogues and I will remove this disease out of the way. I am curious to attend these dialogues because of all we learn at these sessions.” António Amade, community leader of Canaruma, Alua (Eráti district), is confident that community dialogues can improve practices in his village. He said: "When the facilitator returned from training, he informed me he has already held three community dialogues. I did not attend these but helped him organise them; and I noticed people had taken actions in the community. I can see people cleaning the wells before they get water, cleaning in front of the houses, and some even started with the construction of latrines. This made me curious and here I am to participate in the dialogue today; it was a good dialogue, we talked about intestinal worms. If such dialogues can continue, the community will open their eyes and we will reduce diseases.” Community-based facilitators keep a log of all dialogues held, topics covered, actions decided and issues raised in a registry book so that they have this information always available to report to their community leadership. This is community dialogue facilitator Charama dos Reis in Mogovolas District. Malaria Consortium supports the provincial and district health authorities to provide regular supervision and support visits to these newly trained volunteers, to ensure they can apply their knowledge and help their communities’ better deal with NTDs. Malaria Consortium’s Project Manager, Junica Alface, can be seen here showing a community facilitator where he can locate in his guidebook guidance on planning community dialogues. Mogovolas district, Nacoze Community, May 2018. These visits also provide opportunities for district health staff to have conversations with community members, to hear their perspectives on NTDs in general and the community dialogue approach. This is essential in Malaria Consortium’s approach to improve accountability between communities and the health sector, and support bridging the gaps in perception and expectation.

 

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